The impact of payor/provider type on health care use and expenditures among the frail elderly.

OBJECTIVES: This study examined whether health care expenditures and usage by the frail elderly differ under three payor/provider types: Medicare fee for service, Medicare health maintenance organization (HMO), and dual Medicare-Medicaid enrollment. METHODS: In-home interviews were conducted among 450 frail elderly patients of a San Diego, Calif, health care system. Cost and use data were collected from providers. RESULTS: Analyses revealed no difference in total expenditures between fee-for-service and HMO enrollees, but Medicare-Medicaid beneficiaries' expenditures were 46.8% higher than those for HMO enrollees and 52.2% higher than those for the fee-for-service group. Fee-for-service participants were less than half as likely as HMO enrollees to have two or more hospital admissions, but hospital usage rates between those two payor/provider groups did not differ. Not were there payor/provider differences in access to home health care, but HMO home health care users received significantly fewer services than the others. CONCLUSIONS: The care provided to these HMO beneficiaries resulted in a combination of restricted home health use and higher multiple hospitalizations. This raises compelling questions for future research. For the dually enrolled, stronger cost containment may be required.     

Parental behaviour and adolescents' emotional eating

Parents can influence their children's emotional eating behaviour through modelling processes and parenting. In this study, data on parenting (support, behavioural control and psychological control), emotional eating, and demographic variables were gathered among both parents and two adolescent children of 428 Dutch families. Structural equation modelling showed positive associations between parents' emotional eating and adolescents' emotional eating. Adolescent's reports of low maternal support and of high psychological control for younger adolescents and low behavioural control for older adolescents were associated with higher emotional eating. Parents' reports of parenting were not significantly associated with adolescent's emotional eating. Multi-group analyses revealed no significant differences in associations between modelling and parenting factors on the one hand, and adolescent emotional eating on the other, by sex of the older or younger adolescent.     

The correlation of age and comorbidity with therapy and survival in cancer patients in North-Brabant and North-Limburg, 1995-2001

The proportion of elderly cancer patients has increased considerably. This means that more patients are being diagnosed with one or more serious concomitant condition which may complicate the treatment of cancer. Little is known about treatment outcomes, as elderly patients with comorbidity are often excluded from clinical trials. The Eindhoven Cancer Registry has been registering serious co-morbidity in North-Brabant and North-Limburg in the Netherlands since 1993. Using data from patients diagnosed with cancer in 1995-2001, the correlation between age and comorbidity and choice of therapy and survival rates was described. Very elderly patients or patients with co-morbidity often were not treated in accordance with the guidelines. Elderly patients with localized lung cancer or prostate cancer underwent less surgery as often and elderly patients with colorectal cancer, breast cancer or ovarian cancer received less adjuvant chemotherapy or radiotherapy than younger patients. The prognosis was often worse for elderly patients than for younger patients, and the presence of co-morbidity decreased survival in most types of tumour. The question remains whether the prognosis for elderly patients with cancer would improve if more of them were treated in accordance with the guidelines, or if this will only lead to more complications.     

Nutrition knowledge, attitudes and dietary restriction behaviour of Taiwanese elderly

The purpose of this study is to understand knowledge about and general attitudes towards nutrition, dietary restriction attitudes, and dietary restriction behavior in the Taiwanese elderly, and the relationship of these various components to each other. Data from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) were used for analysis and included 1937 elderly persons aged over 65. The results indicated that the elderly had poor nutrition knowledge, especially about the relationship between nutrition and disease. Elderly nutrition attitudes were fair; they tended to disagree with misconceptions about "healthy" or functional foods and also had quite positive general eating attitudes. However, the Taiwanese elderly hold quite strong attitudes influenced by Chinese traditional or food-texture-related dietary restrictions. Elderly people frequently avoid eating foods considered unhealthy by modern medical science (e.g. high fat/cholesterol foods) as well as foods forbidden by Chinese traditional medicine (e.g. "heating" foods, "cooling" foods). Most of the elderly regularly eat three meals a day, however, they seldom pay attention to dietary and nutrition information. The most important sources of nutrition information are offspring or family members, TV, and medical practitioners. In general, elderly men with a higher educational level and living in less remote areas had better nutrition knowledge, held more positive nutrition attitudes, and kept to dietary restrictions less frequently. Elderly people's nutrition knowledge was positively related to their health-care attitudes, general eating attitudes, high- fat or high-cholesterol food restriction behavior, fermented or pickled food restriction behavior, attention to nutrition information, and regularity of meals. However, nutrition knowledge was inversely related to Chinese traditional or food-texture-related dietary restriction behaviors. The results of this study suggest that education of elderly people about nutrition is important, and the design of such nutrition education programs should consider the low educational levels of the elderly. Children or other family members may also be included in the program. The use of TV as a medium for nutrition education of the elderly may also be important for nutrition educators.     

中医情志护理对老年脑血管病人的影响效果分析

目的 探讨中医情志护理对老年脑血管病人的影响效果。 方法 选取2017年3月—2018年3月在某中医院入院的患者,将患者分为对照组与观察组,对照组患者接受常规护理,观察组患者采用情志护理,对比2组患者在不同护理模式下的生活质量评分与护理满意度评分。 结果 观察组患者的生活质量评分、护理满意度评分与对照组患者相比,观察组患者的评分优于对照组,差异有统计学意义(P<0.05)。 结论 将中医情志护理运用于本院老年脑血管疾病患者,可有效的改善患者的生活质量,促进医患关系走向和谐,具有临床意义,值得推广。     

Differences in AIDS Knowledge and Attitudes by Grade Level

Grade-related similarities and differences in AIDS knowledge and attitudes were assessed in 441 fifth, seventh, and tenth graders from one school district. Grade level was a significant variable (p less than .01) on 53% of items. Grade-related differences in knowledge were apparent when students responded to questions tapping information not covered widely in the media and in attitudes when personal engagement in behavior was implied. Cognitive and emotional factors related to developmental milestones were postulated to account for these differences. These findings need to be considered in planning and implementing AIDS prevention programs, especially as education is begun for younger children.     

Depressive symptoms among hospitalized patients in Israel

Depressive symptoms are common among hospitalized patients and can indicate more serious problems. This study examined the level of depressive symptoms among patients in one hospital in Jerusalem, the variables related to depression, and the extent to which social workers provided services to those patients. Over 60% of patients reported high levels of depressive symptoms. Levels were higher among Arabs, those with lower income, small social networks, stronger locus of control (powerful others), weaker internal locus of control, and low emotional support from staff. Social workers were in contact with 44% of patients who had high levels of depressive symptoms.     

Depressive Symptoms Among Hospitalized Patients in Israel

Depressive symptoms are common among hospitalized patients and can indicate more serious problems. This study examined the level of depressive symptoms among patients in one hospital in Jerusalem, the variables related to depression, and the extent to which social workers provided services to those patients. Over 60% of patients reported high levels of depressive symptoms. Levels were higher among Arabs, those with lower income, small social networks, stronger locus of control (powerful others), weaker internal locus of control, and low emotional support from staff. Social workers were in contact with 44% of patients who had high levels of depressive symptoms.     

健康教育对糖尿病住院患者营养知信行的影响

目的评估健康教育对糖尿病住院患者营养知识-态度-行为(KAP)水平的影响,为今后在临床更好开展糖尿病健康教育提供依据。方法将新入院的糖尿病患者分为两组:青壮年组(年龄小于60岁)和老年组(年龄大于60岁),应用自制问卷进行调查,比较两组糖尿病患者接受健康教育前后的营养KAP水平。结果无论青壮年组还是老年组,初入院糖尿病住院患者营养KAP水平低,接受健康教育后两组患者的营养KAP水平均显著提高,前后对比差异有统计学意义;尤其对"糖尿病患者控制总能量的摄入"、"控制食盐摄入量"、"少食多餐"以及"食物交换份"等几项营养知识知晓率提高明显,两组糖尿病患者治疗饮食执行率也分别由72.2%、67.6%提高到94.4%、81.1%。结论健康教育是改善糖尿病住院患者营养KAP的有效方法,对老年糖尿病患者同样适用,建议将健康教育作为糖尿病住院患者临床治疗中的一项常规措施。     

Severity of illness, race, and choice of local versus distant hospitals among the elderly

This study examines travel patterns for hospitalization among elderly patients to address whether there are differences by age and race/ethnicity, and whether the differences persist even when a severe illness occurs. Using the Healthcare Cost and Utilization Project (HCUP) State Inpatient database (SID) of the Agency for Healthcare Research and Quality, the study focuses on New York residents in the 65-and-over age group who are hospitalized in New York or neighboring states. Two types of hospital admissions are used: referral-sensitive admissions (fairly discretionary, high-technology procedures) and ambulatory care-sensitive admissions (avoidable with appropriate primary care). The study found that, after adjusting for other covariates, travel progressively declines with age among the elderly. Travel patterns across elderly age cohorts were not significantly different when patients were more severely ill. Members of racial/ethnic minority groups were less likely to travel than whites, and this gap persisted even when a severe illness occurred.     

Evaluation of a health care programme with nursing tutor in a hospital traumatological facility in a hospital, Granada, Spain, 2004

BACKGROUND: The current trend in patient care is towards a more humanized and higher-quality healthcare. The objective of the present study was to evaluate the results of implementing a programme of healthcare with a reference nurse who welcomes the patient at hospital admission, visits regularly during hospital stay, and resolves doubts and problems. METHODS: Quasi-experimental study (149 cases and 454 non-tutored controls) in patients admitted for scheduled trauma surgery at the Virgen de las Nieves University Hospital, Granada. Sociodemographic and clinical data were gathered at admission. At 15 days after discharge, patients were administered with an interviewer-administered Zung score and an ad hoc questionnaire on satisfaction with different healthcare aspects during hospital stay and understanding of information received. Bivariate analyses and linear and multivariate logistic regression analyses were performed with a study of confounding variables. RESULTS: For the outcome variable anxiety level non-tutored patients had a B coefficient of 2.64 (p<0,01) in the multivariate linear regression analysis controlling for the other variables in the final model: sex, presence of informal career, professional activity, days of hospital stay and understanding of health information. For the outcome variable inadequate understanding information non-tutored patients showed an odds ratio of 3.48 in the multivariate analysis controlling for educational level and presence of informal career. Satisfaction with he friendliness of health care personnel and with the hospital setting did not significantly difference, although the percentage of dissatisfied patients was higher in the non-tutored group: 15% vs 11% (p= 0.34) and 18% vs 12 % (p= 0.11) respectively. CONCLUSIONS: The implemented continued care programme proved effective for these patients, increasing their understanding of information received and reducing anxiety levels.     

Evaluation of Nutrition Deficits in Adult and Elderly Trauma Patients

Background: As metabolism is often escalated following injury, severely injured trauma patients are at risk for underfeeding and adverse outcomes. Methods: From an international database of 12,573 critically ill, adult mechanically ventilated patients, who received a minimum of 3 days of nutrition therapy, trauma patients were identified and nutrition practices and outcomes compared with nontrauma patients. Within the trauma population, we compared nutrition practices and outcomes of younger vs older patients. Results: There were 1279 (10.2%) trauma patients. They were younger, were predominantly male, had lower Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and had an overall lower body mass index compared with nontrauma patients. Eighty percent of trauma patients received enteral feeding compared with 78% of nontrauma patients. Trauma patients were prescribed more calories and protein yet received similar amounts as nontrauma patients. Nutrition adequacy was reduced in both trauma and nontrauma patients. Survival was higher in trauma patients (86.6%) compared with nontrauma patients (71.8%). When patients who died were included as never discharged, trauma patients were more rapidly discharged from the intensive care unit (ICU) and hospital. Within the trauma population, 17.5% were elderly (≥65 years). The elderly had increased days of ventilation, ICU stay, and mortality compared with younger trauma patients. In a multivariable model, age and APACHE II score, but not nutrition adequacy, were associated with time to discharge alive from the hospital. Conclusion: Significant nutrition deficits were noted in all patients. Elderly trauma patients have worse outcomes compared with younger patients. Further studies are necessary to evaluate whether increased nutrition intake can improve the outcomes of trauma patients, especially geriatric trauma patients.     

Cigarette smoking: knowledge, attitudes and behaviour in an adult population in Italy

The study explores knowledge, attitudes, and behaviour regarding cigarette smoking and related factors in an adult population. A total of 935 parents of children attending the eighth class of ten randomly selected primary schools in Catanzaro (Italy) received a questionnaire consisting of questions on demographic and socioeconomic characteristics, knowledge, behaviour and attitudes about cigarette smoking. Six hundred and sixty-nine parents returned the questionnaire, with a response rate of 71.5%. Knowledge of risk associated to smoking was significantly higher in more educated subjects and in past smokers compared to current. Current and past smokers were respectively 39.6% and 17.2%, and current smokers were younger, not married, less prone to consider smoking as a major risk for their health and more likely to live with other smokers compared to past and never smokers. Females of higher education were more likely to be current smokers, whereas male current smokers were more likely to be less educated compared to past or never smokers. The results strongly recommend the provision of accurate information about the health consequences related to smoking, with a more intensive involvement of health care providers, particularly targeted to women and younger age groups.     

Biopsychosocial studies on cutaneous malignant melanoma: psychosocial factors associated with prognostic indicators, progression, psychophysiology and tumor-host response

A series of seven studies investigating biopsychosocial aspects of cutaneous malignant melanoma were conducted by a multidisciplinary group of researchers at the University of California, San Francisco. Two studies investigated the relationship of variables derived from a videotaped psychosocial interview and from self-report measures, and two histopathologic indicators: tumor thickness and level of invasion. Associations of psychosocial variables to prognostic indicators were stronger within the younger vs the older subject group. In a multiple regression analysis, patient delay in seeking medical attention emerged as the most significant variable predicting tumor thickness. A study of factors related to patient delay found longer delays in patients who had lesions on the back, less previous knowledge of melanoma, less understanding of its treatment and less minimization of its seriousness. Another study compared the repressive coping reactions--defined as the discrepancy between reported anxiety and that reflected in electrodermal activity--in melanoma patients, cardiovascular disease patients and disease-free controls. The melanoma group was significantly more 'repressed' on the combined self-report/physiological measure, as well as on other self-report measures of repressiveness. In order to investigate the relationship of psychosocial factors to more disease-relevant physiological variables, the next study focused on two clinical variables significantly predictive of disease outcome:mitotic rate of the tumor and lymphocytes at tumor site. Emotional expression of sadness and anger, rated from the videotaped interviews, was positively correlated with tumor-specific host-response factors and negatively correlated with mitotic rate. In another study, subjects who had died or had disease progression were matched on the basis of tumor and demographic characteristics with subjects who had no evidence of disease by follow-up. The unfavorable outcome group had higher scores on self-report scales of dysophoric emotion and distress which were administered one to three years previously. An experimental investigation of relationships among behavioral, physiological and tumor outcome variables in the Syrian hamster found that general activity was correlated positively with greater tumor growth following induction. These results were compared to those from the preceeding two human studies, and discussed in terms of a stress-arousal-coping model.     

四川省脑卒中患者住院费用影响因素分析

目的 本研究基于2020年四川省脑卒中首次住院患者的病案首页信息，探究脑卒中患者首次住院费用的可能影响因素，为进一步降低患者的经济负担提供参考依据。方法 收集四川省首次住院脑卒中患者的病案首页信息，了解脑卒中患者的费用分布；运用两水平方差成分模型探究影响患者费用的因素。结果 出血性脑卒中患者的费用高于缺血型脑卒中患者(P<0.05)。影响脑卒中患者住院费用的主要因素有：是否手术、是否病危或病重、住院时间、医院级别、脑卒中类型等。结论 应加强在高龄人群中的脑卒中预防宣传工作，降低脑卒中给高龄人群带来的疾病负担。通过合理的入院评估，提高医疗效率，减少住院时间和不必要的手术治疗，有助于降低卒中患者的经济负担。     

老年癌症患者感知需求、心理压力及生活质量的调查研究

目的 晚期癌症患者感知需求的相关研究鲜有报道,本研究调查老年癌症患者的感知需求、心理压力及其生活质量. 方法 随机选择门诊癌症患者为研究对象,要求患者完成简明支持性护理需求问卷(涵盖如下五个方面:健康系统和信息、心理、生理、保健与支持、性需求);综合医院焦虑抑郁量表(HADS)以及欧洲癌症研究与治疗组织(EORTC)的生活质量(QLQ-C30)量表. 结果 得到619份癌症患者的完整数据,其中113例来自65岁以上的老人.除了在性需求方面老年组较年轻组少,其他方面的需求和心理压力老年组并不比年轻组低.生活质量方面:比较两组在症状相关的生活质量上差异无统计学意义,显著性差异主要存在于几个功能领域,包括身体机能、情感、社会交往以及经济状况等. 结论 老年患者与年轻患者在感知需求和心理压力方面几乎没有差异.生活质量方面的差异可能是由于老龄化本身的影响造成的,因此尽管考虑到老龄化对每一生命维度质量的不同影响,医务人员还是应该提供给老年癌症患者与年轻癌症患者同等的优质临床服务.     

Emotional processing and bulimic psychopathology: age as a factor among nonclinical women

OBJECTIVES: This study tested the hypothesis that bulimic attitudes are associated with both attentional bias toward and cognitive avoidance of emotion cues among nonclinical women, considering whether the same pattern was found across early adulthood. METHOD: Eighty nonclinical women were divided into younger (< or =21 years) and older (> or =22 years) age groups. Each completed the Bulimic Investigatory Test and a Stroop task, designed to determine biases in the processing of negative and positive emotional information. RESULTS: Among the older women, more bulimic attitudes were associated with a specific attentional bias toward negatively valenced emotional material. In contrast, the younger women with more severe bulimic attitudes showed greater cognitive avoidance of both positive and negative emotion cues. DISCUSSION: These findings suggest that women with bulimic attitudes differ with age in their processing of emotional information. Potential implications are considered for clinical work with bulimic women of different ages.     

The current situation of older hospitalized patients in a cadre ward in Jilin, China

OBJECTIVE: The proportion of elderly people and the nation's medical expenditures are rapidly increasing in China. The existence of cadre wards, where retired members of the cadre of the Communist Party of China are hospitalized and receive careful treatment, helps in providing care for the elderly. Elderly retired cadre patients are thought to be more frequently hospitalized and to stay in the hospital longer than elderly non-cadre patients on general hospital wards, and therefore might be expected make an important contribution to the increase in the nation's medical expenditures. However the current situation is not well characterized. The aim of this study was to provide a basis for possible solutions related to the cadre patient burden by determining the circumstances and background of these patients with long hospital stays and investigating their needs. METHODS: We analyzed the medical records of hospital discharges from a cadre ward from 2000 to 2004, and from general wards in 2004 at a large university-affiliated hospital in Jilin, China. Additionally, a questionnaire survey including an interview concerning needs was carried out in August 2005 for 100 elderly patients on the cadre ward (91% of the total patients on this ward) of the same hospital at that time. RESULTS: The mean length of hospital stays of patients on the cadre ward decreased by half during the study period, but remained longer than that of patients on general hospital wards. Regression analysis showed that of all the variables measured, the type of ward (cadre vs. general) was the most influential on the mean length of hospital stay. Moreover, patients who were hospitalized more often, males and older individuals showed longer hospital stays. The questionnaire survey showed that there are many patients who could be discharged from the hospital based on their health condition but are not discharged because outside care or welfare services are insufficient, or because there is little information available on social resources. CONCLUSIONS: Although medical policy, by which elderly retired cadre patients receive careful treatment, may contribute to the longer length of the hospital stay of the patients on the cadre ward, it was thought to be important to construct appropriate discharge plans and a support system after discharge to the community. The results provide important information for solution of medical problems related to elderly retired cadre patients in China.     

Surgical-site infection due to Staphylococcus aureus among elderly patients: mortality, duration of hospitalization, and cost.

OBJECTIVES: To examine the impact of surgical-site infection (SSI) due to Staphylococcus aureus on mortality, duration of hospitalization, and hospital charges among elderly surgical patients and the impact of older age on these outcomes by comparing older and younger patients with S. aureus SSI. DESIGN: A nested cohort study. SETTING: A 750-bed, tertiary-care hospital and a 350-bed community hospital. PATIENTS: Ninety-six elderly patients (70 years and older) with S. aureus SSI were compared with 2 reference groups: 59 uninfected elderly patients and 131 younger patients with S. aureus SSI. RESULTS: Compared with uninfected elderly patients, elderly patients with S. aureus SSI were at risk for increased mortality (odds ratio [OR], 5.4; 95% confidence interval [CI95], 1.5-20.1), postoperative hospital-days (2.5-fold increase; CI95, 2.0-3.1), and hospital charges (2.0-fold increase; CI95, 1.7-2.4; dollar 41,117 mean attributable charges per SSI). Compared with younger patients with S. aureus SSI, elderly patients had increased mortality (adjusted OR, 2.9; CI95, 1.1-7.6), hospital-days (9 vs 13 days; P = .001), and median hospital charges (dollar 45,767 vs dollar 85,648; P < .001). CONCLUSIONS: Among elderly surgical patients, S. aureus SSI was independently associated with increased mortality, hospital-days, and cost. In addition, being at least 70 years old was a predictor of death in patients with S. aureus SSI.