Stage of life course and social support as a mediator of mood state among persons with disability.

Objective: This research seeks to determine which aspects of social support are most effective in mediating mood state among working-age and elderly adults with disability (N = 442).

Methods: Participants were identified through random-digit dialing of telephone exchanges and administration of a disability screen. Multiple regression was used to model multiple aspects of social support while holding sociodemographic and disability indicators constant.

Impact of breast cancer treatment guidelines on surgeon practice patterns: results of a hospital-based intervention.

Background: Despite evidence regarding the effectiveness of post-surgical treatments for early-stage breast cancer, older women are less likely to receive appropriate therapy. We evaluated the impact of surgeon-specific "performance reports" on adherence to treatment guidelines among older women with breast cancer.

Methods: We obtained diagnostic and treatment data from hospital tumor registries supplemented with self-reported adjuvant therapy information on 1099 patients with stage I or II breast cancer diagnosed between November 1, 1992, and January 31, 1997, at 6 Rhode Island hospitals.

Facility effects on racial differences in nursing home quality of care.

This paper reviews the literature on racial/ethnic differences in nursing home quality, segregated access to nursing home care, and organizational and community factors that may influence access and quality of care. We present illustrative data on county demographics and the racial mix of African American residents in nursing homes in these counties for a sample of four states. We also briefly describe plans for multilevel modeling to test variation in racial/ethnic disparities in care as a function of nursing home structures and processes and community context.

Decision-making and outcomes of prolonged ICU stays in seriously ill patients.

Background: Despite concern about the high costs and the uncertain benefit of prolonged treatment in the intensive care unit (ICU), there has been little research examining decision-making and outcomes for patients with prolonged ICU stays.

Objectives: To evaluate decision-making and outcomes for seriously ill patients with an ICU stay of at least 14 days.

Design: A prospective cohort study.

Prediction of survival for older hospitalized patients: the HELP survival model. Hospitalized Elderly Longitudinal Project.

Objective: To develop and validate a model estimating the survival time of hospitalized persons aged 80 years and older.

Design: A prospective cohort study with mortality follow-up using the National Death Index.

Setting: Four teaching hospitals in the US.

Gender differences in the frequency and treatment of behavior problems in Parkinson's disease.

Objective: To determine gender differences in the prevalence, survival rates, and management of noncognitive behavioral problems of patients with Parkinson's disease (PD) in nursing homes (NH).

Methods: We performed an observational study on 24,402 residents with PD using the Systematic Assessment and Geriatric drug use via Epidemiology (SAGE) database collected from the Minimum Data Set on a cross-section of over 400,000 NH residents in five US states. Gender differences in behavior were used to predict differences in pharmacologic and nonpharmacologic therapies using logistic regression.

Gender differences in the treatment of behavior problems in Alzheimer's disease. SAGE Study Group. Systemic Assessment of Geriatric drug use via Epidemiology.

Objective: To define gender differences in noncognitive behavioral problems of patients with AD and differences in the associated treatment of those problems.

Design/methods: We performed an observational study using the Systematic Assessment and Geriatric drug use via Epidemiology (SAGE) database, which contains data collected with the Minimum Data Set on a cross-section of nursing home residents in five US states. Behavior problems were documented at the first assessment of 28,367 residents with AD.

Smoking and cancer screening for women ages 42-75: associations in the 1990-1994 National Health Interview Surveys.

Background: Previous studies have found an association between current smoking and lower rates of mammography and Pap testing. The objective of this study was to investigate the association of smoking status with breast and cervical cancer screening across the 1990-1994 National Health Interview Surveys (NHIS). The NHIS provides a consistent set of independent and dependent variables across several surveys, with data collected by a similar in-person interview methodology from year to year.

Prevalence, clinical characteristics, and pharmacologic treatment of Parkinson's disease in residents in long-term care facilities. SAGE Study Group.

Despite the high prevalence of Parkinson's disease (PD) in the elderly, little information is available regarding the epidemiology of the disease in residents in long-term care facilities. Using a population-based database with over 470,000 residents (1992-1996) of all Medicare- or Medicaid-certified nursing homes of five states, we identified 24,402 residents with a diagnosis of PD. We examined data collected with the federally mandated Minimum Data Set, and sociodemographic, clinical, and treatment information.

Organizational determinants of resident satisfaction with assisted living.

This article examines the relationship of organizational factors to resident satisfaction with assisted living, while controlling for resident characteristics. Data were collected in interviews with 156 residents in 13 assisted living facilities. Results indicate that more satisfied residents are also happier, more functionally independent, more involved in their housing decision, and less educated.

Antiischemic therapy in patients with coronary heart disease living in long-term care. Systematic Assessment of Geriatric Drug Use by Epidemiology (SAGE) Group.

We evaluated antiischemic therapy in elderly nursing home residents with a diagnosis of coronary heart disease (CHD) using a population-based data base with over 300,000 residents (1992-1995) of all Medicare/Medicaid-certified nursing homes of five states. We identified 72,263 patients age 65 years or older with a diagnosis of CHD. We examined data collected with the federally mandated Minimum Data Set, drug information, and Medicare hospital claims.

Gender, household labor, and psychological distress: the impact of the amount and division of housework.

Using a national longitudinal survey of a representative sample of 1,256 adults, I assess the impact of the amount of household labor performed and its division within the household on men's and women's depression levels, adjusting for prior mental health status. I test two alternative explanations of the contributions of household labor and the division of household labor to gender differences in depression: differential exposure and differential vulnerability. The results indicate that men's lower contributions to household labor explain part of the gender difference in depression.

Gender roles, marital intimacy, and nomination of spouse as primary caregiver.

Using data from a sample of married men and women undergoing treatment for cancer, we tested two potential hypotheses for the unequal representation of husbands and wives as spousal caregivers, including societal gender role norms and emotional closeness in the marital relationship. Multivariate analyses support both hypotheses; wives are only one third as likely as husbands to select their spouses as caregivers, and spouses who name their mates as confidants are three times more likely than those who do not to also name them as caregivers. We conclude that although gender role norms are key to caregiver selection, the intimacy inherent in the caregiving role renders an emotionally close marriage an important criterion to the selection of spouse as caregiver.

Gender matters: an integrated model for understanding men's and women's health.

Health research has failed to adequately explore the combination of social and biological sources of differences in men's and women's health. Consequently, scientific explanations often proceed from reductionist assumptions that differences are either purely biological or purely social. Such assumptions and the models that are built on them have consequences for research, health care and policy.

Facility characteristics associated with hospitalization of nursing home residents: results of a national study.

Objectives: To test the effect of facility characteristics on the probability of hospitalization of nursing home residents, controlling for resident characteristics and the competing risk of death.

Research Design: Study data were derived from the evaluation of the implementation of the Resident Assessment Instrument, the Minimum Data Set (MDS) in 1993. The data consisted of 2080 residents in 253 NHs as well as the annual On-Line Survey Certification of Automated Records (OSCAR).

Research agenda for developing measures to examine quality of care and quality of life of patients diagnosed with life-limiting illness.

Despite the universality of dying, research has not focused on developing conceptual models and measurement tools for examining the quality of care and quality of life of dying patients and their loved ones. We present here a vision and research agenda for the development of a Tool Kit of Instruments to Measure End of Life Care (TIME). Instruments for inclusion in the eventual "Tool Kit" should be patient-focused and family-centered, clinically meaningful, administratively manageable, and psychometrically sound.

Tacrine use in nursing homes: implications for prescribing new cholinesterase inhibitors. SAGE Study Group. Systematic Assessment of Geriatric Drug Use via Epidemiology.

Objective: To describe the use of tacrine in nursing home residents using data from a clinically based resident assessment instrument used by all US nursing homes.

Methods: Data were from the Systematic Assessment of Geriatric Drug Use via Epidemiology (SAGE) database, a population-based data set with information on 329,520 patients admitted to all Medicare/Medicaid certified nursing homes in four US states (Maine, Mississippi, New York, and South Dakota) from 1992 through 1995. The SAGE database combines information from the Minimum Data Set (MDS) and the On-Line Survey and Certification Automated Record.

Time to nursing home admission for persons with Alzheimer's disease: the effect of health care system characteristics.

Objective: To study the influence of state health care system characteristics on time to nursing home admission (NHA) for persons with Alzheimer's disease (AD).

Method: Up to nine years of Consortium to Establish a Registry for Alzheimer's Disease (CERAD) data on 639 non-Latino White individuals were merged with longitudinal data from the 28 states in which the CERAD participants resided. The state variables reflected characteristics of each state's long-term care (LTC) system, including Medicaid LTC spending practices and the supply of LTC providers.

Increasing mammography among women aged 40-74 by use of a stage-matched, tailored intervention.

Background: Tailoring is a promising technique for encouraging greater performance of health-related behaviors. Tailored interventions are designed to be more individualized to personal characteristics, in contrast to "standard" interventions where all participants receive the same materials.

Methods: A total of N = 1864 women aged 40-74 were recruited from a staff model HMO and randomly assigned to one of three intervention groups: (a) No Educational Materials, (b) Standard Materials, and (c) Stage-Matched Materials.

Benefits of home health care after inpatient rehabilitation for hip fracture: health service use by Medicare beneficiaries, 1987-1992.

Objective: To examine the added benefit of home health services for elderly patients with hip fracture discharged home after inpatient rehabilitation.

Data: Medicare claims from 1% of 1986 beneficiaries followed until 1992.

Study Population: Persons hospitalized with hip fracture at 70 years or older who had no major Medicare claims during the year before hospitalization and who were discharged home after inpatient rehabilitation.

Role of written advance directives in decision making: insights from qualitative and quantitative data.

Objective: To understand the role of written advance directives (ADs) in medical decision making through examination of qualitative and quantitative data sources. We specifically wanted to address whether physicians unilaterally disregard advance directives.

Design: Block randomized controlled trial to improve decision making and outcomes of seriously ill patients.

Key challenges in studying organizational issues in the delivery of healthcare to older Americans.

Objective: Drawing from the articles presented in this special issue, to provide an overview of three key challenges facing researchers in the area of organizational issues in primary care delivery to older adults.

Conclusions: To improve the quality of research done in this area we would recommend that researchers attend to the complexity of (1) defining an appropriate unit of analysis; (2) reframing our traditional models of service delivery to reflect ongoing changes in healthcare system actors and boundaries; and (3) reconceptualizing the outcomes of care to reflect adequately the reality of care for the aging patient.

Psychosocial factors and smoking cessation behaviors among smokers who have and have not ever tried to quit.

Relationships between smoking cessation behaviors and demographic characteristics and attitudes were analyzed among two groups of smokers, those who had and had not ever tried to quit. Telephone interviews were completed with 1501 smokers at baseline and at a 3 month follow-up. Multiple logistic regression analyses were used to identify factors that were associated with planning to quit, attempting to quit and quitting smoking within the two groups of smokers.