Tzvia Blumstein

Beyond keeping active: concomitants of being a volunteer in old-old age.

This study examines concomitants of volunteering in the context of other lifestyle activities. Investigating formal volunteering in old-old age, the authors analyzed data of 148 volunteers versus 1,195 nonvolunteers in a national sample of the Israeli Jewish population aged 75-94. As hypothesized, being a volunteer related (whether as a cause or effect) to more positive functioning on psychosocial markers and prospectively resulted in reduced mortality risk even when other activity outlets (physical activity, everyday activities, having a hobby) were controlled. These findings suggest that the benefits of volunteering in late life are not reducible to those of other activities.

Self-rated health among older adults: a cross-national comparison

Self-rated health (SRH) may have different implications in various social and cultural settings. However, few studies are available concerning SRH among older persons across countries. The aim of this study was to analyse whether there are cross-national differences in the association between status characteristics, several diseases common among older persons, activities of daily living (ADL), and SRH. The study base was the Comparison of Longitudinal European Studies on Aging (CLESA), which includes data from six population-based studies on aging conducted in Finland, Israel, Italy, The Netherlands, Spain and Sweden. The study population comprised 5,629 persons, with participants from all countries except Italy. Logistic regression analyses were used to assess the relationship between status characteristics, health conditions, ADL and SRH. To examine whether the association among status characteristics, health conditions, ADL and outcome differed across the CLESA countries, interaction terms defined as “variable*country” were considered separately for each variable. Regression analyses revealed that sex, education, lifetime occupation, heart disease and respiratory disease were differently distributed across countries. Among homogeneous factors, marital status (OR=1.21), hypertension (OR=1.41), stroke (OR=1.67), diabetes (OR=2.15), cancer (OR=1.47), musculoskeletal diseases (OR=2.44), and ADL (OR=2.72) turned out to be significantly associated with fair or poor SRH. The results indicate that there are differences in self-ratings of health across countries. These differences cannot be explained entirely by status characteristics, self-reported diseases or functional ability. However, an important finding was that in all countries most of the indicators of medical and functional health were homogeneously associated with SRH.

Tracing long-term effects of early trauma: A broad-scope view of Holocaust survivors in late life.

This study addressed long-term effects of extreme trauma among Holocaust survivors (N = 126) in an older (75-94 years) sample of the Israeli Jewish population. Survivors were compared with European-descent groups that had immigrated either before World War II (n = 206) or after (n = 145). Participants in the latter group had had Holocaust-related life histories but did not consider themselves survivors. Controlling for sociodemographics, the results indicated that survivors fared worse than prewar immigrants in certain psychosocial domains, mainly cumulative distress and activity, rather than in health-related ones. Survivors and postwar immigrant comparisons had almost no differences. The study highlights the need for a wide view of functioning facets and comparison groups in delineating late posttraumatic effects.

Physician Visits, Emergency Room Utilization, and Overnight Hospitalization in the Old‐Old in Israel: The Cross‐Sectional and Longitudinal Aging Study (CALAS)

OBJECTIVES: The objective of this paper is to assess the risk factors for physician contact in the month before the interview (PM) and emergency room utilization (ERU) and overnight hospitalization (OH) in the year before the interview, through the use of the behavioral model as a conceptual framework.

Improved survival of hip fracture patients treated within a comprehensive geriatric hip fracture unit, compared with standard of care treatment.

OBJECTIVES To compare survival rates of hip fracture patients treated within a comprehensive geriatric hip fracture unit (CGHFU) with those undergoing a standard of care treatment (SOCT) in general orthopedic wards. DESIGN Retrospective chart review. SETTING A geriatric hip fracture unit of a division of geriatric medicine and rehabilitation and departments of general orthopedic surgery of a tertiary hospital. PARTICIPANTS Participants were 3114 consecutive hip fracture patients: 847 were admitted to CGHFU and 2267 to wards of general orthopedics. INTERVENTION Surgical repair followed by standard rehabilitation course MEASUREMENT Mortality rates at 30 days, 90 days, and 1 year. RESULTS CGHFU population was older (P < .0001), comprised more women (P < .0001), and suffered a greater number of comorbidities (P < .0001). Crude 30-day mortality rates were 1.9% and 3.0% for CGHFU and SOCT, respectively. At 90 days, crude rates were 6.5% and 8.1%, respectively, and 14.8% and 17.3%, at 1 year, respectively. Cox proportional hazard models adjusted for sociodemographics, Comorbidity, and surgery characteristics showed borderline significant lower mortality hazard ratios for CGHFU in comparison with SOCT, for 1-month and 3-month intervals. The adjusted Cox model favored the CGHFU modality of care with regard to 1-year cumulative mortality (hazard ratios 0.78, 95% confidence interval 0.63-0.96, P = .016). Male gender, age, diabetes, and number of operations were predictive of increased 1-year mortality risk in the separate regression models by gender and age group (<85, 85+). CONCLUSION Crude and adjusted mortality rates are lower in a geriatric hip fracture unit, as compared with the common standard of care model of general orthopedic wards. Combined with earlier data on improved functional outcomes of CGHFU, these findings further support the implementation of similar comprehensive orthogeriatric models of care.

Assistance with Personal Care Activities Among the Old-Old in Israel: A National Epidemiological Study

The objectives of this study were to (1) estimate rates of difficulty, need for assistance, and receipt of assistance with activities of daily living (ADLs) among the old‐old in Israel; (2) describe the living arrangements of the dependent old‐old; and (3) gain insight into the caregiving provided to the disabled members of this population.

Effects of tracheostomy on well-being and body-image perceptions.

OBJECTIVE: Quality of life after tracheostomy was addressed by measuring its impact on well being and body image perceptions. STUDY DESIGN AND SETTING: A controlled study in a laryngotracheal clinic of a tertiary referral center. Three groups were studied: 24 cannulated, 19 decannulated, and 20 noncannulated patients. They filled up 3 conventional questionnaires. RESULTS: (1) Satisfaction-with-life scale: reduced scores were detected between cannulated and noncannulated patients. (2) Personality traits: neuroticism and extroversion: no differences were noted. (3) Body cathexis scale: both cannulated and decannulated patients scored less than noncannulated. In tracheostomy-specific issues, decannulated patients scored better than cannulated patients. CONCLUSIONS: Reduced scores after tracheostomy indicate an overall diminished quality of life. These changes correlate with personality traits. Decannulated patients exhibited only slight improvement indicating an incomplete psychosocial recovery. SIGNIFICANCE: This is the first report on tracheostomy related quality of life in noncancer patients conducted with specific psychological questionnaires.

The Effect of a Communal Lifestyle on Depressive Symptoms in Late Life

Objectives: This study compares depression levels among lifetime kibbutz members (n = 525) and old-age kibbutz residents (n = 366) with a comparable national sample (n = 412) and assesses the relationship between depression and individual differences related to lifetime in a kibbutz (e.g., health) and those related to current living conditions (e.g., social network). Methods: The analysis is based on data from the Cross-Sectional and Longitudinal Aging Study conducted in Israel between 1989 and 1992 and the follow-up during 1993 and 1994. Results: The findings indicate significantly lower depressive symptomatology among women, but not among men, residing in kibbutz communities. The women’s lower level of depressive symptoms appears to be a result of better physical and mental functioning among kibbutz members and of such favorable lifestyle characteristics as frequent contact with their children among old-age kibbutz residents. Discussion: Both lifetime and current living conditions contribute to better mental health of women in the kibbutz at older ages.

Cross-national determinants of quality of life from six longitudinal studies on aging: The CLESA Project

Background and aims: The Comparison of Longitudinal European Studies on Aging (CLESA) Project, here presented for the first time, is a collaborative study involving five European and one Israeli longitudinal study on aging. The aim of this paper is to describe the methodology developed for the harmonization of data and the creation of a Common Data Base (CDB), and to investigate the distribution of some selected common variables among the six countries. The design of each study is briefly introduced and the methodology leading to the harmonization of the common variables is described. Methods: The study base includes data from five European countries (Finland, Italy, the Netherlands, Spain, Sweden) and Israel, for older people aged 65–89 living both in the community and in institutions (total, 11557 subjects). For two age classes (65–74 and 75–84), the prevalence ratios or the mean values of the following selected variables are provided: a) sociodemographic variables; b) health habits; c) health status; d) physical functioning; e) social networks and support; and f) health and social services utilization. Results: Statistically significant differences were found between most of the investigated characteristics across the CLESA countries, with very few exceptions. While some of the differences found may be due to cultural variations, others require further investigation and should be encompassed in the main framework of the Project, which is to identify predictors of hospitalization, mortality, institutionalization and functional decline. Conclusions: A common data base is available for the study of the aging process in five European and one Israeli population. These data provide a unique opportunity to identify common risk factors for mortality and functional decline and increase our understanding of country-specific exposures and vulnerability.

Cultural and Educational Disparities in the Use of Primary and Preventive Health Care Services Among Midlife Women in Israel

PURPOSE This study aimed to assess rates of primary and preventive healthcare use among women in midlife from different cultural origins and to identify sociodemographic and health characteristics that could explain cultural differences in health care utilization. METHODS Data were collected for the Womens Health in Midlife National Study in Israel, in which women aged 45-64 were randomly selected according to age and ethnic/origin group strata: Long-term Jewish residents (n = 540), immigrants from the former Soviet Union (n = 151), and Arab women (n = 123). Interviews included measures of primary and preventive visits, clinical screening services (mammogram, Pap smear, bone density), health and lifestyle, and sociodemographics. MAIN FINDINGS Long-term residents reported more preventive visits and screening tests and lower use of primary care, compared with immigrants and Arab women. In multivariate analyses, cultural group, education, self-rated health, and health motivation were significantly associated with utilization of primary and preventive care. Ethnic/origin group differences were mostly related to cultural differences and not to financial barriers or medical factors. For example, among the more traditional group, namely, Arab women, low use of preventive gynecologic care seemed to be related to the lack of physicians of the same culture and gender. CONCLUSIONS The findings underscore the importance of the primary care physician, especially in minority groups, as a provider who can identify at-risk groups and serve as a gateway to health promotion. The findings also suggest that the lack of female providers may be one explanation for the low utilization of gynecologic services among women from traditional cultures.