Abstract:
OBJECTIVE:To compare expenditures and healthcare service use between decedents (in their last year of life) and survivors, all of whom were frail older people, under three payor/provider types. DESIGN:In-home interviews were conducted by home care nurses at baseline and at 6-month intervals for an 18-month period. Utilization and cost data were collected directly from providers and the Health Care Financing Administration for 12 months immediately before death for decedents and for the first 12 months of follow-up for survivors. SAMPLE:Five hundred seventy-seven frail older patients of an integrated healthcare system who were receiving physician prescribed home health services, under Medicare fee-for-service (FFS), Medicare HMO, or Medicare-Medicaid coverage. Frailty was defined as the receipt of physician-prescribed home healthcare services. OUTCOME MEASURES:Acute and long-term healthcare service utilization and expenditures; total healthcare expenditures. RESULTS:After controlling for baseline differences, significant differences in utilization and expenditures of survivors (n = 450) and decedents (n = 127) were demonstrated. Compared with survivors, frail older decedents were approximately: 7 times as likely to have had any hospital admissions 3 times as likely to have had one or more emergency room visits 8 times as likely to have 30 or more physician visits 4 times as likely to have been admitted to a skilled nursing facility and twice as likely to have used home health services after the baseline episode. On average, total expenditures for decedents were 276% higher than for survivors. Total expenditures for Medicaid-Medicare beneficiaries were 42% higher than expenditures for FFS participants, primarily because of higher hospitalization and emergency room expenditures. There were no differences in utilization and expenditures between HMO enrollees and FFS beneficiaries. Finally, interactions between decedent status and payor/provider were not statistically significant in multivariate analyses. CONCLUSION:During the last year of life, frail older people exhibit the same pattern of higher expenditures and service utilization as the general Medicare population. However, differences between decedents' and survivors' healthcare expenditures and resource use did not vary by payor/provider. Thus, cost-containment strategies should focus on new forms of managing healthcare services beyond those currently practiced within Medicare HMOs, traditional FFS, or Medicare-Medicaid in California.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Experton B,Ozminkowski RJ,Branch LG,Li Zdoi
10.1111/j.1532-5415.1996.tb02947.xsubject
Has Abstractpub_date
1996-09-01 00:00:00pages
1098-107issue
9eissn
0002-8614issn
1532-5415journal_volume
44pub_type
杂志文章abstract:OBJECTIVES:Knowledge of male sexual function is somewhat limited because of a lack of current population-based data. This study provides information on sexual function and satisfaction in a population-based sample of men. METHODS:Men aged 40 to 79 years (n = 2115) were selected randomly from the Olmsted County populat...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1995.tb07009.x
更新日期:1995-10-01 00:00:00
abstract:OBJECTIVES:To obtain population-based estimates of emergency department (ED) visits by long-term care (LTC) residents. DESIGN:Retrospective cohort study using administrative data. SETTING:All LTC facilities in Ontario, Canada. PARTICIPANTS:All LTC residents who visited an ED at least once during a 6-month period. M...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2010.02736.x
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVES:To examine the effect of social engagement (SE) on mortality in long-term care. DESIGN:A retrospective cohort study. SETTING:A 725-bed long-term care facility. PARTICIPANTS:A total of 927 long-term care residents who had SE measurements and did not have a serious communication problem. MEASUREMENTS:Minim...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2000.tb02624.x
更新日期:2000-11-01 00:00:00
abstract:OBJECTIVES:To explore and deepen understanding of factors influencing driving exposure for older drivers. DESIGN:Cross-sectional. SETTING:Baseline data on function and driving exposure from 1 week of driving were evaluated. PARTICIPANTS:A convenience sample of 380 drivers aged 75 and older, residing in northwest Syd...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.13440
更新日期:2015-06-01 00:00:00
abstract::It has been reported that postural hypotension in the elderly is common. However, these studies included institutionalized and more or less disabled persons. Furthermore, postural hypotension may be related to baseline blood pressure. In this study, the influence of age and blood pressure on the hemodynamic and plasma...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1989.tb05684.x
更新日期:1989-06-01 00:00:00
abstract:OBJECTIVES:To develop and evaluate a modification of the Fried frailty assessment using population-independent cutpoints and to determine frailty prevalence of community-dwelling elderly people in a German population. DESIGN:Cross-sectional analysis of 8-year follow-up data of a large German cohort study. SETTING:Saa...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2012.04192.x
更新日期:2012-11-01 00:00:00
abstract:OBJECTIVES:To determine the relationships between the biomechanical properties of shoes worn in a cohort of healthy older adults and the risk of falling. DESIGN:Nested case-control study, comparing biomechanical measurements of shoes worn by those who reported a fall with measurements of shoes worn by age- and sex-mat...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2004.52507.x
更新日期:2004-11-01 00:00:00
abstract::Thirty-eight patients with dementia of various etiologies were studied longitudinally to determine the change in cognition over time in subjects with and without hearing impairment. Hearing impaired subjects were older (P less than .0001), but subject groups were otherwise comparable with respect to living arrangement...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1988.tb04363.x
更新日期:1988-11-01 00:00:00
abstract:OBJECTIVES:To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs). DESIGN:A population-based prospective cohort study from 1993 to 1995. SETTING:Community-d...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2004.52207.x
更新日期:2004-05-01 00:00:00
abstract::The objectives of this study were to examine the prevalence of assistive technology (AT) use, type of assistance used for each activity of daily living (ADL) limitation, and correlates of AT use among Native Indian aged 55 and older. Data were collected as part of a cross-sectional study of disability with 505 members...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2010.03140.x
更新日期:2010-11-01 00:00:00
abstract:OBJECTIVES:To compare reports about care experiences of individuals who died within 1 year of survey with reports of those who did not. DESIGN:Medicare Advantage (MA) Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys asked about care experiences. Survey completion dates were linked to Social Secu...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,多中心研究
doi:10.1111/jgs.12121
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVES:To compare two sarcopenia definitions and examine the relationship between them and lower extremity function and other health related factors using data from the baseline examination of the Health Aging and Body Composition (Health ABC) Study. DESIGN:Observational cohort study. SETTING:Two U.S. communities...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1046/j.1532-5415.2003.51534.x
更新日期:2003-11-01 00:00:00
abstract::A study was made of the effects of community nutrition services on 234 noninstitutional elderly aged 65 or older. Many of the problems were related to overweight and longstanding inappropriate food habits. The results indicated that counselling can stimulate an increased awareness of nutrition and improvement in the k...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1978.tb01223.x
更新日期:1978-03-01 00:00:00
abstract:OBJECTIVES:To assess the efficacy of a leg exercise performed in supine position to prevent orthostatic hypotension (OH) in older adults. DESIGN:Case-control study. SETTING:Division of Physical Medicine and Rehabilitation, Salvatore Maugeri Foundation, Scientific Institute of Veruno, Veruno, Italy. PARTICIPANTS:Indi...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.12313
更新日期:2013-07-01 00:00:00
abstract:OBJECTIVE:Prior reports on Hodgkin's disease have suggested a biologic behavior difference between young and old patients. A study of 35,033 patients could confirm that older patients do not do as well as young patients regardless of age. METHODS:The National Cancer Data Base provided data from U.S. tumor registries o...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2000.tb02653.x
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVES:To develop a prediction model for kidney transplantation (KT) outcomes specific to older adults with end-stage renal disease (ESRD) and to use this model to estimate the number of excellent older KT candidates who lack access to KT. DESIGN:Secondary analysis of data collected by the United Network for Organ...
journal_title:Journal of the American Geriatrics Society
pub_type: 社论,多中心研究
doi:10.1111/j.1532-5415.2011.03652.x
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVES:To investigate the effect of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation on quality of life (QOL). DESIGN:Randomized, double-blind, placebo-controlled trial. SETTING:Independently living individuals from the general older Dutch population. PARTICIPANTS:Three hundred two ind...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1532-5415.2009.02361.x
更新日期:2009-08-01 00:00:00
abstract::The relationship between atrial natriuretic peptide (ANP) and age was studied. In elderly subjects (65 to 84 years) higher basal ANP levels were found as compared with those found in young subjects (21 to 23 years). Volume loading (750 mL 0.9% NaCl in 60 minutes) increased ANP levels only in the aged group, and plasma...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1990.tb01502.x
更新日期:1990-11-01 00:00:00
abstract:OBJECTIVES:To describe the prevalence of visual and auditory impairment in frail older persons and to evaluate the association between sensory impairment and overall functional status. DESIGN:Prospective patient evaluation and retrospective analysis of data. SETTING:The outpatient geriatric assessment clinic of a uni...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1999.tb07432.x
更新日期:1999-11-01 00:00:00
abstract:OBJECTIVES:To examine relationships between race and psychotropic drug use (antidepressant, antianxiety, sedative/hypnotic agents) in informal caregivers with symptoms of depression who provide care for elderly relatives with progressive dementia. Whether racial differences in medication use relate to racial difference...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53155.x
更新日期:2005-03-01 00:00:00
abstract:OBJECTIVES:To examine the effect of interventions to optimize medication use on adverse drug reactions (ADRs) in older adults. DESIGN:Systematic review and meta-analysis. EMBASE, PubMed, OVID, Cochrane Library, Clinicaltrials.gov, and Google Scholar were searched through April 30, 2017. SETTING:Randomized controlled ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,meta分析
doi:10.1111/jgs.15195
更新日期:2018-02-01 00:00:00
abstract::Thirty-two patients entered a simple-blind, cross-over study on the action of tocopherol in osteoarthritis; only 3 did not complete the course. Each patient was randomly assigned either to the tocopherol group (600 mg/day for 10 days) or to the placebo group. After 10 days the groups were transposed. The analgesic and...
journal_title:Journal of the American Geriatrics Society
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1111/j.1532-5415.1978.tb01345.x
更新日期:1978-07-01 00:00:00
abstract::A retrospective analysis was made of the records of 100 consecutive geriatric patients with community-acquired bacteremia, admitted to a suburban hospital. The most frequently identified tissue sources for these bacteremias were the urinary tract (34 percent), biliary tract (20 percent), and lungs (13 percent). In 11 ...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1980.tb00622.x
更新日期:1980-07-01 00:00:00
abstract:OBJECTIVES:To determine the long-term survival and independence of individuals with stroke and percutaneous endoscopic gastrostomy (PEG) tube placement. DESIGN:Retrospective cohort study. SETTING:A longitudinal nationally representative community-based sample of older adults. PARTICIPANTS:Individuals with stroke who...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/jgs.14908
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVES:To determine whether body mass index (BMI) is independently associated with cognitive function in postmenopausal women and the relationship between body fat distribution as estimated by waist-hip ratio (WHR). DESIGN:Cross-sectional data analysis. SETTING:Baseline data from the Women's Health Initiative (WH...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2010.02969.x
更新日期:2010-08-01 00:00:00
abstract::Long-term acute care (LTAC) represents a rapidly growing category of Medicare providers, but little is known about its quality, outcomes, and cost-effectiveness. Its defining characteristic, as set by Medicare, is an average length of stay of greater than 25 days. Modern LTAC emerged in the early 1980s as a setting fo...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章,评审
doi:10.1111/j.1532-5415.2007.01162.x
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVE:To study the association of two well known risk factors for breast cancer and the association of knowledge of those risk factors with mammography utilization. DESIGN:Cross sectional: two independent random telephone surveys. SETTING:Two Northeastern metropolitan communities surveyed in 1987 and in 1989. PA...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1992.tb01848.x
更新日期:1992-08-01 00:00:00
abstract:OBJECTIVES:To assess how individual socioeconomic status and neighborhood deprivation affect frailty. DESIGN:Nationally representative population-based study, the English Longitudinal Study of Aging (ELSA), analyzed cross-sectionally. PARTICIPANTS:Four thousand eight hundred eighteen individuals aged 65 and older. M...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2009.02480.x
更新日期:2009-10-01 00:00:00
abstract::The second heart sound was studied by phonocardiography and carotid tracings in 103 elderly subjects without overt evidence of heart disease. Their ages ranged from 60 to 99 years. A normal type of splitting was found in 55.3%, and a single sound in 41.7%. The difference between these percentages and those found in 60...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1977.tb00665.x
更新日期:1977-08-01 00:00:00
abstract::The implications for society of increasing life span to 120 years can only be guessed, but comparing the diversity of responses to aging in different countries may give insights into the possible effect. A European Union-funded study of the recipients of community care services in 11 European countries illustrates how...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.2005.53497.x
更新日期:2005-09-01 00:00:00