W. Groot

Demand of elderly people for residential care: an exploratory study

BackgroundBecause of the rapid aging population, the demand for residential care exceeds availability. This paper presents the results of a study that focuses on the demand of elderly people for residential care and determinants (elderly peoples personal characteristics, needs and resources) that are associated with this demand. Furthermore, the accuracy of the waiting list as a reflection of this demand has been examined.Methods67 elderly people waiting for admission into a home for the elderly, are subjected to semi-structured interviews. The data are analyzed by using multivariate statistics.ResultsElderly people who indicate that they would refuse an offer of admission into a home for the elderly feel healthier (p = 0.02), have greater self-care agency (p = 0.02) and perceive less necessity of admission (p < 0.01), compared to those who would accept such an offer. Especially the inability to manage everyday activities and the lack of a social network are highly associated with the elderly peoples demand for residential care. Furthermore, it is evident that waiting lists for homes for the elderly do not accurately reflect the demand for residential care, since 35% of the elderly people on a waiting list did not actually experience an immediate demand for residential care and stated that they would not accept an offer of admission. Quite a lot of respondents just registered out of a sense of precaution; a strategic decision dictated by current shortages in care provision and a vulnerable health status.ConclusionThe results contribute to the understanding of waiting lists and the demand for residential care. It became apparent that not everybody who asks for admission into a home for the elderly, really needed it. The importance of elderly peoples resources like social networks and the ability to manage everyday activities in relation to the demand for care became clear. These findings are important because they indicate that resources also play a role in predicting elderly peoples demand and as a result can guide the development and the (re)design of adequate health care services.

Health and welfare effects of integrating AIDS treatment with food assistance in resource constrained settings: A systematic review of theory and evidence

The article systematically reviews theory and existing empirical evidence on the health and welfare effects of integrating AIDS treatment with food assistance. While theoretical predictions point to possible improvements in health, consumption and ambiguous effects on labor supply, there are few empirical studies that used robust designs. Five empirical studies are reviewed and in two of them, food assistance improves nutritional status, especially when provided in the form of ready to use therapeutic feeding. However because of methodological concerns, the positive effects of food assistance on weight gain warrant cautious interpretation. One study found a positive association between food assistance and adherence. While no quantitative study evaluated welfare effects, respondents in a qualitative study self-reported the resumption of labor activities, increased dietary diversity and food consumption. There is still limited evidence on the role of duration of AIDS treatment and programmatic aspects like targeting, composition and duration of food assistance. The major conclusion of the paper is that there is still need for further research based on robust designs which investigates both health and household welfare effects.

A direct method for estimating the compensating income variation for severe headache and migraine

A subjective quality of life measurement method is introduced to calculate the compensating income variation for diseases and handicaps. This approach avoids some of the limitations of existing methods. The method is based on the direct measurement of life satisfaction of individuals. We apply the method to severe headache and migraine. It is found that severe headache and migraine have a large effect on well being and that the compensating income variation for severe headache and migraine is substantial.

The use of community-based social services by elderly people at risk of institutionalization: An evaluation

OBJECTIVE To examine the use of community-based social services by elderly people at risk of institutionalization, who prefer to remain at home. METHODS A study with a longitudinal design (measurements at two points in time) was conducted. RESULTS One hundred and thirty-four elderly people (mean age=82 years) were interviewed twice. At baseline, 81 respondents indicated that they made use of at least one social service (60.4%). After 1 year the use of these services did not increase significantly (64.2%, p=0.53). Only two services (socio-cultural activities and restaurant facility) out of five services were used frequently. The respondents reported more autonomy and fewer feelings of loneliness after 1 year. These positive changes cannot be related to an increased use of services. DISCUSSION Overall, the use of social services remained moderate. This raises questions about the need for these services, the possible barriers and the ability of these social services to contribute to de-institutionalization.

Paying informally for public health care in Albania: scarce resources or governance failure?

Informal payments for health care are common in most former communist countries. This article explores the demand side of these payments in Albania. Using tobit and Heckman selection models we control for individual determinants of informal payments in outpatient and inpatient health care. Propensity score matching (PSM) techniques are used to investigate the changes in the characteristics of people paying informally over the different years. Our findings suggest that vulnerable groups in society remain less protected against such payments and policy measures have not reached the most deprived regions of the country.

The short-run causal effect of tumor detection and treatment on psychosocial well-being, work, and income

This paper estimates the short-run causal effect of tumor detection and treatment on psychosocial well-being, work and income. Tumor detection can be considered as a random event, so that we can compare individuals’ average outcomes in the year of diagnosis with the year before. We argue for using panel data estimation techniques that enable us to control for observed and unobserved information intrinsic to the individual and time constants. We use data of a national representative panel in the Netherlands that includes health survey information and data on work, education, and income between 2007 and 2012. Our findings show differences in the psychosocial dysfunction of men and women in response to tumor detection and treatment. Women, not men, are decreasingly likely to participate in the labor force as a result of malignant tumor detection, while no significant effects are found on her personal or household income. We also demonstrate that fixed effects panel data models are superior to matching techniques.

Financial incentives for a healthy life style and disease prevention among older people: a systematic literature review.

BackgroundTo motivate people to lead a healthier life and to engage in disease prevention, explicit financial incentives, such as monetary rewards for attaining health-related targets (e.g. smoking cessation, weight loss or increased physical activity) or disincentives for reverting to unhealthy habits, are applied. A review focused on financial incentives for health promotion among older people is lacking. Attention to this group is necessary because older people may respond differently to financial incentives, e.g. because of differences in opportunity costs and health perceptions. To outline how explicit financial incentives for healthy lifestyle and disease prevention work among older persons, this study reviews the recent evidence on this topic.MethodsWe applied the method of systematic literature review and we searched in PUBMED, ECONLIT and COCHRANE LIBRARY for studies focused on explicit financial incentives targeted at older adults to promote health and stimulate primary prevention as well as screening. The publications selected as relevant were analyzed based on directed (relational) content analysis. The results are presented in a narrative manner complemented with an appendix table that describes the study details. We assessed the design of the studies reported in the publications in a qualitative manner. We also checked the quality of our review using the PRISMA 2009 checklist.ResultsWe identified 15 studies on the role of explicit financial incentives in changing health-related behavior of older people. They include both, quantitative studies on the effectiveness of financial rewards as well as qualitative studies on the acceptability of financial incentives. The quantitative studies are characterized by a great diversity of designs and provide mixed results on the effects of explicit financial incentives. The results of the qualitative studies indicate limited trust of older people in the use of explicit financial incentives for health promotion and prevention.ConclusionsMore research is needed on the effects of explicit financial incentives for prevention and promotion among older people before their broader use can be recommended. Overall, the design of the financial incentive system may be a crucial element in their acceptability.

Group incentives for teachers and their effects on student learning: a systematic review of theory and evidence

The effects of teachers’ group incentives on student achievement are examined by reviewing theoretical arguments and empirical studies published between 1990 and 2011. Studies from developing countries reported positive effects of group incentives on student test scores. However, experimental studies from developed countries reported insignificant effects. Some of the evidence appears to show a positive association between small group size of teachers and the effectiveness of group incentives. Still, it is uncertain whether the key to successful group incentives in teaching emanates from the incentive size, teacher group size, teacher intrinsic motivation, or type of incentive (rank type vs. non-rank type). Furthermore, most studies show that individual teacher incentives have positive effects unlike studies on group incentives. However, there is a lack of comparative studies of group incentives and individual incentives. We conclude that current empirical evidence has unclear policy implications and recommend additional experimental research.

The use of social services by community-dwelling older persons who are at risk of institutionalization: a survey

The use of community-based social services additionally to regular home help services to support older persons at risk of institutionalization was studied. Structured interviews were held with 292 persons, who specifically pointed out that they prefer to remain independently at home. Bivariate and multivariate logistic regression models were developed to study the association between social service use and personal, health-related and wellbeing characteristics. 195 respondents indicated that they made use of at least one social service (68%). Only three services (individual care, social-cultural activities and restaurant facilities), out of nine, were used regularly. Those who lived in a sheltered environment or were supported by informal caregivers or who visited day care had a significantly higher probability of using these services. More attention should be given to the nature and accessibility of community-based social services in order to have distinctive added value in enabling older persons to age in place.