We will examine how responsiveness of Health Care Partners (Primary Care Physicians and Health Significant Others) and self- care undertaken by old-old adults (80+) lessens the adverse impact of chronic illness on their ability to function and help maximize the quality of their lives. Physicians, patients, and Health Significant Others are seen as partners in care, with responsiveness of Health Care Partners enhancing preventive and corrective self-care by patients. Extensive data will be obtained from elders about self-care goals and strategies, patterns of consultation with Health Care Partners, other providers, and lay health consultants, and about perceived responsiveness of Health Care Partners. A major innovative focus of the study deals with mutual influences between responsiveness of Health Care Partners on patterns of support use by elders. Complementary and compensatory models of patient interaction with physicians and Health Significant Others will be considered. We will obtain a long term longitudinal follow-up of old-old adults living in sunbelt retirement communities and a broad cross-section of urban elderly and racial minorities. We will collect four annual waves of data based on in-home interviews of an estimated 350 respondents in Florida and 350 respondents in Cleveland. These elderly constitute committed cohorts in two probability samples of community-based elders. Based on prior attrition rates, a combined sample size of 527 elderly persons is projected for the fourth year follow-up. We will also conduct annual telephone surveys with Primary Care Physicians and Health Significant Others of respondents to ascertain responsiveness in terms of patient knowledge, involvement and communication. We will use least squares regression, structural equations, latent growth curve analysis, and event history analysis to test our comprehensive causal model regarding buffers of the Disability Cascade. Specifically, we will examine the buffering effects of patient-responsive medical care, lay support, and proactive adaptation on the progression from chronic illness to disability and diminished quality of life. Data will also be obtained on satisfaction with health care, mortality and cost of care (information based on Medicare records) as salient medical outcome variables.
| Kahana, Boaz; Dan, Amy; Kahana, Eva et al. (2004) The personal and social context of planning for end-of-life care. J Am Geriatr Soc 52:1163-7 |
