Verena H. Menec

Mobility in Older Adults: A Comprehensive Framework

Mobility is fundamental to active aging and is intimately linked to health status and quality of life. Although there is widespread acceptance regarding the importance of mobility in older adults, there have been few attempts to comprehensively portray mobility, and research has to a large extent been discipline specific. In this article, a new theoretical framework for mobility is presented with the goals of raising awareness of the complexity of factors that influence mobility and stimulating new integrative and interdisciplinary research ideas. Mobility is broadly defined as the ability to move oneself (e.g., by walking, by using assistive devices, or by using transportation) within community environments that expand from ones home, to the neighborhood, and to regions beyond. The concept of mobility is portrayed through 5 fundamental categories of determinants (cognitive, psychosocial, physical, environmental, and financial), with gender, culture, and biography (personal life history) conceptualized as critical cross-cutting influences. Each category of determinants consists of an increasing number of factors, demonstrating greater complexity, as the mobility environment expands farther from the home. The framework illustrates how mobility impairments can lead to limitations in accessing different life-spaces and stresses the associations among determinants that influence mobility. By bridging disciplines and representing mobility in an inclusive manner, the model suggests that research needs to be more interdisciplinary and current mobility findings should be interpreted more comprehensively, and new more complex strategies should be developed to address mobility concerns.

Conceptualizing Age-Friendly Communities

Sur le front politique et des lignes de conduite, l’intérêt a augmenté pour rendre les communautés plus « amies des ainés », cette tendance est restée constante depuis que l’Organisation mondiale de la Santé a lancé son projet « Réseau mondial des Villes-amies des aînés. » Nous conceptualisons les communautés amies des aînés en nous appuyons sur le cadre de l’OMS et l’application d’un point de vue écologique. Ainsi nous visons à rendre explicite les principales hypothèses sur l’interaction entre la personne et l’environnement afin de faire progresser la recherche ou de décisions politiques dans ce domaine. Les prémisses écologiques (par exemple, il doit y avoir une adéquation entre la personne âgée et les conditions environnementales) suggèrent la nécessité d’une approche de recherche holistique et interdisciplinaire. Une telle approche est requise car les domaines amis des aînés (l’environnement physique, le logement, l’environnement social, les possibilités de participation, le soutien communautaire formel et informel et les services de santé, de transport, de communication et de l’information) ne peuvent pas être traitées independamment des facteurs personnels, tels que l’âge, le sexe, le revenu et l’état fonctionnel, ainsi que des autres niveaux d’influence, y compris l’environnement politique. On the political and policy front, interest has increased in making communities more “age-friendly”, an ongoing trend since the World Health Organization launched its global Age-Friendly Cities project. We conceptualize age-friendly communities by building on the WHO framework and applying an ecological perspective. We thereby aim to make explicit key assumptions of the interplay between the person and the environment to advance research or policy decisions in this area. Ecological premises (e.g., there must be a fit between the older adult and environmental conditions) suggest the need for a holistic and interdisciplinary research approach. Such an approach is needed because age-friendly domains (the physical environment, housing, the social environment, opportunities for participation, informal and formal community supports and health services, transportation, communication, and information) cannot be treated in isolation from intrapersonal factors, such as age, gender, income, and functional status, and other levels of influence, including the policy environment.

Does continuity of care with a family physician reduce hospitalizations among older adults

Objective: To examine the relation between continuity of primary care and hospitalizations. Methods: Survey data from a representative sample of older adults aged 67 or over living in the province of Manitoba (n = 1863) were linked to administrative data, which provide complete records of physician visits and hospitalizations. A visit-based measure of continuity of care was derived using a majority-of-care definition, whereby individuals who made 75% of all their visits to family physicians (FPs) to the same FP were classified as having high continuity of care, and those with less than 75% of their visits to the same FP as having low continuity of care. Whether individuals were hospitalized (for either ambulatory care-sensitive conditions or all conditions) was also determined from administrative records. Results: High continuity of care was associated with reduced odds of ambulatory care-sensitive hospitalizations (adjusted odds ratio = 0.67, confidence interval 0.51–0.90) controlling for demographic and self-reported, health-related measures. It was not related to hospitalizations for all conditions, however. Conclusions: The study highlights the importance of continuity of primary care in reducing potentially avoidable hospitalizations.

Does Continuity of Care Matter in a Universally Insured Population

OBJECTIVE To examine the relation between continuity of care and preventive health care and emergency department (ED) use in a universal health care system. DATA SOURCES/STUDY SETTING Administrative data that capture health care use of the entire population of a midwestern Canadian city. STUDY DESIGN A population-based, retrospective study of all individuals who had a least one physician contact in 1998 or 1999 (total N=536,893). METHODS Logistic regressions were conducted to examine the relation between continuity of care, defined in terms of the proportion of total visits to family physicians (FPs) made to the same FP, and cervical cancer screening, breast cancer screening, influenza vaccination, pneumococcal vaccination, and ED visits, controlling for demographic variables, socioeconomic status (defined in terms of relative affluence of neighborhood of residence), and health status. PRINCIPAL FINDINGS Continuity of care was related to better preventive health care and reduced ED use. A consistent socioeconomic gradient also emerged. For instance, the odds of having a mammogram was double for individuals living in the wealthiest neighborhoods, relative to those in the poorest neighborhoods (adjusted odds ratio=2.31, 99 percent CI 2.13-2.50). CONCLUSIONS Having a long-term relationship with a single physician makes a difference even in a universal health care system. Moreover, socioeconomic disparities remain, suggesting the need to target specifically individuals from lower socioeconomic strata for preventive health care.

Primary and Secondary Control-Enhancing Strategies Implications for Health in Later Life

Objectives:The major goal of this article was to assess the link between controlenhancing strategies and health in an older population. In particular, the use of primarycontrol strategies, which involve modifying the environment (e.g., actively persisting) and compensatory secondary-control strategies, which involve modifying the self (e.g., expecting less of oneself) was studied. Methods:Participants (n= 241) in a large-scale longitudinal study were interviewed to assess their use of strategies and their health. Results:Health (physical and perceived) was found to vary for those using primary and compensatory secondary-control strategies; however, the nature of this variation depended on age. Discussion:The findings may indicate that primary-control strategies have positive health implications for the young-old but that these same strategies become detrimental to health in late life. The findings could further suggest that compensatory secondary-control strategies become increasingly more adaptive in late life.

Does the relationship between neighborhood socioeconomic status and health outcomes persist into very old age? A population-based study.

Objective: The purpose of this article is (a) to extend previous research on the relationship between neighborhood socioeconomic status (SES) and health by considering a wide range of health-related measures derived from administrative health care records and (b) to explore whether this relationship persists into old age. Method: The study involved a complete cohort of community-dwelling residents in Winnipeg, Canada, who were 65 years or older in 2004/2005 (N = 77,930). Health measures were derived from administrative claims data. Census data were used to derive neighborhood-level SES. Results: Multilevel logistic regressions indicated that, relative to individuals living in the most affluent areas, those in the poorest areas had significantly higher odds of having arthritis, diabetes, hypertension, congestive heart failure, ischemic heart disease, chronic obstructive pulmonary disease, depression, and stroke. Significant neighborhood income effects tended to be evident among individuals age 65 to 75 as well as those age 75+. Discussion: A wide range of health conditions among older adults are disproportionately clustered into the poorest areas. Programs and services should be designed to meet the needs of older adults of any age in such neighborhoods.

Faculty in Transition: A Longitudinal Analysis of Perceived Control and Type of Institution in the Research Productivity of Newly Hired Faculty.

The systemic changes facing postsecondary institutions today pose a threat to the quality of academic programs unless new faculty can be successfully attracted and retained. To be more competitive in the recruitment and retention of faculty, a better understanding is needed of the adjustment experiences of newly hired faculty. Our study examined the adjustment of new hires at the point of entry into their institutions using research productivity as one indicator of adaptation. It was expected that perceived personal control, age, gender, and type of institution would relate to research productivity. At the beginning of their first and second year, newly hired faculty in three different types of postsecondary institutions responded to a comprehensive questionnaire concerning their initial adjustment experiences. A path analysis indicated both direct and indirect linkages between the independent variables of interest and research productivity. Substantial direct paths were found between the institution type and research productivity, specifically for the research I and liberal arts/comprehensive institutions, and to a lesser degree, between age and research productivity. Age, the research I university, and the liberal arts/comprehensive universities had direct effects on two measures of perceived control and were linked indirectly to research productivity via perceived control. Perceived control resulting from the personal qualities of the faculty members was instrumental to research productivity, whereas perceived control resulting from activities initiated by faculty members were not related to productivity. Surprisingly, gender was not related to research productivity through either direct or indirect paths. If the adjustment of newly hired faculty is viewed in terms of research productivity, then these results suggest that perceived control, the milieu of research-oriented institutions, and age (to a limited extent), are important predictors of faculty performance.

A Prospective Analysis of the Relation Between Self-Rated Health and Health Care Use Among Elderly Canadians

Research indicates that self-rated health is related to a variety of health-related outcomes, such as mortality and functional disability, even when controlling for more “objective” health measures. The present study extends previous research by prospectively examining the relation between self-rated health and health care use among a representative sample of elderly Canadians ( N = 1,181) interviewed in 1991/92. Survey data were linked to administrative records of health care use. Self-rated health was positively related to the number of physician visits during the 12 months following the survey, as well as to the number of tests incurred (e.g., laboratory tests, X-rays), even when controlling for demographic variables, functional disability, morbidity, and prior health care use. Older adults who rated their health as “bad/poor” or “fair” were also more likely to be hospitalized than those who rated their health as “excellent”. These results highlight the importance of considering global measures of health when examining health care use.

Ethnic Differences in Self-Rated Health Among Older Adults: A Cross-Sectional and Longitudinal Analysis

The objectives of this study were to examine whether self-rated health differs among older adults of different ethnic backgrounds and to explore what factors may account for potential differences. The study was based on the 1983 and 1996 waves of the Aging in Manitoba study. A self-report measure of ethnic background was used to categorize participants into four groups: British/Canadian, Northern/Central European, Eastern European, and Other. In both 1983 and 1996, older Eastern European adults had significantly reduced odds of rating their health as good or excellent relative to British/Canadian adults. Controlling for demographic variables, socioeconomic status, language spoken, and health status attenuated but did not eliminate the difference. Global, subjective ratings of health are frequently used to measure health. The ethnic differences found here suggest, however, that ratings may be influenced by cultural factors, which may warrant some caution in making comparisons across ethnic groups.

Hospitalizations at the End of Life Among Long-Term Care Residents

BACKGROUND Concerns have been raised over transfers into acute care hospitals at the end of life. The objective of this study was to examine (a) the extent of and (b) factors related to hospitalization in the last 180 days before death among long-term care (LTC) residents. METHODS The study included all LTC residents from 60 facilities in the province of Manitoba, Canada, who died in 2003/04 (N = 2,379), with data derived from administrative health care records. Multilevel regression analyses were conducted to examine the relationship between resident and facility characteristics and the following: location of death (in hospital vs the LTC facility); whether individuals were hospitalized in the last 180 days before death; and number of hospital days in the last 180 days. RESULTS Overall, 19.1% of LTC residents died in hospital; however, 40.7% were hospitalized at least once in the last 6 months before death. Several resident characteristics (age, trajectory group, and level of care) were related to the outcome measures. Living in a not-for-profit LTC facility decreased the odds of dying in hospital (adjusted odds ratio [OR] = 0.589; 95% confidence interval [CI] = 0.402-0.863) or being hospitalized (adjusted OR = 0.647; 95% CI = 0.452-0.926). CONCLUSIONS Hospitalization at the end of life is common among LTC residents, and the likelihood of hospital transfers is increased for residents who are younger, have organ failure, lower care level needs, as well as among those who live in for-profit facilities. Particular emphasis should, therefore, be placed on targeting these groups to determine the appropriateness of hospital admission and possible ways of reducing transfers.