Role exits among the aged

The concept of role exit presented by Zena Smith Blau in her book, Old Age in a Changing Society, refers to the ongoing process of relinquishing previously enacted social roles; a process which is part of everyday life for men and women of all ages. However, Blau argues that role exits in later life are different from those in earlier stages of the life cycle because they tend to be terminal and involuntary. These factors, according to Blau, cause role exits in old age to negatively influence the individual\u27s overall satisfaction with life. This thesis examines the concept of role exit from three perspective: first, from a theoretical perspective as it emerges out of social role theory; second, in a substantive context as it relates to the problem of old age; and finally, from an empirical perspective as an indicator of reported life satisfaction among a sample of older adults

Subjectively rated health among older men and women.

Subjective health ratings by older adults have been shown to be strong predictors of health services utilization. Despite their recognized importance and predictive value, however, the meaning of health ratings and their relationship to objective measures of health status are not clear. This research addressed two basic questions: (1) To what extent is the meaning of subjectively rated health derived from self-reports of physical health status; and (2) Is this meaning similar for older men and women? Specifically, a causal model of the relationships among three latent variables--health conditions, functional limitations, and subjectively rated health--was proposed and evaluated using the 1984 National Health Interview Survey Special Supplement on Aging (SOA). Health conditions were measured by two indicators--number of conditions ever and number of recent conditions; functional limitations by two indicators--number of daily living activity limits and number of fitness limits; and subjective health by three indicators--ratings of overall health, of activity relative to peers, and worry about health. The proposed model was evaluated by analysis of covariance structures using LISREL procedures. The model was found to fit the data well (GFI.990). Together, health conditions and functional limitations explained 64 percent of the variance in subjectively rated health. Evaluation of the model against the covariance matrices for older males and older females in three age groups, 65-74, 75-84, and 85+, demonstrated acceptable fit for both genders in the two younger age groups. The fit was less satisfactory for men and women 85 years of age and older, perhaps due to the large number of cases with missing data within the oldest age group. Additional analyses, testing for structural equivalence between men and women within the younger two age groups, found that in general, the male-female models were comparable. The results of this study supported the argument that subjective health ratings are derived from older people's knowledge about their objective health status and that the meaning of these ratings is comparable for males and females aged 65-74 and 75-84. These ratings provide valuable information on the health status of older adults and should become a st and ard part of health assessments.Ph.D.Public healthGerontologyUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/162263/1/8920635.pd

National study of chronic disease self-management: age comparison of outcome findings.

IntroductionThe adult population is increasingly experiencing one or more chronic illnesses and living with such conditions longer. The Chronic Disease Self-Management Program (CDSMP) helps participants cope with chronic disease-related symptomatology and improve their health-related quality of life. Nevertheless, the long-term effectiveness of this evidence-based program on older adults as compared to the middle-aged populations has not been examined in a large-scale, national rollout.MethodWe identified baseline characteristics of CDSMP participants aged 65 years or older (n = 687, M = 74.8 years) in the National Study of CDSMP from 2010 to 2012. Comparisons were made to middle-aged participants aged 50 to 64 (n = 325, M = 58.3 years). Assessments were conducted at baseline and 12-month follow-up. Linear and generalized linear mixed models were performed to assess changes in primary and secondary outcomes, controlling the key sociodemographics and number of chronic conditions.ResultsAll primary outcomes (i.e., social/role activities limitation, depression, communication with doctors) significantly improved in both the older and middle-aged cohorts. Although improvements in illness symptomatology (e.g., fatigue, pain, shortness of breath, and sleep problems) were similar across both cohorts, only the middle-aged cohort benefitted significantly in terms of overall quality of life and unhealthy mental health days. Effect sizes were larger among the middle-aged population who were also more likely to enter the program in poorer health and be from minority backgrounds.ConclusionsThe current study documented improved health outcomes but more so among the middle-aged population. Findings suggest the importance of examining how age and interacting life circumstances may affect chronic disease self-management

The impact of chronic disease self-management programs: healthcare savings through a community-based intervention

BACKGROUND: Among the most studied evidence-based programs, the Chronic Disease Self-Management Program (CDSMP) has been shown to help participants improve their health behaviors, health outcomes, and reduce healthcare utilization. However, there is a lack of information on how CDSMP, when nationally disseminated, impacts healthcare utilization and averts healthcare costs. The purposes of this study were to: 1) document reductions in healthcare utilization among national CDSMP participants; 2) calculate potential cost savings associated with emergency room (ER) visits and hospitalizations; and 3) extrapolate the cost savings estimation to the American adults. METHODS: The national study of CDSMP surveyed 1,170 community-dwelling CDSMP participants at baseline, 6 months, and 12 months from 22 organizations in 17 states. The procedure used to estimate potential cost savings included: 1) examining the pattern of healthcare utilization among CDSMP participants from self-reported healthcare utilization assessed at baseline, 6 months, and 12 months; 2) calculating age-adjusted average costs for persons using the 2010 Medical Expenditure Panel Survey; 3) calculating costs saved from reductions in healthcare utilization; 4) estimating per participant program costs; 5) computing potential cost savings by deducting program costs from estimated healthcare savings; and 6) extrapolating savings to national populations using Census data combined with national health statistics. RESULTS: Findings from analyses showed significant reductions in ER visits (5%) at both the 6-month and 12-month assessments as well as hospitalizations (3%) at 6 months among national CDSMP participants. This equates to potential net savings of $364 per participant and a national savings of$3.3 billion if 5% of adults with one or more chronic conditions were reached. CONCLUSIONS: Findings emphasize the value of public health tertiary prevention interventions and the need for policies to support widespread adoption of CDSMP

The impact of chronic disease self-management programs: healthcare savings through a community-based intervention.

BackgroundAmong the most studied evidence-based programs, the Chronic Disease Self-Management Program (CDSMP) has been shown to help participants improve their health behaviors, health outcomes, and reduce healthcare utilization. However, there is a lack of information on how CDSMP, when nationally disseminated, impacts healthcare utilization and averts healthcare costs. The purposes of this study were to: 1) document reductions in healthcare utilization among national CDSMP participants; 2) calculate potential cost savings associated with emergency room (ER) visits and hospitalizations; and 3) extrapolate the cost savings estimation to the American adults.MethodsThe national study of CDSMP surveyed 1,170 community-dwelling CDSMP participants at baseline, 6 months, and 12 months from 22 organizations in 17 states. The procedure used to estimate potential cost savings included: 1) examining the pattern of healthcare utilization among CDSMP participants from self-reported healthcare utilization assessed at baseline, 6 months, and 12 months; 2) calculating age-adjusted average costs for persons using the 2010 Medical Expenditure Panel Survey; 3) calculating costs saved from reductions in healthcare utilization; 4) estimating per participant program costs; 5) computing potential cost savings by deducting program costs from estimated healthcare savings; and 6) extrapolating savings to national populations using Census data combined with national health statistics.ResultsFindings from analyses showed significant reductions in ER visits (5%) at both the 6-month and 12-month assessments as well as hospitalizations (3%) at 6 months among national CDSMP participants. This equates to potential net savings of $364 per participant and a national savings of$3.3 billion if 5% of adults with one or more chronic conditions were reached.ConclusionsFindings emphasize the value of public health tertiary prevention interventions and the need for policies to support widespread adoption of CDSMP

Successes of a national study of the Chronic Disease Self-Management Program: meeting the triple aim of health care reform.

BackgroundEmerging health care reform initiatives are of growing importance amidst concerns about providing care to increasing numbers of adults with multiple chronic conditions. Evidence-based self-management strategies are recognized as central to managing a variety of chronic diseases by improving the medical, emotional, and social role management demands of chronic conditions.ObjectivesTo examine the effectiveness of the Chronic Disease Self-Management Program (CDSMP) among a national sample of participants organized around the Triple Aim goals of better health, better health care, and better value in terms of reduced health care utilization.Research designUtilizing data collected from small-group CDSMP workshops, baseline, 6-month, and 12-month assessments were examined using 3 types of mixed-effects models to provide unbiased estimates of intervention effects.SubjectsData were analyzed from 1170 community-dwelling CDSMP participants.MeasuresTriple Aim-related outcome measures: better health (eg, self-reported health, pain, fatigue, depression), better health care (eg, patient-physician communication, medication compliance, confidence completing medical forms), and better value [eg, reductions in emergency room (ER) visits and hospitalizations in the past 6 mo].ResultsSignificant improvements for all better health and better health care outcome measures were observed from baseline to 12-month follow-up. The odds of ER visits significantly reduced from baseline to 12-month follow-up, whereas significant reductions in hospitalization were only observed from baseline to 6-month follow-up.ConclusionsThis National Study of CDSMP (National Study) demonstrates the successful translation of CDSMP into widespread practice and its potential for helping the nation achieve the triple aims of health care reform

Successes of a national study of the chronic disease self-management program: Meeting the triple aim of health care reform

Background: Emerging health care reform initiatives are of growing importance amidst concerns about providing care to increasing numbers of adults with multiple chronic conditions. Evidence-based self-management strategies are recognized as central to managing a variety of chronic diseases by improving the medical, emotional, and social role management demands of chronic conditions. Objectives: To examine the effectiveness of the Chronic Disease Self-Management Program (CDSMP) among a national sample of participants organized around the Triple Aim goals of better health, better health care, and better value in terms of reduced health care utilization. Research Design: Utilizing data collected from small-group CDSMP workshops, baseline, 6-month, and 12-month assessments were examined using 3 types of mixed-effects models to provide unbiased estimates of intervention effects. Subjects: Data were analyzed from 1170 community-dwelling CDSMP participants. Measures: Triple Aim-related outcome measures: better health (eg, self-reported health, pain, fatigue, depression), better health care (eg, patient-physician communication, medication compliance, confidence completing medical forms), and better value [eg, reductions in emergency room (ER) visits and hospitalizations in the past 6 mo]. Results: Significant improvements for all better health and better health care outcome measures were observed from baseline to 12-month follow-up. The odds of ER visits significantly reduced from baseline to 12-month follow-up, whereas significant reductions in hospitalization were only observed from baseline to 6-month follow-up. Conclusions: This National Study of CDSMP (National Study) demonstrates the successful translation of CDSMP into widespread practice and its potential for helping the nation achieve the triple aims of health care reform. © 2013 by Lippincott Williams and Wilkins

National study of chronic disease self-management: six-month outcome findings.

ObjectiveTo investigate how the Chronic Disease Self-Management Program (CDSMP) changes health outcomes, lifestyle behaviors, and health care service utilization over a 6 month period.MethodThe participants were 1,170 adults enrolled in the National Study of CDSMP in 2010-2012 (M age=65.4 years). Six-month assessments were available for 903 participants. Linear mixed models and generalized linear mixed models were used to assess the changes between baseline and 6-month assessment for primary and secondary outcomes among CDSMP participants.ResultsSocial/role activities limitations, depression, and communication with physicians improved significantly from baseline to 6-month follow-up. Study participants reported significant improvements in more physical activity and less emergency room (ER) visits and hospitalization during that period.DiscussionNationally, CDSMP not only improves health outcomes and lifestyle behaviors but also decreases costly ER visits and hospitalization. Geriatricians and other primary care providers should be encouraged to refer patients with chronic conditions to such self-management programs