The proposed follow-up study will collect data two years after baseline interviews from the """"""""Self-Care Assessment of Community-Based Elderly"""""""" study on the same sample of 3,482 non-institutionalized elderly people aged 65 years and older. Baseline survey purposes were to provide a national database on self-care behaviors practiced by non-institutionalized elderly persons to: establish prevalence of self-care for functional impairments, symptoms of illness and health concerns, and health promotion and health maintenance; test cross-sectional exploratory hypotheses concerning self-care; and provide baseline data for further longitudinal studies. Purposes of the proposed follow-up study are to assess the: (1) extent to which patterns of self-care behavior predict policy-relevant outcomes (viz., death, institutionalized care, use of health services, health status, functional status and residential mobility); (2) extent to which patterns of self-care behavior impact upon the predicted patterns of frailty among the population ages 75-84 and 85 and older; and (3) differential impact of rural versus urban place of residence, in combination with self-care practice, on health and functional status outcome. The stratified random national sample is geographically clustered within 50 randomly selected sampling units in 38 urban and 12 rural areas across the United States. In addition to representing rural and urban populations, the sample design over-sampled the oldest ages so analyses can focus on issues related to the oldest and frail elderly population. The proposed study will re-contact all subjects by telephone to collect information about their health, functional status, residential mobility, current self-care behavior and institutionalization over the two-year period since baseline. Health Care Financing Administration data will be used to determine health care utilization and costs to Medicare. Information about deaths will be obtained through the National Death Index and death certificates. Despite the potential importance of facilitating self-care knowledge and skills as part of a national strategy for general health enhancement and health care cost containment, virtually nothing has been known about the extent to which elderly persons in the United States practice self-care in their daily lives, particularly for managing functional limitations that might otherwise necessitate institutional care. The present study provides the first nationally-representative database on self-care behaviors practiced by community-based elderly persons, and will allow generalizations about well and frail elderly persons of all age groups in rural and urban areas. This database will be useful to a variety of health and health-related professions and service organizations that assist elderly persons to live at home for the maximum possible time through cost-effective health promotion and disease prevention interventions, as well as facilitate the estimation of the insurability of long-term care services by public and private insurers.
