Amasa B. Ford

Health and Function in the Old and Very Old

This report advocates conceptual separation and parallel assessment of medically diagnosed health conditions and functional disability in clinical and epidemiological studies of the aged. Data from a study of urban elderly are presented to demonstrate how this can be done and to reexamine the meaning of self‐reported illness and disability.

Sustained personal autonomy: A measure of successful aging

Objectives: This study addresses the following question: What characteristics of urban, noninstitutionalized elders predict which individuals are most likely to remain independent of personal assistance during a 2-year observation period? Methods: A population-based sample of 602 noninstitutionalized urban residents aged 70 and older was followed for 2 years. Results: Ninety-eight of the 487 survivors remained independent. Factors associated with sustained independence were relatively younger age, male gender, fewer medical conditions, good physical function, and nonsmoking. The attitudes “favors family or self over agency assistance” and “does not expect filial obligation” were also independently associated. Discussion: The results are consistent with previous studies of successful aging and showthat attitudes expressed at baseline favoring personal independence are associated with sustained autonomy during a period of at least 2 years.

Antibody Responses to Bordetella pertussis Antigens and Clinical Correlations in Elderly Community Residents

A serological study to determine the frequency of Bordetella pertussis infection in 100 adults aged >/=65 years was carried out over a 3-year period. Ten serum samples (collected every 4 months) from each subject were examined for IgA and IgG antibodies to the following B. pertussis antigens: pertussis toxin (PT), filamentous hemagglutinin (FHA), pertactin, and fimbriae-2. A >/=2-fold titer increase in ELISA units from one time period to the next was considered serological evidence of infection. The rate of serologically defined infection (i.e., in which there was an increase in titer against any antigen) was 19.7 per 100 person-years. With the use of more specific criteria that indicate definite B. pertussis infection (>/=2-fold increase in titer to PT) and probable B. pertussis infection (>/=2-fold increase in titer to PT or >/=2-fold increase to fimbriae-2), the rates were 3.3 and 8.0 per 100 person-years, respectively. Fifty percent of individuals with definite B. pertussis infections had time-associated symptomatology. Antibody patterns over time suggest that antibody to FHA and perhaps to pertactin is stimulated by infections with other organisms, as well as B. pertussis infections. Our data suggest that symptomatic pertussis occurs in elderly individuals. Consideration should be given to immunization of the elderly with acellular pertussis vaccines.

Violent death in a metropolitan county. Changing patterns in homicide (1958-74).

Analysis of homicide patterns in Cuyahoga County, Ohio (metropolitan Cleveland), for 1958-1974 discloses the following major trends: a dramatic rise in overall homicide rates in the city (320 per cent) and suburbs (200 per cent); an increase in justifiable homicide; a doubling of the percentage of homicides incident to other felonies; a markedly increased incidence of homicide among younger persons; a conspicuous rise in firearm killings (now 81 per cent of all homicides); and a continued preponderance of intraracial homicide, with the highest rates among nonwhite males in the city. The trends in Cuyahoga County are consistent with those in other United States metropolitan counties. Homicide is responsible for a major part of the decreased life expectancy among young, urban, non-white men. The factor most consistently associated with these trends is the increased use of handguns.

Smoking and cognitive impairment : A population-based study

OBJECTIVE: To test the hypothesis that there is an inverse relationship between smoking and cognitive impairment by examining the prevalence and incidence of such impairment in a representative cohort of older urban residents.

Effect of Giving Care on Caregivers’Health

This longitudinal study of 121 caregivers of the elderly evaluates the change in their self-assessed mental and physical health over two years. The care recipients, who were drawn from a random sample of noninstitutionalized urban elders, showed increased need for help with personal and instrumental activities of daily living in this period. Both the physical and mental health of the caregivers declined significantly during the study. Predictors of decline in physical health of the caregivers at the end of the study were poorer physical health at the start, the amount of help they provided, a decline in their own mental health, and an increase in the number of other persons also available to provide care. In contrast, decline in caregivers’ mental health at the end was predicted only by poorer mental health at the start and by decline in physical health.

THE DOCTOR-PATIENT RELATIONSHIP AS DESCRIBED BY PHYSICIANS AND MEDICAL STUDENTS.

Description of the doctor-patient relationship and of satisfactions and dissatisfcwtions experienced by physicians have been developed from responses to a sentencecompletion form given by a sample of medical school faculty, medical students and practitioners. From these descriptions, a model was developed with legitimate, rational control as the nucleus, combining intellectual and affective elements. The kind of control which the physician exercises is based on the patients personal consent and on the physicians knowledge and skill. The physicians most evident satisfactions arise from personal affiliation and the giving of help and care, while his dissatisfactions frequently stem from lack of control, and are mainly attributed to the patient.

Attitudinal Influences on the Elderly's Use of Assistance

This research examines the use of informal and formal assistance with personal and instrumental activities of daily living and the amount received by a randomly selected sample of urban older persons. A modified version of the Andersen behavioral model is used to organize explanatory factors that include the elderlys attitudes toward service use and filial expectations. Findings underscore the important influence of attitudes on assistance use in contrast to self-designated race, which had no influence either independently or in interaction with attitudinal variables. Elderly persons more likely to receive assistance were women of older age with lower incomes, who expressed more concerns about using services and were more physically disabled. Those receiving larger amounts of help had fewer concerns about using formal services and lived with their primary caregivers.

Impaired and disabled elderly in the community.

A nine-year representative, longitudinal study of 1,598 urban elderly shows that two to eight times as many impaired or disabled are cared for in the community as in institutions. Younger age, male gender, better income, and living with others, especially children, favor continuing care in the home.

Energy expenditure in assisted ambulation

Abstract The average energy cost of assisted ambulation in a group of 20 elderly patients convalescing from hip fractures was found to be 2.82 Calories per minute. This rate is approximately 30 per cent of the maximum energy expenditure for healthy men of the same age and may approach the actual maximum for certain patients. No significant differences in energy expenditure were demonstrated among patients using crutches, walkers, or parallel bars. Certain individuals showed marked increases of pulse rate or blood pressure during 3 minutes of assisted ambulation, and it is suggested that pulse rate may be used as a guide to the optimal duration of exercise in a specific case.