A sample of 40 elderly residents was observed for 14 days on each of three consecutive occasions separated by 3 months. The observations focused on interactions involving the elderly resident and social partners. The results indicated a high level of stability across occasions in resident behaviors. The interactional and behavioral profiles observed were similar across length of institutionalization, sex, and health status of residents for the institutional context studied. Examination of interactional patterns for the different resident behaviors, however, revealed quite discrepant social contingencies. Following dependent self-care behaviors of residents, interactional responses by social partners represented a continuous supportive behavior contingency; following independent self-care behaviors, no social contingencies were observed. Similarly, obstructively engaged and nonengaged resident behaviors were not followed by any social contingencies; following constructively engaged behaviors of residents, an intermittent supportive contingency by social partners was found. The results are discussed in relation to learned helplessness and control.
A number of state-level pharmaceutical assistance programs have been established as a result of the growing recognition of the role of pharmaceuticals in the long-term care of the elderly. However, existing research does not provide a coherent expectation for patterns of use by rural and urban elderly. The data for this analysis are drawn from a larger study of the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE). PACE provides prescription medicines for elderly who meet income requirements. The research project was designed to assess the characteristics of PACE program participants and non-participants on a wide range of issues. Chi-square analysis and regression models were used to assess the association between rural and urban residence and access to the PACE Program. The results indicate that rural/urban status of the elderly is not a significant predictor of the use of PACE. Other traditional variables (e.g., health self-rating and physician visits) did predict difference in the pattern of use.
Despite documentation that rural elderly have reduced access to both primary care and specialist physician services, there have been very few studies comparing rural and urban patterns of prescription drug use. This is unfortunate, because prescription drugs are the most commonly used type of health care by the elderly. This research merged claims data for a random sample of 18,641 enrolled elderly in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) for the years 1984 through 1988 with Medicare inpatient and outpatient health services records and with county-level demographic and health services resources data bases to test several models of factors associated with prescription drug use. The Human Resources Profile County Code from 1980 census data (HRPCC80) in the Area Resource File provided a very detailed (10 levels) definition of rurality. Consistent with our hypotheses based on preliminary studies, neither rurality designations nor county-level health care resource indices, nor interaction terms of health services resources with rurality were powerful predictors of prescription drug use. Use of health services (from Medicare data) and variables of longevity and continuity in the PACE program were consistently robust predictors of prescription drug use. Personal demographic characteristics were also strong predictors: white widowed women under age 85 with relatively higher incomes used more prescription drugs.
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