Agreement between Self-Reported and Routinely Collected Health Care Utilisation Data among Seniors

Objective: To examine the agreement between self-reported and routinely collected administrative health care utilisation data, and the factors associated with agreement between these two data sources. Data Sources/Study Setting: A representative sample of seniors living in an Ontario county within Canada was identified using the Ontario Ministry of Health’s Registered Persons Data Base in 1992. Health professional billing information and hospitalisation data were obtained from the Ontario Ministry of Health and Long-Term Care (OMH) and the Ontario Health Insurance Plan (OHIP). Principal Findings: Substantial to almost perfect agreement was found for the contact utilisation measures, while agreement on volume utilisation measures varied from poor to almost perfect. In surveys, seniors overreported contact with general practitioner and physiotherapists or chiropractors, and underreported contact with other medical specialists. Seniors also underreported the number of contacts with general practitioners and other medical specialists. The odds of agreement decreased if respondents were male, aged 75 years and older, had incomes of less than $25,000, had poor/fair/good self-assessed health status, or had two or more chronic conditions. Conclusion: The findings of this study indicate that there are substantial discrepancies between self-reported and administrative data among older adults. Researchers seeking to examine health care use among older adults need to consider these discrepancies in the interpretation of their results. Failure to recognize these discrepancies between survey and administrative data among older adults may lead to the establishment of inappropriate health care policies.health services utilisation; seniors; self-reports; agreement; billing data

Describing Disability among High and Low Income Status Older Adults in Canada

The purpose of this study was to determine the prevalence, types, and severity of disabilities, as well as the medical conditions that may have caused disabilities among non-institutionalized older adults by high and low income. Disabled individuals aged 55 years and older were identified from the 1986 and 1991 Health and Activity Limitation Surveys. The overall unweighted sample sizes for each survey were 132,337 in 1986 and 91,355 in 1991. Approximately 40% of senior men and women reported having at least one disability, with women just slightly more likely than men to report being disabled. Almost twice as many senior women had low income compared with senior men. Mobility and agility disabilities were the most common types of disabilities reported by older adults. Arthritis/rheumatism was the medical condition most often reported as the primary cause of a disability among women. Men most often reported diseases of the ear and mastoid processes, with differences reported by low and high income respondents. Among 55-64 year olds, low income respondents were generally less likely to be categorized as mildly disabled and more likely to be categorized as severely disabled compared with high income respondents. In an effort to postpone or prevent disabilities in an ever-growing older population, public health initiatives are required to educate older adults about medical conditions and impairments that often lead to disability, particularly among low income seniors.disability; income; seniors

Describing Disability among High and Low Income Status Older Adults in Canada

The purpose of this study was to determine the prevalence, types, and severity of disabilities, as well as the medical conditions that may have caused disabilities among non-institutionalized older adults by high and low income. Disabled individuals aged 55 years and older were identified from the 1986 and 1991 Health and Activity Limitation Surveys. The overall unweighted sample sizes for each survey were 132,337 in 1986 and 91,355 in 1991. Approximately 40% of senior men and women reported having at least one disability, with women just slightly more likely than men to report being disabled. Almost twice as many senior women had low income compared with senior men. Mobility and agility disabilities were the most common types of disabilities reported by older adults. Arthritis/rheumatism was the medical condition most often reported as the primary cause of a disability among women. Men most often reported diseases of the ear and mastoid processes, with differences reported by low and high income respondents. Among 55-64 year olds, low income respondents were generally less likely to be categorized as mildly disabled and more likely to be categorized as severely disabled compared with high income respondents. In an effort to postpone or prevent disabilities in an ever-growing older population, public health initiatives are required to educate older adults about medical conditions and impairments that often lead to disability, particularly among low income seniors.disability; income; seniors

Caregiving process and caregiver burden: Conceptual models to guide research and practice

BACKGROUND: Parental care for a child with a developmental disability is an enormous responsibility, one that can far exceed that of typical parental care. While most parents adapt well to the situation of caring for a child with a disability, some do not. To understand parents' adaptations to their children's disabilities, the complex nature of stress processes must be accounted for and the constructs and factors that play a role in the caregiving must be considered. DISCUSSION: Evidence suggests that there is considerable variation in how caregivers adapt to their caregiving demands. Many studies have sought to qualify the association between caregiving and health outcomes of the caregivers. Contextual factors such as SES, child factors such as child behaviour problems and severity of disability, intra-psychic factors such as mastery and self-esteem, coping strategies and social supports have all been associated with psychological and/or physical outcome or parents or primary caregivers. In reviewing these issues, the literature appears to be limited by the use of traditional analytic approaches which examine the relationship between a factor and an outcome. It is clear, however, that changes to single factors, as represented in these studies, occur very rarely even in the experimental context. The literature has also been limited by lack of reliance on specific theoretical frameworks. SUMMARY: This conceptual paper documents the state of current knowledge and explores the current theoretical frameworks that have been used to describe the caregiving process from two diverse fields, pediatrics and geriatrics. Integration of these models into one comprehensive model suitable for this population of children with disabilities and their caregivers is proposed. This model may guide future research in this area

Evidence of wet-dry cycles and mega-droughts in the Eemian climate of southeast Australia

Understanding past climate variability is critical to informing debate of likely impacts of global warming on weather and climate, and water resources. Here we present a near annual resolution reconstruction of climate developed from a speleothem that spans the Eemian [Marine Isotope Stage 5e (MIS 5e)] from 117,500 to 123,500 years BP—the most recent period in the Earth’s history when temperatures were similar to those of today. Using\ua025\ua0Mg,\ua088Sr, and\ua0137Ba as proxies, we show the first indication of solar and teleconnection cyclic forcing of Eemian climate in southeast Australia, a region at present often affected by severe drought and bushfires. We find evidence for multi-centennial dry periods interpreted as mega-droughts, and highlight the importance of understanding the causes of these in the context of a rapidly warming world, where temperatures are now, or projected to exceed those of the Eemian