Accuracy of Self-Reported Physical Capacities as a Clinical Screening Test for Older Adults With Mobility Disability

Background: Screening for poor physical performance has the potential to identify older adults at risk for loss of future independence, yet clinically feasible measures have yet to be identified. Methods: Using data from the National Health and Aging Trends Study, we evaluated the diagnostic utility of self-reported physical capacities of older adults (walking three blocks or six blocks, climbing 10 stairs or 20 stairs) compared to the objectively measured Short Physical Performance Battery (SPPB). Sensitivity, specificity, and likelihood ratio (LR) were calculated across three SPPB cut-points (≤8, ≤9, ≤10). Results: Sensitivity of single item-measures for detecting a low SBBP averaged 0.39 (range: 0.26-0.52), specific averaged 0.97 (range: 0.94-0.99) and likelihood ratio averaged 20.0 (range: 9.0-35.5). Among age and gender subgroups, all measures maintained clinically applicable LRs (minimum = 4.59). Conclusion: Single-item self-reported physical capacities are accurate for screening older adults with physical limitations, making them potentially useful in healthcare settings.

Viatical settlements: effects on terminally ill patients

PURPOSE

This study was performed to assess the knowledge, attitudes, and experiences with viatical settlements among hospice staff who provide financial counseling to terminally ill patients and their families.

DESCRIPTION OF STUDY

A random sample of 300 hospices in the 50 states was selected from the National Hospice Directory. Staff members who provide financial counseling to patients and families were interviewed by phone using a 31-item structured questionnaire.

RESULTS

The response rate was 80%. The results showed that only 4% of hospices provide information about viatical settlements to all patients, while 32% provide information only if asked. Only 9% of respondents rated themselves as very informed about viatical settlements, and 53% rated themselves as moderately informed. Of the 47 hospices where at least one patient had used a viatical settlement, 92% felt the patient had a positive experience using the resource. In response to a hypothetical case of a terminally ill patient considering a viatical settlement, 40% responded positively, while 51% were neutral.

CLINICAL IMPLICATIONS

Among hospice financial counselors who have had experience with viatical settlements, most report positive experiences. When asked to respond to a hypothetical case, most respondents were either neutral or positive. However, lack of knowledge about viatical settlements may limit the availability of this resource for terminally ill patients and their families.