No upper age limit exists for Medicare benefits for mammography screening, but benefits for women older than age 75 remain unclear. From a clinical perspective, it would be useful to know if there is an upper age limit for women beyond which screening for breast cancer will not extend life. Using a decision-analysis model, the author examined the utility of screening using cohorts of women age 75 to 79, 80 to 84, and 85 and older, with and without cognitive impairment. The analysis evaluated different scenarios of the benefit of biennial screening versus no screening for women who had no prior screening and women who had participated in a regular screening program. Screening increased Quality Adjusted Life Years (QALYs) at all ages. Marginal savings in life expectancy adjusted for quality of life for women with no prior screening ranged from 43.5 days for healthy 75 to 79-year-old women to 25.9 days for women older than age 85. Among cognitively impaired women who were never screened, savings ranged from 20 to 5.5 days for the three age cohorts. Biennial screening among women who had been screened continuously resulted in substantially smaller life expectancy savings, from 3.3 days for healthy individuals age 75 to 79 to less than 1 day for women older than age 85. Cost effectiveness analysis indicated the reduction in costs associated with managing recurrent disease gained by early diagnosis with mammography was greatest among the population with no prior screening. Although the increase in QALYs was consistently lower for cognitively impaired women than for their healthy counterparts, the presence of cognitive impairment did not alter the finding that screening increased QALYs.
During the Persian Gulf War (1990-1991), more than 228,000 National Guard and reserve members were recalled to active duty. Little information exists about the effect of wartime military separation among the civilian spouses of guard and reserve personnel. This grounded theory study describes the effect of the Persian Gulf War separation on 14 guard and reserve spouses. Data were generated from in-depth interviews and were analyzed using the constant comparative method. Three patterns of coming to terms with the separation emerged from analysis of the intensive interviews: (a) settling in immediately, (b) struggling followed by settling in, and (c) struggling without relief. Each pattern is associated with different patterns of social support that affect the relationship between uncertainty and adjustment. These findings provide important information for nurses who work with spouses who can anticipate this type of separation.
Resilience, a novel variable in fibromyalgia research, was a unique predictor of physical function. Further research is needed to learn more about the relationships between resilience, fibromyalgia impact, and the aging process.
Although several definitions and categorizations of home environmental modification strategies exist, previous researchers have not addressed whether the conceptualizations developed by clinicians and researchers match the way families think about how they modify the home environment in order to provide care to frail elders. The aim of the analysis reported here was to describe, from the family's perspective, the home environmental modification strategies that they use. Twenty-four caregivers of community-dwelling elders with a variety of impairments were interviewed. Seventeen families provided guided tours of the elder's home and allowed selected observation of some caregiving activities. Forty-four modification strategies were identified and categorized into one of seven home environmental modification purposes: organizing the home, supplementing the elder's function, structuring the elder's day, protecting the elder, working around limitations or deficits in the home environment, enriching the home environment, and transitioning to a new home setting. More research is needed on the processes families use to generate and refine the home environmental modification strategies identified in this study.
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