Introducing Unobserved Heterogeneity in Earnings Mobility

This paper introduces and describes unobserved heterogeneity in earnings quintiles transition matrices in the US. Unobserved heterogeneity is found to play a crucial role in earnings mobility. Each individual is attracted, given his characteristics, towards a specific zone of the distribution. At the stationnary equilibrium, the earnings quintiles distribution is thus segmented. Interestingly, while the level of earnings mobility has remained quite stable since 1970, the width of these zones has decreased, such that this segmentation was more pronounced in the 80's and the 90's than in the 70's, especially in the middle of the quintiles distribution.earnings mobility; unobserved heterogeneity; segmentation; state dependence; dynamic multinomial logit

Feasibility of Recommended Cognitive Screening Tools for Older Adults in Carehomes

No abstract available

The falls efficacy scale international (FES-I): a comprehensive longitudinal validation study

Method: five hundred community-dwelling older people (70-90 years) were assessed on the FES-I in conjunction with demographic, physiological and neuropsychological measures at baseline and at 12 months. Falls were monitored monthly and fear of falling every 3 months. Results: the overall structure and measurement properties of both FES-I scales, as evaluated with item response theory, were good. Discriminative ability on physiological and neuropsychological measures indicated excellent validity, both at baseline (n = 500, convergent validity) and at 1-year follow-up (n = 463, predictive validity). The longitudinal follow-up suggested that FES-I scores increased over time regardless of any fall event, with a trend for a stronger increase in FES-I scores when a person suffered multiple falls in a 3-month period. Additionally, using receiver-operating characteristic (ROC) curves, cut-points were defined to differentiate between lower and higher levels of concern. Conclusions: the current study builds on the previously established psychometric properties of the FES-I. Both scales have acceptable structures, good validity and reliability and can be recommended for research and clinical purposes. Future studies should explore the FES-I's responsiveness to change during intervention studies and confirm suggested cut-points in other settings, larger samples and across different cultures

The role of concern about falling on stepping performance during complex activities

Background There is limited understanding of the underlying mechanisms explaining the role of concern about falling on fall risk in older people. Anxiety is known to interact with cognitive resources and, as people get older, they require more cognitive resources to maintain balance. This might affect an individual's ability to perform cognitive-motor tasks concurrently. The aim of this study was to investigate the effect of a visuospatial dual-task on stepping performance in older people with and without concern about falling and the impact of repeating this task in those with high concern about falling. Methods Three-hundred-eight community-dwelling older people, aged 70 to 90 years old, participated in the study. Participants were asked to perform a Choice Stepping Reaction Time (CSRT) task in two conditions; once without any other tasks (single task condition), and once while simultaneously performing a visuospatial task (dual-task condition). Participants were asked to rate their levels of concern and confidence specifically related to each of the 25 stepping trials (before/after). We also measured general concern about falling, affect, and sensorimotor and cognitive functioning. Results Total stepping reaction times increased when participants also performed the visuospatial task. The relation between general concern about falling and stepping reaction time, was affected by sensorimotor and executive functioning. Generalised linear mixed models showed that the group with moderate to high levels of general concern about falling had slower total stepping reaction times than those with lower levels of concern about falling, especially during the dual-task condition. Individuals with greater general concern about falling showed reduced confidence levels about whether they could do the stepping tasks under both conditions. Repeatedly performing the stepping task reduced the immediate task-specific concern about falling levels and increased confidence in all participants. Conclusions These findings reveal that people with higher general concern about falling experienced more difficulties during a dual-task condition than people with lower levels of concern. Of further interest, better sensorimotor and cognitive functioning reduced this effect. Graded exposure has potential to reduce concern about falling during fear-evoking activities, especially in conjunction with therapies that improve balance, mood and cognitive function

Development, implementation and evaluation of Australia\u27s first national continuing medical education program for the timely diagnosis and management of dementia in general practice

Background: Dementia is the second leading cause of death in Australia. Over half of patients with dementia are undiagnosed in primary care. This paper describes the development, implementation and initial evaluation of the first national continuing medical education program on the timely diagnosis and management of dementia in general practice in Australia. Methods: Continuing medical education workshops were developed and run in 16 urban and rural locations across Australia (12 were delivered as small group workshops, four as large groups), and via online modules. Two train-the-trainer workshops were held. The target audience was general practitioners, however, international medical graduates, GP registrars, other doctors, primary care nurses and other health professionals were also welcome. Self-complete questionnaires were used for the evaluation. Results: Of 1236 people (GPs, other doctors, nurses and other health professionals) who participated in the program, 609 completed the full program (small group workshops (282), large group workshops (75), online modules (252)); and 627 elected to undertake one or more individual submodules (large group workshops (444), online program (183)). Of those who completed the full program as a small group workshop, 14 undertook the additional Train-the-trainer program. 76% of participants felt that their learning needs were entirely met and 78% felt the program was entirely relevant to their practice. Conclusion: Continuing medical education programs are an effective method to deliver education to GPs. A combination of face-to-face and online delivery modes increases reach to primary care providers. Train-the-trainer sessions and online continuing medical education programs promote long-term delivery sustainability. Further research is required to determine the long-term knowledge translation effects of the program

Dementia Care Mapping and Patient-Centred Care in Australian residential homes: An economic evaluation of the CARE Study, CHERE Working Paper 2008/4

Background: As the population ages, the incidence of dementia and its burden on society will increase. The economic costs of dementia are high, particularly for persons in the mid and late stages of the disease, when formal care arrangements such as nursing home placement are required. The need for care is often precipitated by the development of behavioural and psychological symptoms of dementia (BPSD) which also severely affect the quality of life of affected persons and their carers The Caring for Aged-Care REsident Study (CARES), the first randomised controlled trial to evaluate Dementia Care Mapping (DCM) and Person Centred Care (PCC), demonstrated that either of the two interventions improved outcomes compared to Usual Care (UC) on the primary outcome measure, the Cohen-Mansfield Agitation Inventory (CMAI). This study reports the results of an economic evaluation which was undertaken in conjunction with the trial. This information will provide additional information to assist policy makers in making choices between competing options. Methods: Fifteen nursing homes were randomised to one of three conditions: DCM, PCC or Usual Care (UC). The sample consisted of 360 residents with dementia. Data were collected at baseline, three months, and eight months by assessors blind to group assignment. In addition to the CMAI, data were collected about the use and costs of health care resources and pharmacological interventions. Total costs associated with each of the interventions were estimated, which were contrasted with the outcomes using standard health economics methodology. Results: Over one year, the cost per residential setting of implementing DCM and PCC relative to UC was $10,034 and$2,250 respectively. The additional cost per resident-level unit improvement in CMAI post-intervention (at follow-up) relative to UC was $48.95 ($46.89) for DCM and $8.01 ($6.43) for PCC. Compared to DCM, PCC produced a greater reduction in anxiety and agitation at a lower cost. Therefore, DCM was dominated by PCC and removed from the economic evaluation. Sensitivity analysis suggests this result is robust to changing model parameters. Conclusions: PCC provides a greater decrease in agitation and related behavioural and psychological symptoms of dementia, compared with DCM, at a lower cost and is the preferred option for cost-effectiveness. While there is no existing standard for a reasonable cost for a point improvement in CMAI, the cost per unit under PCC seems acceptable.Dementia, patient centred care

A systematic review of what factors attract and retain nurses in aged and dementia care

Aim. To present evidence-based factors for the recruitment and retention of licensed nurses caring for older people and persons with dementia. Background. The international nurse shortage crisis is intensified in the aged and dementia care sector. Strategies to address this crisis rely on qualitative, quasi-experimental, anecdotal and unsubstantiated literature. Design. Systematic literature review. Method. Search terms 'nurse''nurses''nursing''clinical supervision''staff''staffing''staff mix''staff levels''recruitment''retention''aged care''gerontology''gerontological''dementia care''residential''nursing home,' were used in all possible combinations and applied in a wide range of relevant academic databases, with secondary hand searches of selected bibliographies. Results. Two hundred and twenty-six papers were retrieved and scanned, with 105 chosen for closer examination that were relevant to recruitment and retention strategies for dementia and aged care nursing. Twenty-five of the papers chosen for review were rated at level 2++ to 3, according to the guidelines of the National Institute for Health and Clinical Excellence (The NICE Guidelines Manual, National Institute for Health and Clinical Excellence, London). The 25 critically reviewed papers are organised as promising strategies for (1) nurse recruitment and (2) nurse retention. Conclusions. The intrinsic rewards of the caring role attract nurses to dementia and aged care. Essential strategies linking recruitment with retention are: careful selection of student nurse clinical placements and their ongoing supervision and education, training for skills, leadership and teamwork for new and existing nurses, increased staffing levels, pay parity across different health settings and family friendly policies. Relevance to clinical practice. A family-friendly, learning environment that values and nurtures its nursing staff, in the same way as nurses are expected to value and care for their patients and residents, is critical in ensuring their retention in dementia and aged care. © 2010 Blackwell Publishing Ltd

A multifactorial approach for understanding fall risk in older people

OBJECTIVE: To identify the interrelationships and discriminatory value of a broad range of objectively measured explanatory risk factors for falls. DESIGN: Prospective cohort study with 12-month follow-up period. SETTING: Community sample. PARTICIPANTS: Five hundred community-dwelling people aged 70 to 90. MEASUREMENTS: All participants underwent assessments on medical, disability, physical, cognitive, and psychological measures. Fallers were defined as people who had at least one injurious fall or at least two noninjurious falls during a 12-month follow-up period. RESULTS: Univariate regression analyses identified the following fall risk factors: disability, poor performance on physical tests, depressive symptoms, poor executive function, concern about falling, and previous falls. Classification and regression tree analysis revealed that balance-related impairments were critical predictors of falls. In those with good balance, disability and exercise levels influenced future fall risk-people in the lowest and the highest exercise tertiles were at greater risk. In those with impaired balance, different risk factors predicted greater fall risk-poor executive function, poor dynamic balance, and low exercise levels. Absolute risks for falls ranged from 11% in those with no risk factors to 54% in the highest-risk group. CONCLUSIONS: A classification and regression tree approach highlighted interrelationships and discriminatory value of important explanatory fall risk factors. The information may prove useful in clinical settings to assist in tailoring interventions to maximize the potential benefit of falls prevention strategies

Essais d'économie appliquée sur l'éducation, l'information et les salaires

This work contains three essays in Microeconometrics of Education. In the first chapter we estimate peer effects and teacher effects in a French university. Random assignment is tested and is not rejected. Teacher effects are significative and the weakest students benefit from the presence of the best students in their group, which is not detrimental for the latter. These results are robust. Consequently, the optimal policy is to mix students, and we show that segmenting students by level would imply a substantial fall of the weakest students average results.In the second chapter we study the impact of imperfect information on educational choices using an educational choice dynamic structural model. We discard the idea that individuals know perfectly their own characteristics on the labor market when they make their decision. We suppose that they build their initial a priori in accordance with their observed ability in school. Then these beliefs are updated in a bayesian way each time the individual observes a wage. We show that around 20% of individuals would educate differently with perfect information, but generally only one year more or one year less. In the third chapter, we introduce unobserved heterogeneity in earnings mobility by modelling earnings quintiles dynamics with a dynamic multinomial logit with unobserved heterogeneity. The semi-parametric estimation shows a segmentation of earnings quintiles distribution, very correlated with individuals education. Conditional transition matrices asymmetry leads to reject earnings dynamics modelisations that use standard gaussian ARMA processes. Moreover we confirm that the reduction in long term earnings inequality due to earnings mobility is almost totally driven by a reduction in within-group inequality. Also, we find a more important reduction of within-group inequality than previously estimated with observed heterogeneity.Cette thèse présente trois essais en microéconométrie de l'éducation. Dans le premier chapitre nous estimons les effets de pairs et les effets maîtres dans le cadre particulier d'une université française. L'hypothèse identifiante d'affectation aléatoire des étudiants dans les groupes est testée et n'est pas rejetée par les données. Les effets estimés sont significatifs, d'amplitude comparable et robustes. Les étudiants les moins bons bénéficient de la présence dans leur groupe des étudiants les meilleurs, sans que cela nuise à ces derniers. Par conséquent, il est optimal de mixer des étudiants de différente qualité dans les groupes, et nous montrons qu'instituer des groupes de niveau ferait chuter de manière substantielle la note moyenne des étudiants les moins bons. Dans le deuxième chapitre nous travaillons sur l'impact de l'imperfection d'information sur les choix d'éducation. Nous nous plaçons dans le cadre des modèles structurels dynamiques de choix d'éducation. Nous remettons en cause l'idée selon laquelle au moment de faire leur choix les individus connaissent parfaitement leurs propres caractéristiques sur le marché du travail. Nous supposons que les individus forment leurs croyances en fonction de leur aptitude et leur goût à l'école, qu'ils connaissent. Ces croyances sont révisées de manière bayésienne à chaque observation d'un salaire. Nous montrons qu'environ 20% des individus feraient des choix différents en information parfaite. Les différences de niveau d'éducation ne seraient cependant en général que d'une année d'études en plus ou en moins. Dans le dernier chapitre, nous introduisons de l'hétérogénéité inobservée dans la mobilité des salaires en modélisant la dynamique des quintiles de salaires à l'aide d'un logit multinomial dynamique avec hétérogénéité inobservée. L'estimation semi-paramétrique du modèle met à jour une segmentation de la distribution des quintiles, fortement corrélée avec le niveau d'éducation des individus. Le caractère asymétrique des matrices de transition conditionnelles implique le rejet des modélisations ARMA standard gaussiennes de la dynamique des salaires. Nous confirmons que la mobilité salariale ne réduit quasiment pas les inégalités salariales de long terme entre groupes, mais qu'au sein de chaque groupe elle les réduit plus ce qui avait été précédemment estimé avec de l'hétérogénéité observée