Age differences in ratings of medical care among older adults living in the community

Development of the 'Patient perspective On Care and Rehabilitation process' instrument (POCR)

BACKGROUND AND AIMS

There is a lack of instruments for assessing patient-perceived quality of care developed from a process perspective and also from theoretical concepts based on a patient perspective. The objective was to develop an instrument for following-up the care and rehabilitation process of the elderly from the patients' perspective.

METHODS

The present instrument, the 'Patient perspective On Care and Rehabilitation process" (POCR), is based on a theoretical framework for the patients' evaluation of the care process, i.e., an instrument-construction reflecting that the patients' needs differed during the care process. The POCR contains two scales; one measures the fulfilment of needs and the other the importance of the fulfilment of needs. Data collection took place via telephone interviews.

RESULTS

A factor analysis based on 306 cases resulted in seven factors reflecting the different phases in the care process and with an explained variance of 60.8. Assessed by Cronbach's alpha coefficient, the internal consistency was 0.83 for the total importance scale and between 0.55-0.71 for each factor.

CONCLUSIONS

The POCR is a valid, reliable and useful multidimensional instrument for measuring patient-perceived outcome of the care and rehabilitation process in the elderly.

The moderators of patient satisfaction

The purpose of this study was to determine which Department of Defense (DOD) active duty patient sociodemographic, health status, geographic location, and utilization factors, predict overall patient satisfaction with health care in military facilities. A theoretical framework developed from patient satisfaction and social identity theories and from previous empirical findings was used to develop a model to predict patient satisfaction and delineate moderating variables. The major finding indicated in this study was the significance of patients' characteristics in moderating their satisfaction. Principal components factor analysis and hierarchical linear regression revealed that patient specific factors predicted patients' satisfaction after controlling for factors depicting patients' evaluations of health system characteristics. Patient specific factors provided added, although very minimal, explanatory value to the determination of patients' satisfaction. The study findings can aid in the development of targeted, objectively prioritized programs of improvement and marketing by ranking variables using patients' passively derived importance schema.

Caregiving arrangements of older disabled women, caregiving preferences, and views on adequacy of care

The role of women in caregiving to elderly people has focused primarily on their involvement as givers of care. In contrast, this article focuses on older women as recipients of caregiving. Data from the WHAS and the WHAS Caregiving Study are used to describe: the relationship of caregiving arrangements among moderately to severely disabled older women to sociodemographic, health and functional status; the characteristics of primary family caregivers and the assistance they provide; preferences for caregiving arrangements among both care recipients and caregivers; and views on adequacy of caregiving among older women cared for by family. Overall, about one quarter of these women had no caregiver, reflecting the inclusion in the WHAS of women with only moderate functional difficulty, but close to two-thirds relied on family members, and 15% on paid help only. Greater reliance on family was associated with being age 80 or older, black, and living with others. Women with poorer functioning--more ADL and IADL difficulties, difficulty taking medications without help, low cognitive functioning, not emotionally vital--also were significantly more likely to be cared for by family. Caregiving preferences varied among older women and their husband and daughter caregivers. Husbands consistently viewed in-home family help as the best caregiving arrangement regardless of levels of need. Older women and daughter caregivers both saw nursing homes as the best option for people with dementia and substantial care needs. One-quarter of elderly women chose in-home paid help as the best arrangement for meeting ADL/IADL needs. Older women generally held positive views of the assistance they received from family members. Younger women and lower income women were more likely to indicate they received less help than needed.