Ruth E. Matthias

The outcome of hospitalization for acute illness in the elderly

The use of acute‐care hospitals by the elderly is rising rapidly, particularly in the age group 75 and older. Any changes that will reduce the length of stay could result in considerable savings in health care costs. It is imperative to look at present policies and explore possible changes that could reduce costs by reducing the total hospital days. A study was conducted in a 290‐bed county‐funded community hospital in California that serves the majority of disadvantaged and poor elderly residing in an area with a population of approximately 300,000 persons. The objective was to determine what demographic, medical, and sociologic characteristics of elderly patients recorded at admission would be of value in predicting those most likely to change their functional status.

Benzodiazepine Use in Older, Community-Dwelling Southern Californians: Prevalence and Clinical Correlates

OBJECTIVE: To determine the use of benzodiazepines (BZDs) in an older, community-dwelling sample and to examine the sociodemographic and clinical correlates of BZD use. DESIGN: A cross-sectional study of 1752 elderly people (aged ≥65 y) who completed a mailed medication survey and a telephone health status survey. PARTICIPANTS: Participants were invited to participate in a large Medicare demonstration project on prevention by their private physicians, who were also enrolled in the larger study. Participants had to be English-speaking, could not have dementia or a terminal illness, and had to give informed consent to participate in the study. MAIN OUTCOME MEASURES: Sociodemographic and health status variables that predicted BZD use were examined. Sociodemographic variables included age, gender, ethnicity, education, and income. Health status variables included functional status, with measures of mental, social, and physical health. Influenza immunization status was used as an indicator for preventive health services use and self-reported chronic illness was used as a measure of comorbidity. RESULTS: Twenty percent of the participants used BZDs at least twice in the past year. We found that those who used BZDs were more than twice as likely to take ten or more drugs, two-and-a-half times more likely to have difficulty falling asleep, and over twice as likely to be depressed. BZD users were also more likely to be white, to have a college education, and to have received a recent influenza shot, but were not more likely to be women when controlled for health status. CONCLUSIONS: Further clinical research should explore the relationship between BZD use among older patients and the BZD-associated adverse clinical factors we observed, as well as the association between multiple drug use and potential adverse outcomes in older BZD users.

The risk of placement in a nursing home after acute hospitalization.

Using data from an urban Professional Standards Review Organization, the authors examined the pattern of discharges for persons aged 65 years and older from acute hospitals for 1979 and 1980. Of the 9% of elderly persons who were discharged to nursing homes, those older than 85 years were 10 times as likely to enter a nursing home as those aged 65; females were twice as likely as males; and those with a diagnosis of mental illness were more likely than those with a diagnosis of physical disease, but the effects were additive. Even after adjustments for patient source, patient characteristics, and therapeutic service, the university teaching hospital was less likely to discharge elderly patients to nursing homes than were the 10 community hospitals in the area.

Paying Friends, Family Members, or Strangers to Be Home-Based Personal Assistants How Satisfied Are Consumers?

This study describes consumers who hire friends, family members, or strangers as paid personal assistants and compares service satisfaction among the three groups. From surveying 511 consumers of self-directed home care services, the authors found that consumers who hire friends as workers are younger and more educated than consumers who hire family members and strangers, and they are more impaired than consumers with strangers as workers. The friend cohort experiences more stability with their personal assistants than does the stranger cohort but not as much stability as the family cohort. On some dimensions of consumer satisfaction, friends as workers are perceived by consumers to be either the same as or better than strangers, but they also are perceived as either the same as or worse than family workers. Using friends as paid workers is an important resource. Researchers and policy makers should further explore this approach because the need for home-based personal assistance continues to increase.

“Intent to Stay” Among Paid Home Care Workers in California

ABSTRACT The continuing shortage of entry-level healthcare workers highlights the need to understand worker retention and turnover. This study focuses on intent to stay among 618 paid home care workers in California, half from agencies, and half employed under a consumer-directed model that includes both relatives and non-relatives of the client. Most workers (63.3%) report that they will very likely be working as a caregiver in 12 months, but more family than non-family caregivers say so. Being related to the client, and having fewer clients, more training, more job satisfaction, and hopes for a raise, all predict intent to stay. However, when we analyze family caregivers separately, there are no significant predictors of intent to stay.

Of Family, Friends, and Strangers: Caregiving Satisfaction Across Three Types of Paid Caregivers

ABSTRACT This study examines the experiences of 609 family, friend, and unrelated caregivers hired directly by clients under a consumer-directed model of home care. Using telephone survey data of clients and workers in Californias In-Home Supportive Services program, this research compares outcomes and identifies predictors of caregiving work satisfaction across these three groups. In the total sample, feeling well prepared for the work predicted higher levels of satisfaction, while being Latino/Hispanic (as compared to being White or Black) predicted lower levels of satisfaction. Predictors varied depending on the caregivers relationship with the client. In particular, friend caregivers who felt prepared were more satisfied than either strangers or family members. Understanding more about caregiver-client relationships and satisfaction is important to future workforce recruitment and retention efforts.