Validation of a fall-risk screening test, the Elderly Fall Screening Test (EFST), for community-dwelling elderly.

Falls are the most common type of injury among the elderly, and the source of both functional and psychological morbidity. The aim of this study was to validate the Elderly Fall Screening Test (EFST). In a community primary-care clinic, the members 60 years or older who were functionally independent were screened. Of the 568 elderly persons who met these criteria, 361 were interviewed once and 283 persons were re-interviewed a year later. The EFST, a five-item test, was used to divide participants into low- and high-risk groups. Concurrent criterion validity was assessed by physical examinations conducted by physicians who were blind as to the risk designation. Using data from the follow-up interview, predictive validity was assessed on both fall-related and general health measures. Based on the results of the EFST, 28% of the respondents were designated as being at high risk for falls (i.e. having a score of two or more risk items). The results of physicians' examinations corroborated the screening test results in 75% of the cases, with 83% sensitivity and 69% specificity. In the follow-up interview, the high-risk group, as compared to the low-risk group, was more likely to have high scores on EFST, a fall in the past month or year, frequent near falls, and an injurious fall. Those with high EFST scores were more likely to report four or more sick days in the past six months, a hospitalization in the past year, poor self-rated health, a decline in health in the past 6 months, and symptoms of depression. The EFST has both criterion and predictive validity. It can be useful in community-based prevention programmes with functionally independent elderly people.

After epidemiological research: what next? Community action for health promotion.

The underlying purpose of all epidemiological research is ultimately to use inferences in order to prevent disease and promote health and well-being. Effective skills in translating results into appropriate policy, programs, and interventions are inherently tricky, and often politically controversial. Generally they are not taught to epidemiologists formally, even though they are a traditionally part of public health practice. To move from findings to policy change requires that the informed and committed epidemiologist should known how to: (1) organize affected parties to negotiate successfully with government and industry; (2) activate populations at risk to protect their health (3) communicate responsibly with lay persons about their health risks so as to encourage effective activism; (4) collaborate with other professionals to achieve disease prevention and health promotion goals. The paper presents and discusses four case studies to illustrate these strategies: (1) the grass-roots social action that was the response of the community to the environmental contamination at Love Canal, New York; (2) mobilization of recognized leaders within the gay community to disseminate HIV risk reduction techniques; (3) collaboration with an existing voluntary organization interested in community empowerment through health promotion in a Chicago slum by using existing hospital, emergency room admissions, and local motor vehicle accident data; (4) a self-help group, MADD (mothers against drunk driving) which fought to change public policy to limit and decrease drunk driving. In addition, the importance of multidisciplinary collaboration and responsible communication with the public is emphasized. Factors that limit the ability of the epidemiologist to move into public health action are discussed, including who owns the research findings, what is the degree of scientific uncertainty, and the cost-benefit balance of taking affirmative public action. Putting epidemiological knowledge to good use should be an integral part of an epidemiologist's repertoire.

Elderly volunteers: assessing their potential as an untapped resource.

In these times of dwindling resources for human services, the elderly are considered by many policy analysts and researchers to be the largest untapped source for volunteer recruitment. In this article we identify the origins of this societal expectation, its current actualization, and then analyze factors contributing to and deterring actual deployment of large numbers of elderly as volunteers. To assist in this analysis we have employed the conceptual framework that examines expected age, period, and cohort effects among the elderly on volunteerism in order to provide a basis for more realistic projections. Our findings indicate that elderly volunteers cannot be viewed as the cure-all to a squeeze on economic resources. In light of expected changes in future cohorts, elderly volunteers can be expected to increase their contribution only if creative recruitment and training methods will be used by volunteer administrators.

Organizing social work services with adult cancer patients: integrating empirical research.

Today only half of those diagnosed with cancer will die of the disease, leaving enormous room for psychosocial interventions to improve the psychological or functional status of those coping with the disease. Therefore, social workers in oncology must be current with empirical research. In an effort to integrate current research into social work practice, we reviewed empirical studies with sound research designs to answer the following questions: (1) What portion of cancer patients are likely to need social work services? (2) What types of services do social workers provide to meet these needs? and (3) Who is likely to be (or not to be) the recipient of these services. Does intervention research include diverse (non-traditional, non-white and non-middle class) clients? The results show about one third of patients will be judged at high-risk for psychosocial problems but that only 15-25% of those who are diagnosed with cancer will eventually use psychosocial oncology services. Some have mainly instrumental, concrete needs, and others will use psychosocial counseling. A review of the inclusion of minorities and non-traditional, non-middle-class groups, shows that they are not adequately represented in current intervention research in psychosocial oncology. Methods for enlarging their access and participation are suggested.

Social work with adult cancer patients: a vote-count review of intervention research.

The meaning of a cancer diagnosis has changed in the past decades, bringing with it a myriad of psychosocial interventions to improve the psychological or functional status of those coping with the disease. Today, social workers in oncology need to be current with research in order to integrate empirical and practical knowledge. In an effort to assist in this process, we reviewed empirical studies to address the following questions: (1) When are patients likely to be willing to accept help? (2) Is there sufficient evidence to show that some types of psychosocial treatment are effective in improving psychological or physical functioning? (3) Are certain treatments preferable for some cancer patients depending on the type of cancer and stage of disease? Using a vote-count review of 40 intervention studies in psychosocial oncology, 36 documented some positive outcomes from treatments, 4 studies exhibited null findings, and no studies were found to have clearly negative results. Studies revealed the most positive results from interventions during the treatment phase, next from interventions at diagnosis, and lastly from interventions during the terminal stage. Individual and group formats showed a comparable level of efficacy. Interventions that included cognitive behavioral methods had the most consistently positive results. Those intervention studies where social workers were involved in the research were less successful at demonstrating efficacy. This difference was due primarily to the fact that social workers often did not include cognitive behavioral interventions in their research. Based on the results of this study, social workers might want to reevaluate their intervention strategies.

Stress management consultation to Israeli social workers during the Gulf War.

Social workers operating under emergency conditions may feel overwhelmed and incapacitated by their own stress reactions. During the Gulf War, social work faculty in Israel acted as consultants to help hospital social workers manage stress and regain professional efficacy. The Stress Management Consultation (SMC) was a short-term group intervention designed to enable social workers to work through their stress reactions and to model a method the workers could use with their own target populations. Qualitative feedback from both participants and administrators indicated that the SMC model was effective and could be applicable to a large range of settings and treatment populations.

Blood pressure among immigrants to Israel from areas affected by the Chernobyl disaster.

OBJECTIVES: To validate and analyze apparent association of hypertension with exposures to radiation at Chernobyl among immigrants to Israel from the contaminated areas. METHODS: Data were collected in 1991 and 1994 from two samples of persons who immigrated to Israel from the contaminated zone around the Chernobyl nuclear power plant. The first sample were self-referred for evaluation in a clinic by whole-body cesium measurement, physical examination, and questionnaire (N = 756, 328 from less exposed and 438 from more exposed areas). The second wave data were collected in 1994 during home interviews for evaluation of psychosocial factors associated with their experience (N = 708, 121 from more exposed and 253 from less exposed areas). In the second study a referent group was included (n = 334) who were matched by age, sex, and year of immigration who immigrated from other areas outside of the contaminated zone. Estimates of exposure were based on the IAEA map of ground-level cesium isotope (137Cs) contamination. RESULTS: In the 1991 sample, 21% from high exposure areas and 16% from less exposed areas had elevated systolic blood pressure (> 140 mmHg). Elevated diastolic blood pressure (> 90 mmHg) had a similar difference between more and less exposed groups (21% and 16%). Age- and sex-specific analyses showed that statistically different levels were found in the older age groups. In the 1994 sample, we confirmed a relationship between exposure and elevated blood pressure. 33% of those from the more exposed areas and 34% of those from less exposed areas had elevated systolic blood pressure, compared with 23% of the comparison group, with a similar trend found in diastolic blood pressure. The relationship between exposure and blood pressure was accentuated in the group of respondents who had high scores on PTSD symptoms. Of the psychological variables analyzed, systolic blood pressure was most strongly related to cancer-related anxiety and somatization. A discriminant function analysis showed that three variables: age, reporting a significant loss from the Chernobyl accident, and fear of cancer correctly differentiated 72% of those with normal and high blood pressure. CONCLUSIONS: There is a relationship between exposure to Chernobyl and high blood pressure, partly due to the psychological reactions to the accident.