The Aging Population in the Twenty-First Century Statistics for Health Policy (1988) / Chapter Skim
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3 Health Status and Quality of Life
3 Health Status and Quality of Life
Pages 65-93
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From page 65... ...
From a physiological perspective, differences between individuals characteristically increase with advancing age in those factors that change with age, such as blood glucose level and blood pressure. From a clinical perspective, specific subgroups of elderly individuals can be identified, including the 5 percent who at any one time are residing in long-term care facilities and the larger portion who have major functional declines.
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From page 66... ...
The network of current and potential informal supports, such as family or friends, has an important role in modulating the clinical impact of underlying disease and is often the major determinant in decisions to institutionalize elderly people. For every impaired elderly person in a nursing home, there are approximately two equally impaired elderly people living in the community who often can remain there by virtue of the critical role of informal support systems, which provide approximately 80 percent of their Tong-term care (Doty, 1986~.
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From page 67... ...
Longevity Extension and Compression of Morbidity A major policy issue relates to the relationship between changes in the mortality experience of the elderly population and coincident changes in the underlying morbidity and disability experiences. In 1900, a man who reached the age of 65 could expect to live 11 more years, and a woman age 65 could expect to live 12 more years.
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From page 68... ...
While it is clear that the overall mortality experience of the elderly population has an underlying curve of morbidity experience in which individuals accumulate diseases and losses in specific capabilities, the specific interactions between the development of diseases and the subsequent development of disability have not been elucidated. It is particularly important to recognize that many different pathologic processes may result in, or contribute to, identical functional impairments.
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From page 69... ...
On one hand, many elderly individuals in acute care facilities receive chronic care. Some are admitted to an acute care hospital in order to gain access to a long-term care facility, and some are admitted to a hospital because of a worsening of a chronic condition.
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From page 70... ...
With increasing age people may be differentially successful in learning to recognize their own limits, avoid various environmental risk factors (e.g., quit smoking) , or modify the severity of the risk (e.g., smoke less)
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From page 71... ...
The entire array of diseases present in an individual patient must be considered as models are developed to describe pathways to dependency and as treatment plans are developed. Multiple pathology has obvious implications for health interview surveys, provider surveys, hospital discharge records, and the vital statistics on cause of death.
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From page 72... ...
The surveys relevant to this chapter are the National Health and Nutrition Examination Survey and the National Health Interview Survey and its supplements. A related source of information is the series of national medical expenditure surveys conducted by the National Center for Health Services Research ant!
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From page 73... ...
Although health status is not its major focus, SIPP does provide data that can be used to relate health status to income; SIPP is discussed in detail in Chapter 10. The National Health Inter~riew Surrey The National Health Interview Survey is a principal source of information on the health of the civilian, noninstitutionalized population of the United States.
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From page 74... ...
The follow-up could be carried out by a combination of telephone calls and personal interviews with varying frequencies appropriate to the age of the sample member. The Integrated System of Health Interview Surveys The NCHS plans to replace the NHIS by 1989 with an Integrated System of Health Interview Surveys (ISHIS)
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From page 75... ...
Recommendation 3.2: The pane] recommends that the National Institute on Aging and the National Center for Health Statistics support methodological work to increase the participation of older people in examination and interview surveys.
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From page 76... ...
. As a result, a reasonable upper bound for the length of 95 percent confidence intervals in this setting is 6 percent, for which the minimum sample size needs to be n = 700.
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From page 77... ...
Data on Cause of Death To ascertain which nonrespondents have died in a longitudinal survey of the health status of the elderly, it is essential to match nonrespondents against the National Death Index (NDI) , unless there are other definitive ways of identifying deaths.
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From page 78... ...
Longitudinal data sets can also take into account the latency that characterizes the development of chronic diseases, the often long period between the recognition of a disease and its functional impact. Longitudinal data sets provide the capacity to establish patterns of change over time in individuals, which is increasingly important with the recognition of the tremendous variability among the elderly.
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From page 79... ...
To understand the illness histories of the elderly, recording the health status and lifestyle of these individuals earlier in life becomes important for many reasons. Among them are the association of psychological factors in middle age with morbidity later in life, the effects of risk-enhancing behavior in middle age on subsequent morbidity, and the need to identify the transition points from one functional status or health state to another.
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From page 80... ...
Dependency and institutionalization are the exception. However, major functional impairment is clearly agerelated among the elderly; approximately 5 percent of individuals ages 65-74 require assistance in basic activities of daily living, while 35 percent require such assistance by age 85 (National Center for Health Statistics, 1983a)
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From page 81... ...
Measures of the functional status of the active elderly are needed to trace the transitions from their well state to states of disability along the continuum of health. Most of the well-known measures describe functional status along one of four dimensions: physical function, cognitive function, mental health function, and social function.
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From page 82... ...
For example, one scale (the original or adaptation of the Katz Activities of Daily Living ADL Index) typically identifies approximately 10 percent of the noninstitutionalized elderly population with limitations (Katz et al., 1983~.
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From page 83... ...
In her study published by the World Health Orgar~ization (WHO) in 1984, Fillenbaum argues for a multidimensional approach to functional status (p.5~: There have been few attempts to make a comprehensive asnessment of the well-being of representative groups of elderly people as a basis for policy decisions concerning the provision of appropriate services.
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From page 84... ...
Assessment not only should be multidimensional, but also should be in terms of functional status. Fillenbaum focuses on three multidimensional functional assessments: the comprehensive assessment and referral evaluation (CARE)
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From page 85... ...
that the National Institute on Aging and the National Center for Health Statistics support methodological work to improve the validity and reliability of measures of cognitive and physical impairments of the elderly. The emphasis in the provision of health care to the elderly should be on maintaining functional capability and increasing active life expectancy.
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From page 86... ...
Diagnoses themselves are often a weak criterion for assessing the health care needs of the elderly (Besdine, 1983~. QUALITY OF LIFE The General Concept Several of the topics discussed earlier in this chapter are related to the quality of life, which for older persons includes the extension of longevity, the compression of morbidity, health and functional status, and psychosocial factors as modifiers of disease.
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From page 87... ...
status as one of four dimensions that define quality of life for older persons, along with socioeconorn~c status, general life satisfaction, and self-esteem and related measures. As defined here, health status consists of physical, psychological, and social components.
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From page 88... ...
In this connection, it is worth reiterating that aging does not inevitably result in decline of health status or function: older persons are very heterogeneous with respect to health and functional status, and improvement in both successful aging can and does occur. Functional Status Functional status including the ability to perform sel£care activities and to carry out activities of daily living such as cooking, shopping, and cleaning is more critical to quality of life than morbidity or diagnosis per se.
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From page 89... ...
Productive Activity Increasing longevity should be accompanied not only by the maintenance or enhancement of physical, mental health, emotional, and social function, but also by productive activity that is recognized by oneself and others as socially useful. The development of statistics on the full range of productive activities, especially among older men and women, is important for both scientific reasons and national policy.
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From page 90... ...
Several properties of productive behavior follow from this definition: (1) With the exception of paid employment, for which the market value is established by the payment, no other activity is currently counted as productive; market value must be estimated or attributed for these activities under the proposed definition.
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From page 91... ...
Recommendation 3.9: The pane! recommends that the Department of Labor, in conjunction with the Bureau of the Census and the Department of Health and Human Services, develop a concept of productive activity that includes both paid and unpaid work and that can be measured and reported in surveys such as the Current Population Survey, the National Health Interview Survey, and the Survey of Income and Program Participation, as well as in the decennial census.
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From page 92... ...
Some development of measures has been done on all of the broad activity categories with which we are concerned: paid employment, unpaid voluntary work in organizational and informal settings, and work that produces goods for one's own consumption. All of these available measures involve self-report to some extent.
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From page 93... ...
Conclusion In order to document the quality of life experienced by older persons, both community residents and those residing in institutions, new measures, suitable for cross-sectional and longitudinal surveys, will have to be developed. Recommendation 3.10: The panel recommends that national population-based surveys such as the National Health Interview Survey and the National Nursing Home Survey (which includes a population component)
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