Title III services: variation in use within a state.

Using data from Connecticut's management information system for Title III funds, we found, first, that such services are reaching at least one person in every town and thus modestly fulfilling a gateway function; about 9% of Connecticut's elderly use Title III services, with 20% of the oldest old obtaining such services. Nutrition services are reaching the most elderly, both numerically and geographically; among the oldest old (85+), home care service use was most widespread. Indices of use were not statistically related to specific characteristics of the towns' populations (i.e., percentage of elderly, poor, or minority elderly), but small cities and rural towns had the highest use levels. Presence of nutrition sites within the town and service through two of the five area agencies on aging (AAAs) were also correlated with high service use, controlling for the rural-urban continuum. Those two AAAs received the highest per capita amount of Title III funds, based on the state's targeting formulas.

Anticipating the needs of the U.S. aged in the 21st century: dilemmas in epidemiology, gerontology, and public policy.

Reductions in the prevalence of chronic disease, functional dependence, and associated social problems among aged Americans have been predicted on the basis of improving environmental and social conditions, more effective public health measures, and advances in medical care. Public policy makers have found such predictions attractive since improved health status in old age could significantly offset the increase in health care resources which would otherwise be required to meet the needs of the country's growing number of elderly. This paper reviews the epidemiologic model underlying such predictions. Key assumptions of the model are evaluated by examining the health and social well-being of elderly residing in a socioeconomically advantaged community with an age structure similar to that projected for the United States in the 21st century. Despite their long-standing advantages in education, employment, income, housing, health care, and community services, these elderly experienced age adjusted rates of health and social problems comparable to those found in nationwide samples of elderly. No evidence of a compression of health problems into the final years of life could be found. Considerable diversity in problem constellations suggested a need for sophisticated packages of health and support services. These findings suggest that any significant improvements in the health status of the aged due to general improvements in living conditions or health behavior are unlikely to emerge before the proportion of aged Americans doubles in the first quarter of the 21st century. If this is so, public policy in the U.S. must be directed to expanding and improving health and social services for the elderly in the foreseeable future. Attempts to hold expenditures on the aged constant, or to reduce such expenditures, would seriously compromise the health of the nation's elderly.

An alternative model in geriatric care.

An analysis is presented of one long-term care facility's attempt to develop a comprehensive geriatric program including care of the patient in a hospital, a skilled nursing home, a day hospital, or a clinic for care of the ambulatory aged. The goal was to raise issues for debate and discussion, especially in terms of the evolving role of medical directors in long-term care. The need for group professionalism in cooperation with the Board of citizens in community geriatric practice is emphasized.