The proposed research will assess changes in functional and health characteristics of an elderly (65+) and oldest-old (85+) nationally representative sample of persons followed from 1982 to 1988. Changes in the use of acute and LTC services for persons of equivalent health and functional status will be examined by relating patterns of Medicare SNF, Home Health and acute hospital use for three periods related to recent Medicare changes, i.e., before (before Oct. 1983), during (Oct. 1983 to Oct. 1987), and after (after October 1987) the introduction of Prospective Payment for reimbursement of acute hospital stays. The 1988 survey provides 6 years observation of the mortality, health and functional changes of persons surveyed in 1982 and 4 years on those surveyed in 1984. Medicare Part A records for the period 1980-89 will be linked to all persons in the 3 surveys. Deaths will be identified in Medicare records and death certificates obtained using the National Death Index. For comparability, questionnaires in earlier surveys will be used in 1988 as well as similar sampling procedures for persons who a.) were 65+ in 1984 but not disabled or institutionalized and b.) became 65 between 1984 to 1988. The instruments provide detailed information on functional and health status, informal care support, sociodemographics, housing, health service and economic status. A public use file with longitudinally linked records for 1982, 1984, and 1988 will be released as soon as a cleaned tape with longitudinal weights is available. The linked longitudinal surveys and Medicare Part A files will be used to analyze, with multivariate event history models: a.) functional and health status changes, b.) trajectory of service use of different types (i.e., hospital, SNF and home health) for persons with different levels and types of functional impairment, c.) effects of changes in Medicare on the service use trajectories for persons with specific types of health and function problems, and d.) differential effects of cognitive impairment versus physical disability on Medicare service use. Data will also be available on two longitudinally followed Medicaid populations. Methodological development of multivariate event history strategies for analyzing linked morbidity, disability and mortality processes will be conducted.
Showing the most recent 10 out of 14 publications
