Impact of Medicare's prospective payment system and the farm crisis on the health care of the elderly: a case study.

The spectrum of health care for the rural elderly has been negatively affected by recent changes in Medicare reimbursement policies and by the farm crisis. This case study examined the effects of these changes on the ability of rural hospitals, the aging network, and care-givers to provide adequate and continuous care to the elderly. In this case study, three gaps in services were found: a lack of programs designed to meet the needs of terminally ill patients and their families; a lack of education during the crucial transitional period between hospital discharge and home; and a lack of services and programs for the chronically-ill older adult. More studies are needed to determine if similar service gaps will be found in other rural communities. If so, public attention should be focused on possible solutions.

Affects, demographic variables, and health.

The revised Multiple Affect Adjective Check List (MAACL-R) was given to a national probability sample that consisted of 1,543 adults who also were interviewed, which provided demographic data and self-ratings of health, medication use, and social activities. Standardization procedures have reduced markedly the acquiescence factor and the correlations among the dysphoric affect scales in the MAACL-R. The demographic variables of sex, race, age, education, occupation, income, marital status, religion, geographical area of residence, and size of town or city were related to some of the scales. Positive affect was related directly to self-ratings of health; dysphoric affect was related negatively to these ratings. Frequencies of volunteer activities and social activities in general correlated negatively with depression and positively with positive affect scales.

Measurement of self-concept and self-esteem in older people: state of the art.

Self-concept and self-esteem instruments used in gerontological research were reviewed. Instruments were found to vary substantially in their conceptualization of self-concept and/or self-esteem as well as in the amount of attention given to assessing their psychometric properties. The assumptions made about the relationship of age to self-concept and/or self-esteem also varied. More careful attention to selection, construction, interpretation, and continued validation of instruments is recommended. Several instruments are particularly recommended for further use in gerontological research.

Sensitizing medical students to impression formation processes in the patient interview.

Medical students in a course that included instruction in patient interviewing participated in an experiment devised to alert them to sources of bias which might influence their judgements and management of patients. Students were randomly assigned to one of four groups and exposed to either a videotaped or audiotaped interview of the same patient presented as either normal weight or overweight. Questionnaire responses of students in the two audio groups indicated no detectable differences in the sound tracks of the overweight and normal weight versions of the interview, and these groups were combined for subsequent analysis. A discriminant analysis indicated that students exposed to the overweight video version formed impressions and assessed patient treatment and outcome differently from those exposed to either the video normal or audio versions of the interview. Implications of these findings for medical education are discussed, and suggestions are made for incorporating such sensitization experiments in the medical curriculum.