Race differences in the health of elders who live alone.

This investigation was initiated to determine whether older African Americans who live alone are in poorer health than their White counterparts who live under the same circumstances. Data on 5 measures of health were collected in telephone interviews with a stratified random sample of community-dwelling elders (n = 1,189). Analysis of weighted data indicate that there were fewer differences in health by race among older persons who lived alone compared to elders who lived with others. Where racial differences in health did exist among older adults who lived alone, the differences could only sometimes be accounted for by population composition factors that are known to influence health.

Dental health attitudes among dentate black and white adults.

OBJECTIVES: Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use. METHODS: As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried. RESULTS: Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account. CONCLUSIONS: Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.

Racial differences in the household composition of elders by age, gender, and area of residence.

Using census data and an innovative technique for describing the composition of households from the perspective of elders, this research provides a more detailed description of race differences in living arrangements of older persons than has previously existed. In addition, cross tabulations of race with other factors known to influence household composition (gender, age, and area of residence) are examined. While white women are more likely than black women to live alone, the reverse is true among men. Whites are more likely than blacks to live in married-couple-only households, and blacks are more likely than whites to live in multigenerational households, although these differences decrease with advancing age. Blacks are also more likely than whites to live with collateral kin or non-kin only, although these categories comprise small proportions of the population. Implications of these differences for caregiving and quality of life among older persons are discussed.

Residential differences in the use of pharmacies by older adults and their communication experiences with pharmacists.

This investigation compares adults (65 and older) living in two different types of communities on the characteristics of the pharmacies they use and their patterns of communicating with pharmacists. Telephone interviews were conducted with a random sample (N=400) of respondents, half residing in six nonmetropolitan counties (containing no towns of more than 4,000) and the other half in a single city (population approximately 130,000) located within a metropolitan county. Elders living in the sparsely populated nonmetropolitan areas were more apt to purchase their medications from an independent neighborhood pharmacy than their counterparts who lived in the large city. These pharmacies, however, were more likely to be located in another town. Differences between residential groups were also observed in the communication patterns that older patients had with their pharmacists. Elders residing in sparsely populated areas reported more frequent conversation with their pharmacists about general topics, although not about medicines or other health-related topics. The elders living in small and remote places also reported that they talked with their pharmacists longer, that communication about medications were more often initiated by the pharmacist, and that they were more likely to talk about their medications directly with their pharmacist rather than a non-pharmacist employee. The overall greater frequency of contact and communication between nonmetropolitan elders and their pharmacists would seem to be precursors to establishing a positive provider-client relationship and may increase the probability of more personal, medication-related discussions. Further research is needed, however, to determine if these potentials are transformed into realities and if they lead to more positive medical outcomes for older persons.

Job satisfaction of nurses employed in rural and urban long-term care facilities.

Previous investigators have identified residential differences in the job satisfaction of hospital nurses. However, the degree to which the greater job satisfaction of rural nurses can be generalized beyond hospitals to other work settings, including nursing homes, is unknown. The purpose of this research was to examine the job satisfaction of nurses (registered and licensed practical) employed in both rural and urban nursing homes. A total of 281 nurses from 26 participating nursing homes completed a mailed questionnaire that measured the personal and job-specific characteristics of the nurses and the contextual properties of the facilities in which they worked. The data indicated no statistically significant differences in the overall job satisfaction, or on any of the five subscales of the instrument, between rural and urban nurses. However, a pooled multivariate model identified five factors that predicted the job satisfaction of nurses employed in long-term care facilities: the employees' race and personal income; the employees' perception that their supervisor was interested in their career aspirations; the length of time that the nurses had intended to stay at the time of their hiring; and their current intent to leave.

Should intrastate funding formulae for the Older Americans Act include a rural factor?

Most states maintain an Intrastate Funding Formula (IFF) to allocate Older Americans Act funds to planning and service areas within their state. The intention of these formulae is to target resources to those elders in the greatest economic and social need. To achieve this objective, the vast majority of states include measures of age, income, and race in their IFFs. In contrast, the inclusion of a geographic or rural factor is much more controversial. This research was initiated to determine if there was empirical support for the argument that residence influences the need for services after controlling for those factors commonly used by most states in their IFFs. Using data from the Supplement on Aging to the 1984 National Health Interview Survey, the results demonstrate that residing in a nonmetropolitan area increases the likelihood of poor health and the need for services after controlling for age, income, and race. Results also indicate that collectively the four predictor variables account for a very small proportion of the variance in need.

Residential differences in the use of formal services prior to entering a nursing home.

The relationship between place of residence and use of formal services prior to entering a nursing home was examined in a sample of older persons within 30 days of admission. There were no residential differences in the percent reporting the use of formal services prior to admission. Among those who had been receiving services, there were no residential differences in the number of services received, the kinds of services used, or the average length of time services had been received. Residents of rural facilities were more apt to indicate that needed services were not available in their communities.

Discrepancies in employer-sponsored health insurance among Hispanics, blacks, and whites: the effects of sociodemographic and employment factors.

Using a nationally representative sample of employed adults from the 1987 National Medical Expenditure Survey (NMES), this research explores differences in the incidence and predictors of employer-sponsored health insurance among Hispanics, blacks, and whites. The data suggest that: 1) whites are most likely, and Hispanics are least likely, to have employer-sponsored medical insurance in their own name, or in the name of another individual; 2) Hispanics are most likely, and whites are least likely, to be completely uninsured; and 3) the factors which increase the odds of receiving employer-sponsored coverage in one's own name are relatively similar across racial groups, though they differ substantially in magnitude.

Predicting the receipt of employer-sponsored health insurance: the role of residence and other personal and workplace characteristics.

Americans without health insurance constitute a significant public policy concern. Previous research has demonstrated that rural Americans are more likely to be without coverage. Beyond documenting this comparative disadvantage, however, current research has two specific deficiencies: studies have not examined whether the factors that predict the receipt of employer-sponsored health insurance are equivalent across residence categories, and few studies have used a multivariate framework to examine the predictors of the receipt of health insurance. Using data from the 1987 National Medical Expenditure Survey, the influence of residence is examined along with other variables known to be associated with an increased likelihood of receiving health insurance from an employer (specifically, seven employee and six workplace characteristics). At a bivariate level, an individual's place of residence did affect the probability of receiving health insurance from an employer, with nonmetropolitan workers least likely to receive such benefits. The influence of the employee and workplace characteristics on receipt of insurance, however, did not vary significantly by place of residence. In a multivariate model, six employee and six workplace characteristics were identified as significant predictors. These findings do not refute the existence of important residential differences in health insurance coverage, rather, they suggest that the differences are due to identifiable population and workplace characteristics that vary in their distribution by residence.

A multivariate assessment of the effects of residence on infant mortality.

This research examines the relationship between residence and infant mortality. The purpose of the study was to identify the effects of maternal residence on infant mortality, using a multivariate model which included both individual and county-level variables known to be associated with suboptimal birth outcome. Data on all births in Florida during 1987 were drawn from birth and infant death certificates. In addition, information concerning county sociodemographic structure and medical resources were gathered and linked to the individual records. After examining the distributions of selected risk variables across a five-category measure of residence (from most urban to most rural), a logit model was estimated to predict the odds of an infant death associated with maternal residence. At the bivariate level, rural residents were found to have increased odds of an infant death compared to residents of all other residence categories. Second, a logit model was estimated that controlled for the influence of important maternal, infant, and county risk characteristics. The results of this second, more fully specified model indicate that residence did not have an independent direct effect on infant mortality when the influence of the other risk factors was controlled. We conclude that although residence does not influence infant mortality directly, it does influence mortality indirectly through its association with key risk factors. In particular, because population characteristics and medical resources are differentially distributed across rural and urban areas, residence remains an important factor to be considered when predicting health outcomes. The implications of these findings for policy-makers and health planners, as well as for health services researchers, are also discussed.

Informal and formal health care systems for the rural elderly.

The preceding sections have been an attempt to touch on a broad spectrum of issues related to the health care of older persons living in the rural United States. This article was intended to be an overview of research issues and, as a consequence, we have been unable to go into great depth in any one area of inquiry; we have certainly not included all of the research questions on areas where present knowledge is incomplete. In broad terms, we suggest that future rural health services research on the elderly be concentrated on the following five major categories of inquiry: --A better understanding of the location and distribution of the elderly in rural America --A better understanding of the life conditions affecting the health of the rural elderly --A better understanding of the health status of the rural elderly --A better understanding of the development, delivery, and impact of health services for the rural elderly, and --A better understanding of the methodological and theoretical difficulties of studying the health and health care of the rural elderly.

Residence differences in the health status of elders.

Using data from the 1984 Supplement on Aging to the National Health Interview Survey, this study examined residential differences on a selected group of health status measures among persons 65 years of age and older (N = 11,497). Mean values on indicators of health and impairment for each of the residence categories were examined before and after adjusting for distributional differences in background and demographic characteristics which are associated with both health and residence. Three important conclusions emerged from the analysis: (1) health status does not vary with residence in a unitary fashion; (2) the relationship between residence and health status does not appear to fall along a straightforward rural-urban continuum; and (3) there is both diversity in, and a general patterning of, the significant relationships between health and residence with the extremes of health status located in the rural categories.