Health locus of control in late life: a study of genetic and environmental influences in twins aged 80 years and older

The factor structure of health locus of control (Form A; K. A. Wallston, B. S. Wallston, & R. DeVellis, 1978) was examined in 420 octogenarians (M age = 83.2 years), and the contributions of genetic and environmental factors to health-control beliefs in 141 octogenarian twin pairs (71 identical, 70 same-sex fraternal) were estimated. Factor analyses reproduced previously proposed factors (Internal, Chance, and Powerful Others). Associations between health-control beliefs and life satisfaction, depression, and other health-related measures (e.g., self-rated health, outpatient contacts, and hospitalization), were modest. Quantitative genetic analyses revealed significant shared environmental influence on the Chance subscale, and significant familiality (attributable to a combination of genetic and shared environmental influences) on the Powerful Others subscale; there was no evidence of familiality on the Internal subscale.

Health locus of control in late life: a study of genetic and environmental influences in twins aged 80 years and older

The factor structure of health locus of control (Form A; K. A. Wallston, B. S. Wallston, & R. DeVellis, 1978) was examined in 420 octogenarians (M age = 83.2 years), and the contributions of genetic and environmental factors to health-control beliefs in 141 octogenarian twin pairs (71 identical, 70 same-sex fraternal) were estimated. Factor analyses reproduced previously proposed factors (Internal, Chance, and Powerful Others). Associations between health-control beliefs and life satisfaction, depression, and other health-related measures (e.g., self-rated health, outpatient contacts, and hospitalization), were modest. Quantitative genetic analyses revealed significant shared environmental influence on the Chance subscale, and significant familiality (attributable to a combination of genetic and shared environmental influences) on the Powerful Others subscale; there was no evidence of familiality on the Internal subscale.

Health technology assessment in Ireland

Ireland's health system is primarily funded from general taxation and is publicly provided, although private health care retains a considerable role. It is a unique structure, a mixture of universal health service free at the point of consumption and a fee-based private system where individuals subscribe to private health insurance that covers some of their medical expenses. The recent history of the Irish health services saw consolidation of existing services and an expansion into new areas to adapt to changing practices and needs. There has also been a drive to extract maximum efficiency so as to maintain the volume and quality of patient services at a time of very tight financial constraints. Introduction of new health technologies continued to accelerate. New technologies tended to spread rapidly before systematic appraisal of their costs and benefits. When the state is involved in funding the public hospital system, acceptance of new technology is a matter for discussion between agencies and the Department of Health and Children. Decisions about spending annual "development funding" have generally not been based on careful assessment of proposals for new technology. In 1995, a healthcare reform put new Public Health Departments in Health Boards in a prime position in Ireland's health services organization. These departments now emphasize evidence-based medicine. While Ireland does not have a national health technology assessment (HTA) program, there are plans to form an advisory group on HTA in 1998. HTA is seen as a significant element of future health policy in Ireland.

Postdischarge medication use of elderly cardiac patients from urban and rural locations

BACKGROUND

After discharge from an acute care setting, elderly cardiac patients take a variety of medications in the home setting. Their pharmacologic regimens are often quite complex, and may involve drugs from several therapeutic categories. Patterns of medication use can be one measure of patient status after discharge because they can indicate whether medical conditions are stabilized. A problem related to medications during the postdischarge period is residence of the patient. For persons discharged to rural settings, access to health care resources and follow-up monitoring of medications may be problematic.

METHODS

This longitudinal study followed postdischarge medication use over a 5-month period. Thirty-two elderly persons admitted to a large tertiary care center for treatment of cardiac conditions were recruited. Baseline information was collected on demographics and health status, and subjects were then interviewed by telephone at 2, 4, 12, and 20 weeks postdischarge. Analysis of functional health complaints assessed by the Medical Outcomes Short Form (SF-36) and cardiac symptom scores were correlated with new and standing prescriptions over time and across geographic locations. Potential confounders such as age, gender, and severity of illness were controlled for.

RESULTS

Statistical analyses on continuity of medication use and changes in the category of medication prescribed revealed that urban subjects were prescribed more drugs and experienced significantly more alterations in their drug regimens.

CONCLUSIONS

Contrary to expectations, urban subjects appeared to do worse over the postdischarge period with greater drug utilization that directly predicted the number of hospital readmissions and number of emergency room visits, even though their severity of illness was no different from their rural counterparts at the time of discharge.

Origins of individual differences in episodic memory in the oldest-old: a population-based study of identical and same-sex fraternal twins aged 80 and older

The relative importance of genetic and environmental influences on episodic memory in very late life was studied using a quantitative genetic approach. Identical (n = 125) and same-sex fraternal (n = 157) twin pairs, aged 80 and older (mean age = 83.3; SD = 3.1) and without a diagnosis of dementia were tested with seven memory measures: (1-2) Digit Span Forward and Backwards, (3) Prose Recall, (4) Thurstone's picture memory test, and the Memory in Reality (MIR) test, including the subtasks of (5) free recall, (6) recognition, and (7) relocation. Heritabilities, estimated by structural equation modeling, ranged from .04 to .49. The digit span backward test showed the highest heritability (h2 = .49), while heritabilities were typically lower for the long-term memory measures. The results demonstrate genetic influences on memory in the oldest-old, but suggest that the magnitude of these effects differs across memory measures.

Rurality and prescription drug utilization among the elderly: an archival study

Despite documentation that rural elderly have reduced access to both primary care and specialist physician services, there have been very few studies comparing rural and urban patterns of prescription drug use. This is unfortunate, because prescription drugs are the most commonly used type of health care by the elderly. This research merged claims data for a random sample of 18,641 enrolled elderly in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) for the years 1984 through 1988 with Medicare inpatient and outpatient health services records and with county-level demographic and health services resources data bases to test several models of factors associated with prescription drug use. The Human Resources Profile County Code from 1980 census data (HRPCC80) in the Area Resource File provided a very detailed (10 levels) definition of rurality. Consistent with our hypotheses based on preliminary studies, neither rurality designations nor county-level health care resource indices, nor interaction terms of health services resources with rurality were powerful predictors of prescription drug use. Use of health services (from Medicare data) and variables of longevity and continuity in the PACE program were consistently robust predictors of prescription drug use. Personal demographic characteristics were also strong predictors: white widowed women under age 85 with relatively higher incomes used more prescription drugs.

Drug use and prescribing problems in four state Medicaid programs

In this article the authors present population-level prevalence rates for 61 specific drug-related problems occurring in three State Medicaid programs (Maryland, Iowa, and Washington) from 1989 through 1996 and a fourth (Georgia) from 1994 through 1996. The findings represent the first application of a consistent drug utilization review (DUR) screener program to Medicaid data across States. The study finds major differences in DUR failure rates among the four States with the lowest rates in Georgia and the highest in Washington. Only Iowa showed any population-level reduction in DUR failure rates during the study period, however, rates for community-dwelling elderly fell in most States.

Substantial genetic influence on cognitive abilities in twins 80 or more years old

General and specific cognitive abilities were studied in intact Swedish same-sex twin pairs 80 or more years old for whom neither twin had major cognitive, sensory, or motor impairment. Resemblance for 110 identical twin pairs significantly exceeded resemblance for 130 fraternal same-sex twin pairs for all abilities. Maximum-likelihood model-fitting estimates of heritability were 62 percent for general cognitive ability, 55 percent for verbal ability, 32 percent for spatial ability, 62 percent for speed of processing, and 52 percent for memory. There was also evidence for the significant influence of idiosyncratic experience as the environmental component that most determines individual differences in cognitive abilities late in life.

Assessment and control of nonresponse bias in a survey of medicine use by the elderly

Health services research based on survey data is subject to potentially serious selection bias because observations are typically available only for survey respondents. This study describes a method of assessing and controlling for selection bias in the context of a survey of prescription and over-the-counter drug use by the elderly. A random sample of 6,500 Pennsylvania Medicare enrollees was sent a questionnaire regarding medicine use, insurance coverage, and health status in 1990. Applying a two-stage, limited dependent variable selection model developed by Heckman to baseline Medicare enrollment and utilization data for both respondents (70%) and nonrespondents (30%) allowed us to detect and control for negative and significant nonresponse bias in estimates of prescription drug use. Purchase of over-the-counter medication was free of such bias. The report describes how the Heckman method can be applied in other cases where health services survey samples are generated from program or organizational files that contain person-level data on all members of the sample frame.

Patterns of outpatient prescription drug use among Pennsylvania elderly

The Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) provides outpatient prescription drug coverage for nearly one-half million State residents 65 years of age or over with income under $15,000 per year. A description of the PACE program is provided herein, along with data and multivariate results relating to the demographic characteristics of PACE beneficiaries, duration of enrollments, drug utilization and expenditure rates, average prices for covered prescriptions, and drug expense distributions.

Use of a state-level pharmaceutical assistance program among urban and rural elders

A number of state-level pharmaceutical assistance programs have been established as a result of the growing recognition of the role of pharmaceuticals in the long-term care of the elderly. However, existing research does not provide a coherent expectation for patterns of use by rural and urban elderly. The data for this analysis are drawn from a larger study of the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE). PACE provides prescription medicines for elderly who meet income requirements. The research project was designed to assess the characteristics of PACE program participants and non-participants on a wide range of issues. Chi-square analysis and regression models were used to assess the association between rural and urban residence and access to the PACE Program. The results indicate that rural/urban status of the elderly is not a significant predictor of the use of PACE. Other traditional variables (e.g., health self-rating and physician visits) did predict difference in the pattern of use.