Effects of VA adult day health care on health outcomes and satisfaction with care.

It was hypothesized that ADHC would have a positive effect on the health of patients and their care givers and result in greater satisfaction with care than customary care. Measurement of health outcomes for patients included assessment of overall, psychological, and social health, and survival. Care giver assessment concentrated on psychosocial health. Findings indicated no difference in health outcomes between patients assigned to ADHC or their care givers and their counterparts assigned to customary care. Further analysis of subgroups found that there were 3 subgroups of patients for whom those assigned to ADHC had better outcomes (as indicated by lower Sickness Impact Profile scores) than those assigned to customary care. These subgroups included those who were 1) not married, 2) most satisfied with their social support network, and 3) not hospitalized at the time of enrollment in the study. Patients and their care givers assigned to ADHC were more satisfied with their care than those in nursing homes, but not more satisfied than those in hospital-based home care. Care givers reported significantly greater satisfaction with patient care in ADHC than did care givers of patients receiving care in nursing homes or ambulatory care clinics.

Elderly wards and their legal guardians: analysis of county probate records in Ohio and Washington.

We examined the demographic profiles of older wards and their guardians in Ohio and Washington states. The adjudication process, as experienced by older persons placed in legal guardianship, was also explored. Findings suggest that current state statutes of guardianship as they pertain to elders may not be feasible or fair. In particular, standardized and reliable assessments of competency are lacking; a family member's petition for guardianship is seldom challenged by the older person; and the primary goal of most guardianship cases to preserve the estate of the older individual.

The validity of proxy-generated scores as measures of patient health status.

This study examines the validity of proxy assessments as substitutes for patient assessments of patient physical and psychosocial health status. Data were obtained from 275 patient-proxy pairs who were enrolled in a national study of Adult Day Health Care. Patients and proxies (informal caregivers such as spouses) were asked to complete the Sickness Impact Profile (SIP) based on the patients health status. Findings showed that patient-generated and proxy-generated physical scores were highly correlated, although proxies rated patients as slightly more impaired than the patient's rated themselves. The correlation between psychosocial scores was not high enough to consider proxy responses as valid substitutes for patient responses. We explored these differences in response by comparing regression equations predicting patient-generated and proxy-generated physical and psychosocial SIP dimension scores. Variance in the patient-generated psychosocial score was explained by physical function, psychological distress, cognitive status and patient age. Proxy-generated psychosocial scores were primarily explained by the caregiver's psychological distress and perceived burden. These findings point out the importance of considering the source of patient health status estimates when interpreting the results of research studies.

Antecedents and consequences of remarriage in later life.

Using the Retirement History Study (RHS), respondents were identified who entered the study widowed or divorced, and then remarried. Respondents were also identified who entered the study as married, became widowed or divorced, and then remarried. In the latter case, because of limitations of the RHS, only males were observed. With some matching relevant to the types of analyses carried out, comparison groups were selected, providing an opportunity to examine both antecedents and consequences of remarriage.