Self-assessed global quality of life: a comparison between African-American and white older patients with arthritis.

Quality of life (QOL) perceptions influence patient decisions and preferences for care and, more importantly, physicians may render recommendations based on their impressions of the patient's QOL. QOL is perceived differently by different ethnic groups. This may have implications for understanding ethnic disparities in medical procedure utilization such as joint replacement for osteoarthritis. In a study of 596 elderly male patients with moderate to severe symptomatic knee/hip osteoarthritis, we examined how African-American and white patients rate their overall QOL. We adjusted their responses for important demographic, clinical, and psychosocial potential confounders. African-American (44%) and white (56%) patients in this study were comparable, except that African-Americans reported lower socioeconomic status compared with whites. After adjusting for all other study covariates, African-American ethnicity (B= -0.121, P = 0.004) was negatively correlated with overall QOL ratings. How ethnic variations in perceptions of QOL impact observed ethnic disparity in the utilization of joint replacement therapy needs further investigation.

"Going home" or "leaving home"? The impact of person and place ties on anticipated counterstream migration.

PURPOSE: The probability of anticipated return migration in retirees is explored. DESIGN AND METHODS: Survey data were analyzed from interviews with a sample of elderly European Americans who migrated to a metropolitan city on Florida's east coast following retirement. RESULTS: Results are consistent with the specification of the 2nd move in E. Litwak and C. F. Longino's (1987) life course model of retirement migration. Respondents were unlikely to anticipate a return move unless ties to the back home community made such a move possible. IMPLICATIONS: Ties with children, both back home and in Florida, significantly influence consideration of a return move.

Coping with tooth pain: a qualitative study of lay management strategies and professional consultation.

This research analyzes transcripts of semi-structured interviews with patients presenting with tooth pain at a rural dental clinic in North Florida. The primary objectives are to identify the strategies patients use to manage their pain and to elucidate the decision-making process leading to the clinic visit. Although respondents understood that their condition was not self-limiting, only about one-half contacted the clinic within several days of the onset of their pain. Most tried one or more lay management strategies.

Dental self-care among dentate adults: contrasting problem-oriented dental attenders and regular dental attenders.

Self-care behaviors are common and can act as substitutes for or supplements to formal health care services. We tested the hypothesis that problem-oriented dental attenders (POAs) report more dental self-care behaviors than do regular dental attenders (RAs), presumably as a substitute for professional care. The Florida Dental Care Study is a longitudinal cohort study of changes in oral health, in which we measured dental self-care behaviors related to three common dental problems: toothache pain, bleeding gums, and tooth loss. Despite using less dental care, POAs were less likely to report "conventional" methods as means to prevent the three dental problems; however, they were more likely to report that homemade remedies, topical medications, or mouthwashes were ways to prevent or treat these problems. POAs were also more likely to believe that "nothing can be done" to prevent these problems. Additionally, POAs had more negative dental attitudes, used less dental care during follow-up, had more dental disease, were the only persons who extracted at least one of their own teeth, and were more likely to use tobacco. With the exception of dental self-extractions, no single self-care belief or behavior distinguished POAs from RAs, nor were POAs likely to have different explanations for dental problems. Instead, the pattern was one of modest differences on a number of items. Although POAs use less dental care, they do not compensate by employing more "conventional" dental self-care behaviors, but report being more likely to employ "unconventional" behaviors. They also are more likely to believe that nothing can be done to prevent dental problems.

Informal exchanges with non-kin among retired sunbelt migrants: a case study of a Finnish American retirement community.

OBJECTIVES: This study examined informal exchanges with non-kin among retired Sunbelt migrants, with special emphasis on the impact of ethnic enclaves in generating exchanges of instrumental assistance and emotional support among elderly European Americans. METHODS: Data were collected through interviews with four samples of elders: Finnish Americans who migrated to an ethnic retirement community in Florida; European Americans who migrated to the same community but are not part of an ethnic enclave; Finnish Americans living in an age-integrated setting in Minnesota; and retired European Americans living in the same Minnesota community. RESULTS: Migrants were less likely than elders aging-in-place to report informal exchanges with non-kin. Finnish American migrants were less likely than other European American migrants to provide instrumental assistance to non-kin but were more likely to anticipate relying on informal long-term care support, regardless of proximity to kin. There were no differences in the two migrant samples in exchanges of emotional support. DISCUSSION: Evidence regarding substitution of non-kin for geographically distant kin is mixed. Results are consistent with a strategy of "banking" support, at the community level among the Finnish American migrants and at the network level among other European American migrants.

Women's health care: cross-cultural encounters within the medical system.

Women, particularly minority women, have inadequate health care and treatment outcomes caused by a number of extrinsic and intrinsic factors. Salient external systems factors addressed in this article include the lack of health insurance and the inadequate organization and delivery of health care services, for example, difficult-to-reach clinic locations and limited hours of operation. The multiple family roles of women often necessitate alterations in adherence and treatment activities to fulfill competing time and resource demands. Furthermore, culturally widespread lay therapeutic activities, and more culturally limited ethnomedical practices, are routinely employed by patients, yet often are unknown or not acknowledged by physicians. Internal factors, that is, beliefs and attitudes and their behavioral outcomes, are described for African-American, Latino-American, Haitian-American, Asian-American and Native American patients. Suggestions are made for the enhancement of interethnic physician-patient communication. The medical encounter is the nexus for many factors that influence the quality of women's health care.

Symptom reporting during physician consultation. Results of a health diary study.

Most studies of physician consultation focus on decisions to contact health care providers. In this article, the authors examine decisions regarding which symptoms to report once people contact physicians. Data for the analysis were gathered through interviews and health diaries completed by a probability sample of 667 elderly people, based on a subsample of 152 respondents who consulted physicians during the 3-week reporting period. A qualitative analysis produced behavioral patterns underlying decisions to report some but not other symptoms experienced on the day of physician contact. Logistic regression was used to explore the extent to which predispositions of individuals that precede the onset of symptoms and the type of symptom experience explain the distribution of these reporting patterns. Variation in the percentages of people reporting particular symptoms indicates that these reporting patterns cannot be explained solely by the type of symptoms people experience. The decisions regarding which symptoms to report reflect respondents' attribution of cause, the impact of symptoms on their daily lives, and the broader health and social context in which they confront particular symptoms.

The impact of symptom interpretation on physician utilization.

This article explores physician consultation decisions among a sample of elderly people living in community settings. The analysis integrates the insights of research on illness behavior, particularly symptom interpretation and lay consultation, with previous specifications of the Health Behavior Model. Data were gathered through personal interviews and health diaries completed on a daily basis for 21 consecutive days by a probability sample of older people living in community settings. Results indicate that uncertainty regarding potential seriousness, level of pain or interference, and causal attributions were the most consistently significant predictors of physician contact.

Older people's recommendations for treating symptoms: repertoires of lay knowledge about disease.

This paper explores the content of older people's repertoires of lay knowledge regarding treatment strategies for commonly occurring symptoms. Data were collected through in-depth personal interviews in a sample of people 65 years and older living in community settings and managing their own health. Respondents mentioned a total of 657 specific treatment recommendations for 15 symptoms. Although very few mentioned treatments that were uniformly harmful, over two-thirds recommended treatments that could be harmful under certain conditions. Most respondents also identified treatments considered palliative or therapeutic. Implications of the results for patient education are discussed.

Factors affecting the frequency of health enhancing behaviors by the elderly.

The authors examined the frequency of health-enhancing behaviors practiced by the elderly living in community settings, with emphasis on the impact of disease and disability on the frequency of those practices. Data were collected through personal interviews with a probability sample of 667 respondents in a 4-county region of northeastern New York. Almost all respondents said they engaged in at least one health-enhancing practice on a regular basis. The most commonly reported behaviors involved dietary practices. Results of the analysis support the importance of differentiating among health-enhancing behaviors that are undertaken as primary levels of prevention, in contrast to those undertaken as secondary or tertiary levels of prevention.

Drug combinations and potential for risk of adverse drug reaction among community-dwelling elderly.

Data were gathered through personal interviews from a sample of 667 people 65 years of age and older, living in community settings and managing their own health. Almost two thirds of these older respondents reported at least one drug-drug or drug-alcohol combination associated with a possible adverse reaction. The largest percentage of respondents were taking combinations of medications that could place them at risk for hypotension and cognitive impairment. These results suggest the need for more detailed screening of specific medications used by older people who report taking certain categories of drugs.

Alcohol use and potential risk for alcohol-related adverse drug reactions among community-based elderly.

This paper documents the frequency of alcohol consumption and concurrent use of alcohol and medications in a random sample of elderly community dwellers. Further, a profile of older persons who are likely to be drinking alcohol is developed and the extent to which they are at potential clinical risk due to their concurrent use of alcohol with prescription and over-the-counter medications is explored. While approximately 43 percent are abstainers, the majority of older respondents reported using alcohol. Older drinkers who take one or more drugs which place them at potential risk for negative drug-alcohol interactions represent one-quarter of this sample but are often overlooked in estimating the extent of alcohol problems in the elderly. By far, the most common risk was from the use of OTC pain medications and alcohol (19 percent). The multivariate analyses revealed that sex, educational attainment, and religious affiliation are important factors to consider in developing a profile of older people who are at risk for alcohol-related ADRs. Implications for health care and social service professionals who work with elderly community-dwellers are discussed.

Predictors of use of paid help among older people living in the community.

We examined the impact of level of impairment, access to informal services, and household income on the use of paid help by impaired older people using data from the Supplement on Aging to the 1984 National Health Interview Survey. Consistent with previous research, results indicate that impaired elders turn to paid help when informal resources are unavailable. Paid help is more prevalent among elderly people with adequate economic resources and with access to entitlements. Income exerts the greatest impact on situations in which older people have the most discretion regarding acceptance of and sources of help.

Lay evaluation of symptoms by older people: an assessment of potential risk.

This paper examines the appropriateness of lay evaluations of potential risk of symptoms among a sample of 667 elderly people living in community settings. Data were gathered through personal interviews and 3 weeks of structured health diaries in which older respondents recorded the symptoms they experienced. Potential medical risk was determined on a symptom by symptom basis based on clinical information gathered during the interviews. Almost three fourths of the respondents exhibited potential clinical risk for at least one symptom they experienced during the 3-week diary period. One in eight respondents was judged at risk yet gave no evidence of physician consultation, either during or prior to the diary period. Implications of these results for health education designed to improve consultation decisions among elderly people are discussed.

Self-care responses to symptoms by older people. A health diary study of illness behavior.

Although studies of illness behavior have concentrated on utilization of formal services, recent research has highlighted the importance of lay care. In this article, patterns of self-treatment of symptoms among a sample of older people living in community settings are explored. Data were collected through personal interviews and health diaries completed by a probability sample of 667 elderly people. A majority of respondents managed most symptoms on their own. A decision to take no action was a common response to a number of symptoms. Prescription and over-the-counter medications were the most frequently reported intervention strategies. Multivariate analyses affirmed the importance of both symptom interpretation and symptom experience on lay treatment decisions. Causal attributions and prior experience with symptoms exhibited a less consistent impact on lay care strategies. Whether people ignore or treat symptoms appears to have less to do with their familiarity and causal explanation than with whether or not the symptom causes them pain or discomfort, whether it interferes with their desired activities, or whether they think it might be indicative of a serious decision.

Patterns of illness behavior among rural elderly: preliminary results of a health diary study.

This paper summarizes the responses of rural elderly people to a variety of symptoms experienced during a three-week period. Responses to symptoms included causal attributions, consultation patterns, and intervention strategies. Data recorded in diaries during a three-week period highlight the importance of lay care in the illnesses of older people. Most symptoms were managed by older respondents themselves. When symptoms were discussed with someone else, the consultant was most likely a family member or friend rather than a health care professional. Only one third of the respondents contacted any formal provider about any of their symptoms. The majority of respondents combined medical and nonmedical explanations in interpreting their symptoms. The most frequent response to a symptom was doing nothing. The next two most commonly reported interventions were over-the-counter medications and activity limitation. Analyses revealed few differences among residential categories in patterns of illness behavior. Rural-urban differences often disappeared when controlling for demographic and socioeconomic background which covary with residence.

Size and effectiveness of informal helping networks: a panel study of older people in the community.

This paper examines the impact over time of changes in older people's health and functional capacity on the size and effectiveness of their informal helping networks. Theoretical perspectives on networks differ in their predictions regarding the impact of declines in health on network size. Previous empirical studies have not examined the effects of changes in health on the size of networks. We examine empirical evidence on the impact of health changes on informal helping networks with longitudinal data obtained from a probability sample of older people living in the community. Results suggest that networks respond to diminishing health by increasing the scope of assistance provided but neither increase nor decrease in size as a consequence. The results also suggest that declines in functioning can produce increases in needs which exceed the capacity of informal networks.

Males as helpers: the role of sons, relatives, and friends.

The informal helping networks of most frail elderly people are dominated by women. Men are also involved in helping older people, although most male caregivers are husbands. This paper examines the contributions of men other than husbands who provide assistance to a sample of community-based elderly people. Data were gathered through personal interviews with elders and their primary helpers at two points in time. Male helpers provide intermittent assistance with occasional tasks but less frequently undertake routine household chores. Some evidence indicates a shift toward female caregivers as the elder's functional capacity decreases over time.

Other roles of caregivers: competing responsibilities or supportive resources.

Although the majority of research has conceptualized other roles of caregivers as competing commitments, a growing body of literature views multiple roles as supportive resources. This study examined the impact of multiple roles on the caregiving experience among informal helpers of a probability sample of elderly people living in a community setting. Results indicate that other roles, particularly when caregiving involves a large time commitment, do contribute to burden. However, other roles, especially roles outside the family, are also associated with improved caregiver well-being.