Robert L. Kane

A randomised controlled trial of hospice care.

Terminally ill cancer patients at a Veterans Administration hospital were randomly assigned to receive hospice or conventional care. The hospice care was provided both in a special inpatient unit and at home. 137 hospice patients and 110 control patients and their familial care givers (FCGs) were followed until the patients death. No significant differences were noted between the patient groups in measures of pain, symptoms, activities of daily living, or affect. Hospice patients expressed more satisfaction with the care they received; and hospice patients FCGs showed somewhat more satisfaction and less anxiety than did those of controls. Hospice care was not associated with a reduced use of hospital inpatient days or therapeutic procedures and was at least as expensive as conventional care.

The role of hospice in reducing the impact of bereavement.

Survivors of patients in a randomized controlled trial of a hospital-based hospice were followed for 18 months after the patients death. There were no significant differences in the anxiety or depression between hospice survivors (N = 56) and controls (N = 40). Neither were there significant differences in bed days, physician visits or scores on a 6-item health scale, even when the survivors initial health status was held constant. No clear pattern of differences emerged in social participation, contacts with friends or relatives, smoking or drinking behaviors. We conclude that hospice care did not provide any protective effect for the bereavement period.

Channeling Health: A Review of the Evaluation of Televised Health Campaigns

This article reviews efforts to assess the effectiveness of television programs on changing health behaviors. The relatively limited literature to date has featured primarily correlational studies which permit ted no causal conclusions. The few experimental studies available present a mixed picture. Numerous methodologic problems beset any effort at assess ment of effectiveness. Perhaps the greatest difficulty is operationalizing a design that permits true experimental manipulation on a relevant sample without contamination. The several methodologic problems and some potential means of surmounting them are discussed.

Acute hospitalization in a home for the aged.

All acute hospitalizations from a 229‐bed home for the aged for a four‐year period were analyzed. Of 373 residents eligible for the study, 239 individuals were hospitalized a total of 503 times. Five patients were admitted seven times. Median length of stay was 9.4 days. Of 235 primary diagnoses, only nine occurred at least 1% of the time. Sixty‐six different complications, representing 131 occurrences, were noted during hospitalization. Hospital mortality was 11.7%. Of first admissions 9.2% died and 19% of survivors required a higher level of care. One year later 40% had died and 17% were at a higher level of care. Logistic regression identified four variables significantly associated with death within six months of first hospitalization: age, hospital complication, surgical procedure, and diagnosis of acute myocardial infarction. Compared with nonhospitalized residents, hospitalized residents were more likely to be male, but no age effect was noted. Survival differences did not emerge until the third year of the study. J Am Geriatr Soc 33:519, 1985

The Feasibility of Universal Long-Term–Care Benefits: Ideas from Canada

CANADAS expansion of its program of universal health insurance to include long-term care offers valuable insights for similar broad-based efforts in the United States. Most Canadian provinces provide universal long-term–care benefits that include health care, personal care, and social services for functionally impaired persons. Such services are offered both in residential settings, such as nursing homes, and in the community. Eligibility is based on functional impairment without regard to the individuals income; co-payments, if levied, are designed to leave even the poorest pensioner with a small disposable income. In the fall of 1981, we undertook a two-year study of long-term .xa0.xa0.

Are Physicians Sensitive to the Special Problems of Older Patients

The sensitivity of primary care physicians to the health care needs of older patients was explored by means of an analysis of the use of diagnostic tests and therapeutic procedures during ambulatory visits. Survey data on a total of 28,265 visits to internists, family and general practitioners were examined to determine possible age‐related differences in care. The study found that diagnostic testing falls off significantly for patients 75 years of age or older and that internists use substantially more tests for each age group than do family and general practitioners. The pattern of use of diagnostic tests in this secondary analysis does not address the issue of “appropriateness” but does suggest a pattern that makes little sense based on the known distribution of disease and functional disability in aging populations.

Level of care and complications among geriatric patients discharged from the medical service of a teaching hospital

To assess the effects of hospitalization on the subsequent placement and supportive care of elderly patients, the medical records of 233 consecutive patients aged 75 years or older, admitted to the medical service of a university hospital, were reviewed. The level of care on admission and at discharge, hospital‐associated complications, and demographic data were abstracted for each patient. At discharge, 1 per cent returned to a nursing home, 6 per cent were newly placed in a nursing home, 65 per cent returned to the same level of care as on admission, 10 per cent returned home with an increased level of care, and 18 per cent died or were discharged to another acute care facility. Complications occurred in 30 per cent of patients but did not correlate with age, increased level of care at discharge, or increased rate of nursing home placement. Few elderly patients were discharged to nursing homes, and most returned home without arrangements for increased care.

The influence of domestic position on health status.

Data from the Robert Wood Johnson Foundation 1982 survey of access to health care are used to examine the influence of household composition and members domestic position--e.g. age, sex, marital status, and presence of children, on health status and use of health services. A hierarchical analysis was undertaken to sort groups of individuals and households having different domestic structures. The results of the analyses of use and access for these groups show that, after controlling for age, domestic position and household arrangements are significant explanatory variables. Ways to refine the approach are discussed.

Adherence to health care regimens among elderly women.

This study examined selected components of nurse practitioners care to determine which contributed most to the intent to adhere to the care plan. High and low levels of components of care (technical quality, psychosocial, and patient participation) were depicted by videotapes of a patient visit to a nurse practitioner. The videotapes were randomly selected and shown in 26 senior citizen nutrition centers in a metropolitan area. Elderly women indicated how likely they would be to adhere if they had been the patient in the tape.High psychosocial care was the only component significantly related to intent to adhere; however, the significance did not hold in an analysis of covariance when individual characteristics were controlled. Individual characteristics related to high intent to adhere were widowed marital status, religion, perceived importance of the examination, social network, and preexisting satisfaction with health care.

Opportunities for health services research in the VA with regard to care of the aged

The VA has recognized that it must respond vigorously to the problems of the aging veteran: the ways in which it responds can be significantly shaped by, and in turn will shape, health services research conducted in the VA medical care system. The VA has the resources necessary to conduct comprehensive, valuable research within its system—a large, aging patient population; the new Geriatric Research, Education and Clinical Centers; and the Gerontology fellows program. Despite some barriers to research on all modalities of care for the aging veteran, there are four promising areas in which enterprising health services research can be conducted: prognostic studies, community care, geriatric manpower, and clinical epidemiology.