Use of services in old age: data from three surveys of elderly people

Incidence of Parkinson's disease and modifiable risk factors in Korean population: A longitudinal follow-up study of a nationwide cohort

Introduction

We aimed to investigate the incidence of Parkinson's disease (PD) by age and year for each sex as well as the modifiable risk factors for PD. Using data from the Korean National Health Insurance Service, 938,635 PD and dementia-free participants aged ≥40 years who underwent general health examinations were followed to December 2019.

Methods

We analyzed the PD incidence rates according to age, year and sex. To investigate the modifiable risk factors for PD, we used the Cox regression model. Additionally, we calculated the population-attributable fraction to measure the impact of the risk factors on PD.

Results

During follow-up, 9,924 of the 938,635 (1.1%) participants developed PD. The incidence of PD increased continuously from 2007 to 2018, reaching 1.34 per 1,000 person-years in 2018. The incidence of PD also increases with age, up to 80 y. Presence of hypertension (SHR = 1.09, 95% CI 1.05 to 1.14), diabetes (SHR = 1.24, 95% CI 1.17 to 1.31), dyslipidemia (SHR = 1.12, 95% CI 1.07 to 1.18), ischemic stroke (SHR = 1.26, 95% CI 1.17 to 1.36), hemorrhagic stroke (SHR = 1.26, 95% CI 1.08 to 1.47), ischemic heart disease (SHR = 1.09, 95% CI 1.02 to 1.17), depression (SHR = 1.61, 95% CI 1.53 to 1.69), osteoporosis (SHR = 1.24, 95% CI 1.18 to 1.30), and obesity (SHR = 1.06, 95% CI 1.01 to 1.10) were independently associated with a higher risk for PD.

Discussion

Our results highlight the effect of modifiable risk factors for PD in the Korean population, which will help establish health care policies to prevent the development of PD.

Social networks and social activities promote cognitive functioning in both concurrent and prospective time: evidence from the SHARE survey

The study aimed to investigate the role of social activities, social networks as well as socioeconomic status (SES) in influencing some aspects of cognitive functioning (immediate and delayed verbal recall tests and semantic verbal fluency) in elderly people over time. This analysis was conducted on a sample of 31,954 healthy elderly people (58% female, mean age 65.54 ± 9.74) interviewed in both the fourth and sixth waves of the Survey on Health, Aging and Retirement in Europe (SHARE), in 2011 and 2015. A structural equation model with measurement component was used to assess the relationship between cognitive function, social life and SES over time. Multilevel ordinal logistic regression was applied to explain satisfaction with social network in relation to different types of social network across countries. Being equipped with good cognitive skills did not seem to be predictive of their maintenance over time (latent coefficient = 0.24, p value = 0.34). On the contrary, the subject's social and participatory life, understood as satisfying one's social network and engaging in diversified non-professional social activities, seemed to play a crucial role in the maintenance of cognitive functions in the elderly (latent coefficient = 3.5, p value = 0.03). This research suggests that a socially active and participatory lifestyle mitigates the effects of the physiological process of brain aging.

Longitudinal Analysis of Outpatient Physician Visits in the Oldest Old: Results of the AgeQualiDe Prospective Cohort Study

OBJECTIVES

The aim of this study was to identify determinants of outpatient health care utilization among the oldest old in Germany longitudinally.

DESIGN

Multicenter prospective cohort "Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe).

SETTING

Individuals in very old age were recruited via GP offices at six study centers in Germany. The course of outpatient health care was observed over 10 months (two waves).

PARTICIPANTS

Primary care patients aged 85 years and over (at baseline: n=861, with mean age of 89.0 years±2.9 years; 85-100 years).

MEASUREMENTS

Self-reported numbers of outpatient visits to general practitioners (GP) and specialists in the past three months were used as dependent variables. Widely used scales were used to quantify explanatory variables (e.g., Geriatric Depression Scale, Instrumental Activities of Daily Living Scale, or Global Deterioration Scale).

RESULTS

Fixed effects regressions showed that increases in GP visits were associated with increases in cognitive impairment, whereas they were not associated with changes in marital status, functional decline, increasing number of chronic conditions, increasing age, and changes in social network. Increases in specialist visits were not associated with changes in the explanatory variables.

CONCLUSION

Our findings underline the importance of cognitive impairment for GP visits. Creating strategies to postpone cognitive decline might be beneficial for the health care system.

Parkinson's disease in Germany: prevalence and incidence based on health claims data

BACKGROUND

In Germany, epidemiological information on Parkinson's disease (PD) is rare and outdated. Considering aging populations, current prevalences and incidence rates about this age-related disease would be important for adequate public health planning.

METHODS

We used newly available health claims data sets from the largest German health insurer dating 2004-2007 and 2007-2010 with an analysis population in the base years of 491 038 persons aged 50 and older. Quarter-specific information about ICD-10 diagnoses and PD drug prescriptions from the inpatient and outpatient sectors was used to validate PD cases. Estimations were presented for two validation strategies relying on repeated PD diagnoses (SIa) and on one PD diagnosis followed by at least one PD drug prescription (SIb).

RESULTS

The standardized prevalence was 797 (SIb) to 961/100 000 persons (SIa), showing an age-specific increase up to category 85-89 and a decline thereafter. The standardized incidence rate was 192 to 229/100 000 person-years with a similar age-specific shape. Prevalences and incidences rates were higher for men compared to women in regard to age.

CONCLUSIONS

Health claims data are found to be suitable for PD assessment using the repeated diagnoses or PD drug prescriptions as necessary criteria.

Social Isolation and Medicare Spending: Among Older Adults, Objective Social Isolation Increases Expenditures while Loneliness Does Not

Objectives

Evaluate objective isolation and loneliness' impact on Medicare spending and outcomes.

Methods

We linked Health and Retirement Study data to Medicare claims to analyze objective isolation (scaled composite of social contacts and network) and loneliness (positive response to 3-item loneliness scale) as predictors of subsequent Medicare spending. In multivariable regression adjusting for health and demographics, we determined marginal differences in Medicare expenditures. Secondary outcomes included spending by setting, and mortality.

Results

Objective isolation predicts greater spending, $1,644(p<0.001) per beneficiary annually, whereas loneliness predicts reduced spending, -$768(p<0.001). Increased spending concentrated in inpatient and nursing-home (SNF) care; despite more healthcare, objectively isolated beneficiaries had 31%(p<0.001) greater risk of death. Loneliness did not predict SNF use nor mortality, but predicted slightly less inpatient and outpatient care.

Conclusions

Objectively isolated seniors have higher Medicare spending, driven by increased hospitalization and institutionalization, and face greater mortality. Policies supporting social connectedness could reap significant savings.

Support Network Type and Health Service Utilization

A secondary analysis of data from a national survey of elderly people in Israel applied a quick clustering procedure to a set of relational and interactional variables to derive a typology of support networks. The procedure produced six network types significantly differentiated by the gender, age, education, years of residence in the country, and health status of the focal elders in the network. They are characterized respectively as (1) diversified, (2) friend and family, (3) narrow family focused, (4) attenuated, (5) religious family focused, and (6) traditional extended family support networks. Respondents in the different network types were found to have differing degrees of health service utilization, as measured on a combined index of nine health services. The healthiest respondents with the most diversified support networks made the greatest use, and those with family-focused networks made the least use of health services.

Community-based service use by people with AIDS: the relevance of informal caregivers

This paper reports on community-based service use by persons with AIDS or disabling HIV (PWAs) who have an informal caregiver, with specific focus on four categories of service: nursing care; practical help; psychological services; and help with the management of personal affairs. Data are drawn from a large-scale community-based survey of caregivers in San Francisco and Los Angeles (n = 642). Caregivers report that PWAs make substantial use of community-based support: 85% use at least one service; half or more use psychological services (51%) and practical help (61%). Multivariate logistic regression models fit for each of the four categories of service use include bothPWA and caregiver characteristics as determinants, applying the widely recognized Andersen model. Our analytic models best fit nursing care and practical help outcomes and portray the complexity inherent in Andersen's framework. Correlates of service use vary by service type, illustrating the need to further study the fullest possible array of community-based services. Alongside traits of the PWA, caregiver characteristics are found to be important determinants of PWA service use, highlighting the relevance of informal caregiving to the larger system of AIDS care.

Using the capability approach to understand the determinants of subjective well-being among community-dwelling older people in New Zealand

BACKGROUND

as the longevity of the population increases, attention has turned to quality of life of older people as a component of healthy ageing. The objective of this study was to use Welch Saleeby's model of the capability approach to explore the determinants of subjective well-being among older people.

METHODS

this analysis used data from a sample of older people, aged 50-87, from 2012 wave of the New Zealand Longitudinal Study of Ageing (NZLSA) (n = 2,793). Structural equation modelling was used to examine the relationships between the commodities (number of chronic conditions reported, physical and mental health), and personal and environmental factors (economic living standard and discrimination), on the capabilities of older people to achieve well-being.

RESULTS

the findings supported Welch Saleeby's model. Capabilities mediated the relationship between commodities and well-being, indicating that increasing the range of real opportunities available to older people is a key step in increasing well-being. Age and gender were also found to be significant moderators of these relationships. The relationship between economic living standards and well-being was weakest for the oldest participants, but experiences of discrimination had a stronger effect on well-being in this age group.

CONCLUSION

Welch Saleeby's model of the capability approach provides a useful framework for advancing the ethics of care as it highlights the multidimensional nature of well-being in later life. Focusing on expanding capabilities for older people enables policymakers and practitioners to understand the resources and supports required to enable well-being in the context of health challenges.

Confidant network types and well-being among older europeans

PURPOSE OF THE STUDY

To derive a typology of confidant networks among older adults in Europe and to examine them in relation to country differences and well-being (CASP-12).

DESIGN AND METHODS

The study population was composed of persons aged 65 and older in 16 countries from the 4th wave of the Survey of Health, Ageing and Retirement in Europe (N = 28,697). K-means cluster analysis was applied to data from a newly implemented name-generating network inventory. CASP-12 scores were regressed on network type controlling for country and potential sociodemographic and health confounders.

RESULTS

Six prototypical confidant network types were discerned, including proximal and distal family-based networks of varying configurations, as well as friend-based and other-based network types. Regional country differences in network type constellations were observed. Better well-being was found to be associated with network types with greater social capital. Respondents with no named confidants had the lowest CASP-12 scores, and those embedded in "other" network types also exhibited a negative association with well-being.

IMPLICATIONS

The study demonstrates the utility of name-generating network inventories in understanding the social capital of older persons. It also shows that accessible family ties are strong correlates of well-being in this population. Finally, it documents the importance of improving the means to detect the small but significant subgroup of isolated older people-those who have no confidants on whom they may rely.

A U.K. case study of who uses NHS direct: investigating the impact of age, gender, and deprivation on the utilization of NHS direct

OBJECTIVES

National Health Service (NHS) Direct provides a 24/7 telephone-based healthcare advice and information service to the public in England. Locally based studies have suggested variation in the uptake of this service among the United Kingdom's diverse population. This study seeks to examine this issue at a national level.

SUBJECTS AND METHODS

One month's period of national data was collected (July 2010) from the NHS Direct Clinical Assessment System for all 0845 4647 calls in England. Calls were matched to place of residence and were analyzed for age, gender, and deprivation using negative binominal regression.

RESULTS

Within the context of NHS Direct the pattern of calls was highest for children 5 years old and under, with lowest call rates found for males and older people (65+ years old). Furthermore, call rates were lowest in the most deprived areas for children (0-15 years old). Gender differences were noted, whereby male call rates were higher in the most deprived areas for all age groups. Furthermore, call rates for or on behalf of older females (60+ years old) were lower in areas of extreme deprivation.

CONCLUSIONS

The findings suggest there is variation in usage of NHS Direct. Such usage appears to be influenced by age, gender, and deprivation. Further research is required to examine the underlying factors that contribute to variation in uptake of these services. This will enable the development of future promotional campaigns that can target particular sections of the population to encourage use of telephone-based health services.

Associations of Social Relationships with Consultation for Symptoms of Depression: A Community Study of Depression in Older Men and Women in Québec

To assess associations between social relationships and consultation for symptoms of depression, data from a representative sample of 2,811 French-speaking community-dwelling older adults in Québec were used. Less than half of the older adults meeting DSM criteria for depression ( N = 379; 47.1%) had sought consultation about their depression-relevant symptoms in the preceding 12 months. Having a cohabitant partner or having children were not associated with frequency of consultation for women. Men without a partner tended to consult more frequently than men with a cohabiting partner (OR = 2.5; 95% CI = 0.81, 7.88). None of the men without a confidant had consulted. Among the 67 men with a confidant, consultation was more frequent among those not cohabiting with a partner (70%) than among those with a cohabiting partner (46%). The influence of social relationships on consultation for depression differed in men and women in this population of depressed elderly people in Québec.

Do general practitioners recognize mild cognitive impairment in their patients?

OBJECTIVES

The need for recognition of mild cognitive impairment (MCI) in primary care is increasingly discussed because MCI is a risk factor for dementia. General Practitioners (GPs) could play an important role in the detection of MCI since they have regular and long-term contact with the majority of the elderly population. Thus the objective of this study is to find out how well GPs recognize persons with MCI in their practice population.

DESIGN

Cross-sectional study.

SETTING

Primary care chart registry sample.

PARTICIPANTS

3,242 non-demented GP patients aged 75-89 years.

MEASUREMENTS

GPs assessed the cognitive status of their patients on the Global Deterioration Scale (GDS). Thereafter, trained interviewers collected psychometric data by interviewing the patients at home. The interview data constitute the basis for the definition of MCI cases (gold standard).

RESULTS

The sensitivity of GPs to detect MCI was very low (11-12%) whereas their specificity amounts to 93-94%. Patients with MCI with a middle or high level of education more often got a false negative assignment than patients with a low educational level. The risk of a false positive assignment rose with the patients' degree of comorbidity. GPs were better at detecting MCI when memory or two and more MCI-domains were impaired.

CONCLUSION

The results show that GPs recognise MCI in a very limited number of cases when based on clinical impression only. A further development of the MCI concept and its operationalisation is necessary. Emphasis should be placed on validated, reliable and standardised tests for routine use in primary care encompassing other than only cognitive domains and on case finding approaches rather than on screening. Then a better attention and qualification of GPs with regard to the recognition of MCI might be achievable.

Healthcare utilisation among the Belgian elderly in relation to their socio-economic status

OBJECTIVES

To analyse the association between healthcare utilisation of elderly persons (65 and over) in Belgium in terms of contacts with GP or specialist and the socio-economic indicators household income, highest educational level within the household, and housing tenure.

METHODS

A cross-sectional study based on 4494 non-institutionalised elderly participants in the Belgian Health Interview Surveys of 2001 and 2004. Socio-economic gradients in contacts (yes or no) with a GP or specialist were explored, based on the socio-behavioural model of Andersen, a conceptual framework that includes the most important determinants of healthcare utilisation. Three multivariate models were constructed using multiple logistic regression.

RESULTS

After adjustment for age, sex, health status (self-assessed health, functional restrictions, and comorbidity), region, and living situation, initial differences in contacts with a GP and specialist between the different socio-economic groups disappeared among the elderly. On the other hand, contacts with a specialist remain dependent on SES in the younger population.

CONCLUSIONS

Adjustment for the determinants of healthcare utilisation among the Belgian elderly nullified the socio-economic gradients in contacts with a GP and specialist that initially existed. The results point to a potential link with the Belgian social and health policy.

Differentials in mortality up to 20 years after baseline interview among older people in East London and Essex

OBJECTIVE

to identify socio-psychological predictors of mortality during a 20-year follow-up period among people aged 65 to <85 and 85+ at baseline interview.

STUDY DESIGN AND SETTING

elderly people living at home in East London and mid-Essex, who responded to surveys of successful survival in older age in the late 1980s; their mortality was traced through the National Health Central Registry.

RESULTS

adjusted analyses show that, as expected, the hazard rate for mortality over a 20-year follow-up was reduced for younger respondents and increased for less functionally able respondents. The hazard ratio for males was almost one and a half times that of females. The hazard rate was also reduced with each categorical increase in life satisfaction and was consistently reduced for those who undertook crafts, social visiting and activities regularly. There was some variation by age and sex.

CONCLUSION

the results show that social participation is associated with lower risks of death, particularly among people aged 65 to <85, and that life satisfaction is also protective, particularly among females and people aged 85+, even when health status and socio-demographic circumstances are controlled. The study thus provides support for the hypothesised influence of social participation and subjective well-being on survival in older age.

Determinants of home-based formal help in community-dwelling older people in Finland

Knowledge of the determinants of use of formal home-based services among older people is of particular importance for predicting the need for and cost of care in the future. The aim of this study was to estimate the frequency of formal and informal help among community-dwelling older people and to assess the determinants of home-based formal help, with a special emphasis on the frequency of help from spouse, from children and other relatives and friends. We used nationally representative cross-sectional data from 1,166 community-dwelling Finnish persons aged 70-99. Determinants of formal help were assessed with logistic regression models. Receiving formal help was most strongly related to need factors such as age and functional capacity. Adjusted for need factors, receiving help from spouse or living with someone else than the spouse decreased the odds of receiving formal help. In contrast, the more frequently the children helped, the larger were the odds of receiving formal home-based help. Help from other informal sources did not affect receipt of formal help. Our results thus suggest that intra-household help from spouse or from other co-residents may partly offset expected cost increases in the formal care sector brought about by an aging population. The results further suggest that help from children and help from formal sources is likely to be concomitant and that children may act as agents seeking formal help also in a welfare state based on the universal and equal care services.

Factors associated with health care utilization by the elderly in a public health care system

OBJECTIVE

The objective was to determine the factors associated with the use of health care services by the elderly residing in the community.

METHODS

A cross-sectional study on 787 elderly people over 64 years of age from Albacete City (Castilla-La Mancha, Spain). The study was carried out by personal home interviews during a 9-month period. The dependent variables were: health care utilization, and characteristics. The independent variables were: self-reported health status, self-reported morbidity, medication use, functional status, mental health, lifestyle habits, social support, and sociodemographic status.

RESULTS

The health care services were used by 74.5% in the last 3 months of which 59.4% were general practitioner visits, 18.4% were to nursing staff, and 16.5% were specialist visits. Laboratory tests were performed in 39.2% and radiological examinations in 24.9%. Emergency visits accounted for 2.4%, and hospitalization, 2.9%. Users of health care services among the elderly population were objectively more ill, although there was a group of healthy individuals who also visited the physician and a large group of elderly with considerable health problems who never saw their physician. In the multivariate analysis, general practitioner utilization was independently associated with a perceived unmet need for care (OR = 3.15), a negative self-reported health status (OR = 2.51), and a lower educational level (OR = 2.41).

CONCLUSIONS

Subjective factors as perceived need for care, a negative self-reported health status and lower educational level are important factors that influence in the utilization of health care services.

Opinions on changes in the Romanian health care system from people's point of view: a descriptive study

After 10 years of changes, the Romanian people were asked to assess the consequences of the reforms that were carried out through the health care system in the last decennium. This article studies the opinion of changes among individuals and socio-economic-demographic groups living in Dolj region. Such surveys are rare in Romania. People show to have different opinions on quality of care, accessibility and on attitudes of politicians to health care comparing the present state of affaires with the past one. Overall the people judge the actual situation preferable to the past. The elderly, the chronically ill and the people who believe that people were happier 10 years ago have a more critical view on the changes especially in terms of accessibility. The higher educated people have a more positive opinion on the consequences of the reforms. The results may help to improve the communication between policy makers and the population. It is suggested that the involvement of the citizens in the health care reforms may realize a better implementation of Romanian health care reforms. This involvement is lacking.

Older people as health service consumers 3: obstacles to access in the village

Faster access to hospital services, swift advice and treatment in GP surgeries and quicker access to information at home are among the improvements brought about as a result of recent Government policies in England. These developments have increased the infrastructure, such as walk-in clinics and extended surgery hours, but the responsibility lies with the patient to present themselves. Although older people use NHS services proportionately more than other age groups, they also tend to normalize disease symptoms, attributing them to ageing (Tod et al, 200a). This article, the third in a series which addresses older people's beliefs and behaviour in relation to health care, discusses the factors which influence the accessing of health services within an older, white village community in South England.

Barriers to accessing health care: the perspective of elderly people within a village community

Many initiatives which emphasise the consumerist stance of patients make the apparent assumption that patients have the knowledge and desire to exercise their consumer rights. This study explores the extent to which there is a consumerist ethos among elderly people in a village community, and the factors which influence the accessing of health care in the community. Using a mini-ethnographic approach, nine key informants were observed and interviewed. Cultural factors were found to influence coping in health and illness, and in legitimising access to primary health care. No informant saw the need to exercise their rights as consumers of health care, suggesting that despite initiatives to involve patients as partners in health care, the hierarchical position of the elderly people in the village is unchanged from the days of the medical model in health care, and is a significant barrier to their use of health services.

Living arrangements and health status in later life: a review of recent literature

The living arrangements of older persons play a key role in their use of formal and informal care, as well as in their health and well-being. Nurses engaged in primary care, discharge planning, and home care are strategically positioned to contribute to an optimal fit between older persons and their home environment. This article describes the demographic significance of late-life living arrangements and proposes a model for organizing the complex web of factors associated with household composition and late-life migration. The article then summarizes qualitative and quantitative evidence in support of the proposed model. Key areas for nursing research and strategies for applying available research are identified.

Health services accessibility among Spanish elderly

The paper aims to identify the variables that best explain the use of health services by people aged 65 and over in Spain. The data comes from the 1993 Spanish National Health Survey (ENSE 93). The conceptual framework is the model proposed by Andersen, who suggests that utilisation is a function of predisposition to use the services, the ability to use them and of need. A bivariate and multivariate analysis (SPSS-X Discriminant Procedure) is conducted to define the predictors that best discriminate users and non-users. The use of each health service is explained by a different set of variables. The need variables play a more important role in predicting the use of non-discretionary services that are more closely related to healing processes (medical consultations, emergencies and hospitalisation). The predisposing and enabling variables are more relevant in explaining the use of dental services, indicating a certain degree of inequity of these discretionary services.

Costs of formal care for frail older people in England: the resource implications study of the MRC cognitive function and ageing study (RIS MRC CFAS)

The aim of this paper is to quantify service use and costs of supporting frail older people at home in the community, using data collected in a longitudinal multicentre stratified randomised study for 1055 mentally frail, physically frail, and mentally and physically frail subjects. Average costs per person per week were found to total 64.45 Pounds Sterling, with a small number of services accounting for a large proportion of the total costs. The level of services offered by the nonstatutory voluntary and private sectors was found to be small. To highlight issues for policy makers, the extent of cost variations between a number of different subgroups were calculated. These bivariate analyses revealed substantial variation in costs, especially according to household structure, type of frailty, whether admission to continuing care accommodation occurred and survival. Multiple regression analysis demonstrated that 26% of the variation in log average weekly costs could be explained by a number of socio-demographic and health status variables. A particularly close relationship was observed between costs and whether admission to continuing care accommodation occurred, highlighting a need for policy-makers to examine the nature and scale of provision of alternative community based care packages. The results demonstrate that descriptive cost data such as those presented can provide information useful to the planning process, enabling more informed choices to be made over the provision of services for particular groups of people.

General practice in urban and rural Europe: the range of curative services

The variation in the range of services provided by general practitioners (GPs) is not only related to personal characteristics and features of the country's health care system but also to the geographical circumstances of the practice location. In conurbations health services are more widely available than in the countryside, where GPs often are the only providers. With highly mobile populations and a plentiful supply of doctors, in cities the prevailing regulations for access and use of services are more difficult to maintain. It is also more difficult to control access and thus opportunities for inappropriate use are greater. Against this background an international study was conducted on variation in task profiles of GPs, especially focusing on differences between urban and rural practices. In 1993 standardised questionnaires in the national languages were sent to samples of GPs in 30 countries. Various aspects of service provision were measured as well as practice organisation, location of the practice and personal backgrounds of the GP. Completed questionnaires were received from 7,233 respondents, an overall response rate of 47%. Sources of variation have been analysed by using a two-level model. Rural practices provided more comprehensive services regardless of the health care system. Approximately half of the variation was explained by features of a country's health care system. The GP's position at the point of access to health care was strongly associated with the gatekeeper function controlling access to secondary care. In western countries where the GPs were self employed they had greater involvement in technical procedures and chronic disease management. There was a considerable gap between the task profiles of GPs in eastern and western Europe. We found evidence of a reduced gatekeeper role in inner cities in those countries where GPs held this position. GPs with an estimated overrepresentation of socially deprived people and elderly in the practice population reported a wider range of services. Differences also appeared to be related to factors which are largely controlled by the individual doctor, such as level of training and education, availability of equipment and practice staff. The results have important implications for education, policy development and health care planning both in eastern and western Europe.

Methodological challenges in measurements of functional ability in gerontological research. A review

This article addresses two important challenges in the measurement of functional ability in gerontological research: the first challenge is to connect measurements to a theoretical frame of reference which enhances our understanding and interpretation of the collected data; the second relates to validity in all stages of the research from operationalization to meaningful follow-up measurements in longitudinal studies. Advantages and disadvantages in different methods to do the measurements of functional ability are described with main focus on frame of reference, operationalization, practical procedure, validity, discriminatory power, and responsiveness. In measures of functional ability it is recommended: 1) always to consider the theoretical frame of reference as part of the validation process (e.g., the theory of "The Disablement Process"; 2) always to assess whether the included activities and categories are meaningful to all people in the study population before they are combined into an index and before tests for construct validity; 3) not to combine mobility, PADL and IADL in the same index/scale; 4) not to use IADL as a health-related functional ability measure or, if used, to ask whether problems with IADL or non-performance of IADL are caused by health-related factors; 5) always to make analyses of functional ability for men and women separately as patterns of functional ability and patterns of associations between other variables and functional ability often vary for men and women; and 6) to exclude the dead in analyses of change in functional ability if the focus is on predictors of deterioration in functional ability.

Determinants of the use of ambulant social care by the elderly

Policy makers and scientists are increasingly concerned with the use of formal care services by the elderly. This article demonstrates that there are three different care systems: the informal, the commercial and the formal (public) system. In terms of prevalence, the formal system is the least important one. By means of a cross-sectional sample of the elderly population of Antwerp, an Andersen model is estimated to explain the use of formal services. This model shows that the level of functional capacity of the elderly is a crucial factor. Yet, the effect this has on the use of care varies according to the different living arrangements. "Need" as such, therefore, does not determine the use of formal services, since its effect is modified by the different alternatives that are at the disposal of the elderly person (living arrangements, informal care, income, availability of commercial alternatives). In the conclusion it is argued that the Andersen model, in a cross-sectional design, is inadequate to construct a theory concerning the use of care services.

Disease, impairment, disability and social handicap: a community based study of people aged 70 years and over

The aim of this research was to investigate the prevalence of disability in a total population-based sample aged 70 years and over, the social handicap resulting from the disability and the diseases and impairments contributing to disability in the most disabled subjects. From the initial sample of 856 subjects, 782 (91.4%) participated. Disability in the tasks examined varied from 1.3% of subjects unable to feed themselves to 24.4% unable to carry out housework. In the 74 most disabled subjects comorbidity was common. The major clinical disorders that contributed to impairment and disability were heart failure, osteoarthritis, stroke and dementia. Those who were disabled were considerably more likely to be handicapped than those not disabled (odds ratio 6.65, 95% confidence interval 4.73-9.36). When social support was considered, the estimated risk of handicap associated with disability ranged from 3.19 (95% CI 1.92-5.30) for the subset of subjects who had a spouse, to 52.00 (95% CI 4.03-670.6) for subjects without emotional support.