No abstract

Data on 15,899 noninstitutionalized, elderly adults taken from the 1978 Health Interview Survey were used to assess the effects of the predisposing, enabling, and need characteristics on the volume of physician and hospital utilization. These were measured three ways: the actual number of visits (nights), and truncated and logarithmic transformations of that actual volume. Multiple regression analyses explain 3.9% to 21.3% of the variance in physician utilization and 5.1% to 9.4% of the variance in hospital utilization. The unique contributions of the need characteristics account for 56.8% to 66.7% of the variance explained in physician utilization and 74.5% to 77.7% of the variance explained in hospital utilization, suggesting an apparently equitable system is operative in elderly adults' use of health services. The effects of the three methods of coding physician and hospital utilization on the significance of the regression coefficients and the magnitude of the R2 values were examined and their implications are discussed.

The development of a 16-item nutritional risk index (NRI) is chronicled from its inception through its application in three studies designed to assess its reliability and validity. Study I involved a survey of 401 community-dwelling elderly in St. Louis, Missouri who were interviewed at baseline, 4-5 mo later, and 1 yr later. Study II involved a cross-sectional survey of 377 male outpatients attending two clinics at the St. Louis Veterans Administration Medical Center. Study III involved a cross-sectional survey of 424 community-dwelling elderly in Houston, Texas. Internal consistency reliability coefficients ranged between 0.47 and 0.60, and test-retest reliability coefficients ranged between 0.65 and 0.71. Validity was established by using the NRI to predict the use of health services, as well as by correlating it with a variety of anthropometric, laboratory, and clinical markers of nutritional status. The utility of the NRI for future applications is discussed.

Audio tapes of encounters between a physician, an elderly patient and an accompanying relative are used to describe the formation of coalitions in triadic relationships. A coalition is defined as interaction between two members of a triad who adopt a common strategy in contention with the third member. Preliminary analysis suggests that each medical encounter may contain several coalitions which vary in duration, topic, objectives of members and alignment of members.