Lara B. Russell

Prediction of subjective age, desired age, and age satisfaction in older adults: Do some health dimensions contribute more than others?

Of all the variables that have been shown to contribute to subjective age, health variables typically explain the greatest proportion of variance, with poorer health related to feeling older than ones chronological age. Despite the significant contribution of health to subjective age, little research has explored the relative importance of different dimensions of health to subjective age. The primary aim of the present study was to examine the relative importance of various physical, mental, social, and emotional dimensions of health, as well as satisfaction with health, to measures of subjective age, desired age, and satisfaction with age in a sample of 875 older men and women. The results indicated that: (1) certain combinations of health dimensions and satisfaction with health accounted for relatively large proportions (20—36%) of the variance in subjective age and satisfaction with age but not desired age; (2) subjective age and satisfaction with age were explained by different combinations of health dimensions; and (3) the health predictors of subjective age and satisfaction with age differed somewhat for men and women and for young-old and old-old groups.

Importance Ratings and Weighting: Old Concerns and New Perspectives

This article describes key concepts, reviews empirical findings, and discusses important issues related to the use of subjective importance ratings and importance weighting. The review of empirical findings focuses on weighting achieved via the multiplicative model and on 3 areas in which weighting is commonly used: quality of life, self-esteem, and job satisfaction. An important distinction is made between issues regarding importance ratings and those related to importance weights. Directions for future research are suggested throughout the article.

Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study

BackgroundThe aim of this study was to identify what is most important to the quality of life (QoL) of those who experience homelessness by directly soliciting the views of homeless and hard-to-house Canadians themselves. These individuals live within a unique social context that differs considerably from that of the general population. To understand the life areas that are most important to them, it is critical to have direct input from target populations of homeless and hard-to-house persons.MethodsFocus groups were conducted with 140 individuals aged 15 to 73 years who were homeless or hard-to-house to explore the circumstances in which they were living and to capture what they find to be important and relevant domains of QoL. Participants were recruited in Toronto, Ottawa, Montreal, and Vancouver. Content analysis was used to analyze the data.ResultsSix major content themes emerged: Health/health care; Living conditions; Financial situation; Employment situation; Relationships; and Recreational and leisure activities. These themes were linked to broader concepts that included having choices, stability, respect, and the same rights as other members of society.ConclusionsThese findings not only aid our understanding of QoL in this group, but may be used to develop measures that capture QoL in this population and help programs and policies become more effective in improving the life situation for persons who are homeless and hard-to-house.Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study.

Some Thoughts on Gathering Response Processes Validity Evidence in the Context of Online Measurement and the Digital Revolution

The Digital Revolution has fundamentally changed how people think, communicate, and work. Moreover, increased use of the internet has resulted in more research being conducted online. Given that online data collection may be affected by differences in technology, mode-related design features, and respondents’ own technology-related skills and attitudes, it is important to validate the inferences made from measures administered online. Response processes refer to the series of steps or strategies a respondent uses in providing responses to test items. As a source of validity evidence, we are interested in whether these response processes are consistent with what we would expect when measuring the intended construct. Examining response processes can help inform if, and how, the online environment and online surveys may impact the inferences made from measures. At the same time, existing and emerging digital technologies provide opportunities to conduct response processes validation research in new and creative ways.

Multiattribute health utility scoring for the computerized adaptive measure CAT-5D-QOL was developed and validated

OBJECTIVES The CAT-5D-QOL is a previously reported item response theory (IRT)-based computerized adaptive tool to measure five domains (attributes) of health-related quality of life. The objective of this study was to develop and validate a multiattribute health utility (MAHU) scoring method for this instrument. STUDY DESIGN AND SETTING The MAHU scoring system was developed in two stages. In phase I, we obtained standard gamble (SG) utilities for 75 hypothetical health states in which only one domain varied (15 states per domain). In phase II, we obtained SG utilities for 256 multiattribute states. We fit a multiplicative regression model to predict SG utilities from the five IRT domain scores. The prediction model was constrained using data from phase I. We validated MAHU scores by comparing them with the Health Utilities Index Mark 3 (HUI3) and directly measured utilities and by assessing between-group discrimination. RESULTS MAHU scores have a theoretical range from -0.842 to 1. In the validation study, the scores were, on average, higher than HUI3 utilities and lower than directly measured SG utilities. MAHU scores correlated strongly with the HUI3 (Spearman ρ = 0.78) and discriminated well between groups expected to differ in health status. CONCLUSION Results reported here provide initial evidence supporting the validity of the MAHU scoring system for the CAT-5D-QOL.

Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada

ABSTRACT Objective: Individuals who are homeless or vulnerably housed have a higher prevalence of concurrent disorders, defined as having a mental health diagnosis and problematic substance use, compared to the general housed population. The study objective was to investigate the effect of having concurrent disorders on health care utilization among homeless or vulnerably housed individuals, using longitudinal data from the Health and Housing in Transition Study. Methods: In 2009, 1190 homeless or vulnerably housed adults were recruited in Ottawa, Toronto, and Vancouver, Canada. Participants completed baseline interviews and four annual follow-up interviews, providing data on sociodemographics, housing history, mental health diagnoses, problematic drug use with the Drug Abuse Screening Test (DAST-10), problematic alcohol use with the Alcohol Use Disorders Identification Test (AUDIT), chronic health conditions, and utilization of the following health care services: emergency department (ED), hospitalization, and primary care. Concurrent disorders were defined as the participant having ever received a mental health diagnosis at baseline and having problematic substance use (i.e., DAST-10 ≥ 6 and/or AUDIT ≥ 20) at any time during the study period. Three generalized mixed effects logistic regression models were used to examine the independent association of having concurrent disorders and reporting ED use, hospitalization, or primary care visits in the past 12 months. Results: Among our sample of adults who were homeless or vulnerably housed, 22.6% (n = 261) reported having concurrent disorders at baseline. Individuals with concurrent disorders had significantly higher odds of ED use (adjusted odds ratio [AOR] = 1.71; 95% confidence interval [CI], 1.4–2.11), hospitalization (AOR = 1.45; 95% CI, 1.16–1.81), and primary care visits (AOR = 1.34; 95% CI, 1.05–1.71) in the past 12 months over the four-year follow-up period, after adjusting for potential confounders. Conclusions: Concurrent disorders were associated with higher rates of health care utilization when compared to those without concurrent disorders among homeless and vulnerably housed individuals. Comprehensive programs that integrate mental health and addiction services with primary care as well as community-based outreach may better address the unmet health care needs of individuals living with concurrent disorders who are vulnerable to poor health outcomes.

Self-Reported Ability to Walk, Run, and Lift Objects among Older Canadians

Aims. The purpose of the study was to develop new self-report instruments to measure the ability to walk, run, and lift objects and describe the distribution of these abilities among older Canadians. Methods. Questions were developed following a focus group. We carried out an online survey among members of the Canadian Association of Retired Persons. The distribution of each ability was described and presented graphically according to age, sex, and number of health conditions. We calculated summary scores for each ability and assessed their reliability and relationships with health status and use of health services. Results. 22% of the subjects reported difficulty walking 100 m, 15% were unable to run 10 m, and 50% had difficulty lifting 10 kg. Men reported higher abilities than women but differences according to age were small. Test-retest reliability ranged from 0.89 for walking to 0.88 for running and 0.81 for lifting. Scores for the three measures correlated with other measures of health status as expected. Conclusions. The study provided new data on self-reported walking, running, and lifting abilities among older Canadians. The new measures are valid, reliable, and easy to interpret. We expect these measures to be useful in clinical and research settings.