uab center for aging · john porter lillis, bs barbara meek smith, ... plementary survey of older...

STATE OF ALABAMA LONG TERM CARE NEEDS ASSESSMENT

Report Prepared Under the Direction of

Patricia Sawyer Baker, PhD Richard M. Allman, MD

UAB Center for Aging

AUGUST 2004

Charting the Course is a program to assist in planning for the long term healthcare needs of Alabama’s older citizens. A main component of Charting the Course is a survey of adults aged 55 and older, conducted by the Center for Aging at the University of Alabama at Birmingham (UAB). A sample of community-dwelling Alabama residents participated in face-to-face inter-views completed between May 2002 and August 2003. This report provides an analysis of data from these interviews.

This report was supported by an Interagency Agreement Between the Board of Trustees of the University of Alabama for the University of Alabama at Birmingham and Alabama Medicaid Agency.

Patricia Sawyer Baker, PhD Project Director

Richard M. Allman, MD

Project Co-Director

Other UAB Contributors to This Report Eric Bodner, BS Tara Kolstad, BA

John Porter Lillis, BS Barbara Meek Smith, MA

Teresa Tennyson Freddie M. Thomas

Richard Watt Beverly Williams, PhD

Long Term Care Task Force Contributors

Nick Sellers Task Force Member Frank Brown USA Healthcare Danny Cottrell, RPh Registered Pharmacist Robert Crowder Executive Director Southern Alabama Regional Council on Aging John Dunbar Unicare, Inc. Norman Estes President and Chief Executive Officer Northport Health Services, Inc. Rick Harris, JD Alabama Department of Public Health Mary Ann Holt Legislative Affairs Director Alabama Nursing Home Association Daniel Hughes Task Force Member Alva Lambert Executive Director State Health Planning and Development Agency Mike Lewis Alabama Medicaid Agency Miller Piggott Executive Director Alzheimer’s of Central Alabama Melissa Mauser Galvin, PhD, MPH Associate Dean, External Affairs Associate Professor, Department of Health Behavior UAB School of Public Health Marilyn Ferguson Director, Long Term Care Division Alabama Medicaid Agency

Lee Guyton Owner, Ross Rock Management Altoona Pines Nursing Home Ruth Harrell Task Force Member John Shuster, MD Research Physician VA Medical Center, Tuscaloosa W. Dale Walley Task Force Chairman Donald E. Williamson, MD State Health Officer Rebecca Wright President, Wright and Associates Lance Brown Task Force Member Mary Hayes Finch, JD, MBA Director, Office of Policy and Legislative Affairs Alabama Medicaid Agency Richard E. Powers, MD Associate Professor UAB, Division of Neuropathology Director, Bureau of Geriatric Psychiatry Alabama Department of Mental Health and Mental Retardation John Searcy, MD Medical Director Alabama Medicaid Agency Kathy Hall Deputy Commissioner, Program Administration Alabama Medicaid Agency ShaDel Williams Task Force Member

Project History and Overview

Goals: The State of Alabama Long Term Care Task Force presented a workgroup report in December 2000 which identified the need to evaluate the current and emerging medi-cal conditions and social needs of older Alabama residents. It was recommended that a representative survey of Alabama residents aged 55 and older be conducted, similar to the Statewide Survey of Alabama’s Elderly done in 1986-7. As part of this survey, knowl-edge of services would be assessed. Another recommendation was to compile a com-plementary survey of older adults in Alabama nursing homes. The UAB Center for Aging was consulted and awarded a contract to conduct the survey. The project consists of three components: I. Summary of the Minimum Data Set collected for Alabama Nursing Home Residents (report submitted April 2004) II. Charting the Course: Summary of data from community-dwelling older adults (this report) III. Charting the Course: Knowledge of Services (report submitted October 2003) The study is designed to compare older (65 years old and older) to younger (55 to 64 year olds) community-dwelling adults. The survey also is designed to compare the 65 years and older community-dwelling adults to nursing home residents aged 65 years and older (reported in the Minimum Data Set analyses). These comparisons will permit state leaders to predict future health and service needs. Questionnaire Development: The questionnaire content areas were identified by mem-bers of the Long Term Care Task Force. Specific areas covered include sociodemo-graphic factors, general health and medical conditions, health care utilization, family/social needs and resources, and retirement planning (see Appendix 1).

Organization of This Report Project goals and the development of the questionnaire used for in-home interviews are briefly discussed below. A description of the characteristics of older adults in Alabama follows. The descriptive information in “Aging in Alabama” is based on 2000 census data. A more detailed description of study methodology precedes the graphical summary of interview data. The presentation generally follows the format of the questionnaire, and is subdivided into sections. A guide to reading elements of the report is provided on page 1.

I. Introduction: Aging in Alabama ......................................................................... vi Map 1: Alabama Population, 2000 ............................................................... vii Map 2: Median Age by County .....................................................................viii Map 3: Percent 55 and Older by County ...................................................... ix Map 4: Percent 65 and Older by County ........................................................x Map 5: Percent 75 and Older by County ....................................................... xi Map 6: Number of Centenarians by County ................................................ xii II. Methods Questionnaire Design ....................................................................................xiii

Sampling Strategies and Recruitment Design .............................................. xvi Project Implementation .................................................................................. xx Statistical Procedures ...................................................................................xxii

III. Results Elements of the Report...................................................................................1 Section I: Background .................................................................................2 Section II: General Health ..........................................................................24 Section III: Activities/Mobility .......................................................................37 Section IV: Health Services Utilization.........................................................47 Section V: Medical History..........................................................................55 Section VI: Diet and Nutrition .....................................................................68 Section VII: Cognitive Functioning and Emotional Health............................75 Section VIII: Spirituality.................................................................................77 Section IX: Social Care...............................................................................82 Section X: Retirement Planning.................................................................88 Section XI: Long Term Planning.................................................................92

IV. References...................................................................................................105 V. Appendices A. Questionnaire B. Frequency Tables C. Other Documentation

Contents

The 2000 U.S. census confirmed the changing population profile of the United States and Alabama. Approximately one in eight persons was over the age of 65, unprecedented in the history of the United States. Between 1990 and 2000, the highest percentage of growth was among those 85 years and older. Additionally, the number of persons aged 45-64 (the “baby boomers”) increased by 34% during this period. At the same time, birth rates have decreased such that future projections will continue the trend of population aging and the percentage of older adults will continue to increase through 2030. Although our aging society reflects the success of many programs (government, economic, health), there will be many challenges to these programs in the future.

Alabama Aging Highlights from the 2000 Census Life-Expectancy for an Alabamian born in 2000 was 74 (U.S. 77) White Females: 78.7 (U.S. 80.1) White Males: 72.3 (U.S. 74.9) Black and other race Females: 72.3 (U.S. 75.2) Black and other race Males: 68.2 (U.S. 68.3) Life-Expectancy for an Alabamian who turned 65 in 2000 was 16.5 (U.S. 18.0) In 2000, approximately 35,000 Alabamians celebrated their 65th birthday. From 2000 to 2001 there was a net increase of 5,246 persons 65 and older. The median age (half older and half younger) was 36 (Map 2). % Persons over 55: 995,330 or 22% (Map 3) % Persons over 65: 579,798 or 13% (Map 4) % Persons over 75: 263,050 or 6% (Map 5) % Persons over 85: 67,301 or 1.5% In 2000, there were 897 centenarians in Alabama (Map 6).

Alabama ranks 25th in the nation for the percent of adults aged 65 and older.

Alabama ranks 9th in the nation for the percent of adults aged 65-74.

Alabama ranks 29th in the nation for the percent of adults aged 75 and older.

Alabama ranks 3rd in the highest rate of elders living in poverty (19%: U.S. = 13%)

Aging in Alabama

AGING IN ALABAMA PAGE vi

Baldwin

Calhoun

Etowah

Houston

Jefferson

Lauderdale

Lee

Madison

Marshall

Mobile

Montgomery

Morgan

Shelby Tuscaloosa

Autauga

Blount

Chilton

Coffee

Colbert

Cullman

Dale

Dallas

De Kalb

Elmore

Jackson Limestone

Russell

Saint Clair

Talladega

Tallapoosa

Walker

Bibb

Bullock Choctaw

Clay

Cleburne

Conecuh

Coosa

Crenshaw

Fayette

Greene

Hale

Henry

Lamar

Lowndes

Perry

Pickens

Sumter

Washington

Wilcox Barbour

Butler

Chambers

Cherokee

Clarke

Covington

Escambia

Franklin

Geneva

Lawrence

Macon

Marengo

Marion

Monroe

Pike

Randolph

Winston

SECTION 1: BACKGROUND ALABAMA AREA DEFINTIIONS

Map 1: Alabama Population 2000* 4,447,100

82,231 - 662,047 (Urban)

39,593 - 80,321 (Mid-Size)

21,399 - 38,440 (Rural)

9,974 - 20,949 (Rural)

County Distribution by Population Size

PAGE vii

Map 2: Median Age by County

AGING IN ALABMA

28Lee

32Macon

32Tuscaloosa

33Sumter

33Pike

34Perry

34Montgomery

34Wilcox

35Mobile

35Dale

35Hale

35Lowndes

35Bibb

35Bullock

35Washington

35Autauga

36Dallas

36Elmore

36Russell

36Monroe

36Shelby

36Clarke

36Madison

36Limestone

36Barbour

36Chilton

36Jefferson

36Greene

36Lawrence 37

De Kalb

37Blount

37Marengo

37Franklin

37Morgan

37Saint Clair

37Houston

37Marshall

37Talladega

37Escambia

37Pickens

37Calhoun

38Coffee

38Cullman

38Cleburne

38Jackson

38Lauderdale

38Randolph

38Butler

38Chambers

38Coosa

38Conecuh

38Winston

38Choctaw

38Etowah

39Walker 39

Lamar

39Colbert

39Clay

39Crenshaw

39Baldwin

39Fayette

39Marion

40Henry

40Geneva

40Tallapoosa

40Covington

40Cherokee

28Lee 28Lee

32Macon 32

Macon

32Tuscaloosa

32Tuscaloosa

33Sumter

33Sumter

33Pike 33Pike

34Perry 34

Perry

34Montgomery

34Montgomery

34Wilcox 34

Wilcox

35Mobile 35

Mobile

35Dale 35Dale

35Hale 35Hale

35Lowndes

35Lowndes

35Bibb 35Bibb

35Bullock

35Bullock

35Washington

35Washington

35Autauga

35Autauga

36Dallas 36

Dallas

36Elmore

36Elmore

36Russell

36Russell

36Monroe

36Monroe

36Shelby 36

Shelby

36Clarke 36

Clarke

36Madison

36Madison

36Limestone

36Limestone

36Barbour

36Barbour

36Chilton 36

Chilton

36Jefferson

36Jefferson

36Greene

36Greene

36Lawrence

36Lawrence 37

De Kalb 37

De Kalb

37Blount 37

Blount

37Marengo

37Marengo

37Franklin

37Franklin

37Morgan

37Morgan

37Saint Clair

37Saint Clair

37Houston

37Houston

37Marshall

37Marshall

37Talladega

37Talladega

37Escambia

37Escambia

37Pickens

37Pickens

37Calhoun

37Calhoun

38Coffee 38

Coffee

38Cullman

38Cullman

38Cleburne

38Cleburne

38Jackson

38Jackson

38Lauderdale

38Lauderdale

38Randolph

38Randolph

38Butler 38

Butler

38Chambers

38Chambers

38Coosa 38

Coosa

38Conecuh

38Conecuh

38Winston

38Winston

38Choctaw

38Choctaw

38Etowah

38Etowah

39Walker

39Walker 39

Lamar 39

Lamar

39Colbert

39Colbert

39Clay 39Clay

39Crenshaw

39Crenshaw

39Baldwin

39Baldwin

39Fayette

39Fayette

39Marion 39

Marion

40Henry 40

Henry

40Geneva

40Geneva

40Tallapoosa

40Tallapoosa

40Covington

40Covington

40Cherokee

40Cherokee

Median Age

27 to 30 years

30 to 33 years

33 to 36 years

36 to 39 years

39 to 41 years

PAGE viii

Map 3: Percent of Alabama Population 55 and Older by County

AGING IN ALABMA

15Lee

17Shelby

19Tuscaloosa

20Autauga

20Elmore

20Limestone 20

Madison

20Montgomery

21Barbour

21Dale

21Lowndes

21Mobile

22Bibb

22Bullock

22Hale

22Jefferson

22Lawrence 22

Morgan

22Pike

22Saint Clair

22Sumter

22Washington

23Blount

23Chilton

23Clarke

23Dallas

23Houston

23Macon

23Monroe

23Russell

23Talladega

23Wilcox

24Calhoun

24Coffee

24De Kalb

24Escambia

24Greene

24Marengo

24Perry

25Cleburne

25Coosa

25Cullman

25Franklin

25Jackson

25Lauderdale

25Marshall

26Baldwin

26Butler

26Chambers

26Choctaw

26Colbert

26Conecuh

26Etowah

26Pickens

26Randolph

26Walker

26Winston

27Crenshaw

27Fayette

27Henry

27Lamar

27Marion

27Tallapoosa

28Cherokee

28Clay

28Geneva

29Covington

15Lee 15Lee

17Shelby 17

Shelby

19Tuscaloosa

19Tuscaloosa

20Autauga

20Autauga

20Elmore 20

Elmore

20Limestone

20Limestone 20

Madison 20

Madison

20Montgomery

20Montgomery

21Barbour 21

Barbour

21Dale 21Dale

21Lowndes

21Lowndes

21Mobile 21

Mobile

22Bibb 22Bibb

22Bullock 22

Bullock

22Hale 22Hale

22Jefferson

22Jefferson

22Lawrence

22Lawrence 22

Morgan 22

Morgan

22Pike 22Pike

22Saint Clair

22Saint Clair

22Sumter 22

Sumter

22Washington

22Washington

23Blount 23Blount

23Chilton 23

Chilton

23Clarke 23

Clarke

23Dallas 23Dallas

23Houston

23Houston

23Macon 23

Macon

23Monroe

23Monroe

23Russell 23

Russell

23Talladega

23Talladega

23Wilcox 23

Wilcox

24Calhoun

24Calhoun

24Coffee 24

Coffee

24De Kalb

24De Kalb

24Escambia

24Escambia

24Greene 24

Greene

24Marengo

24Marengo

24Perry 24Perry

25Cleburne

25Cleburne

25Coosa 25Coosa

25Cullman

25Cullman

25Franklin

25Franklin

25Jackson

25Jackson

25Lauderdale

25Lauderdale

25Marshall

25Marshall

26Baldwin

26Baldwin

26Butler 26Butler

26Chambers

26Chambers

26Choctaw

26Choctaw

26Colbert 26

Colbert

26Conecuh

26Conecuh

26Etowah 26

Etowah

26Pickens

26Pickens

26Randolph

26Randolph

26Walker 26

Walker

26Winston

26Winston

27Crenshaw

27Crenshaw

27Fayette 27

Fayette

27Henry 27Henry

27Lamar 27Lamar

27Marion 27

Marion

27Tallapoosa

27Tallapoosa

28Cherokee

28Cherokee

28Clay 28Clay

28Geneva 28

Geneva

29Covington

29Covington

% 55 and Older

15 to 19

19 to 23

23 to 27

27 to 31

PAGE ix

9Lee

9Shelby

10Autauga

10Madison

11Elmore

11Limestone

11Montgomery

11Tuscaloosa

12Barbour

12Blount

12Chilton

12Dale

12Lawrence

12Mobile

12Morgan

12Saint Clair

12Talladega

12Washington

13Bullock

13Clarke

13Cleburne

13Jackson

13Lowndes

13Pike

13Russell

14Bibb

14Calhoun

14Dallas

14Escambia

14Hale

14Houston

14Jefferson

14Macon

14Monroe

14Sumter

14Wilcox

15Choctaw

15Coffee

15Colbert

15Coosa

15Cullman

15De Kalb

15Fayette

15Franklin

15Greene

15Lauderdale

15Marengo

15Marion

15Marshall

15Perry

15Randolph

15Walker

15Winston

16Baldwin

16Butler

16Chambers

16Cherokee

16Conecuh

16Etowah

16Geneva

16Lamar

16Pickens

17Clay

17Covington

17Crenshaw

17Henry

17Tallapoosa

9Lee 9Lee

9Shelby 9

Shelby

10Autauga

10Autauga

10Madison

10Madison

11Elmore 11

Elmore

11Limestone

11Limestone

11Montgomery

11Montgomery

11Tuscaloosa

11Tuscaloosa

12Barbour

12Barbour

12Blount 12Blount

12Chilton 12

Chilton

12Dale 12Dale

12Lawrence

12Lawrence

12Mobile 12

Mobile

12Morgan 12

Morgan

12Saint Clair

12Saint Clair

12Talladega

12Talladega

12Washington

12Washington

13Bullock 13

Bullock

13Clarke 13

Clarke

13Cleburne

13Cleburne

13Jackson

13Jackson

13Lowndes

13Lowndes

13Pike 13Pike

13Russell 13

Russell

14Bibb 14Bibb

14Calhoun

14Calhoun

14Dallas 14

Dallas

14Escambia

14Escambia

14Hale 14Hale

14Houston

14Houston

14Jefferson

14Jefferson

14Macon 14

Macon

14Monroe

14Monroe

14Sumter 14

Sumter

14Wilcox 14

Wilcox 15

Choctaw 15

Choctaw

15Coffee 15

Coffee

15Colbert 15

Colbert

15Coosa 15

Coosa

15Cullman

15Cullman

15De Kalb

15De Kalb

15Fayette 15

Fayette

15Franklin

15Franklin

15Greene 15

Greene

15Lauderdale

15Lauderdale

15Marengo

15Marengo

15Marion 15

Marion

15Marshall

15Marshall

15Perry 15Perry

15Randolph

15Randolph

15Walker 15

Walker

15Winston

15Winston

16Baldwin

16Baldwin

16Butler 16Butler

16Chambers

16Chambers

16Cherokee

16Cherokee

16Conecuh

16Conecuh

16Etowah 16

Etowah

16Geneva

16Geneva

16Lamar 16

Lamar

16Pickens

16Pickens

17Clay 17Clay

17Covington

17Covington

17Crenshaw

17Crenshaw

17Henry 17

Henry

17Tallapoosa

17Tallapoosa


AGING IN ALABMA

% 65 and Older 9 to 11

11 to 14

14 to 16

16 to 18

PAGE x


AGING IN ALABMA

3Shelby

4Autauga

4Lee

4Madison

5Barbour

5Dale

5Elmore

5Lawrence

5Limestone

5Lowndes

5Morgan

5Saint Clair

5Tuscaloosa

5Washington

6Bibb

6Blount

6Calhoun

6Chilton

6Clarke

6Cleburne

6Coffee

6Coosa

6De Kalb

6Escambia

6Houston

6Jackson

6Marshall

6Mobile

6Montgomery

6Pike

6Russell

6Talladega

6Winston

7Baldwin

7Bullock

7Cherokee

7Choctaw

7Colbert

7Conecuh

7Cullman

7Dallas

7Franklin

7Greene

7Hale

7Jefferson

7Lamar

7Lauderdale

7Macon

7Marengo

7Marion

7Monroe

7Perry

7Pickens

7Randolph

7Sumter

7Walker

7Wilcox

8Butler

8Chambers

8Clay

8Etowah

8Fayette

8Geneva

8Henry

8Tallapoosa

9Covington

9Crenshaw

3Shelby 3

Shelby

4Autauga

4Autauga

4Lee 4Lee

4Madison

4Madison

5Barbour

5Barbour

5Dale 5Dale

5Elmore

5Elmore

5Lawrence

5Lawrence

5Limestone

5Limestone

5Lowndes

5Lowndes

5Morgan

5Morgan

5Saint Clair

5Saint Clair

5Tuscaloosa

5Tuscaloosa

5Washington

5Washington

6Bibb 6Bibb

6Blount 6

Blount

6Calhoun

6Calhoun

6Chilton 6

Chilton

6Clarke 6

Clarke

6Cleburne

6Cleburne

6Coffee 6

Coffee

6Coosa 6

Coosa

6De Kalb

6De Kalb

6Escambia

6Escambia

6Houston

6Houston

6Jackson

6Jackson

6Marshall

6Marshall

6Mobile 6

Mobile

6Montgomery

6Montgomery

6Pike 6Pike

6Russell 6

Russell

6Talladega

6Talladega

6Winston

6Winston

7Baldwin

7Baldwin

7Bullock

7Bullock

7Cherokee

7Cherokee

7Choctaw

7Choctaw

7Colbert 7

Colbert

7Conecuh

7Conecuh

7Cullman

7Cullman

7Dallas 7

Dallas

7Franklin

7Franklin

7Greene

7Greene

7Hale 7Hale

7Jefferson

7Jefferson

7Lamar 7

Lamar

7Lauderdale

7Lauderdale

7Macon 7

Macon 7

Marengo 7

Marengo

7Marion 7

Marion

7Monroe

7Monroe

7Perry 7Perry

7Pickens

7Pickens

7Randolph

7Randolph

7Sumter 7

Sumter

7Walker 7

Walker

7Wilcox 7

Wilcox 8

Butler 8

Butler

8Chambers

8Chambers

8Clay 8Clay

8Etowah 8

Etowah

8Fayette

8Fayette

8Geneva

8Geneva

8Henry 8

Henry

8Tallapoosa

8Tallapoosa

9Covington

9Covington

9Crenshaw

9Crenshaw

8 to 10

3 to 5

5 to 6

6 to 7

7 to 8

% 75 and Older

PAGE xi

Map 6: Number of Centenarians by County

AGING IN ALABMA

0Fayette 1

Cleburne

1Lamar

1Randolph

2Bibb

2Henry

3Clay

3Conecuh

3Lawrence

3Sumter

4Barbour

4Cherokee

4Chilton

4Choctaw

4Coosa

4Franklin

4Lowndes

4Wilcox

5Crenshaw

5De Kalb

6Bullock

6Dale

6Geneva

6Greene

6Saint Clair

6Washington

7Covington

7Limestone

7Marengo

7Pike

8Autauga

8Hale 8

Perry

8Winston 9

Blount

9Butler

9Jackson

9Russell

10Clarke

10Colbert

10Macon

10Marion

10Monroe

10Morgan

11Escambia

11Talladega

11Tallapoosa

12Chambers

12Coffee

12Cullman

12Lauderdale

12Walker

13Elmore

13Pickens

15Etowah

15Lee

18Baldwin

19Houston

20Shelby

22Calhoun

22Marshall

23Dallas

33Madison

34Tuscaloosa

37Montgomery

74Mobile

193Jefferson

0Fayette

0Fayette 1

Cleburne 1

Cleburne

1Lamar 1

Lamar

1Randolph

1Randolph

2Bibb 2Bibb

2Henry 2

Henry

3Clay 3Clay

3Conecuh

3Conecuh

3Lawrence

3Lawrence

3Sumter 3

Sumter

4Barbour

4Barbour

4Cherokee

4Cherokee

4Chilton 4

Chilton

4Choctaw

4Choctaw

4Coosa 4

Coosa

4Franklin

4Franklin

4Lowndes

4Lowndes

4Wilcox 4

Wilcox

5Crenshaw

5Crenshaw

5De Kalb

5De Kalb

6Bullock

6Bullock

6Dale 6Dale

6Geneva

6Geneva

6Greene

6Greene

6Saint Clair

6Saint Clair

6Washington

6Washington

7Covington

7Covington

7Limestone

7Limestone

7Marengo

7Marengo

7Pike 7Pike

8Autauga

8Autauga

8Hale 8Hale 8

Perry 8Perry

8Winston

8Winston 9

Blount 9

Blount

9Butler 9

Butler

9Jackson

9Jackson

9Russell 9

Russell

10Clarke 10

Clarke

10Colbert 10

Colbert

10Macon 10

Macon

10Marion 10

Marion

10Monroe

10Monroe

10Morgan 10

Morgan

11Escambia

11Escambia

11Talladega

11Talladega

11Tallapoosa

11Tallapoosa

12Chambers

12Chambers

12Coffee 12

Coffee

12Cullman

12Cullman

12Lauderdale

12Lauderdale

12Walker 12

Walker

13Elmore 13

Elmore

13Pickens

13Pickens

15Etowah 15

Etowah

15Lee 15Lee

18Baldwin

18Baldwin

19Houston

19Houston

20Shelby 20

Shelby

22Calhoun

22Calhoun

22Marshall

22Marshall

23Dallas 23

Dallas

33Madison

33Madison

34Tuscaloosa

34Tuscaloosa

37Montgomery

37Montgomery

74Mobile 74

Mobile

193Jefferson

193Jefferson

PAGE xii

METHODS Questionnaire Design

METHODS: QUESTIONNAIRE

The State of Alabama Long Term Care Task Force reviewed the questionnaire used for the UAB Study of Aging, a prospective observational study of Medicare beneficiaries recruited from five counties of Central Alabama between 1999-2001 with funding from the National Institute on Aging. The initial two hour in-home assessment for that study included content areas of sociodemo-graphic variables, specific medical diseases as well as geriatric syndromes, assessments of neuropsychological status, health care utilization, medications, and physical activity. The Task Force decided to use the UAB Study of Aging questionnaire as a guide to develop a questionnaire for the Charting the Course survey.

The Task Force contracted the UAB Center for Aging to refine the questionnaire for this survey. They directed the addition of questions related to long term care planning. All data were to be col-lected in face-to-face interviews with participants. To ensure that the State of Alabama Long Term Care Needs Assessment interview would not exceed two hours, the Task Force suggested the de-letion of outside of their areas of interest. These recommendations were provided to the UAB Center for Aging who developed a questionnaire for the Task Force.

After several review sessions, a draft of the questionnaire was presented to the Committee for final approval in February 2001. For purposes of data entry, the questionnaire was formatted using Teleform, which produces a computer scannable form. (The questionnaire is presented in Appen-dix A.)

The State of Alabama Long Term Care Needs Assessment questionnaire contains the following content areas (presented in the order they are asked in the questionnaire):

INTRODUCTION Sex

Type of Housing Environmental Descriptions Address/Location

SECTION I: BACKGROUND

Number of Persons in Household

Family Military Service Education Employment Status Financial Information

Age Birth Date Ethnicity Marital Status Birth State Years in Alabama Property Owner Alabama Driver’s License Alabama Voting Status

PAGE xiii

SECTION II: GENERAL HEALTH Self Perceived Health

General Feelings/Anxiety

General Physical Symptoms

Pain

Hearing

Vision Oral Status/Dental

SECTION III: ACTIVITIES/MOBILITY

Social Activity

Physical Activity

Falls

Aids/Equipment

Instrumental Activities of Daily Living

Activities of Daily Living

Home Health Services Received

Transportation

SECTION IV: HEALTH SERVICES UTILIZATION

Health Insurance

Physician Information

Emergency Room/Hospital Prescription Drug Usage

SECTION V: MEDICAL HISTORY

Diseases

Conditions

Surgeries

Continence

Medications

METHODS: QUESTIONNAIRE PAGE xiv

SECTION VI: DIET AND NUTRITION Height/Weight

Eating Patterns/Meals

Tobacco Use

Alcohol Use

SECTION VII: COGNITIVE FUNCTIONING AND EMOTIONAL HEALTH

Cognitive status (MMSE)

Geriatric Depression Scale

SECTION VIII: SPIRITUALITY Church Attendance

Religious Activities

Spirituality

SECTION IX: SOCIAL SUPPORT Care Giving

Care Receiving

SECTION X: RETIREMENT PLANNING A. Employed

B. Retired

SECTION XI: LONG TERM PLANNING

Long Term Insurance

Planning for Death

Planning for Serious/Terminal Illness

Advanced Directives

HEALTH SERVICES QUESTIONNAIRE

(Reported submitted to Alabama Medicaid, October 2003)

METHODS: QUESTIONNAIRE PAGE xv

Methods Sampling Strategy and Recruitment Design

The State of Alabama Long Term Care Task Force goal was to recruit a sample that was representative of the State of Alabama. To achieve this goal, the first criteria was to select counties based on size of the county and geographic distribution. Counties of Alabama were categorized by the population size of the county (Census 2000 and the University of Alabama Center for Business and Economic Research, 2001, see Map 1). Following these designations, we describe counties with 82,231-662,047 persons as urban counties; counties with 39,593-80,321 persons as mid-size counties; counties with 21,399-38,440 persons as rural counties; and counties with 9,974-20,949 persons as most rural counties. Combining these designa-tions with north/south geographic region (Alabama Rural Health Association), the popula-tion of Alabama is described below.

North Population % of State Population

Urban 1,743,914 39% Mid-Size 664,389 15% Rural 205,034 5% Most Rural 116,753 3% South Population % of State Population Urban 967,647 22% Mid-Size 298,410 7% Rural 280,712 6% Most Rural 170,271 4%

State Total 4,447,100

METHODS: IMPLEMENTATION PAGE xvi

METHODS: IMPLEMENTATION v

The second criteria for selection from each category was based on the % of the county classified as urban (Census 2000) and adjacency to urban counties. Urban counties were eligible if they were classified as being 65% urban. Mid-size counties were eligible if they were less than 50% urban and adjacent to a

urban county included in the study and a Rank 3 or Rank 4 county. Rural counties were eligible if they were less than 35% urban and not adjacent to

either a Rank 1 or Rank 2 county. Most rural counties were eligible if they were less than 30% urban and not adjacent

to either a Rank 1 or Rank 2 county.

Additional criteria were established to select only one urban county from each MSA(Metropolitan Statistical Area*) and to select only counties in which at least 20% of the county population was aged 55 years or older.

The following counties were selected: North Urban: Jefferson and Madison Counties Mid-size: Limestone and Walker Counties Rural: Randolph County Most Rural: Lamar County South Urban: Houston, Mobile, and Montgomery Counties Mid-size: Dale and Houston Counties Rural: Monroe Most Rural: Conecuh

*The general concept of a metropolitan area is that of a large population nucleus, together with adjacent communities having a high degree of social and economic integration with that core. Metropolitan areas generally comprise one or more entire counties.

PAGE xvii

Statisticians determined that a sample size of 1200 would give adequate power to detect differences by age, race, sex, and area of residence. A stratified random sampling design was established to ensure that the proportion of study subjects would represent the state population over the age of 55. Recruitment was designed to reflect the state population. 1. Population 60% of the sample would be recruited from Rank 1 counties. 22% would be recruited from Rank 2 counties. 11% would be recruited from Rank 3 counties. 7% would be recruited from Rank 4 counties.

2. After the counties for the study were identified, a target recruitment num-ber for each county was determined. This number was proportionate to the population of all counties identified in that ranking.

For example, for the Rank 1 counties (which comprise 60% of the state population and 60% of the sample) the included counties were Houston, Jefferson, Madison, Mobile, and Montgomery. Of these five counties, Jefferson county has a population that is 40% of the total. Thus 40% of the Rank 1 participants were recruited from Jefferson County

3. Within counties, target goals for white/non-white recruitment were set to reflect the composition of selected counties within a Rank category

4. Within counties, target goals were set to reflect the age and gender com-position of the state population aged 55 and older. Of this population, per-sons aged 55-64 represent 42% of the total and persons aged 65 and older represented 58% of the population. The percent of females over the age of 55 was 57% and the percent of males was 43%.

5. To assure that there would be statistical power for comparisons, the number of subjects derived for target goals were rounded to include non-whites over whites. This resulted in a slight over-sampling of non-whites.

METHODS: IMPLEMENTATION PAGE xviii

A list of 13,000 names and phone numbers of a random selection of Alabama residents in proportionate numbers to recruitments goals by county, age group, and sex was pur-chased. These names were drawn from 31 different sources and were representative of the state in terms of household income. These names were entered into databases by county, age group (55-64 and 65 and older), and sex. A computer program was used to put the names in random order. Re-cruitment began by contacting the first name in each group and continued until the re-cruitment goal for that group was complete. Recruitment: 1. A letter was sent to the resident’s address describing the study. A toll free

number was provided so that potential participants could inquire about the study or ask to have their names withdrawn from consideration.

2. A screening call was made to determine eligibility. Persons had to be living in

the community and over the age of 55. Participants had to be able to commu-nicate with the interviewers and be willing to be interviewed. As recruitment goals within counties were met for age, race, and sex criteria, recruitment was closed for that specific group. If the person who was contacted was ineligible or did not wish to participant, we asked if anyone else in the household was eligible. Only one person from a household could participate.

3. Interview appointments were made by trained interviewers who went to partici-

pants’ homes to conduct the interview. After the informed consent was signed, the interview was conducted. Completed interviews were returned to the UAB Center for Aging.

4. Within one to two weeks after interviews were completed, a staff person from

the UAB Center for Aging contacted the participant to thank them for their participation. This call served as a quality control to determine that the inter-view was done accurately and professionally. Most participants reported that they enjoyed the opportunity to be interviewed for Charting the Course.

METHODS: IMPLEMENTATION PAGE xix

METHODS: IMPLEMENTATION

Methods Project Implementation

December 2000 State of Alabama Long Term Care Task Force workgroup report identified the need to

evaluate the current and emerging medical conditions and social needs of older Alabama residents.

Preliminary Plans Consultation with the UAB Center for Aging related to the feasibility of conducting a

survey similar to the Statewide Survey of Alabama’s Elderly, 1986-7

Presentations about the UAB Study of Aging made by the Center for Aging to the Task Force

Negotiation related to a contract for the UAB Center for Aging

October 2001 Interagency Agreement between the University of Alabama and Alabama Medicaid

Agency finalized

November 2001 Preliminary plans for sample design presented to the State of Alabama Long Term Care

Task Force

January 2002 Sampling design finalized

Recruitment protocol determined

Completed test version of the questionnaire

Reviewed and tested for cultural sensitivity

UAB Institutional Review Board submission

February 2002 Questionnaire reviewed and approved by State of Alabama Long Term Care Task Force

Databases designed to track recruitment

Plan analyses reviewed for the Minimum Data Set

Interviewer guidelines established, began to recruit interviewers

PAGE xx

March 2002 IRB approval for revised questionnaire

Charting the Course logo approved by Task Force

Test data entry system for questionnaire

Print materials

Prepare mailing procedures

Set-up system for delivering and receiving interviews

April 2002 Interviewer training Initial set of letters mailed in North Alabama

May 2002 Interviewing begun Interview goal schedule:

400 interviews completed by Sept. 1, 2002

600 interviews completed by Dec. 31, 2002

900 interviews completed by May 1, 2003

1200 interviews completed by Aug. 1, 2003 August 2003-August 2004 Data entry, data preparation, verification, and analyses for reports

October 2003 Minimum Data Set obtained

Knowledge of Services Report submitted

April 2004 Minimum Data Set report submitted

August 2004 Charting the Course final report submitted

METHODS: IMPLEMENTATION PAGE xxi

1. Completed questionnaires were returned to the UAB Center for Aging and a visual inspection made to assure that data were entered correctly. Forms were then scanned and a database was created. SPSS, a statistical software package developed for use in the social sciences, was used for all analyses.

2. Descriptive statistics were examined for each variable in the survey. (See Frequency Table, Appendix B.) The frequency, mean, and range of values were noted to detect potential errors. If there were discrepancies, such as out-of-range values, or missing information, the original form was examined to clarify the values. Pie charts and bar graphs showing the distribution of a characteristic for the total sample were generated from these data. Note that due to rounding, subtotals may not sum to 100%.

3. For this report, we examined data by counties based on population. Counties with populations above 82,000 were classified as urban; counties with populations between 22,000 and 82,000 were classified as midsize; counties with less than 22,000 population were classified as rural.

4. To examine differences within age groups, between blacks and whites, between males and females, and among residents of urban, mid-size, and rural counties, we utilized the Chi Square test of significance. This test compares the observed and expected frequen-cies for each response to assess whether categories contain the expected number of responses. If the test determines that the observed responses differ from the expected responses and that the difference is likely to occur in the population, it is considered to be statistically significant. The parameters of the test were set to show significance at the 0.05 level. This means that 95% of the time or 95 times out of 100, detected differ-ences reflect true population differences.

5. Results of the Chi-square test were used to determine the information presented in this report. When comparing age groups, males to females, blacks to whites, and areas of residence, we report results only if they differ from the findings for the total sample.

6. Persons were included in the analyses if they were African-American or white. In the course of recruitment, 7 participants (0.6% of the sample) were enrolled who were neither African-American nor white. The number of persons from these groups did not represent a sufficient size to generalize to the population, and thus were not used in the statistical analyses. By county, there were four persons in Mobile (2 female American Indian/Alaskan natives; 1 male Asian/Pacific Islander; 1 male Hispanic); one person each in Jefferson, Madision, and Monroe counties (a female American Indian/Alaskan native, a male Hispanic, and a female American Indian/Alaskan native, respectively).

Statistical Analysis

METHODS: IMPLEMENTATION PAGE xxii

Page number

PAGE 3 SECTION 1 : BACKGROUND

One35%

Two 49%

Three 10%

Four or More6%

Number of persons living in household [10]

49% of participants live with their spouse.

1% live with a parent.

17% live with a child.

8% live with a grandchild.

4% live with some other relative.

2% live with an unrelated person.

HOUSEHOLD MEMBERS

LIVES ALONE BY AGE AND SEX

Sex

51% of females

13% of males

Age

27% of 55-64 year olds


Questionnaire Section and Topic

Question number from

survey

Question

Breakdown of response categories to show differences within age groups; between blacks and whites; between males and females; and among residents of urban, mid-size, and rural counties.

Additional information related to the question topic. Unless other-wise noted, percentages repre-sent the proportion of the entire sample, N = 1204.

Elements of the Report

Graph showing breakdown of responses for all participants.

Only results significantly different from the whole sample are noted. In this example, only Age and Sex dif-fered from responses indicated in the pie graph.

PAGE 1

SECTION 1: BACKGROUND

Rural - North 12%

Midsize - South 10%

Midsize - North 12%

Urban - South 25%

Urban - North32%

Rural - South 9%

Region within Alabama

Age 75 +27%

Age 55-6441%

Age 64-7432%

Male43%

Female57%

Black27%

White73%

Sex

Charting The Course Sample Description

Race/Ethnicity

Age distribution


Region within Alabama

Sex Race/Ethnicity

Age distribution

Region Number Urban-North 411 Midsize-North 147 Rural-North 105 Urban-South 309 Midsize-South 122 Rural-South 110 Total 1204

Age Group Number

55-64 494 64-74 382 75 + 328 Total 1204

Race/Ethnicity Number

Whites 876 Blacks 328 Total 1204

Sex Number

Females 690 Males 514 Total 1204

Charting The Course Numerical Sample Description


Marital status [4]

WIDOWED BY AGE AND SEX

Age 18% of 55-64 year olds


52% of 75 years and older

Sex 51% of females

8% of males

Separated1%

Divorced13%

Widow ed33%

Married49%

Never Married4%

MARRIED BY AGE, RACE, AND SEX




Race 52% of whites

42% of blacks

Sex 26% of females

82% of males


One35%

Two 49%

Three 10%

Four or More6%

Number of persons living in household [10]

LIVING ALONE BY AGE AND SEX

HOUSEHOLD MEMBERS

Sex 51% of females

13% of males




49% of participants lived with their spouse.

17% lived with a child.

8% lived with a grandchild.

4% lived with some other relative.

2% lived with an unrelated person.

1% lived with a parent.

Other 10%

Single-family Home90%


Type of housing [Intro. 3]

SINGLE FAMILY HOME BY SEX

8% of participants lived in a multi-family home.

2% lived in an apartment building.

Less than 1% of participants lived in:

A house with one or more apartments.

Housing especially for the elderly.

Some other type of housing.

OTHER HOUSING

Sex 86% of females

95% of males


Amenities in the home [Intro. 4]

58

33

8

0

50

100

Outside StairsLeading Into

Home

Stairs InsideHome

Ramp

Perc

ent o

f Sam

ple

4638

20

50

100

Computer InternetAccess

Special PhoneService

Perc

ent o

f Sam

ple

100 100 98 93

0

50

100

Electricity Heat Available AirConditioning

Fans Available

Perc

ent o

f Sam

ple

Yes87%

No13%


Property ownership [7]

Number of years lived in Alabama [6]

PROPERTY OWNERSHIP BY RACE AND SEX Race

88% of whites

83% of blacks

Sex 81% of females

94% of males

More Than 20 Years93%

11-20 Years 4%

6-10 Years 2% 5 Years or Less

1%

Other Southern 15%

Other US11%

Other Country1%

Alabama 73%


Place of birth [5]

Possession of valid Alabama driver’s license [8]

ALABAMA BORN BY RACE AND COUNTY SIZE

No8%

Yes92%

NO ALABAMA DRIVER’S LICENSE Age




Race 4% of whites

19% of blacks

Sex 12% of females

3% of males

Race 67% of whites

87% of blacks

Residence 69% of urban residents

71% of mid-size county residents

83% of rural residents

Sex 74% of females 70% of males

Yes94%

No6%


Registered Alabama voters [9]




REGISTERED VOTER BY RESIDENCE

5% of participants rarely voted.

9% sometimes voted.

81% voted regularly.

PREVALENCE OF VOTING

91% of participants voted in national elections.

90% voted in state elections.

90% voted in local elections.

TYPES OF ELECTION IN WHICH PARTICIPANTS VOTED


NO LIVING CHILDREN BY SEX

Sex 10% of females

6% of males Two 28%

Three 21%

Four or More 28%

No Children 10%

One 13%

Number of living children [11]

21% of participants had no children or no children living in Alabama.

26% had one child living in Alabama.

54% had two or more children living in Alabama.

NUMBER OF CHILDREN LIVING IN ALABAMA

26% of participants had no children or no children living within an hour drive.

30% had one child living within an hour drive.

45% had two or more children living within an hour drive.

NUMBER OF CHILDREN LIVING WITHIN AN HOUR DRIVE

11% of participants had no children or little or no contact with their children.

3% had contact ranging from four times per year to once a month.

12% had contact ranging from two times per month to once a week .

16% had contact ranging from two to four times per week.

58% had contact at least five times per week.

FREQUENCY OF CONTACT WITH CHILDREN

14% of participants provided care for their children.

PROVIDING CARE FOR CHILDREN


Yes83%

No17%

Participants with grandchildren [12]

FREQUENCY OF CONTACT WITH GRANDCHILDREN

21% of participants had no grandchildren or little or no contact with their grandchildren.


18% had contact ranging from two times per month to once a week.



17% had no grandchildren.

14% of participants provided care for their grandchildren.

PROVIDING CARE FOR GRANDCHILDREN

5% of participants provided care for children and grandchildren.

PROVIDING CARE FOR BOTH CHILDREN AND GRANDCHILDREN

No70%

Yes and Needs

Assistance12%

Yes and Does Not

Need Assistance

18%

PARENT REQUIRING ASSISTANCE BY AGE




5% of participants had a parent living with family.

1% had a parent living in an assisted living facility.

1% had a parent with a live-in caretaker.

4% had a parent living in a nursing home.

2% had a parent that had another arrangement.

Less than 1% had a parent living in a board or care home.

LIVING ARRANGEMENTS OF PARENTS NEEDING ASSISTANCE

20% of participants reported parents living in Alabama.

17% reported a parent living within an hour drive.

RESIDENCE OF PARENT

2% of participants had little or no contact with any parent.


7% had contact ranging from two times per month to once a week .



FREQUENCY OF CONTACT WITH PARENT


Living parent [13]

LIVING PARENT BY AGE, SEX, AND RESIDENCE

Sex 25% of females

37% of males








One20%

Two 18%

Three 16%

Four or More 31%

None15%

NO SURVIVING SIBLINGS BY AGE, RACE, AND SEX

Number of living siblings [14-15]

64% of participants reported that they had living brothers.

68% reported that they had living sisters.

LIVING SIBLINGS




Race 17% of whites

12% of blacks

Sex 17% of females

13% of males







PARTICIPANTS WITH FIVE OR MORE FAMILY MEMBERS WITHIN AN HOUR DRIVE BY AGE AND RESIDENCE


Number of family members within an hour drive [16]




PARTICIPANTS WITH NO FAMILY MEMBERS WITHIN AN HOUR DRIVE

None8%

One to Two17%

More Than Five 61%

Three to Five 14%

Yes28%

No72%

MILITARY SERVICE BY AGE, RACE, SEX, AND RESIDENCE




Race 31% of whites

20% of blacks




Sex 1% of females

64% of males

Number (Percent) Branch Average Time Served Minimum Time Maximum Time

182 (15%) United States Army 6 years 1 year 38 years

50 (4%) United States Navy 8 years 1 year 35 years

71 (6%) United States Air Force 10 years 1 year 41 years

3 (1%) United States Marines 8 years 2 years 32 years

2 (0.2%) United States Coast Guard 14 years 6 years 22 years

14 (1%) Other Military Service 7 years 1 year 36 years

TYPE AND LENGTH OF SERVICE BRANCH PARTICIPATION


Military service [17]

ELIGIBLITY FOR MILITARY BENEFITS THROUGH FAMILY BY RACE, SEX, AND RESIDENCE

Race 11% of whites

4% of blacks




Sex 12% of females

4% of males

Eligibility for military benefits (through self or family member) [17-18]


Family members with military service [18]

Spouse24%

Other family59%

None17%

Not Eligible76%

Family Only 6%

Self and Family

1%

Self Only 17%


Highest level of education [19]

DID NOT COMPLETE HIGH SCHOOL BY AGE, RACE, SEX, AND RESIDENCE




Race 20% of whites

41% of blacks




Sex 28% of females

22% of males

ADVANCED EDUCATION (POST HIGH SCHOOL) BY AGE, RACE, SEX, AND RESIDENCE




Race 50% of whites

29% of blacks




Sex 41% of females

48% of males

Some College/Assoc.

Degree23% High School

Graduate30%

9-11 years16%

1-8 years10%

College Graduate12%

Graduate/Professional

Degree10%


Less Than $12,000

22%

$12,000 or More 78%

Income* [23]

Sex

30% of females

10% of males




Race 15% of whites

40% of blacks




INCOME LESS THAN $12,000 BY AGE, RACE, SEX, AND RESIDENCE

*Responses indicating perceived income adequacy (“All things considered, would you say your in-come is not enough to make ends meet; gives you just enough to get by on; keeps you comfortable, but permits no luxuries; or allows you to do more or less what you want?”) were used to define an income category for persons with missing responses to reported income. These responses corre-sponded to income categories of $8,000 to $11,999, $12,000 to $15,999, $20,000 to $29,999, and $40,000 to $49,999, respectively.

2

8

11

13

0

5

10

15

20

Less Than $5,000 $5,000-$7,999 $8,000-11,999 $12,000-15,999

Per

cent

of S

ampl

e

7

16

10

13

0

5

10

15

20

$16,000-$19,999 $20,000-$29,000 $30,000-$39,999 $40,000-$49,999

Per

cent

of S

ampl

e


Income distribution* [23]

* See footnote on previous page.

9

53

2

0

5

10

15

20

$50,000-$75,000 $75,000-$99,999 $100,000-$149,000 $150,000 or More

Perc

ent o

f Sam

ple


Sex

20% of females

10% of males




Race 12% of whites

27% of blacks

Race 8% of whites

24% of blacks

Sex

16% of females

6% of males

Somewhat Difficult

27%

Not Very Difficult

57%

Impossible1% Very Difficult

15%

Ability to afford basic expenses [21]

VERY DIFFICULT/IMPOSSIBLE TO PAY FOR BASICS BY RACE, AGE, AND SEX

Comfortable, No Luxuries

29%

Not Enough12%

Just Enough27%

Very Comfortable

32%

NOT ENOUGH INCOME BY RACE AND SEX

Income description related to standard of living [22]


RETIRED BY AGE, RACE, AND SEX

FULL-TIME EMPLOYMENT BY AGE, RACE, AND SEX

Sex

61% of females

68% of males

Race 66% of whites

60% of blacks







Race 21% of whites

16% of blacks

Sex

16% of females

25% of males

64

20

11 9

0

20

40

60

80

Retired Full-Time Disabled Part-Time

Per

cent

of S

ubje

cts

Employment (multiple responses possible) [20]

DISABLED BY AGE, RACE, AND RESIDENCE

Race 9% of whites

18% of blacks








EMPLOYMENT SUMMARY

773 participants were retired.

Of the retired participants,

12 worked full-time.

43 worked part-time.

31 did volunteer work.

3 reported being unemployed.

236 participants were employed full-time.

Of participants who were employed full-time,

12 were also retired.

6 also worked part-time.

1 did volunteer work.

107 participants were employed part-time.

Of the participants who were employed part-time,

43 were retired.

6 also had full-time employment.

4 were volunteers.

2 were disabled.

137 participants are disabled.

37 participants have never worked outside the home.

SECTION 2: GENERAL HEALTH




Race 34% of whites

53% of blacks




Poor13%

Fair26%

Good31%

Very Good18%

Excellent12%

Self-perceived health [1]

FAIR/POOR HEALTH BY AGE, RACE, AND RESIDENCE

Worse 42%

Same 44%

Better14%

Health today compared to three years ago [2]




HEALTH WORSE THAN THREE YEARS AGO BY AGE, RACE, AND RESIDENCE




Sex 46% of females

37% of males

SECTION 2: GENERAL HEALTH – SYMPTOMS

DEPRESSION BY SEX AND RESIDENCE Sex

19% of females

12% of males




No84%

Yes16%

Depression* [3-4,15]

57% of participants said “yes” when asked if they had ever experienced sad spells or depression.

16% were currently taking medication for sadness or depression.

7% reported that sad spells or depression limited their activities.

HISTORY OF SAD SPELLS OR DEPRESSION

*Participants were classified as having depression if they answered “always” or “very often” when asked, “How much of the time during the past 4 weeks have you not taken interest or pleasure in doing things?” or if they answered “always” or “very often” when asked “How much of the time dur-ing the past 4 weeks have you felt downhearted or blue?”


No76%

Yes24%

Anxiety [5, 7,16 ]

ANXIETY BY RESIDENCE




24% of participants said “yes” when asked if they had ever experienced anxiety or panic attacks.

9% were currently taking medication for anxiety or panic attacks.

2% reported that anxiety limited their activities.

HISTORY OF ANXIETY

*Participants were classified as having anxiety if they answered “always” or “very often” when asked, “How much of the time during the past 4 weeks have you felt tense or high-strung?” or if they answered “almost never” or “never” when asked “How much of the time during the past 4 weeks have you felt relaxed and free of tension?”


Sex 12% of females

7% of males




No90%

Yes10%

Nervousness / Nerves [6, 17]

NERVOUSNESS BY AGE, SEX, AND RESIDENCE

HISTORY OF NERVOUS BREAKDOWN 6% of participants said “yes” when asked if they had ever had a nervous breakdown.

3% were currently taking medication for a nervous breakdown.

2% reported that a nervous breakdown limited their activities.

*Participants were classified as having problems with nervousness if they answered “always” or “very often” when asked, “How much of the time during the past 4 weeks have you been bothered by nervousness or your nerves?”

Never or Almost Never

66%

Sometimes19%

Very Often or Always

15%


Race 31% of whites

27% of blacks

Sex 34% of females

24% of males





39%

Sometimes 31%


30%

Fatigue [8]

FATIGUE (VERY OFTEN OR ALWAYS) BY RACE, SEX, AND RESIDENCE

Shortness of breath [9]

Race 16% of whites

13% of blacks




SHORTNESS OF BREATH (VERY OFTEN OR ALWAYS) BY RACE AND RESIDENCE


Sex 3% of females

2% of males





3%


90%

Sometimes7%


67%

Sometimes22%


11%

Nausea [10]

NAUSEA BY SEX AND RESIDENCE

Balance problems [11]

BALANCE BY AGE, RACE, AND RESIDENCE Age




Race 10% of whites

11% of blacks




SECTION 2: GENERAL HEALTH– SYMPTOMS

Fainting [12]

Less than 1% of participants reported fainting “very often” or “always.”

1% reported fainting “sometimes.”

PREVALENCE OF FAINTING

Frequency of pain [13]

12% of participants reported having agonizing pain.

7% reported dreadful pain.

27% reported uncomfortable pain.

20% reported annoying pain.

34% reported that they experienced no pain.

23% reported that pain interfered with their normal work “a little bit” or “moderately.”

20% reported that pain interfered with their normal work “quite a bit” or “extremely.”

DESCRIPTION OF PAIN

Sex 38% of females

28% of males




PAIN (VERY OFTEN OR ALWAYS) BY SEX AND RESIDENCE

Never or

Almost Never40%

Sometimes26%


34%

SECTION 2: GENERAL HEALTH– HEARING




Race 10% of whites

5% of blacks

Sex 6% of females

12% of males

Good91%

Poor9%

Hearing: Interviewer’s evaluation [20]

POOR HEARING ABILITY (INTERVIEWER’S EVALUATION) BY AGE, RACE, AND SEX

No89%

Yes11%

Hearing aid usage [18]

45 of the 133 participants who reported using a hearing aid had hearing difficulty even when wearing the hearing aid.

HEARING AID EFFICACY

HEARING AID BY AGE, RACE, AND SEX




Race 12% of whites

8% of blacks

Sex 8% of females

15% of males

SECTION 2: GENERAL HEALTH– VISION

POOR VISION BY AGE, RACE, SEX, AND RESIDENCE Age




Race 16% of whites

24% of blacks

Sex 21% of females

16% of males




No 82%

Yes18%

Poor vision* [26-29]

2% of participants were legally blind.

1% were blind.

BLINDNESS

8% had difficulty reading traffic signs, street signs, or store signs.

7% had difficulty seeing steps, stairs or curbs.

17% had difficulty reading a newspaper or book.

38% had difficulty reading small print.

VISION DIFFICULTY

*Poor vision was defined as having two of the following vision problems: reading traffic signs; seeing steps; reading a newspaper; or reading small print.

Not Regular or Never22%

Every 1-2 Years78%


NOT REGULAR OR NEVER HAD EYE EXAMINATION BY AGE AND SEX

Frequency of eye examinations [22-23]




Sex 19% of females

26% of males

58% of participants had their last eye examination within the past year.

35% had their last eye examination one to five years ago.

5% had their last eye examination more than five years ago.

1% did not know when their last eye examination had been.

72% were given a prescription for eye glasses.

68% obtained prescribed glasses.

2% said they could not obtain glasses because of cost.

LAST EYE EXAMINATION

Yes32%

No63%

Doesn't know5%

Yes60%

No36%

Doesn't know4%


NO INSURANCE FOR EYE EXAMINATIONS BY AGE, SEX, AND RESIDENCE

Insurance coverage for eye glasses [25]

Insurance coverage for eye examinations [24]




Sex 38% of females

42% of males




NO INSURANCE FOR EYE GLASSES BY RACE AND RESIDENCE Race

70% of whites

62% of blacks




No51%

Yes49%

Eye disease [26]

EYE DISEASE BY AGE AND SEX Age




Sex 54% of females

43% of males

37% of participants currently had or had had cataracts.

23% had had cataract surgery.

9% had glaucoma.

7% had retinal eye disease.

CATARACTS AND EYE DISEASE


More Than One Year

49%

Within Past Year 51%

DENTAL VISITS MORE THAN ONE YEAR AGO BY AGE, RACE, AND RESIDENCE

Frequency of dental examinations [30]




Race 42% of whites

69% of blacks




15% of participants had dentures and reported that they did not know, had never been, or had not been to a dentist in the past five years.

16% of participants needed dental care, but did not go. 11% did not go because of cost. 1% did not go because there was no time. 12% had changed eating habits because of dental problems.

DENTAL CARE ISSUES

Mouth rinse 60% used mouth rinse four or more times per week. 22% used mouth rinse sometimes. 19% never used mouth rinse. Flossing 34% flossed four or more times per week. 21% flossed sometimes. 23% never used dental floss. 23% have dentures.

DENTAL HYGIENE

SECTION 2: GENERAL HEALTH– DENTAL

Active39%

Moderately active31%

Minimally active21%

Not active9%

Active49%

Moderately active28%

Minimally Active17%

Not active6%

SECTION 3: ACTIVITY/MOBILITY

Physical activity [3]

Social activity [1]

MINIMAL OR NO SOCIAL ACTIVITY BY RESIDENCE




MINIMAL OR NO PHYSICAL ACTIVITY BY AGE, SEX, AND RESIDENCE

79% of participants reported being satisfied with their amount of social activity.

18% reported that they had too little social activity.

3% reported that they had much social activity.

SATISFACTION WITH SOCIAL ACTIVITY




Sex 33% of females

25% of males




Race 28% of whites

35% of blacks


Types and frequency of activities [5]

41

21 17

4

0

20

40

60

Walking forExercise

GeneralExercise

Us ing ExerciseEquipm ent

Aerobics

Perc

ent o

f Sam

ple

4.3

(1,21)

Average Times per Week

(Minimum, Maximum)

4.3

(1,20)

3.7

(1,10)

3.4

(1,7)

3% of participants reported golfing.

3% reported dancing.

16% reported that they did not participate in any regular activity.

OTHER ACTIVITY AND INACTIVITY

53

42

30

0

20

40

60

Yardwork StrenuousHousework

Gardening

Perc

ent o

f Sam

ple

2.2

(1,7)

Average Times per Week

(Minimum, Maximum)

1.8

(1,21)

3.1

(1,7)

25% of participants reported difficulty walking.

18% were unable to walk 3-4 blocks or 1/4 mile; another 23% had difficulty walking 3-4 blocks or 1/4 mile.

33% reported difficulty going up/down stairs.

10% reported difficulty getting outside.

AMBULATION DIFFICULTY


Falls within the past year [6]

FALLS BY AGE, RACE, AND SEX Race

28% of whites

23% of blacks

Sex 31% of females

21% of males




13% of participants had fallen one time.

10% had two to four falls.

3% had five or more falls.

13% had fallen within the past three months.

12% suffered injurious falls.

8% obtained medical treatment because of their falls.

FREQUENCY AND CONSEQUENCES OF FALLS

Did Not Fall 73%

At Least One Fall27%


4

7

1 1

0

3

6

9

Oxygen Toilet Bedpan Hospital Bed

Per

cent

of S

ampl

e

Less than 1% of participants used crutches, elevator chairs, ventilators, artificial legs, transfer lifts, roll-in showers or other walking equipment.

OTHER EQUIPMENT

1614

9

6

0

10

20

30

Cane Bathing Aids Walker Wheelchair

Perc

ent o

f Sam

ple

2 2 2 1

0

3

6

9

Orthopedic Shoes Lift Chair Scooter Brace

Perc

ent o

f Sam

ple

Mobility equipment currently used [7]

14% of participants had insurance coverage for equipment.

INSURANCE FOR EQUIPMENT





Race 8% of whites

17% of blacks

Sex 14% of females

6% of males

UNAFFORDABLE EQUIPMENT NEED BY AGE, RACE, AND SEX

Yes11%

No89%

Equipment needed, but unaffordable [9]

4% of participants reported needing scooters.

2% reported needing rails in the bathroom.

1% reported needing a cane or walker.

1% reported needing a wheelchair.

1% reported needing a lift chair.

1% reported needing special shoes.

1% reported needing other bathroom equipment.

1% reported needing some other unspecified equipment, but could not afford it.

TYPES OF UNAFFORDABLE EQUIPMENT NEEDED

No Difficulty 63%

One18%

Three3%

Four 5%

Two9%

Five to Six 2%


ANY IADL DIFFICLTY BY AGE, RACE, SEX, AND RESIDENCE Age




Race 35% of whites

43% of blacks

Sex 45% of females

26% of males




Instrumental Activities of Daily Living (IADL): Difficulties reported [IADL 1-6]

Number of IADL Difficulties

30

1610 8 6 5

0

20

40

60

DoingHeavy

Housework

Shopping Doing LightHousework

PreparingMeals

Using theTelephone

ManagingMoney

Per

cent

of S

ampl

e


Activities of Daily Living (ADL): Difficulties reported [ADL3-6,9]

ANY ADL DIFFICULTY BY AGE, RACE, SEX, AND RESIDENCE Age




Race 26% of whites

35% of blacks

Sex 33% of females

23% of males




No Difficulty 72%

Four 2% Five

1%

Three4%

Two6%

One15%

23

11 95 3

0

20

40

60

Transferring Bathing Dressing Toileting Eating

Per

cent

of S

ampl

e

Number of ADL Difficulties

Yes5%

No95%




HOME HEALTH CARE/HOSPICE NEED BY AGE, SEX, AND REGION

Sex 8% of females

2% of males




3% of participants reported needing home health care or hospice, but were not receiving it.

HOME HEALTH CARE/HOSPICE NEED BUT NOT RECEIVED


Home health care or hospice need [11]

Of the 2% of participants who received services at home, 11 participants reported that Medicare paid for home health services. 9 participants reported that Medicaid paid for the services. 6 participants paid themselves or had help from family. 1 person had health insurance.

SOURCES OF PAYMENT

Of the 3% of participants who needed, but did not receive services at home, 17 participants wanted someone to help clean the house. 11 participants wanted a social worker to identify any assistance available. 4 participants wanted someone to help with bathing and dressing. 3 participants wanted a nurse to check on their condition. 2 participants wanted someone to help with medicine. 2 participants wanted a physical therapist to come to the home.

MOST VALUABLE SERVICE NOT RECEIVED

Of the 2% of participants who received services at home, 18 participants used a home health system. 8 participants used another service. 1 participant used hospice.

TYPES OF SERVICES

43

2923

31

8

0

20

40

60

Cab/Taxi Bus Van service None Does NotKnow

Per

cent

of S

ampl

e

Yes95%

No5%

SECTION 3: ACTIVITY/MOBILIY

Reliable transportation [12]

NO RELIABLE TRANSPORTATION BY AGE, SEX, AND RACE




Race 3% of whites

12% of blacks

Sex 8% of females

2% of males

85% of participants had access to a car that they drove themselves.

24% had access to a car that someone else drove.

29% were transported in someone else’s car by a family member, friend, or neighbor.

1% used a community transportation service.

2% used a bus or other public transportation.

USUAL SOURCES OF TRANSPORTATION (MULTIPLE RESPONSES POSSIBLE)

8% of participants reported using any of these other modes of transportation.

OTHER AVAILABLE TRANSPORTATION

Always90%

Never1%

Sometimes3%

Most of the Time6%

SECTION 3: ACTIVTY/MOBILITY

Availability and time of arrival for ambulance service [16]

Seatbelt use [14]

NEVER USES SEATBELT BY RESIDENCE




3 participants reported it would be more than one hour for the arrival of an ambulance.

AMBULANCE SERVICE

Less Than 15 Minutes

72%

No Service 1%30 Minutes to

1 Hour 2%

15-30 Minutes 20%

Does Not Know Time

4%

Does Not Know If There

Is Service 1%

No5%

Yes95%

No4%

Yes96%

SECTION 4: HEALTH SERVICES UTILIZATION




Race 3% of whites

8% of blacks

Sex 5% of females

3% of males

Insurance for health care [1]

NO HEALTH INSURANCE BY RACE, SEX, AND AGE

61% of participants had Medicare. 25% had Medicare supplemental insurance. 9% had Medicaid. 7% had both Medicaid and Medicare. 34% had insurance through an employer. 25% had other private insurance. 6% had insurance through a VA program.

TYPES OF HEALTH INSURANCE (MULTIPLE RESPONSES POSSIBLE)

NO DOCTOR BY SEX

Sex 4% of females

6% of males

Regular doctor for health care [2]


38% of participants had seen a doctor within the last month.

41% had seen a doctor within the last six months.

9% had seen a doctor within the last seven to twelve months.

4% had seen a doctor within the last one to two years.

2% had seen a doctor more than two years before.

1% had never seen a doctor or did not know.

LAST VISIT TO GENERAL HEALTH CARE DOCTOR

6% of participants had not seen a doctor in the last year.

11% had one visit in the last year.

40% had two to four visits in the last year.

28% had five to eleven visits in the last year.

10% had twelve to eighteen visits in the last year.

3% had nineteen to twenty-four visits in the last year.

3% had more than twenty-five visits in the last year.

NUMBER OF DOCTOR VISITS IN THE LAST YEAR

3% of participants did not know or never had a physical exam.

49% had a physical exam within the last six months.

27% were examined from six months to one year ago.

9% were examined between one and two years ago.

11% were examined more than two years ago.

LAST PHYSICAL EXAM

69% of participants saw more than one doctor.

66% saw a specialist.

2% saw more than one doctor because of convenience.

1% saw more than one doctor because of cost.

1% saw more than one doctor because of insurance.

MORE THAN ONE DOCTOR

Doctor visits [2-3]

71 69

57

0

20

40

60

80

Mammogram Breast Exam Pap Smear

Per

cent

of W

omen

71

0

20

40

60

80

1

Perc

ent o

f Men


Examinations performed within the last year [8]

38 37 36

0

20

40

60

Stool Blood Test Colon Screening Digital Rectal Exam

Per

cent

of S

ampl

e95

8982 81 78

0

20

40

60

80

100

BloodPressure

Blood Drawn Blood Count Cholesterol Blood Sugar

Perc

ent o

f Sam

ple

Prostate Exam


No76%

Yes24%

Needed doctor visit but did not go [5]

12% of participants said that they put off going to the doctor.

6% cited lack of money as a reason.

3% cited transportation problems.

2% cited fear.

1% cited they were unsure of whom to see.

1% cited they were dissatisfied with their provider.

Less than 1% cited distance as a reason for not seeing a doctor.

REASONS FOR NOT SEEING DOCTOR DESPITE NEED (MULTIPLE RESPONSES POSSIBLE)

NEEDED DOCTOR VISIT BUT DID NOT GO BY RESIDENCE, RACE, SEX, AND AGE







Race 22% of whites

30% of blacks

Sex 27% of females

20% of males


No77%

Yes23%

Emergency Room visit within the last year

EMERGENCY ROOM VISITS WITHIN LAST YEAR BY RACE, SEX, AND AGE Age




Race 21% of whites

27% of blacks

Sex 25% of females

20% of males

NUMBER OF EMERGENCY ROOM VISITS IN LAST YEAR

17% of participants had one Emergency Room visit within the last year.

4% had two Emergency Room visits within the last year.

2% had three to five Emergency Room visits within the last year.

1% had five or more Emergency Room visits within the last year.


No69%

Yes31%

Hospitalizations in last year [10]

HOSPITALIZATIONS IN LAST YEAR BY AGE, RACE, AND RESIDENCE Residence

30% of urban residents






Race 33% of whites

26% of blacks

NUMBER OF HOSPITALIZATIONS

21% of participants had one hospitalization within the past year.

5% had two hospitalizations within the last year.

4% had three to five hospitalizations within the last year.

1% had five or more hospitalizations within the last year.


No99%

Yes1%

Resident at a nursing home, mental health facility or VA facility in last year [11]

FACILITY RESIDENT BY AGE

No12%

Yes88%

43% of participants had prescriptions from multiple doctors. 86% took their medicine as directed by a physician. 5% took medicine only when they feel they need it. 12% changed the prescription due to cost. 17% were unable to afford prescribed medications. 4% took medications prescribed for others.

PRESCRIPTION MEDICATIONS

Age 0.2% of 55-64 year olds



Prescription medication use [13]

PRESCRIPTION DRUG USE BY AGE, SEX, AND RESIDENCE

Sex 90% of females

85% of males











Race 25% of whites

34% of blacks

Sex 30% of females

24% of males




No28%

Yes72%

Prescription medication insurance [12]

NO PRESCRIPTION MEDICATION INSURANCE BY AGE, RACE, SEX AND RESIDENCE

24% of participants had private insurance.

34% had insurance through their employer.

7% had Medicaid insurance.

8% had VA insurance.

5% had another type of insurance.

TYPES OF INSURANCE (MULTIPLE RESPONSES POSSIBLE)

Of the 87% of participants who took prescription medications,

the average spent per month on prescription medications was $96.33.

COST OF PRESCRIPTION DRUGS

3% of participants had been told by a physician that they had liver disease.

2% had been told that they had Alzheimer’s Disease or dementia.

2% had been told that they had epilepsy or a seizure disorder.

1% had been told that they had Parkinson’s Disease.

3% were paralyzed.

OTHER MEDICAL CONDITIONS

SECTION 5: MEDICAL HISTORY

Medical conditions [1-34]

10.1

11

12.9

13.5

14.6

20.5

21.1

21.2

25.3

29.4

38.8

41

62.4

62.5

0 20 40 60

Stroke/TIA

Peripheral Neuropathy

Anemia

Osteoporosis

Thyroid

Respiratory Problems

Diabetes

Spinal Stenosis

Cancer

Circulation Problems

Digestive Tract Problems

Heart Problems

Arthritis/Gout

Hypertension

Percent of Sample


Surgeries [35]

3.8

5.2

5.5

8.1

12.1

12.5

16.4

23.4

0 20 40 60

Hip

Stomach

Bladder

Back

Knee

Heart

Gall Bladder

Cataract

Percent of Sample

10% of the male participants had undergone prostate surgery (approximately half were for prostate cancer).

7% of the female participants had undergone breast cancer surgery.

2% had colon cancer surgery.

1% had lung cancer surgery.

OTHER SURGERIES


Medical conditions by age

55-64 64-74 75+ Hypertension 56% 64% 70% Arthritis 54% 66% 71% Heart 33% 42% 52% Digestive tract 36% 43% 38% Circulation 25% 29% 36% Cancer 18% 27% 34% Spinal Stenosis 23% 23% 17% Diabetes 19% 26% 19% Respiratory 20% 21% 20% Thyroid 12% 16% 16%

Anemia 12% 12% 15% Neuropathy 10% 12% 11% Stroke 5% 12% 16% Renal/Kidney 4% 7% 9% Liver Disease 3% 4% 2%

Osteoporosis 10% 13% 20%

55-64 64-74 75+ 1 Hypertension Arthritis Arthritis 2 Arthritis Hypertension Hypertension 3 Digestive Tract Digestive Tract Heart 4 Heart Heart Digestive Tract 5 Circulation Circulation Circulation 6 Spinal Stenosis Cancer Cancer 7 Respiratory Diabetes Respiratory 8 Diabetes Spinal Stenosis Osteoporosis 9 Cancer Respiratory Diabetes 10 Anemia (10/11) Thyroid Spinal Stenosis 11 Thyroid (10/11) Osteoporosis Thyroid 12 Neuropathy Anemia (12/13) Stroke 13 Osteoporosis Neuropathy (12/13) Anemia 14 Stroke Stroke Neuropathy 15 Renal/Kidney Renal/Kidney Renal/Kidney

Medical conditions ranked by age


Medical conditions by race

Medical conditions ranked by race

White Black 1 Arthritis Hypertension 2 Hypertension Arthritis 3 Heart Circulation 4 Digestive Tract Heart 5 Cancer Digestive Tract 6 Circulation Diabetes 7 Spinal Stenosis Respiratory 8 Respiratory Cancer 9 Diabetes Anemia

10 Thyroid (10/11) Spinal Stenosis 11 Osteoporosis (10/11) Stroke 12 Anemia Neuropathy 13 Neuropathy Thyroid 14 Stroke Osteoporosis 15 Renal/Kidney Renal/Kidney

White Black Hypertension 56% 80% Arthritis 61% 67% Heart 43% 36% Digestive tract 41% 32% Circulation 26% 38% Cancer 28% 19% Spinal Stenosis 24% 13% Diabetes 17% 31% Respiratory 21% 19% Thyroid 16% 10%

Anemia 12% 14% Neuropathy 11% 10% Stroke 10% 11% Renal/Kidney 7% 5% Liver Disease 3% 2%

Osteoporosis 16% 6%


Medical conditions by sex

Medical conditions ranked by sex

Male Female Hypertension 60% 64% Arthritis 55% 68% Heart 42% 40% Digestive tract 33% 43% Circulation 25% 33% Cancer 29% 23% Spinal Stenosis 21% 21% Diabetes 21% 21% Respiratory 18% 22% Thyroid 7% 20%

Anemia 6% 18% Neuropathy 11% 11% Stroke 9% 11% Renal/Kidney 6% 6% Liver Disease 3% 4%

Osteoporosis 1% 23%

Male Female 1 Hypertension Arthritis 2 Arthritis Hypertension 3 Heart Digestive Tract 4 Digestive Tract Heart 5 Cancer Circulation 6 Circulation Cancer 7 Spinal Stenosis Osteoporosis 8 Diabetes Respiratory 9 Respiratory Spinal Stenosis (9/10)

10 Neuropathy Diabetes (9/10) 11 Stroke Thyroid 12 Thyroid Anemia 13 Anemia (13/14) Stroke 14 Renal/Kidney (13/14) Neuropathy 15 Dementia Renal/Kidney


Medical conditions by residence

Medical conditions ranked by residence

Rural Mid-Size Urban Hypertension 63% 66% 61% Arthritis 61% 72% 59% Heart 42% 47% 39% Digestive tract 44% 44% 35% Circulation 32% 32% 28% Cancer 23% 27% 25% Spinal Stenosis 24% 25% 19% Diabetes 23% 23% 20% Respiratory 19% 23% 20% Thyroid 13% 15% 15%

Anemia 15% 18% 11% Neuropathy 11% 12% 11% Stroke 12% 9% 10% Renal/Kidney 10% 7% 5% Liver Disease 3% 3% 3%

Osteoporosis 8% 15% 15%

Rural Mid-Size Urban 1 Hypertension Arthritis Hypertension 2 Arthritis Hypertension Arthritis 3 Digestive Tract Heart Heart 4 Heart Digestive Tract Digestive Tract 5 Circulation Circulation Circulation 6 Spinal Stenosis Cancer Cancer 7 Cancer Spinal Stenosis Diabetes(7/8) 8 Diabetes Respiratory Respiratory(7/8) 9 Respiratory Diabetes Spinal Stenosis

10 Anemia Anemia Thyroid 11 Thyroid Thyroid (11/12) Osteoporosis 12 Stroke Osteoporosis (11/12) Neuropathy 13 Neuropathy Neuropathy Anemia 14 Renal/Kidney Stroke Stroke 15 Osteoporosis Renal/Kidney Renal/Kidney


Surgeries by age

Surgeries ranked by age

55-64 64-74 75+ Cataract 8% 22% 49% Gall Bladder 15% 18% 17% Heart 9% 14% 16% Knee 12% 13% 11% Back 8% 8% 8% Bladder 3% 7% 7% Stomach 5% 6% 5% Hip 5% 3% 9% Colon Cancer 1% 2% 5% Lung Cancer 0.2% 1% 1%

55-64 64-74 75+ 1 Gall Bladder Cataract Cataract 2 Knee Gall Bladder Gall Bladder 3 Heart Heart Heart 4 Back Knee Knee 5 Cataract Back Hip 6 Stomach Bladder Back 7 Bladder Stomach Bladder 8 Hip Hip Stomach (8/9) 9 Colon Cancer Colon Cancer Colon Cancer (8/9)

10 Lung Cancer Lung Cancer Lung Cancer


Surgeries by race

Surgeries ranked by race

White Black Cataract 26% 17% Gall Bladder 19% 9% Heart 15% 6% Knee 13% 9% Back 10% 3% Bladder 7% 2% Stomach 6% 5% Hip Surgery 4% 3% Colon Cancer 2% 3% Lung Cancer 1% None

White Black 1 Cataract Cataract 2 Gall Bladder Gall Bladder 3 Heart Knee 4 Knee Heart 5 Back Stomach 6 Bladder Back 7 Stomach Hip (7/8) 8 Hip Colon Cancer (7/8) 9 Colon Cancer Bladder

10 Lung Cancer


Surgeries by sex

Surgeries ranked by sex

Male Female Cataract 22% 24% Gall Bladder 11% 21% Heart 20% 7% Knee 13% 11% Back 8% 8% Bladder 2% 8% Stomach 4% 6% Hip 2% 5% Colon Cancer 2% 3% Lung Cancer 1% 1%

Male Female 1 Cataract Cataract 2 Heart Gall Bladder 3 Knee Knee 4 Gall Bladder Back 5 Prostate Bladder 6 Back Heart 7 Stomach Breast Cancer 8 Hip Stomach 9 Bladder Hip

10 Colon Cancer Colon Cancer

9.7% of men reported prostate surgery. 6.8% of women reported breast cancer surgery.


Surgeries by residence

Surgeries ranked by residence

Rural Mid-Size Urban 1 Cataract Cataract Cataract 2 Gall Bladder Gall Bladder Gall Bladder 3 Heart Knee Knee 4 Back Heart Heart 5 Knee Back Back 6 Bladder Stomach Bladder 7 Stomach Bladder Stomach 8 Hip Hip Hip Surgery 9 Colon Cancer Lung Cancer Colon Cancer

10 Lung Cancer Colon Cancer Lung Cancer

Rural Mid-Size Urban Cataract 21% 23% 24% Gall Bladder 14% 20% 16% Heart 14% 13% 12% Knee 6% 16% 13% Back 7% 12% 7% Bladder 6% 7% 5% Stomach 5% 8% 4% Hip Surgery 3% 4% 4% Colon Cancer 1% 0.4% 4% Lung Cancer None 1% 1%

Yes20%

No80%

No60%

Yes40%


Incontinence: Fecal [41]

Incontinence: Urinary [38]

FECAL INCONTINENCE BY RACE Race

21% of whites

16% of blacks

URINARY INCONTINENCE BY AGE, RACE, SEX, AND RESIDENCE Race

42% of whites

35% of blacks

Sex 53% of females

23% of males







Yes31%

No69%

Yes6%

No94%


Pressure ulcers [42]

Constipation [39]




PRESSURE ULCERS BY RACE Race

7% of whites

3% of blacks

CONSTIPATION BY AGE, RACE, SEX, AND RESIDENCE Race

28% of whites

38% of blacks

Sex 39% of females

20% of males




No Medications7%

One to Tw o 21%

Three to Four 25%

Five to Eight25%

Eight or More22%

26% of participants took at least one medication without knowing the reason.

9% took two or more medications without knowing the reason.

7% took at least one medication using a dosage different from the prescribed dosage.


PERCENT OF PARTICIPANTS REPORTING EIGHT OR MORE MEDICATIONS BY AGE, RACE, SEX, AND RESIDENCE

Number of medications

Race 23% of whites

18% of blacks

Sex 25% of females

17% of males







Less Than 205%

20 to 24.927%

25 to 29.937%

More Than 3031%

SECTION 6: DIET AND NUTRITION

Body Mass Index (BMI)* [1-2]

BMI LESS THAN 20 BY AGE, SEX, AND RESIDENCE




Sex 7% of females

2% of males




BMI GREATER THAN 30 BY AGE AND RACE

Race 26% of whites

41% of blacks




*Body Mass Index (BMI) is a measure of body fat for adults. It is based on height and weight. A BMI between 20 and 25 is considered normal for adults. A BMI of 25-29.9 indicates overweight, and over 30 indicates obesity. A BMI under 20 indicates underweight.

Three or more63%

One 4%

Irregular3%

Two30%

Very good51%

Poor3%

Good36%

Fair 10%


FAIR OR POOR APPETITE BY AGE, RACE, SEX, AND RESIDENCE

Number of meals eaten per day [6]

Description of Appetite [5]

Race 11% of whites

15% of blacks

Sex 14% of females

10% of males







FEWER THAN THREE MEALS A DAY BY AGE AND RACE

Race 29% of whites

45% of blacks




2% of participants reported skipping meals because of a lack of food. GOING HUNGRY

Someone Else Shops

22%

Shops for Self 78%

Self68%

Other3%

Other Family4%

Spouse25%


DOES NOT SHOP FOR GROCERIES BY SEX

Person who prepares meals [9]

Shopping for groceries [8]

Sex 11% of females

37% of males

16% of participants reported that their spouse shopped for groceries.

6% reported that another family member does the shopping.

1% reported that a friend does the shopping.

Less than 1% of participants reported that a neighbor, home health assistant or somebody else shopped.

WHO DOES THE GROCERY SHOPPING

1% or participants reported that they ate out.

1% had meals prepared by a friend.

1% had meals prepared by neighbors, community meal programs, home health

assistant or another source.

OTHER MEAL PREPARATION

No95%

Yes5%


PARTICIPANTS WHO EAT AT SENIOR CENTER BY AGE, RACE, AND SEX

Participants who eat at a senior center [11]




Sex 6% of females

3% of males




Senior Center meals are predominantly lunch; only two participants reported having breakfast.

1% of participants had meals delivered to their homes.

1 participant had meals delivered daily.

4 had meals delivered 5-6 days per week.

4 had meals delivered 2-4 days per week.

7 had meals delivered once a week.

Lunch was the main meal delivered (10 participants).

Frozen meals were delivered to 5 participants.

MEALS DELIVERED TO HOME

No59%

Yes41%

*The Nutritional Screening Initiative, a project of the American Academy of Family Physicians, the American Dietetic Association and the National Council on Aging, Inc. developed a checklist to determine nutritional risk. Scores range from 0 to 21. A score of 0-2 is no risk, 3-5 indicates moderate nutritional risk; 6 or more indi-cates nutritional risk. (Questions listed in Appendix C.)


Nutritional Risk*

Participants who usually eat meals alone [10]

USUALLY EATS ALONE BY AGE, RACE, AND SEX

Race 38% of whites

49% of blacks

Sex 56% of females

20% of males




NUTRITIONAL RISK BY RACE AND SEX

Race 27% of whites

18% of blacks

Sex 24% of females

16% of males

No Risk 41%

Moderate Risk 39%

Nutritional Risk 20%

No 82%

Current 6%

Former 12%

Current Smoker

14%

Quit Less Than 1 Year

Ago4%

Quit 1 Year Ago or More

38%

Never Smoked44%


Use of other tobacco products [16]

Cigarette smoking status [15]

CURRENT USE OF OTHER TOBACCO PRODUCTS BY AGE, SEX, AND RESIDENCE




Sex 2% of females

11% of males

CURRENT CIGARETTE SMOKER BY AGE AND RACE

Race 13% of whites

17% of blacks




Ever Current Total

Pipe 6% 1% 7%

Cigar 5% 2% 7%

Smokeless tobacco 3% 3% 6%

Snuff 2% 1% 3%

EVER/CURRENT USE OF OTHER TOBACCO PRODUCTS (MULTIPLE RESPONSES POSSIBLE)

No64%

Yes36%


PARTICIPANTS WHO USE ALCOHOL BY AGE, RACE, SEX, AND RESIDENCE

Participants who use alcohol [17]




3 OR MORE DRINKS PER DAY BY AGE AND SEX

Race 38% of whites

30% of blacks

Sex 29% of females

45% of males




Sex 2% of females

13% of males




7% had three or more drinks when they drank.

1% of participants were possibly alcohol dependent.*

ALCOHOL USE

*The CAGE is an instrument to assess probable alcohol dependence (see Question 17b-e).

A positive response to two or more questions indicates probable alcohol dependence.

SECTION 7: COGNITIVE FUNCTIONING

Symptoms of depression* [GS1-15]

SIX OR MORE SYMPTOMS OF DEPRESSION BY SEX AND RESIDENCE Sex

14% of females

8% of males




*The Geriatric Depression Scale is a validated and reliable index of depressive symptoms to screen for possible depression in older adults. The short form consists of 15 yes/no questions about a per-son’s feelings over the week prior to the assessment (see questions GS1-15). Six to 10 symptoms indicate mild to moderate depression, and 10 or more symptoms indicate severe depression.

Fewer than Six Symptoms

89%

Six to Ten Symptoms

8%

Ten or More Symptoms

3%

SECTION 7: COGNITIVE FUNCTIONING

Cognitive Impairment (adjusted for education)* [MS1-15]

PROBABLE COGNITIVE IMPAIRMENT BY AGE AND RACE Race

5% of whites

13% of blacks




*The Mini-Mental State Exam developed by Folstein in 1975 is one of the most widely adopted screening tests for cognitive impairment. Scores range from 0 to 30. For persons with at least 8 years of education, a score lower than 24 is indicative of probable impairment or dementia. It has been suggested that a score lower than18 be used for persons with less than an 8th grade edu-cation.

Impaired7%

Not Impaired 93%

SECTION 8: SPIRITUALITY

No12%

Yes88%

Membership in a religious organization [1]

Twice aMonth

7%

Occasionally20%

Never13%

Once a Week30%

More ThanOnce a Week

30%

Frequency of attendance at a religious service [2]

ATTENDANCE ONE OR MORE TIMES A WEEK BY AGE AND RACE

NO ATTENDANCE BY AGE AND RACE

Race 58% of whites

68% of blacks




Race 16% of whites

6% of blacks







Race 85% of whites

95% of blacks

MEMBERSHIP BY AGE, RACE, SEX, AND RESIDENCE

Sex 90% of females

85% of males





No62%

Yes38%

Preference for more frequent worship service attendance [3]

PREFERENCE TO ATTEND MORE FREQUENTLY BY AGE, RACE, AND SEX




Race 35% of whites

48% of blacks

Sex 44% of females

31% of males

REASONS FOR NOT ATTENDING RELIGIOUS SERVICES AS OFTEN AS DESIRED (MULTIPLE RESPONSES POSSIBLE)

13% of participants cited health problems.


1% cited accessibility of building.

3% cited availability of services.

1% cited church leaders.

2% cited church members.

1% cited clothes or money.

18% cited other unspecified reasons.


No54%

Yes46%

Participation in other religious activities [4]

PARTICIPATION IN OTHER RELIGIOUS ACTIVITIES BY RACE, SEX, AND RESIDENCE

Race 42% of whites

58% of blacks




Sex 50% of females

41% of males

RELIGIOUS ACTIVITY FREQUENCY

8% of participants attended other activities more than once a week.

21% attended other activities once a week.

4% attended other activities twice a month.

5% attended other activities monthly.

5% attended other activities occasionally.


Important18%

Not Important14%

Very Important

58%

SomewhatImportant

10%

SUPPORT FROM FAITH COMMUNITY IMPORTANT BY RACE, SEX, AND RESIDENCE

Race 83% of whites

94% of blacks




Sex 88% of females

84% of males

Importance of support received from faith community [5]

No73%

Yes27%

Decreased religious attendance over last year [6]

14% of participants cited health problems.


2% cited church leaders.

2% cited church members.

1% cited clothes or money.

9% cited other unspecified reason.

DECREASED ATTENDANCE BY AGE, RACE AND SEX




Race 25% of whites

35% of blacks

Sex 33% of females

20% of males

REASONS FOR DECREASED ATTENDANCE (MULTIPLE RESPONSES POSSIBLE)


Not Active9%

Active or Very Active64%

Somewhat or Occasionally

Active27%

Private spiritual life activity [7]

Race 88% of whites

96% of blacks

Sex 95% of females

85% of males

PRIVATE SPIRITUAL LIFE ACTIVITY BY RACE AND SEX

5%

25%35%

49%

75%80%

0

50

100

PersonalSpiritualActivity

Church Television Radio Other No SupportReceived

Sources of spiritual support (multiple responses possible) [8]

No83%

Yes, In Household

8%

Yes, Not In

Household9%

11% of participants provided transportation assistance.

10% provided assistance with shopping.

10% provided assistance with meals.

9% provided assistance with medication management.

9% provided assistance with household chores.

8% provided assistance with finances.

7% provided assistance with personal care services.

TYPES OF CARE PROVIDED

8% of participants reported caring for only one person and that persons lived with the participant.

1% reported caring for two or more people who lived with the participant.

ASSISTANCE PROVIDED WITHIN THE HOUSEHOLD

SECTION 9: SOCIAL CARE

Assistance with daily living provided to others by participants [1]

ASSISTANCE PROVIDED BY AGE AND SEX

Sex 19% of females

15% of males




Of participants providing care, 36 said that sitter services would be helpful. 24 said that a community meals program would be helpful. 21 said that respite care would be helpful. 9 said that social support services would be helpful. 7 said that financial support would be helpful. 6 said that assistance with chores would be helpful. Less than 1% said that support in education/counseling, medical, or transportation would

be helpful.

SUPPORT SERVICES HELPFUL TO CAREGIVERS


Assistance with daily living provided to others (cont.) [1]

Hours of care Of participants providing care, 74 provided care one to nine hours per week. 29 provided care ten to nineteen hours per week. 23 provided care twenty to thirty-nine hours per week. 22 provided care forty to fifty-nine hours per week. 46 provided care sixty or more hours per week (27 of these provided care 24 hours/day).

Assistance with care (multiple responses possible) Of participants providing care, 72 received no assistance. 66 received assistance from family members other than a spouse or child. 49 received assistance from children/grandchildren. 19 received assistance from their spouse. 17 received assistance from paid sitters, nurses, or home health services. 15 received assistance from friends. 9 received assistance from church or community agencies. Stress associated with providing care Of participants providing care, 73 said that providing care was somewhat or extremely stressful.

TIME, ASSISTANCE, AND STRESS ASSOCIATED WITH CARING

ExtremelyLikely72%

SomewhatUnlikely

4%

ExtremelyUnlikely

3%

Unsure8%

Somewhat Likely13%

No62%

Yes14%

Possible14%

Doesn'tKnow10%


POTENTIAL CARGIVER BY AGE, SEX, AND RESIDENCE

Likelihood of care for self from family, if needed [3]

Anticipation of becoming a caregiver in next 10 years [2]




Sex 15% of females

13% of males




NOT SURE/UNLIKELY TO RECEIVE CARE FROM FAMILY BY SEX

Sex 18% of females

12% of males

ExtremelyLikely57%

SomewhatUnlikely

2%

Somewhat Likely20%

ExtremelyUnlikely

3%

Unsure18%


Potential sources of care in the event of a minor illness (multiple responses possible) [5]

Likelihood of care for self from health care system, if needed [4]

NOT SURE/UNLIKELY TO RECEIVE CARE FROM HEALTH CARE SYSTEM BY

RESIDENCE




17

63

0

20

40

60

Friend Hired Caregiver Not Sure/No One

Perc

ent o

f Sam

ple

46

52

23

0

20

40

60

Spouse Child Other Relative

Per

cent

of S

ampl

e


Potential primary long term caregiver, if needed [7]

38

31

7

0

20

40


Per

cent

of S

ampl

e

1

17

6

0

20

40

Friend or Neighbor Hired Caregiver Unsure/No One

Perc

ent o

f Sam

ple


Anticipated living arrangements if unable to care for oneself [6]

Race 8% of whites

9% of blacks

Sex 10% of females

5% of males




ANTICIPATED NURSING HOME PLACEMENT IF UNABLE TO CARE FOR SELF BY RACE, SEX, AND RESIDENCE

58

92

0

20

40

60

Own Home withHelp

Child's Home Other Relative'sHome

Perc

ent o

f Sam

ple

8 82

0

20

40

60

Nursing Home Assisted LivingFacility

Retirement Home

Per

cent

of S

ampl

e

NOT SURE WHERE CARE WOULD BE RECEIVED BY RACE, SEX, AND RESIDENCE Sex

14% of females

12% of males




Race 15% of whites

9% of blacks

Not Employed,

Not Drawing Benefits

2%Employed

26%

Not Employed,

Drawing Benefits

72%

SECTION 10: RETIREMENT PLANNING

Retirement benefits and employment status [R1A-C]

72% of participants were not employed and were drawing benefits. The average age of these participants was 71, and ranged from 55 to 96.

15% of participants planned to retire in the future. The average anticipated retire-ment age was 65, and ranged from 57 to 81 years.

5% of participants said they did not know when they would retire.

7% of participants said they would never retire.

5% of the sample had never been employed.

Of the 71% of formerly employed participants drawing retirement benefits, the aver-age age they stopped working was 59, and ranged from 16 to 91 years. The median age these participants stopped working was 62.

30 participants were not currently employed and not drawing any retirement bene-fits. The average age of the 25 of these participants who expected to draw benefits in the future was 63, and ranged from 60 to 66. 5 participants did not expect to ever draw social security or other retirement benefits

EMPLOYMENT HISTORY AND RETIREMENT AGE

A majority of participants planned to live in Alabama after retirement, ranging from 94% of those still employed, to 98% of those not employed.

RETIREMENT IN ALABAMA

Retired/Not Employed (N=890)

Yes76%

No19%

Don't Know 5%

Currently Employed (N=314)

Don't Know18%

No 27%

Yes55%


Adequacy of retirement plan to provide basics [RA3,RB2]

Has retirement plan [RA3,RB2]


No Retirement

Plan40%

Has Retirement

Plan60%


Has Retirement

Plan82%

No Retirement Plan18%


Retirement plans other than Social Security (multiple responses possible) [RA3,RB2]

NO SAVINGS BY RACE, SEX, AND RESIDENCE Race

82% of whites

91% of blacks

Sex 87% of females

81% of males




NO RETIREMENT PLAN BY AGE, RACE, AND SEX Age




Race 38% of whites

51% of blacks

Sex 51% of females

28% of males

24%

8% 9%6% 4% 3%

9%

9% 6%

2%2%

2%

0%

10%

20%

30%

40%

Work-RelatedPension

401K Savings StateRetirement

TeachersRetirement

Other Pension

Per

cent

of S

ampl

e

Currently Employed Retired/Not Employed



Not Applicable2%

Yes 9%

Don't Know5%

No84%


No 71%

Don't Know3%

Yes 21%

Not Applicable5%

Retirement activities (multiple responses possible) [RA5, RB4]

Adequacy of Social Security to maintain standard of living [RA4]

11% 11% 9%5%

36%

21%19%

0%

10%

20%

30%

40%

50%

Hobbies Travel Volunteer No Retirement

Per

cent

of S

ampl

e

Currently Employed Retired/Not Employed

SECTION 11 : LONG TERM CARE PLANNING

LONG TERM CARE INSURANCE POLICY HOLDER BY RACE AND RESIDENCE

Long Term Care Insurance Policy Holder Status [1]

Race 13% of whites

7% of blacks




Of participants who had Long Term Care Insurance policies, 65 purchased it less than five years ago. 33 purchased it between five and ten years ago. 24 purchased more than ten years ago. 5 were unsure about when the policy was purchased.

WHEN PURCHASED

Of participants who had had Long Term Care Insurance Policies, 18 people reported three years of coverage. All others did not know or indicated another term of coverage. No one reported having only one year of coverage. 92 people had nursing home room and board coverage. 82 people had in-home service coverage. 76 people had assisted living facility coverage. 58 people had day care coverage. 51 people had nursing home ancillary services coverage.

LENGTH AND TYPE OF COVERAGE

Plan to Buy 11%

Has Policy11%

Does Not Have a Policy and Does Not

Plan to Purchase

78%


CONSIDERING PURCHASE OF LONG TERM CARE INSURANCE BY AGE AND RACE

Considering purchasing Long Term Care Insurance* [2]

Race 14% of whites

10% of blacks




Plans in the event of death [3]

35%

64%66%70%

0

40

80

Purchased a cemetary plot

Discussed w ishes w ith

family

Prepared a property w ill

Purchased a pre-paid

burial plan

Per

cent

of S

ubje

cts

*Excludes those (5 participants) who had already purchased a plan.

No Plan 9%

Has Plan 91%

Very Much46%

Somewhat27%

Not Very Much 15%

Not At All12%

Plan in the event of death [3]

NO PLAN BY AGE, RACE, AND RESIDENCE

Race 6% of whites

17% of blacks








Amount of thought for medical care decisions if participant were incapacitated 4]

VERY MUCH THOUGHT GIVEN TO MEDICAL CARE DECISIONS BY AGE, RACE, SEX, AND RESIDENCE

Race 49% of whites

38% of blacks

Sex 49% of females

42% of males







40

48

8

0

20

40

60


Per

cent

of S

ubje

cts

Of participants who preferred a non-relative to make medical decisions if they were incapacitated,

18 named a friend.

Other preferences included pastor, clergy/religious advisor, and physician.

NON-RELATIVE DECISION MAKERS


Preferred surrogate medical decision maker [5]

21

29

4

0

20

40


Per

cent

of S

ampl

e

No45%

Yes55%


Person with whom participant discussed health care preferences [6]

Expressed health care preferences if seriously ill [6]

EXPRESSED CARE PREFERENCES BY AGE, RACE, AND SEX

Race 59% of whites

47% of blacks

Sex 59% of females

51% of males




Of participants who talked with a non-relative about care preferences if the participant were seriously ill,

16 reported talking with a friend.

Other specified preferences included a physician.

NON-RELATIVE

No68%

Yes32%

No18%

Yes82%


DOES NOT KNOW ABOUT LIVING WILLS BY AGE, RACE, SEX, AND RESIDENCE

Has a living will [8]

Knowledge of living wills [7]

Race 11% of whites

37% of blacks

Sex 15% of females

21% of males




DOES NOT HAVE A LIVING WILL BY AGE, RACE, SEX, AND RESIDENCE Race

61% of whites

87% of blacks

Sex 64% of females

73% of males










No74%

Yes26%

No44%

Yes56%


DOES NOT KNOW ABOUT HEALTH CARE POWER OF

ATTORNEY BY RACE

Signed legal document naming someone to make medical decisions [10]

Knowledge of health care power of attorney [9]

Race 37% of whites

61% of blacks

DOES NOT HAVE A SIGNED LEGAL DOCUMENT NAMING SOMEONE TO MAKE MEDICAL DECISIONS BY AGE, RACE, AND SEX

Race 69% of whites

88% of blacks








Designated Health Care Proxy [10]

Of participants who had not signed a legal document for health care,

288 said they had not thought of it.

119 said they did not have the time.

115 said it was not necessary now.

104 said they did not know where or how to do it.

28 said it was hard to think about it.

20 said they did not know who to name.

77 did not give any reason.

REASON FOR NOT SIGNING A LEGAL DOCUMENT FOR HEALTH CARE (MULTIPLE RESPONSES POSSIBLE)

8

13

2

0

5

10

15


Per

cent

of S

ampl

e

Of participants who designated a non-relative as a health care proxy:

7 named a friend.

Other specified preferences included a clergy/religious advisor and physician.

NON-RELATIVE HEALTH CARE PROXIES

My Home73%

Relative's Home

3%

Hospital or LTC Facility

13%

Not Determined

11%


PREFERS HOSPITAL/LONG TERM CARE FACILITY BY SEX AND RESIDENCE

Focus for end-of-life care [12]

Preference for location of end-of-life care [11]

Sex 15% of females

10% of males




AN APPROACH THAT FOCUSES ON EXTENDING LIFE EVEN IF IT CAUSES PAIN AND SUFFERING BY RACE AND RESIDENCE

Race 3% of whites

10% of blacks




Relieve Pain80%

Extend Life 5%

Does Notknow15%


Life-saving procedures at late stage of life-threatening illness [13-15]

VENTILATOR WANTED BY RACE Race

6% of whites

14% of blacks

2415

8

816

9

69

83

68

0%

20%

40%

60%

80%

100%

CPR Feeding Tube Ventilator

Perc

ent o

f Sam

ple

Yes Unsure No

CPR WANTED BY RACE AND SEX Race

20% of whites

35% of blacks

Sex 19% of females

30% of males

FEEDING TUBE WANTED BY RACE AND RESIDENCE Race

10% of whites

27% of blacks




Should NotBe Legal

47%

Legal withRestrictions

28%

Should Be Legal

11%

NoOpinion

12%

Refused2%


Views on physician assisted suicide [16]

PHYSICIAN ASSISTED SUICIDE SHOULD NOT BE LEGAL BY AGE, RACE, SEX, AND RESIDENCE

Race 45% of whites

55% of blacks

Sex 49% of females

45% of males







27% of participants said they could imagine a situation where they would request

physician assisted suicide if legal.

61% said they could not imagine such a situation.

11% were unsure.

1% refused to answer.

WOULD CONSIDER REQUESTING PHYSICIAN ASSISTED SUICIDE

Should NotBe Legal

49%

NoOpinion

12%

Should Be Legal

9%

Legal WithRestrictions

28%

Refused2%


Views on euthanasia [18]

EUTHANASIA SHOULD NOT BE LEGAL BY AGE, RACE, SEX, AND RESIDENCE

Race 48% of whites

54% of blacks

Sex 51% of females

48% of males







27% of participants said they could imagine a situation where they would request euthanasia if legal.

61% said they could not imagine such a situation.

11% were unsure.

1% refused to answer.

WOULD CONSIDER REQUESTING EUTHANASIA


End-of life concerns (multiple responses possible) [20]

CONCERN ABOUT BEING A BURDEN BY RACE, SEX, AND RESIDENCE Race

59% of whites

42% of blacks

Sex 58% of females

49% of males




55

3023 22 20

0

20

40

60

Being aBurden on

Others

No Worries orConcerns

Being in Pain Not HavingDignity

Respected

What WillHappen to My

Family

Per

cent

of S

ampl

e

13 128 4 4

0

20

40

60

Having OtherSevere

Symptoms

Being Alone Don'tKnow/Haven't

ThoughtAbout

What WillHappen To

Me After I Die

Other

Per

cent

of S

ampl

e

REFERENCES: CITATIONS PAGE 105

Alabama Commission on Aging and the University of Alabama Center for Aging. Statewide Survey of Alabama’s Elderly. (Available from the University of Alabama center for Aging, CH19-201, University Center, Birmingham AL 35294.) Alabama County Data Book. April 1997. Montgomery, AL: Alabama Department of Economic and Community Affairs. Cardiovascular Health Study. Manual of Operations. Vol. 1 and 2, 1989. Charlson ME, Sax FL, Mackenzie CR et al. Assessing illness severity: Does clinical judg-ment work? Journal of Chronic Diseases. Folstein MF, Folstein SE, McHugh PR, Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 1975;12: 189-198. Health Status of Rural Alabamians. Montgomery, Alabama Rural Health Association, 1998. Kovar M, Lawton M. Functional disability. Activities and instrumental activities of daily living. In: Lawton M, Teresi J, eds. Focus on Assessment Techniques. 1994, pp 57-75. The Nutrition Screening Initiative: Determine your nutritional health. Washington, DC: Nutri-tion Screening Initiative, 1992. Sheikh JL, Yesavage JA. Geriatric Depression Scales (GDS): Recent evidence and devel-opment of a shorter version. Clinical Gerontologist, 1986;5:165-174. United States Census 2000. http://www.census.gov/main/www/cen2000.html University of Alabama Center for Business and Economic Research, 2001. http://cber.cba.ua.edu/edata/data.html

References

Appendix A Questionnaire

Appendix B Frequency Tables

1

CHARTING THE COURSE

SECTION INTRO - IDENTIFICATION INFORMATION Frequency (n) Percent 1. SEX

Male 514 42.7 Female 690 57.3

2. TYPE OF HOUSING

Single-family home 1082 89.9 Multi-family home 91 7.6 House with one or more apartments 3 0.2 Apartment building 21 1.7 Housing especially for the elderly 4 0.3 Other 3 0.2

3. AMENITIES IN THE HOME Electricity 1204 100.0 Special phone service (TTY/TDD) 28 2.3 Air conditioning 1175 97.6 Stairs inside the home 396 32.9 Fans available 1116 92.7 Heat available 1204 100.0 Outside stairs leading into the home 701 58.2 Inside plumbing 1204 100.0 Ramp 92 7.6 Computer 556 46.2 Internet Access 458 38.0

SECTION 1: BACKGROUND Frequency (n) Percent 1. AGE RANGE (55-96) Mean = 68.54

55 – 64 494 41.0 65 – 74 382 31.7 75 – 84 279 23.2 85 +

2. BIRTHDATE NA NA

3. RACE/ETHNICITY

Black, not of Hispanic origin 328 27.2 White, not of Hispanic origin 876 72.8

4. MARITAL STATUS

Refused 1 0.1 Married 596 49.5 Widowed 392 32.6 Separated 18 1.5 Divorced 154 12.8 Never married 43 3.6

2

Section 1 cont’d Frequency (n) Percent 5. BIRTH PLACE

Alabama 870 72.3 Surrounding south 186 15.4 North east 88 7.3 Mid west 36 3.0 North west 7 0.6 South west 7 0.6 Other country 8 0.7

6. LENGTH OF RESIDENCE IN ALABAMA

Less than one year 1 0.1 One to five years 12 1.0 Six to ten years 22 1.8 Eleven to twenty years 50 4.2 More than twenty years 1119 92.9

7. CURRENT PROPERTY OWNER

Yes 1046 86.9 No 157 13.0 Does not know 1 0.1

8. HAS VALID ALABAMA DRIVERS LICENSE Yes 1107 91.9 No 97 8.1

9. REGISTERED VOTER IN ALABAMA Yes 1131 93.9 No 71 5.9 Does not know 2 0.2 PREVALENCE OF VOTING

Regularly 972 80.7 Sometimes 101 8.4 Rarely 56 4.7

VOTE IN LOCAL ELECTIONS Yes 1084 90.0 No 120 10.0

VOTE IN STATE ELECTIONS Yes 1084 90.0 No 120 10.0

VOTE IN NATIONAL ELECTIONS Yes 1090 90.5 No 114 9.5

3

Section 1 cont’d Frequency (n) Percent 10. NUMBER OF PEOPLE LIVING IN HOUSEHOLD

One 421 35.0 Two 595 49.4 Three 121 10.0 Four 31 2.6 Five 19 1.6 Six 7 0.6 Seven 10 0.8 WHO LIVES IN THE HOUSEHOLD

Spouse 584 48.5 Parent 17 1.4 Child 205 17.0 Grandchild 99 8.2 Other relative 46 3.8 Unrelated person living in home 22 1.8

11. HAVE CHILDREN Yes 1103 91.6 No 101 8.4 A. HOW MANY CHILDREN

One 147 12.2 Two 311 25.8 Three 271 22.5 Four 165 13.7 Five 90 7.5 Six 45 3.7 Seven 29 2.4 Eight 18 1.5 Nine or more 27 2.2

B. HOW MANY STILL LIVING None 15 1.2 One 158 13.1 Two 337 28.0 Three 255 21.2 Four 157 13.0 Five 78 6.5 Six 43 3.6 Seven 30 2.5 Eight 13 1.1 Nine or More 17 1.4

C. HOW MANY LIVE WITHIN ONE HOUR None 195 16.2 One 355 29.5 Two 261 21.7 Three 158 13.1 Four 70 5.8 Five or more 48 4.0

4

Section 1 cont’d Frequency (n) Percent

D. NUMBER THAT LIVE IN ALABAMA None 136 11.3 One 300 24.9 Two 302 25.1 Three 187 15.5 Four 93 7.7 Five or more 69 5.7

E. COMMUNICATE WITH CHILDREN Never 5 0.4 Three times a year or less 7 0.6 Four to ten times a year 8 0.7 Once a month 28 2.3 Two to three times a month 29 2.4 Once a week 117 9.7 Two to four times a week 193 16.0 Five or more times a week 701 58.2

F. PROVIDE CARE FOR CHILDREN Yes 168 14.0 No 920 76.4

12. HAVE GRANDCHILDREN Yes 1004 83.4 No 200 16.6

A. COMMUNICATE WITH GRANDCHILDREN Never 19 1.6 Three times a year or less 25 2.1 Four to ten times a year 41 3.4 Once a month 70 5.8 Two to three times a month 87 7.2 Once a week 135 11.2 Two to four times a week 190 15.8 Five or more times a week 437 36.3

B. PROVIDE CARE FOR GRANDCHILDREN Yes 171 14.2 No 833 69.2

13. HAVE LIVING PARENTS OR PARENTS-IN-LAW

Yes 359 29.8 No 845 70.2 A. PARENTS ABLE TO LIVE INDEPENDENTLY

Yes 236 19.6 No 117 9.7

B. PARENT REQUIRES ASSISTANCE Yes 139 11.5 No 169 14.0

Parent lives with family 58 4.8 Parent lives in assisted living 17 1.4 Parent has a live in caretaker 16 1.3 Parent lives in a board and care home 2 0.2 Parent lives in a nursing home 42 3.5 Parent has some other arrangement 22 1.8

5

Section 1 cont’d Frequency (n) Percent

C. PARENT LIVES WITHIN ONE HOUR DRIVE Yes 210 17.4 No 116 9.6

D. PARENT LIVES IN ALABAMA Yes 236 19.6 No 91 7.6

E. COMMUNICATE WITH PARENT Never 6 0.5 Three times a year or less 15 1.2 Four to ten times a year 11 0.9 Once a month 25 2.1 Two to three times a month 26 2.2 Once a week 61 5.1 Two to four times a week 64 5.3 Five or more times a week 118 9.8

14. PARTICIPANTS WITH LIVING BROTHERS

Range (0-12) 771 64.0 15. PARTICIPANTS WITH LIVING SISTERS

Range (0-13) 813 68.0 16. NUMBER OF FAMILY MEMBERS WITHIN ONE HOUR DRIVE

None 93 7.7 One to Two 200 16.6 Three to Five 169 14.0 More than five 742 61.6

17. SERVED IN THE MILITARY Yes 332 27.6 No 872 72.4 A. BRANCH

Army 182 15.1 Navy 50 4.2 Marine 13 1.1 Air Force 71 5.9 Coast Guard 2 0.2 Other 14 1.2

B. NUMBER OF YEARS SERVED Mean = 7.54 One to Two 112 9.3 Three to Five 112 9.3 Six to Nineteen 46 3.8 Over twenty years 63 5.2

C. ELIGIBLE FOR VETERAN’S BENEFITS Yes 221 18.4 No 111 9.2

6

Section 1 cont’d Frequency (n) Percent 18. FAMILY MEMBER SERVED IN THE MILITARY

Yes 996 82.7 No 207 17.2 Does not know 1 0.1 A. RELATIONSHIP

Spouse 294 24.4 Other 682 56.6

B. ELIGIBLE FOR VETERAN’S BENEFITS Yes 87 7.2 No 830 68.9 Does not know 69 5.7

19. HIGHEST GRADE LEVEL COMPLETED

Range (1 – 17) Does not know 1 0.1 First to Eighth grade 120 10.0 Ninth to Eleventh grade 187 15.5 High School or GED 365 30.3 Some college 201 16.7 Completed tech / Jr. college (Assoc. Degree) 72 6.0 College Graduate 117 9.7 Some graduate / Professional school 24 2.0 Graduate or Professional degree 117 9.7

20. EMPLOYMENT STATUS (multiple responses possible)

Employed full time 236 19.6 Employed part time 107 8.9 Disabled 137 11.4 Retired 773 64.2 Volunteer 36 3.0 Never worked outside the home 37 3.1 Unemployed 24 2.0 Looking for work 6 0.5 Refused 1 0.1

21. ABILITY TO AFFORD BASIC EXPENSES Refused 2 0.2 Does not know 3 0.2 Impossible 10 0.8 Very Difficult 180 15.0 Somewhat difficult 325 27.0 Not very difficult 684 56.8

22. OVERALL INCOME ACCEPTABILITY

Is not enough to make ends meet 146 12.1 Gives just enough to get by on 322 26.7 Keeps you comfortable but permits no luxuries 352 29.2 Allows you to do more or less what you want 337 31.3 Refused 4 0.3 Does not know 3 0.2

7

Section 1 cont’d Frequency (n) Percent 23. TOTAL ANNUAL INCOME

A. Less than $5,000 29 2.4 B. $ 5,000 - $ 7,999 99 8.2 C. $ 8,000 - $ 11,999 122 10.1 D. $ 12,000 - $ 15,999 123 10.2 E. $ 16,000 - $ 19,999 87 7.2 F. $ 20,000 - $ 29,999 147 12.2 G. $ 30,000 - $ 39,999 116 9.6 H. $ 40,000 - $ 49,999 96 8.0 I. $50,000 - $ 74,999 109 9.1 J. $75,000 - $ 99,999 57 4.7 K. $100,000 - $149,999 37 3.1 L. $150,000 or more 22 1.8 M. Does not know 49 4.1 N. Refused 110 9.1

SECTION II: GENERAL HEALTH Frequency (n) Percent 1. GENERAL HEALTH (SELF RATING)

Poor 157 13.0 Fair 315 26.2 Good 372 30.9 Very Good 219 18.2 Excellent 141 11.7

2. COMPARE HEALTH TODAY VS THREE YEARS AGO

Worse 511 42.4 Same 524 43.5 Better 169 14.0

QUESTIONS 3 – 14 ASKED ABOUT POSSIBLE SYMPTOMS OVER THE LAST MONTH

3. NOT TAKEN INTEREST IN DOING THINGS

Never 676 56.1 Almost never 151 12.5 Sometimes 256 21.3 Very often 73 6.1 Always 48 4.0

4. FELT DOWNHEARTED AND BLUE Never 531 44.1 Almost never 189 15.7 Sometimes 366 30.4 Very often 95 7.9 Always 22 1.8 Refused 1 0.1

8

Section II cont’d Frequency (n) Percent 5. FELT RELAXED AND FREE OF TENSION


6. NERVOUSNESS / NERVES Never 697 57.9 Almost never 139 11.5 Sometimes 247 20.5 Very often 67 5.6 Always 54 4.5

7. FELT TENSE OR HIGH STRUNG


8. EXPERIENCED FATIGUE Never 344 28.6 Almost never 134 11.1 Sometimes 369 30.6 Very often 213 17.7 Always 144 12.0

9. SHORTNESS OF BREATH Never 687 57.1 Almost never 104 8.6 Sometimes 230 19.1 Very often 115 9.6 Always 68 5.6

10. EXPERIENCED NAUSEA Never 1035 86.0 Almost never 54 4.5 Sometimes 84 7.0 Very often 24 2.0 Always 7 0.6

11. TROUBLE WITH BALANCE Never 733 60.9 Almost never 81 6.7 Sometimes 264 21.9 Very often 70 5.8 Always 56 4.7

9

Section II cont’d Frequency (n) Percent 12. EXPERIENCED FAINTING


13. EXPERIENCED PAIN Never 412 34.2 Almost never 79 6.6 Sometimes 309 25.7 Very often 164 13.6 Always 240 19.9

14. AMOUNT OF PAIN Agonizing 138 11.5 Dreadful 89 7.4 Uncomfortable 320 26.6 Annoying 245 20.3 No pain 412 34.2 A. AMOUNT PAIN INTERFERED WITH DAILY WORK

Not at all 265 22.0 A little bit 168 14.0 Moderately 106 8.8 Quite a bit 142 11.8 Extremely 94 7.8

15. EXPERIENCE DEPRESSION OVER THE LIFETIME

No 520 43.2 Yes 684 56.8

Takes medication 194 16.1 Limits activities 91 7.6

16. EVER EXPERIENCE ANXIETY OR PANIC ATTACKS

No 913 75.8 Yes 291 24.2


17. EVER EXPERIENCE A NERVOUS BREAKDOWN

No 1137 94.4 Yes 67 5.6


18. HEARING AID USE

No 1071 89.0 Yes 133 11.0

10

Section II cont’d Frequency (n) Percent 19. HEARING ABILITY (SELF REPORT)

Does not know 1 0.1 Good or adequate 1056 87.7 Poor (partially deaf) 145 12 Totally deaf 2 0.2

20. HEARING ABILITY (INTERVIEWER’S EVALUATION) Good or adequate 1098 91.2 Poor (partially deaf) 105 8.7 Totally deaf 1 0.1

21. WEAR CONTACTS OR GLASSES No 49 4.1 Yes 906 75.2 Reading only 249 20.7

Legally blind 28 2.3 Congenital (from birth) 2 0.2 Acquired 26 2.2 Blind 8 0.7 Congenital (from birth) 0 0 Acquired 8 0.7

22. FREQUENCY OF EYE EXAMS

Never 14 1.2 Only if experiencing problems 226 18.8 Every two years 342 28.4 Annually or more often 597 49.6 Other 25 2.1 A. LAST EYE EXAM

Less than one year 700 58.1 One to five years 424 35.2 Over five years 56 4.7 Does not know 10 0.8

B. GLASSES PRESCRIBED No 321 26.7 Yes 869 72.2 BA. GLASSES OBTAINED

Yes 818 67.9 No 51 4.2

BAA. IF NO, REASON WHY Cost 20 1.7 No time 4 0.3 Other 22 1.8

23. HAVE EYE EXAM INSURANCE

No 439 36.5 Yes 722 60.0 Does not know 43 3.6

11

Section II cont’d Frequency (n) Percent 24. EYE GLASSES INSURANCE


25. DIAGNOSED WITH SOME EYE DISEASE No 614 51.0 Yes 590 49.0

Limit activities 21 1.7 A. CATARACTS 450 37.4

Takes medication 29 2.4 Surgery 282 23.4

B. GLAUCOMA 108 9.0 Takes medication 65 5.4

C. OTHER EYE DISEASE 84 7.0 Takes medication 15 1.2

26. DIFFICULTY READING TRAFFIC SIGNS

Does not know 1 0.1 Does not apply 4 0.3 No 1105 91.8 Yes 94 7.8

A little 46 3.8 A moderate amount 23 1.9 A great deal 25 2.1

27. DIFFICULTY SEEING STEPS, STAIRS, CURBS

Does not know 1 0.1 Does not apply 4 0.3 No 1112 92.4 Yes 87 7.2


28. DIFFICULTY READING NEWSPAPERS OR BOOKS Does not apply 4 0.3 Does not know 2 0.2 No 996 82.7 Yes 202 16.8


12

Section II cont’d Frequency (n) Percent 29. DIFFICULTY READING SMALL PRINT

Does not apply 4 0.3 Does not know 2 0.2 No 744 61.8 Yes 454 37.7


30. LAST ORAL EXAM

Does not know 21 1.7 Never 15 1.2 Over five years ago 282 23.4 One to five years ago 277 23.0 Less than one year 609 50.6

31. BEEN WITHOUT NEEDED DENTAL CARE No 1007 83.6 Yes 197 16.4 Why

Cost 135 11.2 Lack of Time 14 1.2 Other Reason 60 5.0

32. CHANGED EATING HABITS DUE TO DENTAL PROBLEMS

Does not know 1 0.1 No 1059 88.0 Yes 144 12.0

33. MOUTH RINSE USE Never 225 18.7 Less than one time per week 89 7.4 Once per week 43 3.6 A few times per week 131 10.9 Four or five times per week 60 5.0 At least once per day 656 54.5

34. FREQUENCY TO FLOSS

No teeth to floss (dentures) 276 22.9 Never 271 22.5 Less than one time per week 85 7.1 Once per week 56 4.7 A few times per week 106 8.8 Four or five times per week 48 4.0 At least once per day 362 30.1

13

SECTION III: MOBILITY

Frequency (n) Percent 1. SOCIAL ACTIVITY LEVEL

Active 594 49.3 Moderately active 334 27.7 Minimally active 200 16.6 Not active 76 6.3

2. BEING SATISFIED WITH AMOUNT OF SOCIAL ACTIVITY Satisfied 952 79.1 Not satisfied, too little 220 18.3 Not satisfied, too much 32 2.7

3. PHYSICAL ACTIVITY LEVEL Active 472 39.2 Moderately active 376 31.2 Minimally active 254 21.1 Not active 102 8.5

4. ABILITY TO WALK ¼ OF A MILE WITHOUT STOPPING Unable 219 18.2 A lot of difficulty 118 9.8 A little difficulty 151 12.5 No difficulty 706 58.6 Does not know 10 0.8

5. EXERCISE PARTICIPATION (multiple responses possible) Walking 495 41.1 Yard work 640 53.2 Gardening 357 29.7 Strenuous housework 509 42.3 General exercises 251 20.8 Exercise equipment 210 17.4 Aerobics 42 3.5 Dancing 37 3.1 Golf 41 3.4 Other 131 10.9 No activities 190 15.8

6. FALLEN IN THE PAST YEAR

No 883 73.0 Yes 321 26.7 A. TIMES FALLEN IN THE LAST YEAR

Mean = 4.23 NA NA One 164 13.6 Two 66 5.5 Three 37 3.1 Four 16 1.3 Five or more times 38 3.2

14

Section III cont’d Frequency (n) Percent

B. TIME OF THE LAST FALL 0 – 3 Months ago 163 13.5 4 – 6 Months ago 89 7.4 7 – 9 Months ago 37 3.1 10 – 12 Months ago 32 2.7

C. DID THE FALL RESULT IN INJURY Does not know 2 0.2 No 173 14.4 Yes 146 12.1

D. WAS MEDICAL TREATMENT RECEIVED No 227 18.9 Yes 94 7.8

7. MOBILITY AIDS CURRENTLY USED (multiple responses possible)

Cane 198 16.4 Walker 107 8.9 Wheelchair 68 5.6 Special “rising seat” chair or lift chair 25 2.1 Elevator / elevator chair 7 0.6 Crutch or crutches 9 0.7 Brace 18 1.5 Scooter 21 1.7 Transfer lift 5 0.4 Hospital bed 14 1.2 Bars or rails in bathroom, shower, or a bath chair 165 13.7 Roll in shower 3 0.2 Toilet seat / bedside commode 79 6.6 Bed pan system 12 1.0 Ventilator 7 0.6 Oxygen 52 4.3

8. OTHER EQUIPMENT USED Special orthopedic shoes 30 2.5 Artificial leg 7 0.6 Other equipment used 14 1.2 Other walking equipment 2 0.2

9. NEED EQUIPMENT BUT UNABLE TO AFFORD IT

Yes 127 10.5 No 1077 89.5 A. EQUIPMENT NEEDED

Scooter 43 3.6 Rails in the bathroom 21 1.7 Cane or walker 16 1.3 Wheelchair 9 0.7 Lift chair 9 0.7 Shoes 8 0.7 Other bathroom equipment 7 0.6 Other 14 1.2

15

Section III cont’d Frequency (n) Percent 10. EQUIPMENT COVERED BY INSURANCE

No 161 13.4 Yes 172 14.3 Not sure does not know 180 15.0 No equipment used 678 56.3 No insurance 13 1.1

11. IN NEED OF HOME HEALTH OR HOSPICE

Yes 65 5.4 No 1138 94.5 Does not know 1 0.1 A. CURRENTLY RECEIVE HOME HEALTH OR HOSPICE

Yes 24 2.0 No 41 3.4 AA. TYPE OF SERVICES RECEIVED

Home health system 18 1.5 Hospice 1 0.1 Other health care services 8 0.7

AB. HOME HEALTH PAID BY Health Insurance 1 0.1 Medicare 11 0.9 Medicaid 9 0.7 Self 5 0.4 Family 1 0.1 Not sure / refused 4 0.3

AC. SERVICE MEETS PATIENT’S NEEDS All of the needs 10 0.8 Most of the needs 6 0.5 Some of the needs 7 0.6 Very few of the needs 1 0.1

B. MOST VALUABLE SERVICE THAT COULD BE RECEIVED A nurse to check on the patient 3 0.2 Someone to help with medicine 2 0.2 Someone to help clean the house 17 1.4 Someone to help with bathing and dressing 4 0.3 A social worker to help identify what assistance is available 11 0.9 A physical therapist that works in the home 2 0.2 Does not know 3 0.2

12. HAVE RELIABLE MODE OF TRANSPORTATION


13. MOST FREQUENT MODE OF TRANSPORTATION

Access to car / drive themselves 1019 84.6 Access to car / someone else drives 289 24.0 Family, friend or neighbor transports them in other car 350 29.1 Community transportation service 16 1.3 Bus or other public transportation 20 1.7 Other 9 0.7

16

Section III cont’d Frequency (n) Percent 14. SEATBELT USE

Always 1086 90.2 Most of the time 69 5.7 Sometimes 31 2.6 Never 15 1.2 Never drive or ride in a car 2 0.2

15. OTHER TRANSPORTATION AVAILABLE IN THE AREA

Bus 352 29.2 Van service 282 23.4 Cab or taxi 520 43.2 Other 28 2.3 None 367 30.5 Does not know 101 8.4 A. USE ANY OF THEM

No 644 53.5 Yes 92 7.6

16. AMBULANCE SERVICE AVAILABLE

Yes 1175 97.6 No 13 1.1 Does not know 16 1.3 A. APPROXIMATE ARRIVAL TIME AFTER CALL

Less than 15 minutes 860 71.5 15 to 30 minutes 240 19.9 30 minutes to one hour 28 2.3 Over one hour 4 0.3 Does not know 43 3.6

IADL1. DIFFICULTY USING THE TELEPHONE

No 1131 93.9 Yes 73 6.1

Some difficulty 52 4.3 A lot of difficulty 16 1.3 Unable to do 5 0.4

IADL2. DIFFICULTY DOING LIGHT HOUSEWORK Does not do for other reason 43 3.6 No 1045 86.8 Yes 116 9.6


17

Section III cont’d Frequency (n) Percent IADL3. DIFFICULTY DOING HEAVY HOUSEWORK

Does not do for other reason 50 4.2 Does not know or refused 1 0.1 No 795 66.0 Yes 358 29.7


IADL4. DIFFICULTY PREPARING MEALS

Does not do for other reason 72 6.0 No 1032 85.7 Yes 100 8.3


IADL5. DIFFICULTY SHOPPING



IADL6. DIFFICULTY MANAGING MONEY



ADL1. DIFFICULTY TURNING FROM SIDE TO SIDE IN BED No 1007 83.6 Yes 197 16.4


ADL2. DIFFICULTY GOING UP AND DOWN STAIRS



18

Section III cont’d Frequency (n) Percent ADL3. DIFFICULTY GETTING OUT OF A BED OR CHAIR

No 924 76.7 Yes 280 23.3


ADL4. DIFFICULTY BATHING OR SHOWERING

No 1067 88.6 Yes 137 11.4


ADL5. DIFFICULTY DRESSING OR UNDRESSING

No 1095 90.9 Yes 109 9.1


ADL6. DIFFICULTY EATING

No 1163 96.6 Yes 41 3.4


ADL7. DIFFICULTY WALKING



ADL8. DIFFICULTY GETTING OUTSIDE No 1081 89.8 Yes 123 10.2


ADL9. DIFFICULTY GETTING TO OR USING THE TOILET



19

SECTION IV: HEALTH SERVICES UTILIZATION

Frequency (n) Percent 1. HAVE HEALTH CARE INSURANCE (multiple responses possible)

No 49 4.1 Yes 1155 95.9

Medicare 734 61.0 Medicaid 106 8.9 Medicare supplemental insurance 294 24.5 Private insurance 306 25.4 Insurance through employer 414 34.3 VA program 69 5.7

2. HAVE A REGULAR DOCTOR TO SEE FOR HEALTH CARE

No 56 4.7 Yes 1148 95.3 A. LAST TIME TO SEE THIS DOCTOR

Within a month 454 37.7 Within 6 months 494 41.0 Within 7 – 12 months 102 8.5 Within 1 – 2 years 52 4.3 Over 2 years 24 2.0 Never 9 0.7 Does not know 13 1.1

3. SEE MORE THAN ONE DOCTOR

No 378 31.4 Yes 826 68.6 A. WHY (multiple responses possible)

Specialist 796 66.1 Convenience 22 1.8 Cost 7 0.6 Insurance 15 1.2

4. NUMBER OF TIMES LAST YEAR TO SEE THE DOCTOR Mean = 6.4 NA NA

5. NEEDED TO SEE THE DOCTOR BUT DID NOT GO No 918 76.2 Yes 286 23.8 A. WHY (multiple responses possible)

Transportation problems 31 2.6 Unsure of who to see 11 0.9 Lack of money 71 5.9 Fear 20 1.7 Distance 3 0.2 Dissatisfaction with provider 6 0.5 Just put it off 138 11.5 Some other reason 58 4.8

20

Section IV cont’d Frequency (n) Percent 6. GO WITH A MEDICAL EMERGENCY

Private physician 161 13.4 Hospital clinic 93 7.7 Emergency room 934 77.6 Health department 2 0.2 Other 6 0.5 Does not know 8 0.7

7. LAST GENERAL PHYSICAL EXAM

Less than 3 months 357 29.7 Less than 6 months 237 19.7 Less than one year 333 27.7 Less than 2 years 111 9.2 More than 2 years 134 11.1 Never 14 1.2 Does not know 18 1.5

8. CHECKED OR HAD DONE WITHIN THE LAST YEAR (multiple responses possible)

Blood drawn 1076 89.4 Blood count 989 82.1 Blood sugar 942 78.2 Cholesterol screening 974 80.9 Blood pressure check 1141 94.8 Colon screening 451 37.5 Digital rectal exam 437 36.3 Stool blood test 460 38.2 Pap smear 393 32.6 Breast exam 473 39.3 Mammogram 492 41.0 Prostate exam 366 30.4

9. BEEN TREATED AT AN EMERGENCY ROOM No 927 77.0 Yes 277 23.0 Mean = 1.67 NA NA B. REASON FOR VISIT

Bleeding 4 0.3 Mental / anxiety problems 4 0.3 Blood Sugar 7 0.6 Stroke 7 0.6 Kidneys 9 0.7 Animal bite / allergy 11 0.9 Blood pressure 12 1.0 Breathing 12 1.0 Virus 13 1.1 Other 21 1.7 Injury or pain 42 3.5 Heart 44 3.7 External problems 46 3.8 Internal problems 47 3.9

21

Section IV cont’d Frequency (n) Percent 10. BEEN TREATED IN A HOSPITAL OVER THE LAST YEAR

No 828 68.8 Yes 376 31.2 A. NUMBER OF VISITS TO A HOSPITAL

Mean = 1.87 NA NA B. REASON FOR THE LAST VISIT

Internal problems 114 9.5 Problem with heart or arteries 68 5.6 External problems, injuries or pain 68 5.6 Colon 25 2.1 Eyes 22 1.8 Virus or bacterial problem 17 1.4 Blood problem, blood pressure, bleeding 14 1.2 Asthma or other repertory problem 8 0.7 Allergy or animal bite 3 0.2 Other 37 3.1

11. BEEN A RESIDENT AT A NURSING HOME, MENTAL HEALTH FACILITY OR VA FACILITY THE LAST YEAR

No 1191 98.9 Yes 13 1.1 A. WHERE

Healthcare 4 0.3 Nursing home 3 0.2 VA facility 2 0.2 Mental health 1 0.1 Other 3 0.2

12. PRESCRIPTION DRUG COVERAGE (multiple responses possible) Does not know 9 0.7 No 323 26.8 Yes 872 72.4

Private insurance 288 23.9 Insurance through an employer 407 33.8 Medicaid 81 6.7 VA 93 7.7 Other 58 4.8

13. TAKE PRESCRIPTION MEDICATION No 146 12.1 Yes 1058 87.9 A. HAVE PRESCRIPTIONS FROM MULTIPLE DOCTORS

No 542 45.0 Yes 517 42.9

B. TAKE MEDICINE AS DIRECTED OR AT CONVENIENCE As directed by a physician 994 82.6 Only when I need it 20 1.7 Both 44 3.7

C. CHANGE THE PRESCRIPTION DUE TO COST Yes 149 12.4 No 913 75.8

22

Section IV cont’d Frequency (n) Percent

D. COST OF MEDICINE PER MONTH Prescription medication Average cost $96.33 NA NA Non prescription medication Average cost $22.30 NA NA

E. BEEN UNABLE TO AFFORD PRESCRIBED MEDICINE Yes 199 16.5 No 890 73.9

F. TAKEN SOMEONE ELSE’S MEDICATION No 1038 86.2 Yes 50 4.2

SECTION V: MEDICAL HISTORY Frequency (n) Percent 1. DIAGNOSED WITH HEART PROBLEMS

No 774 64.3 Yes 430 35.7

Limits activities 84 7.0 A. Heart failure, fluid on the lungs or enlarged heart 91 7.6

Takes medication 57 4.7 B. Chest pain with exertion or heart pain 95 7.9

Takes medication 50 4.2 C. Heart attack, coronary thrombosis or myocardial infarction 146 12.1

Takes medication 86 7.1 D. Irregular heart beat, cardiac arrhythmia or conduction disturbance

200 16.6

Takes medication 102 8.5 2. DIAGNOSED WITH HEART VALVE PROBLEMS

No 1069 88.8 Yes 135 11.2

Limits activities 14 1.2 A. Mitral valve prolapse 42 3.5

Takes medication 17 1.4 B. Mitral valve stenosis / regurgitation 7 0.6

Takes medication 4 0.3 C. Aortic valve stenosis / regurgitation 15 1.2

Takes medication 6 0.5 D. Other valve stenosis / regurgitation 10 0.8

Takes medication 3 0.2 E. Rheumatic heart problems 4 0.3

Takes medication 2 0.2 F. Heart murmur 59 4.9

Takes medication 3 0.2 3. HIGH BLOOD PRESSURE / HYPERTENSION

No 452 37.5 Yes 752 62.5


23

Section V cont’d Frequency (n) Percent 4. DIAGNOSED WITH CIRCULATION PROBLEMS

No 850 70.6 Yes 354 29.4

Limits activities 65 5.4 A. Peripheral arterial disease, poor circulation, hardening of arteries

129 10.7

Takes medication 51 4.2 B. Thrombophlebitis, or pulmonary embolisms 37 3.1

Takes medication 16 1.3 C. Swelling in feet and legs 244 20.3

Takes medication 117 9.7 D. Varicose veins 55 4.6

Takes medication 1 0.1

5. DIAGNOSED WITH DIABETES No 950 78.9 Yes 254 21.1 A. WHAT TYPE

Type I: Insulin dependent or juvenile type 30 2.5 Type II: Non-insulin dependent or adult onset 217 18.0

B. COMPLICATIONS AS RESULT OF DIABETES (multiple responses possible)

Hypoglycemia 59 4.9 Ketosis or ketoacidosis (DKA) 4 0.3 Neuropathy / arthropathy 50 4.2 Renal-kidney disease 17 1.4 Eye disease 48 4.0 Circulatory disorders 47 3.9

6. DIAGNOSED WITH RENAL OR KIDNEY DISEASE No 1130 93.9 Yes 74 6.1

Limits activities 7 0.6 A. RENAL OR KIDNEY FAILURE 28 2.3

Takes medication 9 0.7 B. REQUIRES DIALYSIS 5 0.4

7. RECURRENT URINARY TRACT INFECTIONS (UTI) Yes 154 12.8 No 1050 87.2

8. DIAGNOSED WITH LIVER DISEASE No 1166 96.8 Yes 38 3.2

Limits activities 1 0.1 A. CIRRHOSIS 5 0.4

Takes medication 1 0.1 B. HEPATITIS 22 1.8


24

Section V cont’d Frequency (n) Percent 9. DIAGNOSED WITH ANEMIA OR THYROID PROBLEMS

No 895 74.3 Yes 309 25.7

Limits Activities 13 1.1 A. ANEMIA 155 12.9

Takes medication 56 4.7 B. THYROID PROBLEMS 176 14.6


10. STOMACH, BOWEL OR DIGESTIVE PROBLEMS No 737 61.2 Yes 467 38.8

Limits activities 20 1.7 A. COLON 89 7.4

Takes medication 24 2.0 B. CROHN’S DISEASE 4 0.3

Takes medication 0 0 C. DIVERTICULITIS 80 6.6

Takes medication 18 1.5 D. GALL BLADDER PROBLEMS 99 8.2

Takes medication 2 0.2 E. STOMACH ULCER (PEPTIC OR DUODENAL) 91 7.6

Takes medication 31 2.6 F. ULCERATIVE COLITIS 13 1.1

Takes medication 6 0.5 G. GERD / REFLUX DISEASE 264 21.9


11. PARKINSON’S DISEASE No 1193 99.1 Yes 11 0.9

Takes medication 7 0.6 Limits activities 3 .2

A. INTERVIEWER OBSERVATION OF SHAKING OF HANDS No 1179 97.9 Yes 25 2.1

12. PERIPHERAL NEUROPATHY

No 1070 88.9 Yes 133 11.0


13. EPILEPSY OR SEIZER DISORDER

No 1184 98.3 Yes 20 1.7


25

Section V cont’d Frequency (n) Percent 14. HAD A STROKE

No 1134 94.2 Yes 70 5.8


15. HAD A TRANSIENT ISCHEMIC ATTACK (TIA)

No 1131 93.9 Yes 73 6.1


16. HAVE RESPIRATORY OR BREATHING PROBLEMS

No 957 79.5 Yes 247 20.5

Limits activities 32 2.7 A. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 37 3.1

Takes medication 22 1.8 Oxygen 14 1.2

B. ASTHMA 95 7.9 Takes medication 67 5.6 Oxygen 12 1.0

C. CHRONIC BRONCHITIS 75 6.2 Takes medication 37 3.1 Oxygen 7 0.6

D. EMPHYSEMA 45 3.7 Takes medication 23 1.9 Oxygen 9 0.7

17. EVER REQUIRED HOME OXYGEN (02)

No 1161 96.4 Yes 43 3.6

18. EVER HAD ANY TYPE OF CANCER

No 898 74.6 Yes 305 25.3 Takes medication 12 1.0 A. BREAST

Surgery 47 3.9 Less than 1 year ago 3 0.2 1 – 5 years ago 18 1.5 More than 5 years ago 26 2.2

B. COLON, RECTUM OR BOWEL Surgery 29 2.4 Less than 1 year ago 4 0.3 1 – 5 years ago 15 1.2 More than 5 years ago 17 1.4

26

Section V cont’d Frequency (n) Percent

C. LUNG Surgery 9 0.7 Less than 1 year ago 1 0.1 1 – 5 years ago 5 0.4 More than 5 years ago 5 0.4 Limits activities 4 0.3

D. PROSTATE Surgery 27 2.2 Less than 1 year ago 7 0.6 1 – 5 years ago 19 1.6 More than 5 years ago 18 1.5 Does not remember / Refused 1 0.1

E. SKIN Surgery 113 9.4 Less than 1 year ago 42 3.5 1 – 5 years ago 47 3.9 More than 5 years ago 36 3.0 Limits activities 1 0.1

F. OTHER TYPE OF CANCER Less than 1 year ago 5 0.4 1 – 5 years ago 20 1.7 More than 5 years ago 48 4.0 Does not remember / Refused 1 0.1 Limits activities 2 0.2

19. FAMILY HISTORY OF CANCER (multiple responses possible) No 506 42.0 Yes 698 58.0 BREAST CANCER IN THE FAMILY 208 17.3

Sibling (s) 88 7.3 Parent (s) 53 4.4 Aunt (s) / Uncle (s) 70 5.8 Grandparent (s) 20 1.7

COLON CANCER IN THE FAMILY 131 10.9 Sibling (s) 40 3.3 Parent (s) 50 4.2 Aunt (s) / Uncle (s) 28 2.3 Grandparent (s) 21 1.7

PROSTATE CANCER IN THE FAMILY 83 6.9 Sibling (s) 28 2.3 Parent (s) 46 3.8 Uncle (s) 11 0.9 Grandparent (s) 7 0.6

OTHER CANCER IN THE FAMILY 534 44.4 Sibling (s) 214 17.8 Parent (s) 256 21.3 Aunt (s) / Uncle (s) 111 9.2 Grandparent (s) 71 5.9

27

Section V cont’d Frequency (n) Percent 20. DIAGNOSED WITH ARTHRITIS

No 488 40.5 Yes 716 59.5


A. TYPE OF ARTHRITIS (multiple responses possible) Osteoarthritis / degenerative arthritis 399 33.1 Rheumatism 35 2.9 Rheumatoid arthritis 102 8.5 Does not know 192 15.9 Other 21 1.7

B. WHERE IS THE ARTHRITIS LOCATED (multiple responses possible)

Hips 125 10.4 Knees 280 23.3 Hands 277 23.0 Back / spine 194 16.1 Shoulders 160 13.3 All over 153 12.7 Other 123 10.2

21. DIAGNOSED WITH OSTEOPOROSIS

No 1042 86.5 Yes 162 13.5


22. HAD A PINCHED NERVE OR COLLAPSED DISCS

No 949 78.8 Yes 255 21.2


23. DIAGNOSED WITH GOUT

No 1072 89.0 Yes 132 11.0


24. EVER FRACTURED OR BROKEN A BONE

No 609 50.6 Yes 595 49.4


A. WHAT WAS FRACTURED AND WHEN WAS IT Hip 29 2.4 Upper body 363 30.1 Lower body 295 24.5 Ruptured spinal discs 24 2.0 Vertebral compression fracture or broken back bone 26 2.2

28

Section V cont’d Frequency (n) Percent 25. HAD ANY TYPE OF PARALYSIS

No 1168 97.0 Yes 36 3.0

Limits activities 6 0.5 A. WHAT TYPE OF PARALYSIS

Polio 6 0.5 Monoplegia-paralysis affecting one side 20 1.7 Paraplegia-paralysis of both legs 2 0.2 Quadriplegia-paralysis of both arms and both legs 2 0.2

26. DIAGNOSED WITH ALZHEIMER’S DISEASE OR DEMENTIA No 1178 97.8 Yes 26 2.2

Limits activities 5 0.4 A. ALZHEIMER’S TYPE 9 0.7

Takes medication 4 0.3 B. DEMENTIA, STROKE 3 0.2

Takes medication 1 0.1 C. OTHER TYPE OF DEMENTIA 12 1.0


27. DIAGNOSED WITH SCHIZOPHRENIA No 1198 99.5 Yes 6 0.5

Limits activities 1 0.1 Takes medication 3 0.2

28. DIAGNOSED WITH PROSTATE PROBLEMS

No 332 27.6 Yes 182 15.1

Limits activities 9 0.7 A. PROSTATE DISEASE 39 3.2

Takes medication 16 1.3 B. BENIGN PROSTATE HYPERTROPHY (BPH) 104 8.6

Takes medication 43 3.6 C. PROSTATITIS 34 2.8

Takes medication 6 0.5 D. PROSTATE SURGERY 50

29. EVER BEEN PREGNANT No 66 5.5 Yes 624 51.8 A. How many pregnancies

One 84 7.0 Two 142 11.8 Three 139 11.5 Four 102 8.5 Five 77 6.4 Six to ten 69 5.7 Eleven to twenty 11 0.9

29

Section V cont’d Frequency (n) Percent

B. How many live births None 16 1.3 One 102 8.5 Two 170 14.1 Three 143 11.9 Four 84 7.0 Five to nine 99 8.2 Ten to sixteen 10 0.8

30. HAD ANY PROBLEMS WITH YOUR UTERUS No 400 33.2 Yes 290 24.1

Limits activities 1 .1 A. UTERINE FIBROIDS OR ENLARGED UTERUS 160 13.3

Takes medication 6 0.5 B. PROLAPSED OR FALLEN UTERUS 64 5.3


31. EVER HAD A HYSTERECTOMY OR C-SECTION Hysterectomy with removal of ovaries 232 19.3 Hysterectomy without removal of ovaries 180 15.0 C-Section or Caesarian delivery 42 3.5 Number or C-Sections One 23 1.9 Two 15 1.2 Three or more 4 0.3

32. AGE OF MENOPAUSE Mean = 44.08 NA NA

33. TAKEN HORMONE REPLACEMENT THERAPY

No 266 22.1 Yes 423 35.1 A. HOW MANY YEARS

Up to five years 108 9.0 Five to nine years 60 5.0 Ten to nineteen years 123 10.2 Twenty or more years 103 8.6

B. TYPE OF HORMONE REPLACEMENT THERAPY (multiple responses possible)

Pill 398 33.1 Patch 29 2.4 Cream 8 0.7

34. TAKING HRT NOW No 443 36.8 Yes 219 18.2 A. WHAT TYPE (multiple responses possible)

Pill 204 16.9 Patch 8 0.7 Cream 5 0.4

30

Section V cont’d Frequency (n) Percent 35. HAD ANY OF THE FOLLOWING SURGERIES (multiple responses possible)

Heart surgery 151 12.5 Back surgery 97 8.1 Knee surgery 109 9.1 Knee replacement 55 4.6 Hip surgery 21 1.7 Hip replacement 31 2.6 Bladder surgery 66 5.5 Gall bladder surgery 197 16.4 Stomach surgery 63 5.2 Appendectomy 318 26.4 Tonsillectomy 347 28.8 Other 867 72.0

37. NUMBER OF TIMES TO GO TO THE BATHROOM AT NIGHT None 211 17.5 One 413 34.3 Two 305 25.4 Three 176 14.6 Four or more times 99 8.2

38. LEAK EVEN A SMALL AMOUNT OF URINE No 720 59.8 Yes 484 40.2 A. TAKE MEDICATION

No 415 34.5 Yes 69 5.7

B. HAPPENED IN THE LAST YEAR No 17 1.4 Yes 467 38.8

C. PREVALENCE OF LEAKAGE Less than one time per month 113 9.4 One or more times per month 90 7.5 One or more times per week 95 7.9 Daily 169 14.0

D. HOW MUCH URINE LEAKS OUT A drop or two 184 15.3 Enough to dampen your undergarments 199 16.5 Enough to wet your outer clothing 84 7.0

E. RESTRICT NORMAL ACTIVITIES Not at all 387 32.1 Sometimes 56 4.7 Most of the time 24 2.0

31

Section V cont’d Frequency (n) Percent 39. CONSTIPATION

No 832 69.1 Yes 372 30.9 A. HOW OFTEN

Less than one time per month 91 7.6 One or more times per month 120 10.0 One or more times per week 81 6.7 Daily 80 6.6

40. CHRONIC DIARRHEA

No 1100 91.4 Yes 104 8.6 A. HOW OFTEN


41. EVER LOST CONTROL OF BOWELS

No 966 80.2 Yes 238 19.8 A. HOW OFTEN


42. HAD ANY OPEN WOUNDS OR SORES ON THE SKIN

No 1136 94.4 Yes 68 5.6 A. WHAT KIND (multiple responses possible)

Bedsore 1 0.1 Varicose vein ulcer 3 0.2 Wound due to lack of blood supply 5 0.4 Surgical wound 11 0.9 Other 37 3.1 Unknown 13 1.1

SECTION VI: DIET AND NUTRITION Frequency (n) Percent 1. HEIGHT (SELF REPORT) NA NA 2. WEIGHT (SELF REPORT) NA NA 3. ANY WEIGHT CHANGE OVER 10 POUNDS IN THE LAST 6 MONTHS WITHOUT TRYING


32

Section VI cont’d Frequency (n) Percent A. WHAT KIND

Gained 142 11.8 Lost 122 10.1 Both gained and lost 14 1.2

4. CHANGE OF FOOD INTAKE DUE TO ILLNESS No 959 79.7 Yes 245 20.3

5. APPETITE

Very Good 629 52.2 Good 427 35.5 Fair 116 9.6 Poor 31 2.6 Does not know 1 0.1

6. AVERAGE NUMBER OF MEALS EATEN PER DAY One 43 3.6 Two 360 29.9 Three or more 762 63.3 Irregular 39 3.2

7. SKIP MEALS DUE TO LACK OF FOOD Yes 19 1.6 No 1185 98.4

8. SHOP FOR GROCERIES WITHOUT ASSISTANCE Yes 935 77.7 No 269 23.3 A. IF NOT WHO DOES (multiple responses possible)

Spouse 190 15.8 Family member 66 5.5 Neighbor 1 0.1 Friend 7 0.6 Home health assistance 3 0.2 Other 3 0.2

9. PREPARES THE MEALS

Self 816 67.8 Spouse 301 25.0 Family member 48 4.0 Neighbor 1 0.1 Friend 10 0.8 Community meals program 1 0.1 Home health assistance 4 0.3 Eat out 17 1.4 Other 6 0.5

10. USUALLY EAT ALONE Yes 491 40.8 No 713 59.2

33

Section VI cont’d Frequency (n) Percent 11. EAT MEALS AT A SENIOR CENTER

No 1148 95.3 Yes 56 4.7 B. WHICH MEALS ARE OFFERED (multiple responses possible)

Breakfast 2 0.2 Lunch 51 4.2

12. ANY MEALS DELIVERED

No 1187 98.6 Yes 17 1.4 A. HOW OFTEN

Everyday 1 0.1 Five to six days per week 4 0.3 Two to four days per week 4 0.3 Once per week 7 0.6 Less than once per week 1 0.1

B. WHICH MEALS ARE DELIVERED Breakfast 3 0.2 Lunch (hot meal) 10 0.8 Frozen meal 5 0.4

13. FREQUENCY OF INTAKE OF THE FOLLOWING FOODS A. VEGETABLES

14 times or more 446 37.0 8 to 13 305 25.3 4 to 7 362 30.1 Less than 4 88 7.3 Does not know / refused 3 0.2

B. FRUITS 14 times or more 207 17.2 8 to 13 237 19.7 4 to 7 459 38.1 Less than 4 297 24.7 Does not know / refused 4 0.3

C. MEAT & BEANS (EGGS, NUTS) 14 times or more 426 35.4 8 to 13 347 28.8 4 to 7 362 30.1 Less than 4 67 5.6 Does not know / refused 2 0.2

D. BREADS, GRAINS, PASTAS 14 times or more 489 40.6 8 to 13 302 25.1 4 to 7 299 24.8 Less than 4 110 9.1 Does not know / refused 4 0.3

34

Section VI cont’d Frequency (n) Percent

E. MILK AND DAIRY PRODUCTS 14 times or more 295 24.5 8 to 13 286 23.8 4 to 7 386 32.1 Less than 4 232 19.3 Does not know / refused 5 0.4

F. DESSERTS / CHIPS / OTHER 14 times or more 140 11.6 8 to 13 206 17.1 4 to 7 400 33.2 Less than 4 451 37.5 Does not know / refused 7 0.6

14. FOOD GROUPS CONSUMED THE DAY BEFORE (multiple responses possible)

Grains group (bread, cereal, rice or pasta) 1148 95.3 Vegetable group 1089 90.4 Fruit group 885 73.5 Milk group (milk, yogurt, cheese) 942 78.2 Meat & beans group (meat, poultry, fish, eggs & nuts) 1148 95.3

15. CIGARETTE SMOKING STATUS Never smoked cigarettes 529 43.9 Quit 1 year ago or more 459 38.1 Quit 1 year ago or less 47 3.9 Current smoker 169 14.0 A. NUMBER OF CIGARETTES SMOKED IN A DAY

Mean = 22.11 NA NA B. AGE WHEN STATED TO SMOKE

Mean = 22.11 NA NA C. STOPPED SMOKING AT WHAT AGE

Mean = 45.45 NA NA

35

Section VI cont’d Frequency (n) Percent 16. USED ANY OTHER TYPE OF TOBACCO PRODUCT

No 985 81.8 Yes 219 18.2 A. WHAT TYPE (multiple responses possible)

Smokeless tobacco 84 7.0 Current user 33 2.7 Former user 41 3.4

Snuff 35 2.9 Current user 12 1.0 Former user 21 1.7

Pipe 84 7.0 Current user 9 0.7 Former user 69 5.7

Cigar 88 7.3 Current user 19 1.6 Former user 64 5.3

Other 6 0.5 Current user 4 0.3 Former user 2 0.2

17. DRINK ALCOHOLIC BEVERAGES

No 775 64.4 Yes 429 35.6 A. HAVE MORE THAN 3 DRINKS PER DAY

No 350 29.1 Yes 79 6.6

B. FEEL THE NEED TO CUT DOWN ALCOHOL INTAKE No 51 4.2 Yes 28 2.3

C. OTHERS CRITICIZED DRINKING CONSUMPTION No 68 5.6 Yes 11 0.9

D. FELT BAD OR GUILTY ABOUT DRINKING No 65 5.4 Yes 14 1.2

E. EVER DRANK TO GET RID OF A HANGOVER No 76 6.3 Yes 3 0.2

SECTION VII: COGNITIVE FUNCTIONING AND EMOTIONAL HEALTH Frequency (n) Percent 1. KNEW THE DAY OF THE WEEK

Yes 1174 97.5 No 30 2.5

2. KNEW THE SEASON

Yes 1154 95.8 No 50 4.2

36

Section VII cont’d Frequency (n) Percent 3. KNEW THE DATE

A. Month 1177 97.8 B. Date 1099 91.3 C. Year 1177 97.8

4. KNEW THE COUNTY OF RESIDENCE

Yes 1187 98.6 No 17 1.4

5. KNEW THE ADDRESS OF RESIDENCE

A. Street address 1188 98.7 B. City 1198 99.5 C. State and zip code 1198 99.5 D. Telephone number 1178 97.8

6. REPEATED THE FOLLOWING WORDS CORRECTLY A. Airplane 1198 99.5 B. Dollar 1183 98.3 C. Apple 1181 98.1

7. SPELLED THE WORD WORLD BACKWARDS CORRECTLY A. “D” 1099 91.3 B. “L” 1003 83.3 C. “R” 808 67.1 D. “O” 848 70.4 E. “W” 1016 84.4

8. REPEATED THE FOLLOWING WORDS AGAIN A. Airplane 1011 84.0 B. Dollar 731 60.7 C. Apple 957 79.5

9. RECOGNIZED A WATCH Yes 1202 99.8 No 2 0.2

10. RECOGNIZED A PENCIL Yes 1199 99.6 No 5 0.4

11. REPEAT “NO IF’S, AND’S OR BUT’S”

Yes 1037 86.1 No 167 13.9

12. READ THE INSTRUCTIONS AND THEN CLOSED EYES

Yes 1143 94.9 No 42 3.5 Does not apply 18 1.5

37

Section VII cont’d Frequency (n) Percent 13. FOLLOWED THE FOLLOWING INSTRUCTIONS

A. Picked up paper with right hand 1042 86.5 B. Folds the paper with both hands 1168 97.0 C. Places the paper in their lap 1152 95.7

Subject is physically impaired 12 1.0 14. WROTE A COMPLETE SENTENCE

Right 1114 92.5 Wrong 54 4.5 Does not apply 35 2.9

15. COPIED TWO PENTAGONS Right 837 69.5 Wrong 329 27.3 Did not attempt 37 3.1

EMOTIONAL HEALTH OVER THE LAST WEEK 1. SATISFIED WITH LIFE 1078 89.5 2. DROPPED MANY ACTIVITIES OR INTERESTS 182 15.1 3. LIFE IS EMPTY 162 13.5 4. OFTEN GET BORED 274 22.8 5. GOOD SPIRITS MOST OF THE TIME 1142 94.9 6. AFRAID SOMETHING BAD WILL HAPPEN 103 8.6 7. FEEL HAPPY MOST OF THE TIME 1122 93.2 8. OFTEN FEEL HELPLESS 152 12.6 9. RATHER STAY AT HOME THAN GO OUT 560 46.5 10. HAVE MORE PROBLEMS WITH MEMORY THAN MOST 154 12.8 11. IS IT WONDERFUL TO BE ALIVE 1183 98.3 12. FEEL PRETTY WORTHLESS THE WAY YOU ARE NOW 121 10.0 13. FEEL FULL OF ENERGY 758 63.0 14. SITUATION IS HOPELESS 66 5.5 15. MOST PEOPLE BETTER OFF THAN YOU ARE 127 10.5

SECTION VIII: SPIRITUALITY Frequency (n) Percent 1. MEMBER OF A RELIGIOUS ORGANIZATION

Yes 1054 87.5 No 144 12.0

2. FREQUENCY OF ATTENDANCE TO SERVICES More than once a week 371 30.8 Once a week 355 29.5 Twice a month 81 6.7 Occasionally 235 19.5 Never 156 13.0

38

Section VIII cont’d Frequency (n) Percent

3. DESIRE TO GO MORE OFTEN No 743 61.7 Yes 461 38.3 A. REASONS FOR NOT ATTENDING AS OFTEN AS DESIRED

Health problems 161 13.4 Transportation 86 7.1 Accessibility of building 7 0.6 Availability of services 34 2.8 Church leaders 16 1.3 Church members 20 1.7 Clothes or money 8 0.7 Other 215 17.9

4. PARTICIPATE IN OTHER RELIGIOUS ACTIVITIES

No 645 53.6 Yes 552 45.8 A. HOW OFTEN

More than once a week 97 8.1 Once a week 248 20.6 Twice a month 49 4.1 Monthly 63 5.2 Occasionally 62 5.1

5. IMPORTANCE OF SUPPORT RECEIVED FROM FAITH COMMUNITY

Very important 687 57.1 Important 216 17.9 Somewhat important 120 10.0 Not important 165 13.7

6. HAS ATTENDANCE DECREASED OVER THE LAST YEAR No 875 72.7 Yes 329 27.3 A. WHY

Health problems 170 14.1 Transportation 56 4.7 Church leaders 22 1.8 Church members 20 1.7 Clothes or money 7 0.6 Other 102 8.5

7. ACTIVE IN PRIVATE SPIRITUAL LIFE

No 115 9.5 Yes 1089 90.4 A. HOW ACTIVE

Very active 520 43.2 Active 254 21.1 Somewhat active 148 12.3 Occasionally active 54 4.5 No response 113 9.4

39

Section VIII cont’d Frequency (n) Percent 8. WAYS RECEIVED SPIRITUAL SUPPORT

Church 906 75.2 Television 595 49.4 Personal spiritual activity 961 79.8 Radio 425 35.3 Other 297 24.7 No support received 62 5.1

SECTION IX: SOCIAL CARE Frequency (n) Percent 1. PROVIDE ASSISTANCE WITH DAILY LIVING TO ANYONE

No 993 82.5 Yes 211 17.5 A. HOW MANY PEOPLE

One 170 14.1 More than one 101 8.4

B. CARING FOR SOMEONE IN HOUSEHOLD C. WHAT KIND OF ASSISTANCE

Medicine management 105 8.7 Transportation 134 11.1 Meal preparation 118 9.8 Household chores 110 9.1 Sitting services 60 5.0 Financial assistance 92 7.6 Shopping 119 9.9 Personal care 83 6.9 Other 5 0.4

D. WHAT COULD YOU USE AS A CAREGIVER Sitter services 36 3.0 Respite care 21 1.7 Community meals program 24 2.0 Other (included chores, financial, medical, transportation, etc.) 36 3.0

E. HOURS PER WEEK SPENDING CARE Mean = 40.27 NA NA

F. DOES ANYONE ELSE HELP PROVIDE CARE Spouse 19 1.6 Children 49 4.1 Other family members 66 5.5 Church or community agencies 9 0.7 Friends 15 1.2 No one 72 6.0 Other 18 1.5

G. HOW STRESSFUL IS IT TO PROVIDE THIS CARE Extremely stressful 22 1.8 Somewhat stressful 51 4.2 A little stressful 39 3.2 Not at all stressful 88 7.3 Not sure / does not know 10 0.8

40

Section IX cont’d Frequency (n) Percent

2. ANTICIPATE BEING A CAREGIVER IN THE NEXT 10 YEARS Yes 164 13.6 No 762 63.3 Possible 163 13.5 Does not know 114 9.5 Refused 1 0.1

3. WOULD FAMILY HELP IF NEEDED

Extremely likely 864 71.8 Somewhat likely 156 13.0 Not sure 95 7.9 Somewhat unlikely 47 3.9 Extremely unlikely 42 3.5

4. WOULD THE HEALTHCARE SYSTEM HELP IF NEEDED

Extremely likely 700 58.1 Somewhat likely 238 19.8 Not sure 211 17.5 Somewhat unlikely 19 1.6 Extremely unlikely 36 3.0

5. THE PERSON THAT WOULD HELP FOR MINOR ILLNESSES Spouse / partner 551 45.8 Child 631 52.4 Other relative 282 23.4 Friend or neighbor 207 17.2 Hired caregiver 75 6.2 There is no one 11 0.9 Cannot think of anyone 5 0.4 Not sure / does not know 14 1.2 Other 16 1.3

6. ANTICIPATED HOUSING IF UNABLE TO TAKE CARE OF ONESELF

Own home with help 695 57.7 Child’s home 103 8.6 Other relative’s home 19 1.6 Retirement home 30 2.5 Assisted living facility 98 8.1 Nursing home 100 8.3 Have not thought about it 72 6.0 Not sure / does not know 84 7.0 Other 3 0.2

41

Section IX cont’d Frequency (n) Percent

7. PRIMARY CAREGIVER Spouse / partner 458 38.0 Child 370 30.7 Other relative 78 6.5 Friend or neighbor 15 1.2 Hired caregiver 199 16.5 There is no one 7 0.6 Cannot think of anyone 12 1.0 Not sure / does not know 58 4.8 Other 7 0.6

SECTION X: RETIREMENT PLANNING Frequency (n) Percent A. FOR THOSE THAT HAVE NOT RETIRED YET 314 26.1 1. TENTATIVE AGE FOR RETIREMENT

Average Age 65 5.4 Does not know 56 4.7 Never 82 6.8

2. PLAN ON REMAINING IN ALABAMA AFTER RETIRING


3. DO YOU PARTICIPATE IN ANY RETIREMENT PLAN (BESIDES SS)

No 58 4.8 Yes 256 21.3 A. WHAT TYPE OF PLAN

401K type plan 112 9.3 State employee’s retirement plan 30 2.5 Public school teacher’s retirement plan 24 2.0 Individual savings plan 74 6.1 Pension plan 113 9.4 Other pension plan 23 1.9 Other / does not know 8 .7

B. WILL THIS BE ENOUGH Yes 141 11.7 No 68 5.6 Not sure / does not know 47 3.9

C. CURRENTLY DRAWING ANY RETIREMENT FUNDS Yes 92 7.6 No 155 12.9

42

Section X cont’d Frequency (n) Percent

4. WILL SOCIAL SECURITY BENEFITS PAY ENOUGH Yes 28 2.3 No 264 21.9 Does not know 16 1.3 Not applicable 6 0.5

5. WHAT ARE YOUR PLANS FOR RETIREMENT Volunteer work 106 8.8 Pursue hobbies / recreation 137 11.4 Travel 131 10.9 No plans 50 4.2 No retirement 60 5.0 Other 38 3.2

B. QUESTIONS FOR THOSE NOT WORKING 1. AGE OF RETIREMENT

Average Age 57 4.7 2. PARTICIPATE IN ANY RETIREMENT PLAN (BESIDES SS)


401K type plan 88 7.3 State employee’s retirement plan 68 5.6 Public school teacher’s retirement plan 52 4.3 Individual savings plan 114 9.5 Pension plan 286 23.8 Other pension plan 38 3.2 Other / does not know 28 2.3

B. FOR RIGHT NOW IS THIS ENOUGH Yes 398 33.0 No 98 8.1 Not sure / does not know 28 4.9

3. DOES SOCIAL SECURITY PAY ENOUGH

Yes 187 15.5 No 610 50.17 Does not know 21 1.7 Not applicable 44 3.7

4. SPEND YOUR FREE TIME Volunteer work 222 18.4 Pursue hobbies / recreation 415 34.5 Travel 238 19.8 Other 493 40.9

5. PLAN TO REMAIN IN ALABAMA Yes 842 69.9 No 16 1.3

43

Section X cont’d Frequency (n) Percent

C. QUESTIONS FOR PEOPLE THAT NEVER WORKED

1. AGE STARTED DRAWING SOCIAL SECURITY

Average Age 58 4.8 2. PLAN TO REMAIN IN ALABAMA

Yes 29 2.4 No 1 0.1

3. PARTICIPATE IN ANY RETIREMENT PLAN (BESIDES SS)


401K type plan 3 0.2 State employee’s retirement plan 3 0.2 Public school teacher’s retirement plan 2 0.2 Individual savings plan 0 0 Pension plan 2 0.2 Other pension plan 1 0.1 Other / does not know 0 0

B. WILL THIS BE ENOUGH Yes 3 0.3 No 5 0.4 Not sure / does not know 1 0.1

4. WILL SOCIAL SECURITY PAY ENOUGH

Yes 4 0.3 No 28 2.3 Does not know 3 0.2 Not applicable 3 0.2

5. SPEND YOUR FREE TIME Volunteer work 11 0.9 Pursue hobbies / recreation 16 1.3 Travel 14 1.2 Other 22 1.8

SECTION XI: LONG TERM PLANNING Frequency (n) Percent 1. PURCHASED LONG TERM CARE INSURANCE POLICY

No 1068 88.7 Yes 136 11.3 A. WHEN WAS IT PURCHASED

Less than five years 65 5.4 Five to ten years 33 2.7 More than ten years ago 24 2.0 Does not know 14 1.1

44

Section XI cont’d Frequency (n) Percent B. HOW MANY YEARS OF COVERAGE DO YOU HAVE

Three years 18 1.5 Other 66 5.5 Does not know 52 4.3

C. WHAT TYPE OF SERVICES ARE COVERED In home service 82 6.8 Day care 58 4.8 Assisted living facility 76 6.3 Nursing home room and board 92 7.6 Nursing home ancillary services 51 4.2 Other 7 0.6 Does not know / refused 21 1.7

2. THINKING ABOUT PURCHASING LONG TERM CARE

Yes (Five already have some form of Long Term Care insurance) 140 11.6 No 941 78.2

3. PRECAUTIONS TAKEN IN THE EVENT OF DEATH

Prepared a property will 761 63.2 Purchased a cemetery plot 837 69.5 Purchased a pre-paid burial plan 425 35.3 Discussed wishes with family 794 65.9 No plans 89 7.4 Refused 22 1.8

4. TIME THOUGHT ABOUT WHO WOULD MAKE MEDICAL CARE DECISIONS IF YOU COULD NOT

Very much 549 45.6 Somewhat 329 27.3 Not very much 186 15.4 Not at all 139 11.5 Refused 1 0.1

5. THE PERSON THAT WOULD MAKE THE MEDICAL DECISIONS IF UNABLE

Spouse / Partner 482 40.0 Relative 667 55.4 Friend 18 1.5 Pastor, clergy or religious advisor 1 0.1 Physician 4 0.3 Other 8 0.7 No one 5 0.4 Not sure / do not know 19 1.6

45

Section XI cont’d Frequency (n) Percent

6. TALKED TO ANYONE ABOUT THE CARE YOU WANT TO RECEIVE IF YOU WERE SERIOUSLY ILL

No 536 44.5 Yes 668 55.5 A. WHO

Spouse / partner 249 20.7 Relative 385 32.0 Friend 16 1.3 Physician 1 0.1 Other / No response 17 1.4

B. THINK YOUR WISHES WILL BE RESPECTED Yes 622 51.7 No 6 0.5 Maybe 6 0.5 Does not know / No response 34 2.8

7. KNOW ABOUT LIVING WILLS


8. SIGNED A LEGAL DOCUMENT DESCRIBING THE TYPE OF CARE YOU WISH TO RECEIVE IF TERMINALLY ILL

No 808 67.1 Yes 384 31.9 Does not know 11 0.9 Refused 1 1.1

9. KNOW ABOUT HEALTH CARE PROXIES No 505 41.9 Yes 673 55.9 Does not know 26 2.2

10. SIGNED A LEGAL DOCUMENT NAMING SOMEONE TO MAKE MEDICAL DECISIONS FOR YOU IF YOU WERE UNABLE

No 880 73.1 Yes 308 25.6 Does not know 15 1.2 Refused 1 1.1 A. WHO

Spouse / partner 96 8.0 Relative 189 15.7 Friend 7 0.6 Physician 1 0.1 Pastor, clergy, or religious advisor 1 0.1 Other 1 0.1 Unnamed 13 1.1

46


10B. IF NO, WHY Not necessary now 115 9.6 Hard to think about 28 2.3 Unsure who to name 20 1.7 Do not know where or how to do it 104 8.6 Have not had the time 119 9.9 Never thought about it 288 23.9 Other 129 10.7 No response 76 6.3 Refused 1 0.1

11. DESIRED RESIDENCE AT THE END OF LIFE

In my home 879 73.0 In the home of one of my relatives 41 3.4 In a nursing home 70 5.8 In a hospital 38 3.2 In hospice hospital 17 1.4 In some other long term care facility 28 2.3 No preference 33 2.7 Have not thought about it 67 5.6 Does not know 29 2.4 Refused 2 0.2

12. PREFERENCE TOWARDS TREATMENT IN LIFE THREATENING SITUATIONS

Extending life even if it causes pain and suffering 60 5.0 Focuses on relieving pain even if it shortens life 955 79.3 Does not know 189 15.7

QUESTIONS 13 - 15 ARE ABOUT BEING IN THE LATE STAGES OF A LIFE THREATENING ILLNESS

13. WANT TO BE FED THROUGH A TUBE IF UNABLE TO SWALLOW

Yes 175 14.5 No 825 68.5 Maybe / unsure 196 16.3 Refused 8 0.7

14. WANT A VENTILATOR IF UNABLE TO BREATH

Yes 96 8.0 No 996 82.7 Maybe / unsure 109 9.1 Refused 3 0.2

15. WANT CPR IF HEART STOPPED BEATING Yes 286 23.8 No 815 67.7 Maybe / unsure 101 8.4 Refused 2 0.2

47


16. VIEWS ON LEGALITY OF PHYSICIAN-ASSISTED SUICIDE It should not be legal 570 47.3 It should be legal in a few cases 100 8.3 It should be legal with restrictions 237 19.7 It should be legal 131 10.9 No opinion 141 11.7 Refused 25 2.0

17. IMAGINE REQUESTING PHYSICIAN-ASSISTED SUICIDE Yes 326 27.1 No 737 61.2 Unsure 130 10.8 Refused 11 0.9

18. VIEWS ON LEGALITY OF EUTHANASIA It should not be legal 594 49.3 It should be legal in a few cases 92 7.6 It should be legal with restrictions 241 20.0 It should be legal 109 9.1 No opinion 144 12.0 Refused 24 2.0

19. IMAGINE REQUESTING EUTHANASIA Yes 328 27.2 No 733 60.9 Unsure 130 10.8 Refused 13 0.9

20. HAVE ANY OF THE FOLLOWING WORRIES OR CONCERNS ABOUT THE END OF LIFE (multiple responses possible)

Being in pain 273 22.7 Having other severe symptoms 161 13.4 Being a burden on others 657 54.6 Being alone or abandoned 148 12.3 Not having my dignity respected 265 22.0 What will happen to me after I die 49 4.1 What will happen to my family after I die 236 19.6 Other worries or concerns 42 3.5 No worries or concerns 356 29.6 Does not know / have not thought about it 91 7.6

Appendix C Other Documentation

Nutrition Screening Initiative — DETERMINE

Question Points if Yes I have an illness or condition that has recently made me change 2 the kind and/or amount of food I eat. I eat fewer than two meals per day. 3 I rarely eat fruits, vegetables, and milk products. 2 I have three or more glasses of beer, liquor, or wine almost everyday. 2 I have tooth or mouth problems that make it hard for me to eat. 2 I don’t always have enough money to buy the food I need. 4 I eat alone most of the time. 1 I take three or more different prescription or over-the-counter drugs a day. 1 Without wanting to, I have lost or gained 10 pounds in the past 6 months. 2 I am not always physically able to shop, cook, and/or feed myself. 2 TOTAL SCORE 21

uab center for aging · john porter lillis, bs barbara meek smith, ... plementary survey of older...

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