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[Abolish the humiliating age limit of 65!].

https://arctichealth.org/en/permalink/ahliterature195893
Source
Lakartidningen. 2000 Dec 6;97(49):5828
Publication Type
Article
Date
Dec-6-2000
Author
B. Blomquist
Source
Lakartidningen. 2000 Dec 6;97(49):5828
Date
Dec-6-2000
Language
Swedish
Publication Type
Article
Keywords
Aged
Employment
Health Policy
Humans
Physicians
Prejudice
Private Sector
Public Sector
Sweden
PubMed ID
11188049 View in PubMed
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Accessibility and the Canadian health care system: squaring perceptions and realities.

https://arctichealth.org/en/permalink/ahliterature182001
Source
Health Policy. 2004 Feb;67(2):137-48
Publication Type
Article
Date
Feb-2004
Author
Kathi Wilson
Mark W Rosenberg
Author Affiliation
Department of Geography, University of Toronto at Mississauga, Mississauga, Ont., Canada L5L 1C6. kwilson@eratos.erin.utoronto.ca
Source
Health Policy. 2004 Feb;67(2):137-48
Date
Feb-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude to Health
Canada
Family Characteristics
Female
Health Care Surveys
Health Policy
Health Services Accessibility - standards
Humans
Male
Middle Aged
National Health Programs - organization & administration - standards - utilization
Public Opinion
Socioeconomic Factors
Waiting Lists
Abstract
The 1984 Canada Health Act (CHA) is the major piece of Federal legislation that governs health care accessibility in the provinces and territories. According to the CHA, all provinces and territories in Canada must uphold five principles in order to receive federal funding for health care (universality, comprehensiveness, portability, public administration, and accessibility). In Canada, there are competing views among policy makers and consumers about how the CHA's principle of accessibility should be defined, interpreted and used in delivering health care. During the 1990s, the health care perceptions of Canadians and their health care behaviours were measured through both public opinion polls and Statistics Canada's National Population Health Survey (NPHS). The goal of this paper is to examine perceptions of accessibility in public opinion polls and actual accessibility as measured through the NPHS. Public opinion polls demonstrate that while Canadians want to preserve the principles of the CHA, a majority of Canadians are losing confidence in their health care system. In contrast, the results from the NPHS reveal that only 6% of Canadians aged 25 years and older have experienced accessibility problems. Among those who report access problems, the barriers to accessibility are linked to specific socio-economic, socio-demographic and health characteristics of individuals. We discuss these findings in the context of the current debates surrounding accessibility within the CHA and the Canadian health care system.
PubMed ID
14720632 View in PubMed
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According to need? Predicting the amount of municipal home help allocated to elderly recipients in an urban area of Sweden.

https://arctichealth.org/en/permalink/ahliterature51849
Source
Health Soc Care Community. 2005 Jul;13(4):366-77
Publication Type
Article
Date
Jul-2005
Author
Bettina Meinow
Ingemar Kåreholt
Mårten Lagergren
Author Affiliation
Department of Social Work, Stockholm University, Stockholm, Sweden. bettina.meinow@neurotec.ki.se
Source
Health Soc Care Community. 2005 Jul;13(4):366-77
Date
Jul-2005
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Health Policy
Health services needs and demand
Home Care Services - utilization
Humans
Male
Research Support, Non-U.S. Gov't
State Medicine
Sweden
Urban Population
Abstract
Given the cutbacks which have been carried out in the Swedish welfare state despite the unchanged official policy of allocation of home help services according to needs, it is essential to evaluate the factors which guide the allocation of home help today. Whereas numerous studies have identified factors which predict entry into the home help system, the present paper concentrates on predictors of the amount of home help amongst those allocated assistance. Data were obtained from the population-based care and services section of the 2002 Swedish National Study of Aging and Care-Kungsholmen (SNAC-K). All home help recipients (> or = 65 years of age) living in an inner city district of Stockholm (Kungsholmen) were analysed with ordinary least squares regressions to identify predictors of the number of hours of home help (n = 943). Need indicators, i.e. dependency in activities of daily living (ADLs) and instrumental ADLs (IADLs), and cognitive impairment (Berger scale) were the strongest predictors of more hours of home help. The addition of sociodemographic (i.e. age, gender and income), environmental (i.e. informal care, housing adaptations and housing accessibility) and structural (i.e. variations in allocation decisions between one care manager and another) factors contributed only marginally to the explained variance. Hours of help entitlement increased slightly with greater age. Co-residing individuals were allocated significantly fewer home help hours than those living alone. Income and regular access to informal care were not significant predictors. The fact that services are provided according to need criteria does not necessarily mean that the provided services are adequate to meet needs. On the macro level, social policy decisions and available economic and manpower resources determine the allotment of municipal home help. However, this study in an urban sample suggests that, within the available resources, the amount of home help allocated is guided mainly by need indicators amongst those given assistance.
PubMed ID
15969708 View in PubMed
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Addressing social and gender inequalities in health among seniors in Canada.

https://arctichealth.org/en/permalink/ahliterature184961
Source
Cad Saude Publica. 2003 May-Jun;19(3):855-60
Publication Type
Article
Author
Louise A Plouffe
Author Affiliation
Division of Aging and Seniors Health Canada, Ottawa, Ontario, Canada.
Source
Cad Saude Publica. 2003 May-Jun;19(3):855-60
Language
English
Publication Type
Article
Keywords
Aged
Aging - physiology
Canada
Community Health Planning
Female
Health Policy
Health status
Health Status Indicators
Humans
Male
Quality of Life
Sex Factors
Social Justice
Social Security
Socioeconomic Factors
Abstract
Although canadian seniors enjoy economic security and good health and have made substantial gains in recent decades, this well-being is not equally shared among socioeconomic groups and between men and women. As for younger age groups, income predicts health status in later life, but less powerfully. Potential alternative explanations include an overriding influence of the aging process, the subjective effects of income loss at retirement and the attenuation of the poverty gap owing to public retirement income. Older women are more likely to age in poverty than men, to live alone and to depend on inadequately resourced chronic health care and social services. These differences will hold as well for the next cohort of seniors in Canada. Addressing these disparities in health requires a comprehensive, multisectoral approach to health that is embodied in Canada's population health model. Application of this model to reduce these disparities is described, drawing upon the key strategies of the population health approach, recent federal government initiatives and actions recommended to the government by federal commissions.
PubMed ID
12806488 View in PubMed
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Adherence to beta-blocker therapy under drug cost-sharing in patients with and without acute myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature162000
Source
Am J Manag Care. 2007 Aug;13(8):445-52
Publication Type
Article
Date
Aug-2007
Author
Sebastian Schneeweiss
Amanda R Patrick
Malcolm Maclure
Colin R Dormuth
Robert J Glynn
Author Affiliation
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St (Ste 3030), Boston, MA 02120, USA. schneeweiss@post.harvard.edu
Source
Am J Manag Care. 2007 Aug;13(8):445-52
Date
Aug-2007
Language
English
Publication Type
Article
Keywords
Acute Disease
Adrenergic beta-Antagonists - economics - therapeutic use
Aged
Aged, 80 and over
British Columbia
Case-Control Studies
Cohort Studies
Comorbidity
Cost Sharing
Deductibles and Coinsurance
Diabetes Complications
Female
Health Policy - trends
Humans
Male
Medical Record Linkage
Myocardial Infarction - drug therapy - economics
Patient Compliance - statistics & numerical data
Prescription Fees
Vascular Diseases
Abstract
To evaluate the effects of patient copayment and coinsurance policies on adherence to therapy with beta-adrenergic blocking agents (beta-blockers) and on the rate of initiation of beta-blocker therapy after acute myocardial infarction (MI) in a population-based natural experiment.
Three sequential cohorts included British Columbia residents age 66 years and older who initiated beta-blocker therapy during time intervals with full drug coverage (2001), a $10 or $25 copayment (2002), and 25% coinsurance (2003-2004). We used linked data on all prescription drug dispensings, physician services, and hospitalizations. Follow-up of each cohort was 9 months after the policy changes.
We measured the proportion of subjects in each cohort who were adherent to beta-blocker therapy over time, with adherence defined as having >80% of days covered. We also measured the proportion of patients initiating beta-blocker therapy after acute MI. Policy effects were evaluated using multivariable regression.
Adherence to beta-blocker therapy was marginally reduced as a consequence of the copayment policy (-1.3 percentage points, 95% confidence interval [CI] = -2.5 , -0.04) or the coinsurance policy (-0.8 percentage points, 95% CI = -2.0, 0.3). The proportion of patients initiating beta-blockers after hospitalization for acute MI remained steady at about 61% during the study period, similar to that observed in a control population of elderly Pennsylvania residents with full drug coverage.
Fixed patient copayment and coinsurance policies had little negative effect on adherence to relatively inexpensive beta-blocker therapy, or initiation of beta-blockers after acute MI.
Notes
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PubMed ID
17685825 View in PubMed
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Adult children's perceptions of their responsibility to provide care for dependent elderly parents.

https://arctichealth.org/en/permalink/ahliterature220996
Source
Gerontologist. 1993 Jun;33(3):315-23
Publication Type
Article
Date
Jun-1993
Author
C. Wolfson
R. Handfield-Jones
K C Glass
J. McClaran
E. Keyserlingk
Author Affiliation
Department of Family Medicine, Montreal General Hospital, Quebec, Canada.
Source
Gerontologist. 1993 Jun;33(3):315-23
Date
Jun-1993
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Aggression
Canada
Caregivers - psychology
Dependency (Psychology)
Family - psychology
Female
Health Policy
Home Nursing
Humans
Income
Male
Middle Aged
Parents
Questionnaires
Role
Social Support
Abstract
We examined how adult children in Canada whose parents were hospitalized in an acute care setting perceived responsibility for their parents' care. Using a visual analogue scale, adult children rated the amount of financial, emotional, and physical support families "should" and "could" give to elderly persons described in four vignettes. All scores were high, with "should" consistently higher than "could" for every vignette and for each of the three types of support. For daughters, the more aggressive the parent, the lower the "should" score for financial support. The same relationship was observed for incontinence and these findings were consistent over all four vignettes.
PubMed ID
8325518 View in PubMed
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Adverse events associated with prescription drug cost-sharing among poor and elderly persons.

https://arctichealth.org/en/permalink/ahliterature195424
Source
JAMA. 2001 Jan 24-31;285(4):421-9
Publication Type
Article
Author
R. Tamblyn
R. Laprise
J A Hanley
M. Abrahamowicz
S. Scott
N. Mayo
J. Hurley
R. Grad
E. Latimer
R. Perreault
P. McLeod
A. Huang
P. Larochelle
L. Mallet
Author Affiliation
McGill University Health Center, Royal Victoria Hospital Site, Ross Pavilion, Room 4-12, 687 Pine Ave W, Montréal, Quebec, Canada H3A 1A1.
Source
JAMA. 2001 Jan 24-31;285(4):421-9
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cost Sharing - legislation & jurisprudence
Drug Prescriptions - economics
Emergency Service, Hospital - utilization
Female
Health Policy
Health Services Accessibility - economics
Humans
Insurance, Pharmaceutical Services - economics - legislation & jurisprudence
Logistic Models
Male
Middle Aged
Patient compliance
Poisson Distribution
Poverty
Proportional Hazards Models
Quebec
Self Administration - economics - statistics & numerical data
Social Welfare
Socioeconomic Factors
Abstract
Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups.
To determine (1) the impact of introducing prescription drug cost-sharing on use of essential and less essential drugs among elderly persons and welfare recipients and (2) rates of emergency department (ED) visits and serious adverse events associated with reductions in drug use before and after policy implementation.
Interrupted time-series analysis of data from 32 months before and 17 months after introduction of a prescription coinsurance and deductible cost-sharing policy in Quebec in 1996. Separate 10-month prepolicy control and postpolicy cohort studies were conducted to estimate the impact of the drug reform on adverse events.
A random sample of 93 950 elderly persons and 55 333 adult welfare medication recipients.
Mean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction.
After cost-sharing was introduced, use of essential drugs decreased by 9.12% (95% confidence interval [CI], 8.7%-9.6%) in elderly persons and by 14.42% (95% CI, 13.3%-15.6%) in welfare recipients; use of less essential drugs decreased by 15.14% (95% CI, 14.4%-15.9%) and 22.39% (95% CI, 20.9%-23.9%), respectively. The rate (per 10 000 person-months) of serious adverse events associated with reductions in use of essential drugs increased from 5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly persons (a net increase of 6.8 [95% CI, 5.6-8.0]) and from 14.7 to 27.6 in welfare recipients (a net increase of 12.9 [95% CI, 10.2-15.5]). Emergency department visit rates related to reductions in the use of essential drugs also increased by 14.2 (95% CI, 8.5-19.9) per 10 000 person-months in elderly persons (prepolicy control cohort, 32.9; postpolicy cohort, 47.1) and by 54.2 (95% CI, 33.5-74.8) among welfare recipients (prepolicy control cohort, 69.6; postpolicy cohort, 123.8). These increases were primarily due to an increase in the proportion of recipients who reduced their use of essential drugs. Reductions in the use of less essential drugs were not associated with an increase in risk of adverse events or ED visits.
In our study, increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions.
Notes
Comment In: JAMA. 2001 May 9;285(18):2328-911343477
PubMed ID
11242426 View in PubMed
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Age disparities in stroke quality of care and delivery of health services.

https://arctichealth.org/en/permalink/ahliterature149008
Source
Stroke. 2009 Oct;40(10):3328-35
Publication Type
Article
Date
Oct-2009
Author
Gustavo Saposnik
Sandra E Black
Antoine Hakim
Jiming Fang
Jack V Tu
Moira K Kapral
Author Affiliation
Stroke Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Source
Stroke. 2009 Oct;40(10):3328-35
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Aging - physiology - psychology
Atrial Fibrillation - drug therapy - prevention & control
Cohort Studies
Cost of Illness
Deglutition Disorders - diagnosis - prevention & control - therapy
Emergency Medical Services - standards - statistics & numerical data - trends
Female
Health Policy
Health Services - economics
Hospital Units - standards - statistics & numerical data - trends
Hospitalization - economics
Humans
Longevity
Male
Middle Aged
Mortality - trends
Ontario
Outcome Assessment (Health Care) - economics
Patient Discharge - economics
Pneumonia - epidemiology
Prospective Studies
Quality of Health Care - statistics & numerical data - trends
Quality of Life
Severity of Illness Index
Stroke - complications - mortality - therapy
Thrombolytic Therapy - statistics & numerical data - trends
Warfarin - therapeutic use
Abstract
Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age.
This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay.
Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home.
In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.
PubMed ID
19696418 View in PubMed
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Source
Sykepleien. 1985 Oct 7;72(17):5
Publication Type
Article
Date
Oct-7-1985
Author
A. Blankholm
Source
Sykepleien. 1985 Oct 7;72(17):5
Date
Oct-7-1985
Language
Norwegian
Publication Type
Article
Keywords
Aged
Health Policy
Health Services for the Aged
Humans
Norway
PubMed ID
3854564 View in PubMed
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Age, period, and cohort analysis of regular dental care behavior and edentulism: a marginal approach.

https://arctichealth.org/en/permalink/ahliterature136132
Source
BMC Oral Health. 2011;11:9
Publication Type
Article
Date
2011
Author
Kar-Yan Li
May Chun Mei Wong
Kwok-Fai Lam
Eli Schwarz
Author Affiliation
Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong SAR, China.
Source
BMC Oral Health. 2011;11:9
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Cohort Studies
Cross-Sectional Studies
Denmark
Dental Care - psychology - utilization
Dental Health Surveys
Female
Health Behavior
Health Policy
Humans
Linear Models
Logistic Models
Male
Middle Aged
Mouth, Edentulous - epidemiology
Prevalence
School Dentistry
Sex Factors
Social Class
Space-Time Clustering
Young Adult
Abstract
To analyze the regular dental care behavior and prevalence of edentulism in adult Danes, reported in sequential cross-sectional oral health surveys by the application of a marginal approach to consider the possible clustering effect of birth cohorts.
Data from four sequential cross-sectional surveys of non-institutionalized Danes conducted from 1975-2005 comprising 4330 respondents aged 15+ years in 9 birth cohorts were analyzed. The key study variables were seeking dental care on an annual basis (ADC) and edentulism. For the analysis of ADC, survey year, age, gender, socio-economic status (SES) group, denture-wearing, and school dental care (SDC) during childhood were considered. For the analysis of edentulism, only respondents aged 35+ years were included. Survey year, age, gender, SES group, ADC, and SDC during childhood were considered as the independent factors. To take into account the clustering effect of birth cohorts, marginal logistic regressions with an independent correlation structure in generalized estimating equations (GEE) were carried out, with PROC GENMOD in SAS software.
The overall proportion of people seeking ADC increased from 58.8% in 1975 to 86.7% in 2005, while for respondents aged 35 years or older, the overall prevalence of edentulism (35+ years) decreased from 36.4% in 1975 to 5.0% in 2005. Females, respondents in the higher SES group, in more recent survey years, with no denture, and receiving SDC in all grades during childhood were associated with higher probability of seeking ADC regularly (P
Notes
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PubMed ID
21410991 View in PubMed
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374 records – page 1 of 38.