![[Toolbar]](/pix/ribbon.gif){kind=small}
xx307@po.cwru.edu -- About this server -- Copyright 1994-2001 CWRU -- Unauthorized use prohibited
Posted 12-20-99
Exploring how aging adults provide self-care for their illnesses or enlist support from their doctors, friends, or family may affect the health and health care of older adults. Case Western Reserve University sociologists will undertake a five-year study, "Health Care Partnerships and Self-Care of Older Adults," to look at how and where the elderly find the support to combat illness as they grow frailer.
The National Institutes of Health will provide $1.6 million in funding for the project.
The principal investigators are Eva Kahana, the Pierce T. and Elizabeth D. Robson Professor of Humanities and chair of the Department of Sociology, and Eleanor Stoller, the Selah Chamberlain Professor of Sociology.
Other project researchers are Kyle Kercher, associate professor of sociology; Kurt Stange, associate professor of medicine; and Boaz Kahana, a psychologist from Cleveland State University.
This project is part of a longitudinal study of the elderly which began in 1989. The long-term look at nearly 1,000 older adults has tracked the underlying ways people can age successfully and what proactive measures people use to cope with growing old, says Kahana.
The researchers will look at approximately 350 older adults living in a Clearwater, Florida retirement community and 350 older adults from Cleveland. The average age of study participants is 85 years old, with ages ranging from 79 to 100. By the end of the study, they project that 527 participants will remain in the study.
The study will meld Stoller's interests in what individuals do to treat symptoms of illness and manage chronic disease, with Kahana's pursuit of information about how people marshal health care support when ill. Their innovative look at the health care system extends to support provided by lay consultants or alternative practitioners as well as physicians.
How the participants handle illness concerns the researchers. "The role their doctors and perhaps significant family members play in helping them cope with these illnesses is going to play an increasingly important part in their health," adds Kahana.
Each year of the project, the older adult will complete an extensive interview on issues such as to whom they talk about their health problems, where they seek help in navigating the health system, how they treat symptoms when they appear, and other age-related questions.
Participants will name people who support their health efforts, but will designate one person who they feel plays the most important or significant health role in their lives.
This significant other, who may or may not be a family member, also will answer questions relating to how much they know about the patient's health, what the person does to treat their illnesses, and what drugs, lifestyle changes, or other information the doctor has suggested.
Kahana points out that the significant health other differs from the traditional caregiver, who is someone who might come in and provide some type of service for the individual.
With the permission of the older adult, the researchers will conduct phone interviews with the designated primary care physician, who may be a specialist or a general practitioner.
Kahana notes they are interested in learning whether doctors know who the patient turns to for health advice, whether the doctor knows if suggestions to make lifestyle changes are followed, and which of the health conditions facing the older adult he or she considers their major health problem.
The researchers also will check Medicare records and costs to see if a correlation exists between a strong working support system and good health or lower medical costs.
"We are interested in this triad, but we are not sure whether this triad functions as one -- especially in this era of managed care," says Kahana.
From prior research on managed care, she found less continuity between doctors and patients, which affected confidence and the doctor-patient relationship. In the last wave of information from the Florida study, CWRU researchers discovered that as many as 20 percent of the study's participants had changed doctors in the past year.
"We may find there are no health care partnerships," adds Kahana.
Even though sociologists have spent much time studying how patients adhere to doctors' advice, Stoller found in previous research on an elderly population in upstate New York that when symptoms appear, people tend to treat them first and go to the doctor later.
"We found that most people were quite knowledgeable about treating symptoms and managing chronic conditions," reports Stoller. More than 80 percent of participants in the New York study reported self-care practices that a panel of physicians judged to be therapeutic or palliative. A medical panel found only 2 percent used harmful self-care remedies.
Stoller will find out what self-care behaviors people use to achieve specific goals. "We want to learn what people do to maintain overall health, to reduce risk factors for illness, and to manage ongoing conditions, as well as treat new symptoms," she says. "This will help us broaden our understanding of what self care is."
Because they will visit the individuals four times over the next five years, Kahana notes, they will begin to understand how health partnerships develop or change to reflect the health concerns of the older adult.