Journal of Aging and Health

Health care planners are concerned with projected increases in the numbers of elderly because of their consumption of costly nursing home- and hospital-based services. Using administrative data from the Manitoba health insurance system, this article examines how a health care system has responded to increased numbers of elderly by comparing how different age groups in the population used hospitals, nursing homes, and physicians in 1975 and 1983. Over this period, there was a marked increase in the numbers of elderly, combined with a decrease in the per capita availability of hospital and nursing home beds.

Data drawn from the Supplement on Aging (SOA) to the 1984 National Health Interview Survey (NHIS) were used to identify correlates of older persons' assessments of their capacity to provide self-care. The SOA data set consists of responses, based on personal interviews with 16,148 persons 55 years of age and older. Most assessed their capacity to care for themselves in positive terms; only 11% assessed their capacity to provide self-care as fair or poor. Based on stepwise regression, self-reported health status and perceived control of health accounted for approximately 15% of the 17% of variation explained in the dependent variable. The Health Belief Model may provide a theoretical context in which to understand better the self-care component of the health-care continuum.

When Medicare extends catastrophic coverage to outpatient prescription drugs in 1991, the program will benefit an estimated 15% to 25% of the aged population. For some of these individuals Medicare coverage will mean the difference between economic self-sufficiency and impoverishment due to high medical bills. This article provides empirical estimates of the relationship between third-party coverage of outpatient pharmaceuticals and the risk of medical indigence based on the experience in Pennsylvania following enactment of that state's Pharmaceutical Assistance Contract for the Elderly (PACE), a lottery-financed drug benefit program that currently enrolls nearly half a million residents age 65 and older. The study provides data on the distribution of billed charges for outpatient drugs by income class for PACE enrollees and then uses a time series analysis to estimate the impact of PACE implementation (July 1984) on monthly changes in Medicaid enrollments and expenditures by category of elderly Medicaid recipient over the period July 1981 through June 1987. Study findings are discussed in the context of the forthcoming Medicare drug benefit.

This prospective study evaluates the relationship between the number of prescription and over-the-counter medications used in community-dwelling aged women and changes in mental, physical, and instrumental functioning. Data are derived from two in-home interviews (one year apart) of 609 women 65 years or older identified through a random sample of households in a 20-contiguous census tract area of Baltimore, Maryland. After controlling for age, education, physical health, number of chronic conditions, and baseline functional status, prescription medication use is associated with declines in ability to perform PADL and IADL tasks and increases in symptoms of depression. No associations are observed between prescription drug use and changes in cognitive functioning over one year. The use of over-the-counter drugs is associated with declines in PADL tasks only. Several explanations for results are discussed. Suggestions for future study and prescribing to the significant minority of persons taking multiple medications are given.

This study investigated outcomes of geriatric rehabilitation and predictors of success among 81 consecutive admissions to a 40-bed rehabilitation unit in a long-term care facility. Predictors measured at admission included sociodemographic variables, functional status (both current and prior to illness), social contact, and self-motivation. In all, 62 patients (77%) successfully completed the rehabilitation program; 76% of the successes were discharged home. Failure to discharge successfully rehabilitated subjects was mainly due to placement problems and patient and family preference. Both of the success groups showed significant improvement in functional status (Barthel Index), while failures had poorer initial functional status, and showed no improvement on average. At six-month follow-up, functional status (measured by the Sickness Impact Profile) was similar in the two success groups. No predictors other than functional status were associated with rehabilitation success. Among the successes, better functional status at six months was predicted by aspects of self-motivation.

A battery of cognitive tasks was administered to a group of community-dwelling older adults. They also completed questionnaires assessing their cognitive and memory functioning and mental health status. A person familiar with the participant completed the same set of questionnaires. Little or no association was observed among the laboratory-type cognitive tasks and the self-assessments of cognition and memory, but significant relationships were observed between self-reported mental health and both the cognitive tasks and the subjective memory assessments. However, significant others' assessments of the participants' cognitive and memory functioning were related to laboratory-assessed cognitive functioning. These results suggest that mental health status and both cognitive performance and self-reports of cognitive and memory functioning are linked. Results also suggest that significant others may be better judges of actual cognitive performance than are elders themselves.

Research on the effects of the Medicare Prospective Payment System utilizing DRGs on community service providers indicates that a heavier-care clientele is changing the nature of the community-based long-term care system. This article reports on the impact of DRGs on one provider type, adult day care centers, and the resulting shift toward post-acute care to meet the demands of this new heavier-care clientele. The 39 adult day care centers reported on are part of a larger sample of providers studied over three years in 12 communities within five states.