Diabetes mellitus and comorbidity. Change between 1984-1986 and 1995-1997: results of the Nord-Trøndelag Health Study

The prevention of diabetic complications is a challenge to the health services. A health survey was carried out in the Nord-Tr?ndelag county of Norway during the period 1984-1986 (77,224 respondents) and repeated in 1995-1997 (65,599 respondents). In this study, self-reports of diabetes and other diseases and impairments in the two screenings are compared. Did respondents report more or less morbidity in 1995-1997 than in 1984-1986? Comparisons between self-reports in the two surveys show higher morbidity among young people (below 40 years of age) in 1995-1997 than in 1984-1986, both among people with and without diabetes, but the change was not statistically significant. For the middle-aged (40-59 years of age), there were smaller changes. For older people (above 60 years of age) with diabetes, there was a decrease in some of the reported morbidity, namely for cerebral stroke, mobility impairment, and impairment due to other physical diseases, compared to older people without diabetes. There was a slight increase in reported vision impairment, but smaller than for people without diabetes. The changes in relative risk for people with stroke, mobility and vision impairment, and other physical disease are statistically significant. Splitting the sample according to gender, this trend was only significant among women.     

Relationship between perceived needs and assessed needs for services in community-dwelling older persons

PURPOSE: We examine the relationship between the perceived needs and assessed needs of community-dwelling seniors. DESIGN AND METHODS: Trained research assistants administered the Naturally Occurring Retirement Community Baseline Survey to 268 community-dwelling older adults in suburban Maryland. Perceived and assessed needs were measured in the domains of health and function (memory, health, functional needs, mobility, and financial management), mental health (depression and loneliness), sensory functioning (vision), and health behaviors (nutrition and exercise). RESULTS: In the areas of functional needs, mobility, financial management, loneliness, and vision, persons who scored as more needy were already utilizing significantly more services. Of persons not receiving services, participants in need of memory, physical health, functional, loneliness, and nutrition services were more likely to indicate they would use those services. Although there were significant relationships between assessed needs and perceived needs, there was also a high level of discrepancy, such that a substantial proportion of those participants screened as not needing services requested those services, and a sizable proportion of those who screened as needing services did not request them. The results also show a high prevalence of needs among older adults and yet low service use by those with needs for these services. IMPLICATIONS: Both assessed and perceived needs should be examined in future need assessment surveys. Further investigations into the nature of discrepancies will likely result in improvement in the methodologies of screening assessed and perceived needs. Services targeted to older adults must be made more available to those dwelling in the community.     

Self and older-people referents in evaluating life problems.

This study examined the severity of common life problems among "older people" as reported in national survey data along with similar evaluations of such problems among the respondents themselves. The two surveys, seven years apart (1974-1981), permit the examination of cohort changes in such perceptions over time. People of all ages, including older adults, evaluate the problems of "older people" as being more substantial than such problems among the respondents themselves. More recent cohorts (younger people) were more likely than earlier cohorts to report serious personal problems during the first survey and even more so by the second survey. The more recent cohorts also felt that the seriousness of problems among older people increased over time, whereas earlier cohorts reported just the opposite in assessing the problems of their age peers. It appears that younger people believe older persons' problems are more serious than do the older people themselves, and this difference in perceptions did not disappear over time.     

Satisfaction With Medical and Allied Health Services Among Aged People in Sydney

Objectives : To assess satisfaction with medical and allied health services among community-living aged persons and to determine whether satisfaction had changed over a three-year period. Method : An interview survey of a random sample of 320 people aged 75 years and older was conducted in the inner western suburbs of Sydney between August 1991 and September 1993 and repeated between August 1994 and October 1996 with 227 surviving members of the cohort. Questions covered the use of, and satisfaction with, medical and allied health services during the preceding 12 months. Results : The proportion Very satisfied’ with general practitioner (GP) surgery attendances and house calls over the two surveys ranged between 88% and 100%. The proportion ‘;very satisfied’ with specialist medical services ranged between 87% and 91%. The proportion ‘;very satisfied’ with allied health services ranged from 69% for optometry in 1992 to 93% for audiometry in 1995. There was no significant change over time. Conclusions : These older people displayed high levels of satisfaction with allied health services and very high levels of satisfaction with medical services.     

A German-Israeli Comparison of Informal and Formal Service Use Among Aged 75+

The paper focuses on filial norms and attitudes of older people about the care system of welfare states. It is a further investigation of the OASIS cross national study and examines three questions: First, what do older people in Israel and Germany consider to be the proper balance between the family and the welfare state regarding elder care? Second, what are the responsibilities of the family, the welfare state and other caregivers? Third, in what way do values, filial norms and personal resources relate to actual service use? The empirical data is based on information gathered from respondents living in Israel and Germany, aged 75+. The results of the study indicate that familial help has not been fully replaced by welfare state services. These findings support the complementary perspective. The results also show that most respondents favour a shared responsibility between the welfare state and the family. The findings indicate that familial norms are stable and strong as expressed by elders in both countries. The health situation is the main factor for receiving welfare services and familial help in Israel. In Germany the strong effect of living alone for receipt of welfare services underscores the influence of older adults’ social and personal resources on actual service use. The article discusses the findings referring to the importance of a combined mix of the different sources of help for social policy implications.     

Nursing home resident and facility characteristics associated with pneumococcal vaccination: national nursing home survey, 1995-1999

Objectives: To assess Advisory Committee for Immunization Practices recommendations for the pneumococcal vaccine in nursing home residents using national surveys to examine factors associated with vaccination. Design: Cross‐sectional national sample surveys of nursing homes and nursing home residents with a two‐stage probability design, stratified on size and Medicare and Medicaid certification status. Setting: U.S. nursing homes during 1995, 1997, and 1999. Participants: Six current residents were randomly selected from each facility (n=approximately 8,000 each year). Measurements: Residents' pneumococcal vaccination status was obtained by asking the facility respondent for each resident: “Has [the resident] EVER had a pneumococcal vaccine, that is a pneumonia vaccination?” Vaccination status was coded as yes, no, and unknown. Results: The proportion of residents aged 65 and older that received pneumococcal vaccination increased significantly, from 23.6% in 1995 to 28.2% in 1997 to 37.4% in 1999 (P<.001). The proportion of residents in homes with pneumococcal immunization programs increased significantly, from 65.2% in 1995 to 88.9% in 1999. Conclusion: The proportion of nursing home residents aged 65 and older receiving the pneumococcal vaccine increased significantly from 1995 to 1999. Residents living in nursing homes with programs for pneumococcal immunizations were significantly more likely to be vaccinated.     

Patterns of pneumococcal vaccination and revaccination in elderly and non-elderly adults: a Vaccine Safety Datalink study

Background  

Pneumococcal polysaccharide vaccine (PPV) is recommended for all adults 65 years of age and older and for younger adults with high-risk conditions. While data from national surveys provide information on the proportion of adults 65 years of age and older reporting ever receipt of PPV they do not collect more detailed information, such as age at vaccination or the total number of vaccinations received. In addition, there is relatively little information available on PPV coverage in younger adults with chronic conditions. To assess contemporary patterns of pneumococcal vaccination and revaccination of adults, we conducted a cross-sectional study of adults enrolled in medical care organizations (MCOs) participating in the Vaccine Safety Datalink project.     

Unheard voices: complaint patterns of older persons in the health care system

To examine the patterns and prevalence of complaints about health services among older clients of Health Maintenance Organizations (HMOs), explore demographic correlates, and compare results with the patterns in the younger population. Primary data were collected from the responses of subjects who participated in two national phone surveys, conducted in Israel over a period of 2 years. The final sample included 372 participants aged 65 and older, and 796 younger persons, who believed they had reasons to complain about their HMO. Of the 372 participants with cause to complain, only 23% had actually complained. Subjects who were 75-years-old and above, with below-average income, had 2.5 times higher probability for not complaining than people under 65. No statistically significant differences were found between the older participants and younger participants regarding the reasons for complaints or the procedures for making them. Recommendations are made for the recognition of older persons as a unique group within the health care system and for developing organizational mechanisms for capturing their unheard voices by HMOs.     

Perception of "appropriate" age for retirement among young adults, middle-aged adults, and elderly people

The "appropriate" age for retirement as it is perceived by young adults, middle-aged adults, and elderly people has been studied. No respondents were surprised or had trouble expressing an opinion about the minimum and maximum "appropriate" ages for retirement. Representations of the "appropriate" retirement age vary primarily as a function of the perceived physical constraints involved in the occupation, and also depend on the age of the person being questioned; the younger the respondent, and lower the perceived "appropriate" minimum age. There was no tendency among the young adults to prolong the work life of older individuals. Nor was there a tendency to associate aging with the loss of intellectual capacities likely to lead to early retirement.     

Self-reported comorbidities,perceived needs,and sources for usual care for older and younger homeless adults

BACKGROUND: While older individuals who are homeless tend to be in poorer health, it is less clear how they view their health care needs and whether their self-reported patterns for accessing health services differ from younger homeless counterparts. METHODS: Cross-sectional, community-based survey of homeless adults in Pittsburgh and Philadelphia using face-to-face interviews from population proportionate sampling of sites and random sampling of subjects. Survey questions included physical and mental health comorbidities, self-reported health care, social services and personal needs, means of economic support, and sources for usual health care. For analysis purposes, respondents were grouped by age 18 to 49 years old and 50 years old or older. RESULTS: Overall, 531 adults were interviewed, with 74 respondents 50 years old or older (13.9%). Older homeless persons were 3.6 times more likely to report a chronic medical condition, 2.8 times more likely to have health insurance, and 2.4 times more likely to be dependent on heroin than homeless persons less than 50 years old. However, they also tended to use shelter-based clinics and street outreach teams more commonly as their source of usual care (20.9% vs 10.6%, P=.02) and were significantly less likely to report a need for substance abuse treatment despite high rates of abuse. CONCLUSION: Older homeless adults have a greater disease burden than their younger counterparts. However, it is unclear whether these needs are being appropriately identified and met. There is a need for specific and targeted outreach to connect them to appropriate services.     

Associations of perceived poor societal treatment among the oldest-old

BackgroundPrevious studies of perceived ageism among older people have focused on younger age groups with the respondents’ mean age far below 80.ObjectiveTo explore the perceptions of poor societal treatment of older people among home-dwelling people aged 75–100+ and how their perceptions are associated with demographic characteristics, health, functioning, and wellbeing.MethodsIn the Helsinki Aging Study, a random sample of 2,917 home-dwelling people aged 75–104 received a postal questionnaire inquiring about their health, wellbeing and experiences. The response rate was 74%. We asked: ‘How in your opinion are older people treated in Finland?’ (well/moderately/poorly) and categorized the respondents according to their responses. A multivariable forward stepwise ordered logistic regression model was used to determine the independent associations of the variables on the ordinal level of perceptions of treatment.ResultsOf the participants, 1,653 responded to the index item. Of these, only 13% thought that older people are treated well in society, and 66% and 21% were of the opinion that older people are treated moderately or poorly in society, respectively. Perceived poor societal treatment was more common among women, the younger respondents, and those with lower incomes, as well as family caregivers and those with lower self-rated health and lower psychological wellbeing. Those who were able to walk outside unassisted and those with a regular hobby perceived poor societal treatment more often.ConclusionsSeveral demographic factors, self-rated health, psychological wellbeing and better functioning were associated with perceptions of poor treatment among the oldest-old.     

Increase in screening for colorectal cancer in older Americans: results from a national survey

OBJECTIVES: To compare the proportions of the U.S. population aged 65 and older who underwent tests for colorectal cancer (CRC) in 2000 and 2005 to examine the effect of the change in Medicare reimbursement for screening colonoscopy that occurred in 2001. DESIGN: National population‐based survey. SETTING: United States. PARTICIPANTS: A total of 6,035 respondents to the 2000 National Health Interview Survey (NHIS) and 5,490 respondents to the 2005 NHIS aged 65 and older. MEASUREMENTS: A questionnaire was used to assess self‐reports of testing (colonoscopy, sigmoidoscopy, or home fecal occult blood test (FOBT)) for CRC. Estimates for the U.S. population were extrapolated from the survey results. To account for the complex sampling design, SUDAAN was used to calculate population sizes and proportions. RESULTS: In U.S. adults aged 65 and older, the proportion reporting up‐to‐date CRC testing increased from 39.5% in 2000 to 47.1% in 2005. By 2005, endoscopy had become more common than home FOBT for CRC screening in older adults. In 2000 and in 2005, a higher proportion of men than women were screened across all age groups and for all screening modalities. The proportion screened declined with older age. CONCLUSION: Substantial increases in CRC testing, particularly colonoscopy, followed changes in Medicare reimbursement for screening colonoscopy in adults aged 65 and older. Although nearly half of older adults were up to date with CRC tests, differences remained in the use of screening according to age and sex within this age group.     

Using the SF-36 with older adults: a cross-sectional community-based survey

OBJECTIVES: To assess the practicality and validity of using the 36-item short-form health survey (SF-36) in a community-dwelling population over 65, and to obtain population scores in this age group. DESIGN: Postal survey, using a questionnaire booklet containing the SF-36 and other health-related items, of all those aged 65 or over registered with 12 general practices in Sheffield. Non-respondents received up to two reminders at 3-weekly intervals. SAMPLE: 9897 subjects, aged 65-104 years. MAIN OUTCOME MEASURES: Scores for the eight dimensions of the SF-36 and a modified version of the physical functioning dimension. RESULTS: The SF-36 achieved a response rate of 82% (n=8117) and dimension completion rates of 86.4-97.7%. Internal consistency measured by Cronbach's alpha exceeded 0.80 for all dimensions except social functioning. These results compare favourably with postal surveys of younger adults. We calculated scores for older adults by age and sex. Comparison with data from younger people showed how physical health declines steeply with age, in marked contrast to mental health. CONCLUSIONS: The SF-36 is a practical and valid instrument for use in postal surveys of older people living at home. The population scores provided here may facilitate its use in future surveys of older adults.     

Feeling better? Trends in general health status

OBJECTIVES: We addressed three questions: Have recent improvements in old-age disability been mirrored in changes in self-reported general health status? Are general health status trends similar for younger and older Americans? Have changes in general health status been uniform across demographic and socioeconomic groups? METHODS: Using logistic regression, we analyzed data from the 1982-2003 National Health Interview Surveys (n = 1,445,872 aged 18-69; n = 178,384 aged 70 and older). RESULTS: The proportion of people aged 70 and older reporting disability declined at 1.38% per year and the proportion 70 and older reporting poor/fair health declined at 1.85% per year. There was less of a decline in reports of poor/fair health at younger ages. Trends for the 18-69 population showed widening health disparities by income but narrowing of the race/ethnicity and education gaps. In the older population, there was no change for those aged 80-84 and 85 and older, the race/ethnicity gap persisted, and both education and income differentials widened over time. DISCUSSION: Declines in proportions reporting poor/fair health among the older population in recent decades mirror declines in disability. Although the younger population has not experienced such progress, its prevalence of poor/fair health is low throughout the 21-year analysis period. Of concern are the growing socioeconomic disparities in health for both younger and older populations.     

Older people's decisions regarding ‘ageing in place’: A Western Australian case study

Aim: To investigate ‘ageing in place’ in terms of house, locality and support, related to the Western Australia members of National Seniors Australia. Methods: A postal survey of 6859 members, followed by structured interviews with a subsample of respondents. Results: A similar proportion of respondents (nearly 30%) had either moved house recently or not for at least 20 years. Almost half were intending to stay in their current residence as they aged, this proportion increasing with age. A key reason for staying was having a ‘comfortable’ home. Related to moving, lifestyle change was particularly important for younger respondents and upkeep/maintenance difficulties for older respondents. Conclusion: For varied and complex reasons, many adults choose to move between the ages of 55 and 75. Government policy can further support older Australians to have choices of ‘places’ to live in that maximise their ability to retain independence.     

Levels of cardiac knowledge and cardiopulmonary resuscitation training among older people in Queensland

Objectives: The current study was conducted to determine levels of cardiac knowledge and cardiopulmonary resuscitation (CPR) training in older people in Queensland, Australia. Methods: A telephone survey of 4490 Queensland adults examined respondents’ knowledge of coronary heart disease (CHD) risk factors, knowledge of heart attack symptoms, knowledge of the local emergency telephone number, as well as respondents’ rates and recency of training in CPR. Results: Older participants, aged 60 years and over, were approximately one and a half times more likely than the 30–39 year‐old reference group to have limited knowledge of heart disease risk factors (OR = 1.53), and low knowledge of heart attack symptoms (OR = 1.60). Knowledge of the local emergency telephone number also decreased with age. Older participants had significantly lower rates of training in CPR, with almost three quarters (71.7%) reporting that they had never been trained. Older people who had completed CPR training were significantly less likely to have done so recently. Conclusions: Cardiac knowledge levels and CPR training rates in older Queensland persons were lower than those found in the younger population.     

Primary care experience among older adults in the United States: a retrospective cross-sectional study

BackgroundWhile the importance of primary care becomes more imminent for older adults to manage multi-morbidities, the perception of primary care among this group is not well examined.AimTo evaluate the primary care experience among older adults in the United States (US).MethodsWe conducted a retrospective cross-sectional study examining four domains of primary care: first contact, longitudinality, comprehensiveness, and coordination. Using survey responses from Medical Expenditure Panel Survey (MEPS), we used propensity score matching method to compare the percentage of geriatric (≥65 years old) and non-geriatric (< 65 years old) who answered favorably to questions that supported each domain from 2014 to 2016. Using multivariate regression, we also assessed the impact of each domain on various demographic and perceived need for care features of older adults.ResultsA total of 12,982 surveys were analyzed for geriatric, compared to 62,694 surveys for non-geriatric. Overall, older adults answered more favorably than younger adults for all four domains. However, uninsured older adults, Black older adults and older adults with limitation in activities, cognitive impairments, and multiple comorbidities were more likely to have difficulties in accessing their usual source of care (USC). Additionally, Black, Hispanic, and Asian older adults and cognitively impaired adults perceived less contribution in their own treatment management.ConclusionOlder adults in the US generally experience good quality of primary care, compared to younger adults. However, establishing and maintaining access (first contact) and being involved in disease management (coordination) were perceived as poor by several cohorts of older adults.     

Influence of other-beliefs on self-beliefs and on everyday memory self-report in the elderly

BACKGROUND AND AIMS: Elderly people tend to evaluate their memory functioning pessimistically and have a decrease in self-efficacy beliefs associated with an attributional style which relies mainly on uncontrollable causes. This pattern may be significantly influenced by the caregivers evaluations of self-efficacy beliefs and attributional style of the elderly. This study compares older and younger adults with respect to everyday memory self-assessment, self-efficacy beliefs and attributional style, and examines the relationships between everyday memory self-assessment, self-evaluations, and evaluations by significant others as regards elderly self-efficacy beliefs, attributional style, and everyday memory. METHODS: 100 older, 100 younger, and 100 middle-aged adults were required to complete questionnaires aimed at assessing everyday memory, attributional style, and self-efficacy beliefs. The group of middle-aged adults was asked to complete questionnaires aimed at assessing the perceived efficacy and attributional style of the older and younger participants. RESULTS: Data indicate that, unlike younger adults, the elderly negatively evaluate their everyday memory, have an attributional style mainly characterized by uncontrollable factors, and have less confidence in their memory. A structural equation model shows that the opinions of the significant others (relatives or medical staff) as regards the perceived efficacy and attributional style of elderly people affect their self-efficacy and attributional style which, in turn, influence everyday self-reported memory efficiency. CONCLUSIONS: Results indicate the central role of metamemory in everyday memory evaluation in the elderly, and stress the importance of what significant others think as regards the elderly person in question. From a practical point of view, it makes an important contribution to intervention and prevention programs involving people in close contact with the elderly, by suggesting ways in which significant others can help in optimizing the ability of older people to meet the challenges of aging successfully.