Abstract:

The purpose of this study was to determine the impact of factors on health outcomes of community residing elders. Cox's Interaction Model of Client Health Behavior guided the study, with the client singularity and health outcome elements operationalized. Hypotheses were generated from the theoretical model and testing was conducted through correlation, regression, and LISREL analyses. Client records from a regional aging agency provided sample data. Criteria for inclusion and completeness were met by 2474 records collected from 1981 to 1989. Age of the sample ranged from 65-103 (M = 77.5). Clients were primarily white (65%), female (70%), widowed (61%), elders living alone (54%). Male, black, rural, and low income elders were included in greater proportions than the majority of previous study. A structural equation modeling approach allowed examination of conceptual and methodological relationships simultaneously. Direct, joint, indirect, and interaction effects of demographic characteristics, social influences, environmental resources, and previous health care experiences on functional status, hospitalization, type of service, mortality, and placement were postulated. Effects of health outcomes on each other were also examined. Direct effects of factors accounted for 46% of the variance in functional status, with few environmental resources having affect. Client singularity and functional status direct effects accounted for 25% of the variance in number of hospitalizations and 13% of the variance in total number of services used. Previous health care experiences had the most frequent effects on hospitalizations and primarily environmental resources explained number of services used. Case management, congregate meal, home delivered meal, and outreach were the most frequent services used. Client singularity and functional status affected types of services and accounted for 7-31% of the variance in likelihood of use. Mortality and placement were less explicable than other health outcomes. In addition to direct effects, indirect and interaction effects were present and are delineated. The LISREL analysis was inconclusive with respect to fit of the model and data. Reasons for the inconclusiveness are discussed. Findings support the nursing framework, emphasize a multifaceted client approach, and provide knowledge on which to base health policy, allocation decisions, and service provision. Recommendations for theory refinement, further research, and practice application are explicated.