Use ofHealth

■

Senmces by Women

65 Yearn ofAge

ad Over

United States

Statistics are presented on the utilization of

nonfederal Iy employed office-based

physicians, non-Federal short-stay hospitals,

and nursing homes by women 65 years of age

and over. Estimates are based on data

collected in the National Ambulatory Medical

Care Survey, the National Hospital Discharge

Survey, and the National Nursing Home

Survey. Patterns of use are described by

demographic characteristics of the patients,

patient condition, patient management, and

outcome.

Data From the National Health Survey

Series 13, No. 59

DHHS Publication No. (PHS) 81-1720

U.S. Department of Health

and Human services

Public Health Service

Office of Health Research. Statistics,

and Technology

National Center for Health Statistics

Hyattsville, Md.

August 1981
National Center for Health Statistics

DOROTHY P. ‘RICE,Director

ROBERT A. ISRAEL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Directorfor Analysis

and Epidemwlogv

GAIL F. FISHER, Ph.D.,Associate Directorfor the

CooperativeHealth Statistics System

GARRIE J. LOSEE,Assocrhte Director for Data Bocessing

and Services

ALVAN O. ZARATE, Ph.D., Assistant Directorfor

International Stathtics

E. EARL BRYANT, AssocrizteDirectorfor Interview and

Examination Statistics

ROBERT C. HUBER,Associate D&ectorfor Management

MONROE G. SIRKEN, Ph.D.,Associate Directorfor Research

and Methodology

PETER L. HURLEY, Associate Dtiector for Vital and Health

(lrre Statistics

ALICE HAYWOOD, Information Officer

Library of Congress Catalog Card Number 81-607865

Division of Health CareStatistics

W. EDWARD BACON, Ph.D., Director

JOAN VAN NOSTRAND, Deputy Director

JAMES E. DELOZIER, C%ie~Ambtdatoiy Gwe Statistics

Branch

MARY MOIEN, Chie~ Hospital CareStatistics Branch

EVELYN S. MATHL3, Chie&Long-Term CareStatistics

Branch

MANOOCHEHR K. NOZARY, Chief Technical Service

Branch

.

COOPERATION OF THE U.S. BUREAU OF THE CENSUS

Under the legislation establishing the National Health Survey, the Public Health Service is authorized to use, insofar as

possible, the services or facilities of other Federal, State, or

private agencies.

In accordance with specifications established by the NationaI

Center for Health Statistics, the Bureau of the Census, under a

contractual arrangement, participated in planning the National

Hospital Discharge Survey and collecting its data.
Contents

introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Population characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Health status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sources andlimitations ofdata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ambulatory care in physicians’ offices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patientcharacteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patientcondition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hospital care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patientcondition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nursing homecare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patientcharacteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patientcondition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Listofdetailed tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Technical appendixes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1. Definitions oftermsused inthe National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Il. Definitions oftermsusedinthe National Hospital Discharge Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ill. Definitions ofterms usedintheNational Nursing Home Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. Questionnaires used in the National Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and

the National Nursing Home Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ListofText Figures

1. Percent of married and nonmarried units with earnings income: United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . .

2. Percent of persons with incomes below poverty level, by marital status, sex, and age: United States, 1976 . . . . . . . . . . .

3. Percent of women 65 years of age and over below the poverty line, by famil y status and race or Hispanic origin: United

States, 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Incidence of malignant neoplasmin 10 regions, byageand sex: United States, 1973-77 . . . . . . . . . . . . . . . . . . . . . . . . .

1

1

1

1

6

8

8

9

13

15

16

16

16

19

20

24

24

25

27

29

35

36

55

56

59

61

63

2

3

3

4

...

Ill
5. Incidence of acute conditions per 100 persons per year, by age and sex: United States, July 1977-June 1978 . . . . . . .. . . .

6. Number of acute injuries per 100 persons per year, by age and sex: United States, July 1977-June 1978 . . . . . . . . . . . .

7. Annual rate of office visits made by women for essential benign hypertension, heart disease, diabetes mellitus, and

arthritis andrheumatism, by ageof patient: United States, 1978,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Annual rate of office visits made by women for neuroses, by age of patient: United States, 1978 ... . . . . . . . . . . . . . .

9. Annual rate of office visits made by women for malignant neoplasm of breast and rate of hospital discharges for breast

surgery, byageof patient: United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Percent of office visits made by women, by seriousness of condition and age of patient: United States, 1978 . . . . . . . . .

11. Annual rate of office visits made by women for general medical examination, blood pressure test, and Pap smear, by age

ofpatient: United States, 1978.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. Death rate for malignant neoplasm of cervix uteri, by age of patient: United States, 1976 . . . . . . . . . . . . . . . . ., . . . .

13. Incidence of malignant neoplasm of the cervix uteri among women in 10 regions, by age of patient: United Statesr

1973-77 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14. Number, percent distribution, and rate of patients discharged from short-stay hospitals, by sex and age of patient:

United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15. Number of women 65 years of age and over discharged from short-stay hospitals per 1,000 population, by race:

United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16. Average length of stay of women 65 years of age and over discharged from short-stay hospitals, by age: United States,

1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17. Average length of stay of women 65 years of age and over discharged from short-stay hospitals, by race: United States,

1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18. Hospital fatality rate for women 65 years of age and over discharged from short-stay hospitals, bv race: United Staltes,

1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . ., . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .

19. Number of nursing home residents per l,OOOpopulation 65yearsof age and over, by sex andage: United States, 1977. .

20. Number of nursing home residents per 1,000 population 65 years of age and over, by race and sex: United States,

1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21. Percent of women discharged from nursing homes, by selected chronic conditions and impairments, by age: United

States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22. Percent of women 65years ofage and over discharged from nursing homes who were chairfast or bedfast, or incontinent,

byage:United States, 1978..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

23. Percent of women 65 years of ageandover discharged from nursing homes whoused eyeglasses, wheelchair, or walker,

byage:United States, 1976.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24. Percent distribution of women 65 years of age and over discharged from nursing homes who received intensive nursing

care, by mobility andcontinence status: United States, 1976.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25. Percent of women 65 years of age and over discharged from nursing homes who were incontinent and bedfast orchlairfast, by length ofstay: United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26. Percent of women 65 years of age and over discharged from nursing homes with chronic conditions of senility and

chronic brain syndrome, by length ofstay: U~ited Statesr 1976.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27. Percent of women 65years of age andover discharged from nursing homes, by type of therapy received, by length of

stay: United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

28. Percent ofwomen 65years ofageand overdischarged from nursing homes whoreceived intensive nursing care, by length

ofstay: United States, 1976.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

29. Average length of stay for women 65 years ofage andover discharged from nursing homes, by marital status: United

States, 1976, . . . . . . . . . . . . . ; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ListofTextTables

A. Number, percent distribution, andannual rate ofoffice visits made by females, byraceand age of patient: United Staltesr

1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

B. Number and percent distribution of office visits made by females by age of patient, according to Hispanic or NonHispanic origin: UnitedStates,1979 . . . . . . . . . . . . . . . . . . . ..O .C.-..-o-c,,<t.cct.cc. . . . . . . ..<O..

C. Number and percent distribution of office visits made by women by physician specialty, according to ageofpati(:nt:

United States, 1978 .,.,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

D. Annual rate of office visits made bywomen 65years ofageand over byraceof patient andselected principal diagnoses:

United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E. Prevalence rate with percent of difference and visit rate with percent of difference among women, by age, race, and

selected chronic conditions: United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F. Prevalence rate with percent ofdifference and visit rate with percent ofdifference among patients 65yearsof age and

overrby sex of patient and selected chronic conditions: United States, 1978 . . . . . . . . . , , . . . . . . . . . . . . . . . . . . ,

5

5

12

12

12

13

14

14

15

17

18

21 “

22

22

25

26

28

28

29

30

31

31

32

33

33

8

8

9

9

10

10

iv
G.

H.

J.

K.

L.

M.

N.

o.

P.

Q.

R.

s.

T.

u.

w,

Y.

z.

Number and percent of office visits made by women 65 years of age and over, by selected principal diagnoses and most

frequent second- orthird-listed diagnosis: United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Rate of return office visits made by women, by age of patient and selected principal diagnoses: United States, 1978 . . . .

Number and percent distribution of office visits made by women 65 years of age and over, by disposition of visit: United

States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..-. .. s...’.

Percent distribution of women 65 years of age and over discharged from short-stay hospitals or noninstitutionalized, by

marital status: United States, 1978. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent of office visits made by women 65 years of age and over and number and percent discharged from

short-stay hospitals, by selected first-listed diagnoses: United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent distribution of women discharged from short-stay hospitals by number of diagnoses for each patient, according toageof patient: United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and rate of women discharged from short-stay hospitals, by surgery status and age of patient: United States,

1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. s . . . . . . . . . . . . . . . ...”.

Rate of all-listed operations for women discharged from short-stay hospitals, by age of patient and selected surgical categories: United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Average length of stay of women discharged from short-stay hospitals, by age of patient and selected first-listed diagnoses: United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Average length of stay of women 65 years of age and over discharged from short-stay hospitals, by surgery status and age

ofpatient: United States, 1978.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Average length of stay of women 65 years of age and over discharged from short-stay hospitals, by marital status: United

States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fatality rate of patients discharged from shott-stay hospitals, by sex and age of patient: United States, 1978 . . . . . . . . .

Number and percent distribution of patients 65 yaars of age and over discharged from short-stay hospitals, by sex of

patient anddischarge status: United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distribution of women 65 years of age and over discharged from nursing homes, by age and marital status:

United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...

Percent of women 65 years of age andover discharged from short-stay hospitals and from nursing homes, byseiected

diagnoses: United States, 1978and 1976. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distribution of women 65 years of ageandover diwharged from nursing homes, byselected functional statuses:

United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Average length of stay of patients 65 years of age andover discharged from nursing homes, bysex, age, and marital

status: United States, 1976..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AA. Average age bydischarge status and average length of stay of women65 years of ageandover discharged from nursing

homes, bydischarge status andage of patient: United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BB. Number, percent distribution, and average length of stay of women65 years of ageandover discharged from nursing

homes, byliving arrangement atierdischarge: United States, l976. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11

11

15

18

18

19

20

20

21

22

22

22

23

26

26

27

30

33

34
Symbols

.-. Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500

*

Figure does not meet standards of

reliability or precision

# Figure suppressed to comply with

confidentiality requirements
Use of Health Services by

Women 65 Years of Age

and Over

by Esther Hing and Beulah K. Cypress, Ph. D., Division of

Health Care Statistics

Introduction

Overview

As the American population ages, the health

problems of elderly women will play a greater role in

the concerns of health planners because it is the

elderly woman who more often survives to old age

and thus is subject to greater risk of disease and need

for services. In 1978, 130 women were aged 65T74,

166 aged 75-84, and 220 aged 85 years and over for

every 100 men of the same age.1 The 7-year

difference in life expectancy by sex, which accounted

for the greater number of females in 1978, is

expected to increase to a 10-year difference by the

year 2003.2 Thus the problems of old age will be

largely the problems faced by older women. This

report will examine the use of three major health care

settings by the elderly woman: physicians’ offices,

hospitals, and nursing homes. Data are from three

sample surveys conducted by the National Center for

Health Statistics: the National Ambulatory Medical

Care Survey, the Natiomd Hospital Discharge Survey,

and the National Nursing Home Survey. The data will

show the health problems presented by elderly

women in each of these settings and relate these

problems to treatment or care received. Selected data

on the outcome of care in relation to mortality and

length of stay in hospitals and nursing homes will also

be examined.

Population characteristics

In 1978 an estimated 14.3 million women were

65 years of age and over in the United States. Of

these women, 91 percent were white, 8 percent were

black, and about 1 percent were members of other

races. 1 About 285,000 or 2 percent of the civilian

noninstitutionalized female population 65 years of

age and over were of Hispanic origin.1 Most of the

civilian noninstitutionalized female population 65

years of age and over lived in families (57 percent),

but only 36 percent were wives.1 The most common

marital status for these women was widow. In 1978,

52 percent of the women 65 years of age and over

and 69 percent of those 75 years of age and over were

widowed.1 (The proportion is even higher among

elderly women in institutions.) Nearly half of the

women aged 75 years and over lived alone. 1 The loss

of a spouse creates hardship for the older woman not

only in terms of loneliness and isolation, but also in

terms of reduced financial resources. In 1977, the

median income for an elderly widow was $3,502

compared with $6,059 for an elderly married couple.1 Generally, married couples had higher earnings

than nonmarned persons (figure 1), but even among

the nonmarrieds, the incomes of women were lower

than the incomes of their male counterparts. Thus

more “poor” women were found than “poor” men

(figure 2).

Among all women 65 years of age and over, black

and Hispanic women were more likely to have

incomes below the poverty level (41 and 20 percent,

respectively) than white women were (15 percent)

(figure 3). The poverty of black and Hispanic women

is accentuated if they do not live with families.

However, even among women living with families, a

larger proportion of black women had incomes below

the poverty level (29 percent) than white women did

(6 percent). This proportion is greater because black

women are more likely than white women are to

maintain a family without a husband (21 percent

compared with 8 percent, respectively ).1 Elderly

black women were nearly 3 times as likely as white

women were to be the recipients of public assistante.3 Thus because older women have fewer social

and financial resources to draw on, they are at a

disadvantage when they have a major health problem.

Elderly black and Hispanic women are particularly

vulnerable.

Health status

What are the health problems facing older

women? The major health characteristic of older

1
El Married units

❑ Nonmarried units

100 r

90

80

70

60

50

40

30

20

10

0

55-61 62-64 65-67 68-69 70-72 73 and over

Age inyears

SOURCE: Social Security Administration: Income and Resources of the Aged, SSA Pub. No. 13-11727. Washington. U.S. Government

Printing Office. Jan. 1980.

Figure 1. Percent of married andnonmarried units with earnings income: United States, 1976

women is the greater prevalence of chronic illnesses disorder, frequent constipation, and all anemia condithat cause limitations in how they live, and these are

often multiple in number. According to self-reported

data from the 1978 National Health Interview Survey

(NHIS), elderly noninstitutionalized women had a

higher prevalence than adult women aged 17-44 years

and middle-aged women aged 45-64 years did for the

following chronic conditions or impairments–visual

impairments, hearing impairments, arthritis, hypertensive disease without mention of heart, coronary

heart disease, cerebrovascular disease, diabetes, orthopedic impairments of the lower extremity and hip,

chronic bronchitis, all diseases of the urinary system,

functional and symptomatic upper gastrointestinal

tions (table 1).

Many of. these conditions are likely to coexist

with other chronic conditions, particularly among the

elderly. Persons with hypertension, for example,

report having heart trouble, diabetes, and stroke at

least 3 times more often than persons without

hypertension do.A Persons with diabetes ,are also

more likely than others are to have visual impairments (blindness is 25 times more common among

diabetics than nondiabetics), cardiovascular disease,

and hypertensions

In this respect, the health problems of aging men

are similar to those of aging women. What compli2
40

30

g

P 20

L?

10

0

El Married couples

E! Single men

c1 Single women

55-61 62-64

Age in years

i

.:.:,:,:.:

:::::::::,

..! .. .. .

::::::::..

:.:::::::

.:.,.,..:

y.;~:j.:

65 and over

SOURCE: Social Security Administration: Income and

Resources of the Aged, SSA Pub. No. 13-11727. Washington. U.S. Government Printing Office. Jan. 1980.

Fiaure 2. Percent of ~ersons with income below Dovertv.level. bv

marital status, sex, and age: United States, 1976

cates the picture for older women, however, is that

they live longer, which means that they endure these

chronic conditions longer. Women have higher rates

of long-term chronic diseases while men have higher

rates of fatal diseases. According to data from the

NEHS, women report a higher prevalence of hypertensive disease without mention of heart, arthritis,

diabetes, anemia, thyroid conditions, diseases of

the urinary system, chronic sinusitis, gallbladder

conditions (over 44 years of age), gastritis and

duodenitis (over 44 years of age), diverticuli of the

intestines (over 44 years of age), colitis and enteritis

(over 44 yeara of age), visual impairments (over 64

years of age), orthopedic impairments involving back

or spine, and orthopedic impairments of the lower

extremities and hip (over 74 years of age) than men

do.G-l1 Males report higher rates of heart conditions,

cerebrovascular disease, ulcers, hernia, hearing impairments, speech defects, gout, and missing major and

minor extremities. G-l1 In addition, unpublished data

from the National Cancer Institute’s Surveillance,

Epidemiology, and End Results (SEER) program

show that the incidence of cancer was greater among

elderly males than among elderly females (figure 4).

The SEER survey was conducted in 10 regions of the

United States from 1973-1977.12

Among elderly women, the prevalence of chronic

conditions varies by race. Hypertensive heart disease,

heart conditions, and arthritis are more frequent

H White

El Black

70 ~ n Hispanic origin

I

-

60

50

40

30

20

10

0

Total, 65 years In families Unrelated

and over individuals

Women 65 years and over

SOURCE: U.S. Bureeu of the Census: Social and economic characteristics of the oldar population, 1978:

Current Population Reports, Series P-23, No. 85. Washington. U.S. Government Printing Office, Aug. 1979.

Figure 3. Percent of women 65 years of age and over below the

povery level, by family status and race or Hispanic origin:

United States, 1977

among elderly black women than among elderly

white women.

According to data from the 1978 NHIS, the

incidence of acute conditions decreases with age, but

from 17 years of age and over, women report more

acute conditions per 100 persons in each successive

age group than men do (figure 5). The number of

acute conditions per 100 females 65 years of age and

over was 121 compared with 97 per 100 males 65

years of age and over. One of the classes of acute

conditions occurring more frequently in elderly

women than in elderly men is injuries (including

fractures, lacerations, contusions, burns, and other

injuries) (figure 6). Osteoporosis, a condition in

which bones become thin, brittle, and vulnerable to

fractures, may be the underlying cause for the higher

rate of these injuries to women because it is more

common among elderly women than among elderly

men. 13 Most of these injuries occurred either inside

or on the grounds of their homes. 14

In the remainder of this report, the special health

problems of the older woman will be examined in

relation to her use of the conventional health services

in physicians’ offices, hospitals, and nursing homes.

However, prior to presentation of these patterns of

use, a brief review of the three data sources is

presented to assist in interpreting the data.

3
4,000

3,000

2,000

1,000

,

,

500

400

300

200

100

Male

.

,

/“

,/’

,/

/

/’

/’

i

i

,/’

,/

/

/’

/’

./”

/

o

I

Under 5-9 10-14 15-1920-24 25-29 30.3435-3940-44 45-4950-54 55-5960-6465-69 70-7475-79 80-8485 and

5 over

Age in years

SOURCE: Based on unpublished data from the National Cancer Institute Surveillance, Epidemiology, and End Results [SEER) Program.

Figure 4. Incidence of malignant neoplesm in 10 regions, by age and sex: United States, 1973-77
500 r

o 10 20 30 40 50 60 70 80

Age in years

SOURCE: National Center for Health Statistics: Acute

conditions. incidence. and associated disability: United

Statea, July 1977-Jurie 1978 Vitel and Health ‘Statistics.

Serie$ 10, No. 132. DHEW Pub. No. (PHS) 79-1560.

Public Health Service. Washington. U.S. Government

Printing Office, Sept. 1979.

Figure 5. Incidence of acute conditions per 100 persons per year, by

age and sex: United States, July 1977-June 1978

50 r

40 k

Femalez”

30 -- --- /“

- --+- /

---J’

Male

20

10

t

o~

17-44 45-64 65-74 75 and

over

Age in years

SOURCE: Unpublished data from the National Health

Interviaw Suwey.

Figure 6. Incidence of acute injuries per 100 persons per year, by age

and sex: United States, July 1977-June 1978

5
Sources and limitations of data

The estimates in this report are from the 1978

National Ambulatory Medical Care Survey (NAMCS),

the 1978 National Hospital Discharge Survey

(NHDS), and the 1977 National Nursing Home

Survey (NNHS). The NAMCS is a continuing national

probability sample of ambulatory medical encounters. The scope of the survey covers physician-patient

encounters in the offices of nonfederally employed

physicians classified as “office-based, patient-care”

physicians by the American Medical Association or

the American Osteopathic Association. Visits to

physicians practicing in Alaska and Hawaii; visits to

hospital-based physicians; visits to specialists in anesthesiology, pathology, and radiology; and visits to

physicians who are principally engaged in teaching,

research, or administration are excluded as well as

telephone contacts and nonoffice visits. The sample

for the 1978 NAMCS included 3,007 physicians, 466

of whom were not eligible (out of scope) at the time

of the survey. Of the 2,541 physician? who were

eligible, 1,850 (73 percent) actually participated.

Data on office visits were obtained from a sample of

47,291 visits.

Data presented on hospital care are from the

NHDS, which is a continuing nationwide sample

survey of short-stay hospitals in the United States.

The scope of NHDS encompasses patients discharged

from hospitals, exclusive of military and Veterans

Administration hospitals, located in the 50 States and

the District of Columbia. Only hospitals having six

beds or more for patient use and those in which the

average length of stay for all patients is less than 30

days are included in the survey. The sample for 1978

NHDS included approximately 535 hospitals; 48 of

these were either out of scope or out of business. Of

the 487 in-scope hospitals, 413 (85 percent) actually participated. The sample of discharges obtained

from participating hospitals included approximately

219,000 medical records.

Data presented on nursing home care are from the

1977 NNHS, which is a nationwide sample survey of

nursing homes, residents, discharges, and staff. The

scope of the 1977 NNHS encompassed all types of

nursing homes, including personal care and domiciliary care homes in the conterminous United States.

The sample for the 1977 NNHS included a.mitional

sample of 1,698 nursing homes; 166 were

either out of scope or out of business. Of the 1,532

in-scope nursing homes, 1,451 (95 percent) actually

participated. The sample of discharges from participating nursing homes included 5,142 discharges.

Patient data from the 1977 NNHS were obtained

from two samples of patients–those currently residing in the nursing homes and all patients discharged

from the nursing home during the calendar year

1976. Data in this report are basically from the

discharged resident sample, but selected data will be

presented on residents who were residing in the

nursing home.

Data presented from the NAMCS, NHDS, and

NNHS (discharged resident sample) share several

common characteristics:

1. The data were generally abstracted from patient

health records. In the NAMCS, information was

recorded on the encounter form, which supplied

data on a systematic random sample of visits. In

the NHDS, data were obtained from the face

sheets of a sample of medical records of inpatients discharged from short-stay hospitals.

Data from the NNHS on discharges from nursing

homes were collected by interviewing a member

of the nursing staff who referred to the medical

records. Thus the data in this report are based on

actual use of health resources as recorded on

medical records.

2. The data reflect estimates of patient events rather

than estimates of patients. In the NAMCS, the

patient-physician encounter (visit) was the unit of

analysis and the discharge event was the unit of

analysis in the NHDS and NNHS. Sampled persons who visited a physician more than once dur6
3.

ing the 7day period of data collection were included in the sample as multiple visits, as were

discharges from hospitals and nursing homes

during the 1-year period of data collection.

Data on diamoses in the NAMCS and NHDS were

coded acco~ding to the Eighth Revision of the

International Classification of Diseases, Adapted

for Use in the United States (ICDA).15 Data on

diagnostic categories used in the NNHS, however,

were collected according to medical nomenclature, but they were not coded according to the

ICDA.

Because data in this report are national estimates

based on a sample, they are subject to sampling

errors. Tables and charts of standard errors. used in

the preparation of this report for each respective

survey (NAMCS, NHDS, and NNHS) can be found

in appendix I of previously published reports.1 6-18

These appendixes also contain detailed descriptions

of the survey methods, the sample designs, the data

collection and processing procedures, and the estimation procedures.

Definitions of the terms used in this report are

presented in appendixes I-HI. Facsimiles of the Patient

Record form used in the NAMCS, the Medical

Abstract form used by participating hospitals in the

NHDS, and the Discharged Resident Questionnaire

used in the NNHS are presented in appendix IV. The

reader is urged to review these appendixes for

interpretation of the estimates presented in this

report.
Ambulatory care in physicians’ offices

Patient characteristics

Females of all ages made an estimated 349.2

million visits to office-based physicians in 1978, a

national average of 3.2 visits for each female in the

civilian noninstitutionalized population of the conterminous United States. Visits by women 65 years of

age and over constituted the smallest proportion (16

percent) of this total, but their visit rate of 4.2 visits

per person exceeded that of all other age groups

(table A).

However, visits by older women were not as

frequent for members of black and other races as

they were for their whit% counterparts. In contrast to

Table A. Number, percent distribution, and annual rate of office visits

made by females, by race and age of patients: United States. 1978

Number of rVumber of

Percent

Race and aga

visits per

visits in distribution

thousands

person

par year

All races

Alleges ., . . . . . . . . . . .

Under 25 years.....,..

25-44 years . . . . . . . . . .

45-64 years . . . . . . . . . .

65-74 years . . . . . . . . . .

75 years and over . . . . . .

White

Alleges ., . ., ...,,...

Under 25yaars . . . . . . . .

25-44 years . . . . . . . . . .

45-64 years . . . . . . . . . .

65-74 years . . . . . . . . . .

75 years and over , . . . , .

Black and all other

Alleges . . . . . . . . . . . . .

Under 25 years . . . . . . . .

2544years . . . . . . . . . .

45-64 years . . . . . . . . . .

65-74 years . . . . . . . . . .

75 years and over . . , . . .

349,244

108,283

100,736

83,996

35,258

20,971

308,706

94,659

86,624

75,325

32,445

19,653

40,538

13,625

14,111

8,671

2,813

1,318

100.0

31.0

28.8

24.1

10.1

6.0

88.4

27,1

24.B

21.6

9.3

5.6

11.6

3.9

4.0

2.5

0.8

0.4

3.2

2.4

3.5

3.7

4.3

4.1

3.3

2.5

3.4

3.8

4.4

4.2

2.7

1.8

3.5

3.5

3.5

3.0

an average of 4.2 visits for each white woman 65

years and over, all other women of the same age

visited at a rate of 3.5 per person per year. Visit rates

for white women increased with age through the

group 65-74 years of age, while rates for all other

women remained constant from 25 to 74 years.

Although about 17 percent of all visits lby white

women were made by patients 65 years of age and

over, the comparable proportion for all other women

was 10 percent.

These results by race are true of all visits in the

NAMCS regardless of sex. Similar results were found

in the NHIS, which shows that white persons tend to

visit physicians’ offices at a higher rate than members

of other races do, while all other persons tend to seek

medical care at settings other than physicians’ offices

at a higher rate than white patients do. 1g

Data on patients of Hispanic origin were not

available from NAMCS until 1979. Because of the

relatively small sample of office visits reccrded for

Hispanic women (as well as for men), analysis of

these data was limited. Table B shows that women of

Hispanic origin made 16.3 million visits (about 4.8

percent of all visits by women in 1979). About 10

percent of their visits were made by patients 65 years

of age and over compared with about 18 percent by

women of non-Hispanic origin. Because of problems

Table B. Number and percent distribution of office visits made by

females by age of patient, according to Hispanic or non-Hispanic

origin: United States, 1979

Age

Hispanic Non-Hispanic

origin origin

Number of visits in I.housands

All ages . . . . . . . . . . . . . . . 16,284 3;~13,81 I

percent distribution

Total . . . . . . . . . . . . . . . . . 100.0 100.0

Under 65 years . . . . . . . . . . 90.1 82.4

65-74 years . . . . . . . . . . . . . 6.3 10.2

75 years and over . . . . . . . . . 3.6 7.4

8
in establishing an appropriate population base,

rates were not calculated for non-Hispanic or

panic patients.

Patient condition

visit

HisPhysician specialty. –Patient preference, or need,

for care from a particular medical specialist tends to

be modified with age. This finding is not surprising in

view of the changing health needs of the elderly.

Although proportions of visits to general and family

practitioners and general surgeons were about the

same for middle-aged (45-64 years of age) and elderly

(65 years of age and over) patients, visits to ophthalmologists increased. On the other hand, visits to

obstetrician-gynecologists and psychiatrists decreased

(table C).

Diagnosis. –Table 2 provides a comparison of

visits by women in three age groups based on

diagnostic categories. These data show the pattern of

change in health status with advancing age. For

middle-aged patients (45-64 years of age) mental

disorders, diseases of the respiratory system, and

diseases of the genitourinary system constituted

relatively higher proportions of total visits than they

did for older women. Patients 65 years of age and

over were seen proportionately more often for

diseases of the nervous and circulatory systems.

The leading principal diagnoses made for women

65 years of age and over are listed by rank in table 3.

In NAMCS, the principal (first-listed) diagnosis is the

physician’s diagnosis based on the most important

reason for the patient’s visit. Conditions commonly

associated with older patients such as hypertension,

heart disease, diabetes, arthritis, cataracts, and glaucoma accounted for about one-third of their visits.

Table C. Number and percent distribution of office visits made

by women by physician specialty, according to age of patient:

United States, 1978

Age

Physician specialty 45-64 65-74 75 years

years years and over

All specialties . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . .

General and family practice . . . . . .

Internal medicine . . . . . . . . . . . . .

General surgery . . . . . . . . . . . . . .

Obstetrics and gynecology . . . . . . .

Orthopedic surgery . . . . . . . . . . . .

Cardiovascular diseases . . . . . . . . .

Dermatology . . . . . . . . . . . . . . . .

Urological surgery . . . . . . . . . . . .

Ophthalmology . . . . . . . . . . . . . .

Otolaryngology . . . . . . . . . . . . . .

Psychiatry . . . . . . . . . . . . . . . . .

Another . . . . . . . . . . . . . . . . . .

Number of visits in thousands

83,996 35,258 20,971

Percent distribution

100.0 100.0 100.0

38.5 38.8 39.5

17.1 22.4 24.0

7.5 7.5 7.8

7.7 2.3 *0.9

3.8 3.2 2.5

1.8 2.4 2.3

3.0 2.6 2.4

1.5 1.7 ●1.5

6.5 9.5 12.9

2.2 2.5 2.2

2.6 1.2 ‘0.4

6.8 5.9 3.6

Visit rates for all other women 65 years of age

and over were higher than those of their white

counterparts for essential benign hypertension,

diabetes mellitus, arthritis, and glaucoma; white

women visited at higher rates for heart disease,

osteoarthritis, cataracts, and neuroses (table D).

Comparison of prevalence and visit rates. –The

degree of utilization of office-based physicians by

patients with specific conditions may be examined by

comparing prevalence rates from the NHIS and visit

rates from the NAMCS among selected groups of

patients. Where a prevalence rate for a diagnosis is

higher for one group than for another, it would be

expected that the visit rate would be proportionately

higher for the same group. Table E shows prevalence

and visit rates for six chronic conditions. (Visit rates

are not the same as those in table 6 because several

ICDA codes were aggregated to match those used in

the prevalence rates based on NHIS data.) Comparisons between middle-aged and elderly women and

between white women and women of black and all

other races 65 years of age and over may be made by

using this table. All prevalence and visit rates shown

in table E were higher for elderly women than they

were for middle-aged women, However, except for

patients with arthritis, the percents of difference in

visit rates were higher than those in the corresponding

prevalence rates. For example, the prevalence rate of

cerebrovascular disease was about twice as high

among elderly women as among middle-aged women;

but the visit rate for older women was ahnost seven

times higher. These data suggest that the average

woman aged 65 years and over suffering from

cerebrovascular disease was likely to visit the physician more frequently than a middle-aged woman with

the same problem. A simiIar conclusion couId be

drawn for women with diabetes mellitus, hypertensive disease, and coronary heart disease. Prevalence

Table D. Annual rate of office visits made by women 65 years of age

and over, by race of patient and selected principal diagnoses:

United States, 1978

Race

Principal diagnosis and ICDA code 1 Black

White and

all other

Essential banign hypertension . . . . . . . ...401

Chronic ischemic heart disease . . . . . . . ..412

Diabetes mellitus . . . . . . . . . . . . . . . ...250

Osteoarthritis and allied conditions . . . . .. 713

Cataract . . . . . . . . . . . . . . . . . . . . . ...374

Arthritis, unspecified . . . . . . . . . . . . . .. 715

Symptomatic heart disease . . . . . . . . . . . , 427

Glaucoma . . . . . . . . . . . . . . . . . . . . ...375

Neuroses . . . . . . . . . . . . . . . . . . . . ...300

Medical and surgical aftercare . . . . . . . . . . YI O

Visit rate per

1,000 population

450.4 566.7

266.9 156.9

165.7 175.0

143.1 109.7

130.5 82.5

85.0 130.7

81.1 16.2

66.7 72.2

67.3 29.0

53.9 42.0

‘See reference 15<

9
Table E. Prevalence rate with percent of difference and visit rate with percent of difference among women, by age, racer and selected chronic

conditions: United States, 1978

Age of patient

Race of patients

Percent 65 years and over Percent

Chronic condition and ICDA codel of of

45-64 65 years difference White Black and difference

years and over all other

Rate per Rate per

1,000 population 1,000 population

Diabates mellitus (250)

Prevalence rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visit rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

59.4

88.2

93.9

166.5

58

89

93.0

166.7

*103.4

174.9

411

46

Hypertensive disease (400, 401, 403)

Prevalence rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visit rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

198.3

281.2

302.1

462.9

436

427

52

65

292.4

451.6

397.4

572.9

Coronary heart disease (41 0414)

Prevalence rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visit rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

28.4

79.7

78.8

312.0

379

324

177

291

82.2

317.6

‘46.0

257.1

Cerebrovascular disease (430438)

Prevalence rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visit rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.8

10.1

34.6

76.2

220

654

469

42

32.5

76.1

+55.0

77.4

Arthritis (710-715)

Prevalence rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Visit rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

304.0

162.5

522,1

270.6

72

66

522.0

270.4

523.4

272,4

‘See reference 15.

2,411 ~at=are higher forpatients 65 Years ofa9aand0ver

3Rate ishigher forwhiteraca.

4Rata ishighar for black and all other racas.

and visit rates for arthritis appear to be more

congruent.

According to the data shown intable E,women

65years ofage and over of black and all other races

had ahigher prevalence rate for hypertensive disease

than white women had. However, the difference in

these rates was not matched by a similar increase in

the visit rate, which was lower than expected. This

difference is not surprising in view of the lower rate

of physician visitsby all other women. CM the other

hand, coronary heart disease was 79 percent more

prevalent among white women than amongwomenof

all other races, but their visit rate was only 24 percent

greater. No obvious reason for this difference was

found.

Table F includes similar types of data according

to the sex of the elderly patient. Prevalence rates

were higher for men with coronary heart disease and

cerebrovascular disease; women had a greater prevalence of diabetes mellitus, hypertensive disease, and

arthritis. Except for cerebrovascular disease, higher

visit rates reflected higher prevalence rates, but the

two rates were not always consistent. Despite 31

percent more diabetes among women, their visit rate

for this condition was only 5 percent higher than that

for men. Rates for hypertensive disease and arthritis

were also disproportionate. Elderly men had an

18-percent higher prevalence rate for coronary heart

disease than elderly women had, but in a reversal of

the apparent trend, men visited physicians at a rate

that was 47 percent higher than that for women. This

Table F. Prevalence rate with percent of difference and visit rate with

percent of difference among patients 65 yaars of age and over, by

sex of patient and selected chronic conditions: United Statas,

1978

Sex

Diagnosis and IC.DA code 1

Percent of

Female Male

difference

Rate par

1,000 population

Diabetes mellitus (250)

Prevalence rate . . . . . . . . . . . .

Visit rate . . . . . . . . . . . . . ..d

93.9

166.5

71.9

158,6

31

5

Hypertensive disease (400, 401, 403)

Prevalence rate . . . . . . . . . . . .

Visit rate . . . . . . . . . . . . . . . .

302.1

462.9

179.5

302.5

68

53

Coronary heart disease (41 0-414)

Prevalence rate . . . . . . . . . . . .

Visit rate . . . . . . . . . . . . . . . .

78.8

312.0

93.3

459.2

18

47

Cerebrovascular disease (430-438)

Prevalence rate . . . . . . . . . . . .

Visit rate . . . . . . . . . . . . . . . .

34.6

76.2

59.5

66.9

72

14

Arthritis (710-71 5)

Prevalence rate . . . . . . . . . . . .

Visit rate............,,..

522.1

270.6

303.1

176.8

72

53

‘Sac refarence 15.

tinding was not true for cerebrovascular disease,

however, where the condition was 72 percent more

prevalent among men than among women; but

women visited physicians at a 14 percent higher rate

than men did.

10
Table G. Number of visits made by women 65 years and over for selected principal diagnoses by percent of most frequent second- or third-listed

diagnosis: United States, 1978

Principal diagnosis and ICDA code~

Second- or third-listed diagnosis end ICDA code ~ Diebetes Hypertensive

Coronary

mellitus, disease,

heart Arthritis,

250 400,401,403 disease, 710-715

410-414

Number of visits in thousands

Ail visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,224 6,182 4,166 3,614

Percent

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250 8.6 9.6 “6.0

Hypertensive disease . . . . . . . . . . . . . . . . . . . . . . . . . ..400.401,403 33.3 13.6

Coronary heartdisease . . . . . . . . . . . . . . . . . . . . . . . . . . . ...410-414 ●10.6 8.6

Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-715 ●6.2 7.0 10.5

‘See reference 15.

It is apparent from these data that some conditions create greater impetus for physician visits for

different groups of patients than others do. Additional research on physician visits focusing on specific

problems of the elderly may provide some insight as

to why patients with certain conditions underutilize

available health care.

Concomitant a!iagnoses.-Four chronic iIlnesses

that are prominent among principal diagnoses for the

elderly are also frequently listed as the second or

third diagnoses on the NAMCS Patient Record form.

Because the priority of listing up to three diagnoses in

the NAMCS is related to the patient’s most important

reason for visit, the principal diagnosis, which is the

more urgent problem at one visit may be the less

urgent problem at the next visit. However, the patient

can have multiple conditions. Table G shows that

each of diabetes mellitus, hypertensive disease,

coronary heart disease, and arthritis was frequently

concomitant with one or more of the other three.

The strongest association in visits was between

diabetes mellitus mid hypertensive disease-a direct

reflection of multiple problems reported in the NHIS.

In about one-third of the 2.2 million visits in which

diabetes mellitus was the principal diagnosis, hypertensive disease was the second- or third-listed disease.

Where hypertensive disease was listed first, 9 percent

of those patients also had diabetes mellitus. Other

data in table G may be similarly analyzed.

Other conditions were present in these visits by

elderly women, but they were less frequently found

in the estimates. Because of the limitations of the

sample, valid conclusions cannot be drawn about

other concomitant diagnoses.

Return visit rate, –A measure of physician use

may be obtained from the return visit rate, which is

the ratio of return visits to the number of visits in

which a new problem is presented–that is, the degree

to which a patient with a specific illness returns for

treatment. This degree is often dictated by the nature

of the ailment, but it also includes elements of

Tabla H. Return visit rate of office visits made by women, by age of

patient and selected principal diagnosis: United States, 1978

Age

Principal diagnosis and ICDA code’1

45-64 65 years

years and over

Return visit rate2

All diagnoses . . . . . . . . . . . . . . . . . . . . . . . . 2.1 “ 3.0

Essential benign hypertension . . . . . . . . .401 9.9 15.7

Chronic ischemic heart disease . . . . . . ...412 13.3 13.9

Diabetes mellitus . . . . . . . . . . . . . . . ...250 13.1 22.6

Osteoarthritis and allied conditions . . . . .. 713 2.0 3.8

Cataract . . . . . . . . . . . . . . . . . . . . . ...374 2.7 2.4

Arthritis, unspecified . . . . . . . . . . . . ...715 2,7 9.1

Symptomatic heart disease . . . . . . . . ...427 2.9 3.8

Glaucoma . . . . . . . . . . . . . . . . . . . . ...375 12.8 38.9

Neuroses . . . . . . . . . . . . . . . . . . . . . . . 300 4.6 7.6

Medical and surgical aftercare . . . . . . . . . . Y1 O 6.4 8.9

‘See refarence 15.

2The return vkit rate is the retio of return visits to new problem visi~.

patient motivation and physician encouragement. It is

difficult to separate the three. As table H shows,

these return visit rates varied according to the

diagnosis, with chronic conditions in the upper range,

as expected. Physician utilization was relatively high

for both middle-aged and elderly women who had

hypertension, heart disease, diabetes, and glaucoma.

However, elderly women had consistently higher

return rates than middle-aged patients had. Physician

utilization for cataract was an exception because

correction by surgery decreased the probability of

many return visits. As will be shown in the section

entitled “Hospital care,” extraction of lens to correct

cataract was one of the most common surgical procedures performed on elderly women.

The direction of the curves plotted in figure 7

illustrates how visit rates increased with age for

hypertension, heart disease, arthritis and rheumatism,

and diabetes mellitus. The rates for hypertension and

diabetes decreased, however, after 74 years of age.

This decrease was consistent with a slight decline in

11
.E

.9

>

550

500

450

400

350

300

250

200

150

100

50

0

—- —-— Heart disease

— Essential benign

hypertension

—— Arthritis and

----- Diabetes mellitus

15-24 25-44 45-64 65-74 75 and

over

Age in years

Figure 7. Annual rate of office visits made by women for essential

benign hypertension, heart disease, diabetes mellitus, and arthritis

and rheumatism, by age of patient: United States, 1978

the prevalence rate for women aged 75 years and over

with these conditions.

Physicians see elderly women more frequently for

physical illnesses than for mental conditions. Figure 8

shows that the rate of visit for neuroses declined

rapidly after 44 years of age. For patients 65 years of

age and over, a proportion of this decrease may be

due to limitations on Medicare coverage for psychiatric services.

The rate of women visiting a physician for

malignant neoplasm of breast quadrupled from the

childbearing years (25-44 years) to middle age (45-64

years) (figure 9). However, according to physician

visit data, this problem was not overcome during the

later years. A 35-percent increase was found in the

visit rate from middle age to those aged 65-74 years,

12

c

0

.-

J

2

0

n

0

0

0-

.5.s?

>

140 r

120

100

80

60

40

20

o~l

15-24 25-44 45-64 65-74 75 and

over

Age in years

Figure 8, Annual rate of office visits made by women for neuroses, by

age of patient: United States, 1978

c

.-

o

g

2 40 —

\

0

a

Office visits

0

q

; 30 –

Q

g

z

& 20 —

k

c

0

.9-0

~ 10 –

In

.E Surgery

.2 ---- ------ ------ -. .-.=

>

0

I I I

25-44 45-64 65-74 75 and

over

Age in years

Figure 9. Annual rate of office visits made by women for malignant

neoplasm of breast and rate of hospital discharges for breast

surgery, by age of patient: United States, 1978

and then only a 15-percent decrease occurred in the

rate of visits by women 75 years of age and over. This

decrease was smaller than expected considering the

reduction of the at-risk population through surgical

intervention and death by 75 years of age. The rates
of hospital discharges for breast surgery varied little

from the youngest to the oldest age group indicating

the continued use of surgical procedures during old

age (figure 9).

Despite the rising rate of visits for breast malignancies, the rates of breast examinations decreased

with age. According to the data collected during the

health interviews in 1973, less than half the women

65 years of age and over reported having had a breast

examination within the prior year compared with

over three-fourths of the women 17-24 years of

age.z O Among the elderly women interviewed, about

18 percent had not had a breast examination for 5

years or more. However, these figures may have

changed by 1978.

Seriousness of condition. –Morbid conditions of

elderIy women tended to be evaluated by private

physicians as “serious” or “very serious” proportionately more frequently than those of younger age

groups (figure 10). The high proportion of not serious

visits (57 percent) for women 25-44 years of age

reflects the large number of nonillness visits during

the childbearing years. This proportion decreased to

30 percent for patients 75 years of age and over. At

the same time, the proportion of visits judged

“serious” or “very serious” increased from 14 percent

for the youngest age group to 33 percent for the

oldest age group, reflecting the chronic conditions

presented by the elderly.

Patient management

Services. –Proportions of diagnostic and therapeutic services did not change appreciably with the

age of the patient (table 4). The small increases in the

proportions of electrocardiograms, vision tests, and

60 Y

50

40

30

20

10

0

57.3

25-44

El Not serious

Iz2

Slightly serious

•1 Serious or very serious

.

42.3

37.0

45-64 65-74

Age in years

75 and over

Figure 10. Percent of office visits made by women, by seriousness of condition and age of patient: United States, 1978
blood pressure checks given to patients over 64 years

of age reflect the onset of gerontological problems.

The decrease in the proportion of Pap tests performed during visits was consistent with the decreased rate of that test as a reason for visit which is

discussed in the section entitled “Preventive care.”

Drug prescription, the principal therapy employed during all visits regardless of age, tended to

increase slightly from middle to old age. The NAMCS

included data on specific medication therapy beginning with 1980 and this information will be availabie

in future publications from the National Center for

Health Statistics. This information will be of special

interest regarding the elderly in terms of the influence

of age and sex on ordering psychotropic drugs and of

the extent of use of prescriptions with generic terms.

Preventive care. –Speculation about the elderly

patient’s continuing concern for preventive care has

provided little definitive response. Some evidence (for

and against such motivation) is offered by the item

“reason for visit” in the NAMCS. In this item, the

physician records the symptom, complaint, or other

reason for the visit as accurately as possible in the

patient’s own words (as opposed to the diagnosis

determined by the physician). Figure 11 shows the

visit rate curves for women who visited physicians for

— General medical examination

---- Blood pressure test

350

r

—-—- Pap smear

25-44 45-64 65-74 75 and

over

Age in years

Figure 11. Annual rate of office visits made by women for general

medical examination, blood pressure test, and Pap smear, by age

of patient: United States, 1978

14

a

the stated purpose of obtaining general medical

examinations, blood pressure tests, and Pap smears.

(The number of visits used to calculate these rates

were based on the patient’s expressed reason for the

visit and may not agree with the actual number of

visits in which the services were rendered.) These

examinations are an essential part of goocl health

maintenance. The visit rates for general medical

examinations and blood pressure tests reflect awareness of the need for these visits, at least until ’74years

of age, after which rates for both reasons fell.

However, blood pressure measurement was often

included in the physician’s workup regardless of the

patient’s reason for the visit. This situation was

particularly true for elderly patients where at least

half of their visits included blood pressure monitoring

(see table 4).

Pap tests were clearly not a high priority among

women after 44 years of age because visit rates for

this reason fell sharply at the end of the childbearing

years. Opinions vary regarding the appropriate intervals between Pap tests, with some medical researchers

reporting that older women do not require these tests

as often as younger women do. National statistics,

however, may support the contention that the need

for detection of cervical cancer does not decrease

with age. Hospitalizations in 1978 for cervical cancer

were more frequent for women aged 65 years and

over than for those aged 45-64 years (81 versus 72

per 100,000 population). Death rates provide even

more stark evidence for testing beyond middle age.

Figure 12 illustrates that mortality rates due to

cervical cancer showed a continuous increase with

advancing age. However, the most compelling evidence is offered by the age-specific incidence rates of

malignant neoplasm of the cervix uteri. These rates,

plotted in figure 13, show increasing rates by age for

newly diagnosed cases found in the National Cancer

Institute’s SEER program. 1Z This study showed that

incidence rates were greatest where Pap smears were

30 ~

25-44 45-64 65-74 75 and

over

Age in years

Figure 12. Death rate for malignant neoplasm of carvix uteri, by age

of patient: United States, 1976 *
30

0

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-89 70-74 75-79 80-84 85 and

over

Age in years

SOURCE: Based on unpublished date from the National Cancer 1nstitute Surveillance, Epidemiology, and End Resul- (SEER) Program.

Figure 13. Incidence of malignant neoplasm of the cervix uteri among women in 10 regions, by age of patient: United States, 1973-77

performed more frequently. This finding supports the

need for testing regardless of age.

Outcome

Disposition. –Continuity of care of elderly

women by private physicians is reflected not only by

the high return visit rate discussed earlier, but also by

the physician’s disposition of the visit (table J). The

most common conclusion of the elderly woman’s visit

was the physician’s instruction to return at a specified

time (72 percent). In only about 5 percent of the

visits no followup was planned. About 2 percent of

these patients were referred to another physician and

about 3 percent, or 1.6 million, were admitted to a

hospital from a private physician’s office. The section

entitled “Hospital care” shows that about three times

that number were discharged from short-stay hospitals in 1978. However, note that patients may enter

hospitals from sites other than physicians’ offices and

may be admitted more than once.

Table J. Number and percent distribution of office visits made

by women 65 years of age and over, by disposition of visit:

United States, 1978

Number of

Percent visits in

thousands distribution’

All visits . . . . . . . . . . . . . . . . . . . . 68,230 100.0

No followup planned . . . . . . . . . . . .

Return at a specified time . . . . . . . . .

Return if needed . . . . . . . . . . . . . . .

Telephone followup . . . . . . . . . . . .

Referred to another physician or

agency . . . . . . . . . . . . . . . . . . . .

Returned to referring physician . ., . .

Admit to hospital . . . . . . . . . . . . . .

Other disposition . . . . . . . . . . . . . .

3,010

40,200

10,196

1,912

1,234

534

1,620

424

5.4

71.5

18.1

3.4

2.2

1.0

2.9

0.8

Ipercen= ~i[[ not add to ICJO.O because mora than 1 disposition ‘as

possible.

15
Hospital care

Patient characteristics

In 1978, an estimated 4.8 million women 65

years of age and over were discharged from nonFederal short-stay hospitals. Although the proportion

of women discharged exceeded that of men in the age

groups 64 years and over (65-74 years, 75-84 years,

and 84 years and over), the hospital utilization rate

(discharges per 1,000 population) for men exceeded

that for women in all of the same age categories

(figure 14). As previously mentioned, this finding

may be due to the greater incidence among men of

fatal diseases such as coronary heart disease, cancer,

and cerebrovascular disease for which the appropriate

locus of treatment is the acute care hospital. As a

result of these diseases, elderly men had more

all-listed surgical operations (197 per 1,000 population) than elderly women had (155 per 1,000

population) and required more days of care (4,330

days of care per 1,000 population) than elderly

women did (4,08 1 days of care per 1,000 population).1 T The greater use of these hospital resources

by elderly men suggests that they use a different and

more intensive mixture of hospital services than

elderly women do. Figure 14 also shows that the need

for hospitalization was higher for both sexes after 65

years of age.

Among women patients 65 years of age and over

discharged from hospitals, 3.9 million patients were

identified on the medical record as white and

328,000 patients were identified as members of black

or all other races. However, race was not reported for

an additional 622,000 elderly patients, a larger

number than in the black and all other racial group.

To compute utilization rates for elderly women by

race, race was imputed by distributing those for

whom race was not stated in the same proportions as

those for whom race was identified. (This computation was done because a comparison of utilization

measures for patients with race stated and not stated

suggested that patients with race not stated were

probably distributed by race in about the same

proportions as those for whom race was identified. 1T) This method showed that the rate of

hospital use was lower for elderly women c)f black

and all other races (29 1 per 1,000 populaticm) than

for their white counterparts (343 per 1,000 population) (figure 15). The reason for this lower mte may

be a greater tendency of black than of white women

to delay treatment until later stages of diseases.’2l

Perhaps, patient motivation combined with low socioeconomic status are major determinants in the use of

hospital resources for black and all other elderly

women. Medicare, a nationwide health insurance

program, provides hospital insurance to all persons

aged 65 years and over, but it does not cover all

charges. According to a study of the health status of

minorities and low-income groups, a larger proportion of physician visits by black and all others (38

percent) than by their white counterparts (31 percent) were for mandatory care. z2 Mandatory care in

that study is defined as that care for which a person

should or must see a physician, as compared with

elective care which is defined as preventive care, relief

of symptoms only, or that which would not be

affected by treatment. The same study found that

black and all other persons received fewer preventive

services, on the average, than white persons did. Thus

it is possible that this hesitation on the part clf black

and all other persons to seek comprehensive medical

care may also apply in the use of hospitals by elderly

black and all other women.

Proportions by marital status for elderly women

discharged from hospitals generally were similar to

those found among the civilian noninstitutionalized

population of elderly women with one exception. A

slightly higher proportion of widows was found

among elderly women discharged from hospitals (59

percent) than among civilian noninstitutionalized

elderly women (52 percent) (table K).

Patient condition

First-listed diagnosis: comparison with office

visits. –The first-listed diagnosis on the hospital

16
la Male

•1

Female

700

600

~ 500

.-

~

s

Q.

: 400

0

0

0.

&

Q’ 300

g

k

-c

: 200

100

189.4192

I

45-64

506.7

333.3

65-74 75-84

Age in years

c.-

5

4

3

2

1

0

573.6

85 and over

4.40

3.98r

70

60

50

c

.-o

= 40

a.-

.

.-%

-0

g 30

k

n.

20

10

0

45-64 65-74

53%

47% r

45-64

1.80

L

1.32

75-84

52%

Age in years

.72

52:

85 and over

m.39

85 and over

Age in years

lU s Bureau of the census: E~timate~ of tha population of tha United States, by age, sex, and race: 1976-t0 1978, current ‘OPulatlOn . .

Reports, Series P-25, No. 800. Washington. U.S. Government Printing Office, 1979.

NOTE: Dischargesfrom non-Federal short-stay hospitals, excluding newborn infants.

Figure 14. Number, percent distribution, and rate of patients discharged from short-stay hospitals, by sex and age of patient: United States, 1978

17
record is not necessarily the most important one at

that admission as it is for that visit on the Patient

Record form used in NAMCS. However, some comparison of utilization of physicians’ offices and

inpatient facilities based on diagnosis may be drawn.

The obvious differences in the care offered in

physicians’ offices and short-stay hospitals are reflected by the diagnoses recorded for elderly patients.

400 r

I 343.2

0

291.2

White Black and all other

Race

1 U.S. Bureau of the Census: Estimates of the population

of the United States, by age, sex, and race: 1976 to 1978,

Current Population Reports, Series P-25, No. 800. Wash.

ington, U.S. Government Printing Office, 1979.

2A 13.Percent nonresponse rate for race was found. Thaae

cases were distributed among white and black and all

others according to the distribution of respondents.

Figure 15. Number of women 65 years of age and over discharged

from short-stay hospitals, by race:z United States, 1978

Table K. Percent distribution of women 65 years of age and over

discharged from short-stay hospitals or noninstitutional ized, by

marital status: United States, 1978

Marital status

Hospital Noninstitutionalized

discharges’ population

Percent distribution

All marital statuses . . . . . . . 100.0 100.0

Married . . . . . . . . . . . . . . . 31.2 36.7

Widowed . . . . . . . . . . . . . . 59.0 52.0

Divorced . . . . . . . . . . . . . . 2.8 3.2

Separated . . . . . . . . . . . . . . 0.4 1.8

Never married . . . . . . . . . . . 6.6 6.2

1Excludes 4.3 percent of eldarly female patients discharged with

unknown marital status.

2Based on population data from the u.S. Bureau of the Census: Social

and economic characteristics of the older population: 1978. Current

Population Reports, Series P-23, No 85. Washington. U.S. Government

Printing Office, Aug. 1979.

Long-term chronic conditions such as diabetes melIitus, hypertensive disease, and osteoarthritis and

allied conditions constituted larger proportions of the

physician’s practice than of hospital discharges (table

L). On the other hand, elderly patients with lifethreatening diseases such as chronic ischemic heart

disease, congestive heart failure, cerebrovascular disease, and pneumonia use hospital care proportionately more often than they use office care. As

expected, patients with diagnoses requiring surgery

such as malignant neoplasms, cholelithiasis and other

gastrointestinal conditions, and fractures used hospital facilities to a greater degree than they used

physicians’ offices. Patients with diagnoses of neuroses, who constituted about 2 percent of private

medical practice (table 3) were not seen as often in

hospitals, and patients with diagnoses of psychoses,

who constituted about 1 percent of hospital discharges, were not seen as often in private medical

practice (0.6 percent).

First-listed diagnosis and patient age.–The most

frequent frost-listed diagnoses recorded on the hospital records for different age groups of women

are shown in table 5. This method of tabulation

highlights the pre-eminence of some diagnoses over

others depending on the age of the patient. Although

Table L. Number and percent of office visits made by women 65 years

of age and over and number and percent discharged from

short-stay hospitals, by selected first-listed diagnoses: United

States, 1978

First-listed diagnosis and ICDA code 1

Office Hospital

visits discharges

Total . . . . . . . . . . . . . . . . . . . . . . . . . . .

Malignant neoplasms of breast,

uterus, and other female genital

organs. . .174, 180-184, 199,2, 199.3, 199,4

Diabetes mellitus ., ...,..,...,...250

Anemias, . . . . . . . . . . . . . . . . .. 280-285

Psychoses . . . . . . . . . . . . . . . . . .290-299

Cataract . . . . . . . . . . . . . . . . . . . ...374

Hypertensive disease . . . . . . . . .. 400404

Chronic ischemic heart disease . . . . . . .412

Congestive heart failure . . . , . . . . . .427.0

Cerebrovascular disease . . . . . . . . .430-438

Arteriosclerosis . . . . . . . . . . . . . . ...440

Acute bronchitis and bronchiolitis . . . . .466

Pneumonia . . . . . . . . . . . . . . . ..480-486

Bronchitis, chronic and unqualified .490491

Ulcer of stomach; ulcer of duodenum; peptic

ulcer, site unspecified; and gastrojejunal ulcer . . . . . . . . . . . . . . .531-534

Gastritis and duodenitis . . . . . . . . . . .535

Diverticula of intestine . . . . . . . . . .562

Cholelithiasis . . . . . . . . . . . . . . . . ...574

Uterovaginal prolapse . . . . . . . . . . . . .623

Osteoarthritis and allied conditions . . . .713

Fracture of neck of femur, upper limb, and

other and multiple sites . . . . . . .805-820

Number in thousands

56,230 4,833

Percent

1.2 2.8

4.0 2,8

1.9 1.2

0.6 1.1

3.0 3.5

11.6 1.6

6.1 8.3

1.8 2.9

1,8 5.6

0.7 0.7

0.4 0.8

‘0.4 3.2

1.1 0.8

++0.4 1.1

‘0.4 0.7

++0.4 1.2

*0.4 1.7

‘0.5 0.9

3.3 1.9

1.0 5.3

‘See reference 15.

18
chronic ischemic heart disease was the foremost

diagnosis for all hospitalized women 45 years of age

and over, it constituted an increasingly higher proportion of all discharges with increasing age of the

patient, ranging from about 3 percent for those 45-64

years of age to about 11 percent for those 85 years

and over.

The spectrum of conditions diagnosed in hospitals

becomes narrower as women age. The prominence of

uniquely female problems such as malignant neoplasms of the breast and female genital organs,

uterovaginal prolapse, uterine fibromyoma, and intermenstrual bleeding diminished after 64 years of age.

Similarly, psychoses, alcoholism, ulcers, and disc and

back problems declined in ranks after 64 years of age.

For women 65 years of age and over, diagnoses of

cataract, cerebrovascular disease, and fractures were

more prominent than they were for younger women.

Table 6 shows the most frequent first-listed

diagnoses for elderly women by racial groups. Race

was not stated for about 13 percent of elderly women

discharged, therefore, caution must be used in interpreting differences in diagnoses between the two

racial groups white and black and all other, because

these differences may be influenced by the distribution of those for whom race was not stated. Nevertheless, the data show that among elderly women for

whom race was stated, chronic ischemic heart disease,

cerebrovascular disease, cataract, pneumonia, congestive heart failure, and diabetes mellitus were among

the 10 most frequent first-listed diagnoses for all

racial groups. These 6 diagnoses, however, accounted

for a greater proportion of discharges by black and all

other women (32 percent) than they did for white

women (26 percent). Other differences by race

among elderly female discharges included the higher

ranking of fractures for white women than for black

and all other women. Fracture of neck of femur, for

example, was ranked 5th among elderly white women

and 18th among elderly black and all other women.

As previously mentioned, the incidence of fatal

diseases is more common among elderly men than

among elderly women. As table 7 shows, the discharge rates for elderly men exceeded those for

elderly women for pneumonia, congestive heart failure, and acute myocardial infarction.

All-listed diagnoses. –Up to five diagnoses were

coded from discharge records in 1978. In that year,

an estimated 12.8 million diagnoses were recorded for

the 4.8 million elderly women discharged from

non-Federal short-stay hospitals. Older patients

tended to have increasingly higher numbers of diagnoses. Table M shows that although 60 percent of

middle-aged women had more than one diagnosis, the

comparable proportions were 69 percent for those

aged 65-74 years, 75 percent for those aged 75-84

years, and 78 percent for those aged 85 years and

over.

Patient management

In hospitals, patient management includes diagnostic, therapeutic, nursing, and surgical procedures.

In this section, patient management will be examined

only for surgical procedures because of the limitations of the data collected in the NHDS.

In 1978, one or more surgical operations were

performed for an estimated 1.5 million (30 percent)

of the 4.8 million older women discharged from

hospitals. In that year, a total of 2.1 million surgical

operations, or an average of 1.4 surgical procedures

per elderly women were recorded. Elderly women

were more likely to have surgery than younger

women were; the rate per 1,000 discharges with

surgery for women aged 45-64 years was 86 compared with 104 for women aged 85 years and over

(table N).

It is interesting to compare the percent of

increase in rates for elderly women both with and

without surgery. The rate of discharges for women

Table M. Number and percent distribution of women discharged from short-stay hospitals by number of diagnoses for each patient, according to age

of patient: United States, 1978

Number of diagnoses

Age Totel

1 2 3 4 5

Number of discharges in thousands

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 4,403 1,774 1,174 713 388 354

65years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,832 1,317 1,176 942 651 747

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,305 715 576 427 276 311

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,804 445 425 371 263 300

85years andover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 723 157 175 144 112 136

Percent distribution

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 40.3 26.7 16.2 8.8 b.o

65years And over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 27.3 24,3 19.5 13.5 15,5

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 31.0 25.0 18.5 12.0 13.5

76-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 24.7 23.6 20.6 14.6 16.6

85years andover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 21.7 24,2 20.0 15.4 18.8

19
Table N. Number and rate of women discharged from short-stay hospitals, by surgery status and age of patient: United States, 1978

Number of Number of

Age

Rate of

Total discharges

Hate of

discharges discharges discharges

without surgery with surgery without surgery with, surgery

Number of discharges in thousands Rate per 1,000 population

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,403 2,443 1,959 107.0 85.8

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,305 1,499 807 177.5 95.5

75-84years . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,804 1,313 491 304.5 ‘113.9

85yearsandover . . . . . . . . . . . . . . . . . . . . . . . 723 565 158 372.4 ‘104.1

aged 85 years and over with surgery was 21 percent

higher than that for women 45-64 years, but the

comparable rates for women without surgery was

almost 2?4 times higher (table N). Thus as age

increases hospitalization not involving surgery increases at a faster rate than hospitalization involving

surgery does. This increase is probably due to several

factors. As women get older, they are less able to

undergo the rigors of surgery, they are more prone to

diseases that are not amenable to surgery (e.g.,

cerebrovascular disease), and they are more likely to

have return visits to a hospital for chronic conditions

that do not involve surgery (e.g., chronic ischemic

heart disease, congestive heart failure, and pneumonia).

When elderly women have operations, the procedures performed are different from those of middleaged women. Table O shows that the rates per 10,000

women were higher for women aged 65 years and

over than they were for those aged 45-64 years for

ophthalmological survey (about 60 percent were extraction of lens), vascular and cardiac surgery, abdominal surgery, urological surgery, and orthopedic surgery. The greatest increase was in ophthalmological

surgery, with a 200-percent increase from the age group

45-64 years and a 74-percent increase from the age

group 65-74 years to those aged 75 years and over.

Orthopedic surgery increased 70 percent from those

65-74 years of age to those 85 years of age and over.

Except for neurosurgery, breast, and gynecological

surgery, rates for the procedures listed in table O

were higher for women aged 75 years and over than

they were for those aged 65-74 years. Rates for

gynecological surgery ~lso dropped considerably after

64 years of age (from 366 to 166 to 102 per 10,000

women aged 45-64 years, 65-74 years, and 75 years

and over, respectively). The less variable rate of breast

surgery with increasing age is illustrated in figure 9 in

the ambulatory care section.

The changing health problems of the elderly

emerge from an examination of the operations

performed proportionately most frequently. Specific

surgical procedures are ranked by number and percent of all-listed operations for the four age groups in

table 8. Biopsy accounted for a relatively large

proportion of surgery for all age groups. For patients

65 years of age and over, certain procedures were

Table O. Rate of all-1 isted operations for women dischwred from

short-stay hospitals, by age of patient and selected surgical

categories: United States, 1978

Age

Surgical category and ICDA code’ 45.64 65-74 75 years

years Vears and over

Rate per 10,000 population

Neurosurgery . . . . . . . . . . . ..01-05 34 33 23

Ophthalmology . . . . . . . . . .. ,06-14 54 169 294

Vascular and cardiac surgery . ..24-30 71 116 138

Abdominal surgery . . . . . , . . ,38-48 185 263 312

Urological surgery . . . . . . . . ..54-61 55 68 85

Breast surgery . . . . . . . . . . . . . ..65 54 47 46

Gynecological surgery . . . . ...67-72 366 166 102

Orthopedic surgery . . . . . . ...80-90 176 228 387

‘See reference 15.

pre-eminent regardless of the age group–amcmg these

were reduction of fracture, extraction of lens, and

cholecystectomy. Gynecological procedures, such as

dilation and curettage of the uterus, hysterectomy,

and oophorectomy, which together accounted for 20

percent of the operations performed on women 45-64

years of age, were less prominent for those aged 65-84

years and were no longer among the top 62 percent

of the procedures for wo’men over age 84 years. Patients undergoing plastic repair of cystocele and rectocele or both were also likely to be under 75 years of age.

Among elderly female discharges, black and all

other women (26 percent) were less likely than white

women (30 percent) were to have surgery. Among

operations most frequently performed on elderly

women, biopsy and extraction of lens were the two

most common procedures for both racial groups.

Reduction of fracture with fixation, which was

performed proportionally more often on elderly

white females (7 percent) than on elderly black and

‘all other females (3 percent), may account for this

difference in surgery between racial groups (table 9).

Outcome

The outcome of care in hospitals is reflected in

both the average length of stay and the discharge

status.

Length of stay. –The average length of stay in the

hospital for elderly women reflects both the severity

20
of the illness and the length of time needed by the

elderly to recover from illness. In 1978, the average

hospital stay for elderly women 75-84 years of

age (11.3 days) was considerably longer than that for

middle-aged women 45-64 years of age (8.5 days).

Among women in the age groups 65 years and over

(65-74 years, 75-84 years, and 85 years and over), the

average length of stay continued to increase but not

as dramatically, differing only by a day or less than a

day in each successive age group (figure 16). Examination of the length of stay by first-listed diagnosis shows a similar pattern of increasing length of

stay with increasing age for women with first-listed

c.-

13

/

12.1

12 11.8

11 10.7

10

9

8.5

8

0

45-64 65-74 75-84 85 and

over

Age in years

Figure 16. Average length of stay of women 65 years of age and over

‘discharged from short-stay hospitals, by age: United States, 1978

diagnoses such as malignant neoplasms of the uterus

and female genital organs, diabetes mellitus, chronic

ischemic heart disease, congestive heart failure, and

fractures (table P).

Whether or not the elderly woman had an

operation also affected the length of stay in the

hospital because surgery, compounded by the

patient’s age, lengthened the amount of time needed

to recover. Table Q shows that the average length of

stay for women with surgery increased from 12.2

days for those aged 65-74 years to 16.1 days for

those aged 85 years and over. In contrast, the average

length of stay for elderly women without surgery was

similar for the three age groups 65 years and over

(table Q).

The average length of stay for the 20 most

frequent surgical. procedures performed on elderly

women discharged is presented in table 10.

Living arrangements also affect the length of stay

in hospitals for elderly women. Because older women

are more likely than older men are to live alone, they

may depend on the hospital to provide care for a

longer period following an illness. The average length

of stay for single elderly women was 13.2 days

compared with 10.4 days for elderly married women

(table R). Among elderly women, the average length

of stay was longer for elderly black and all other

women ( 13.3 days) than for elderly white women

(1 1.2 days) (figure 17).

Discharge status and mortality. –During 1978,

patients 65 years of age and over accounted for 70

percent of the 868,700 deaths in hospitals, and

women accounted for 49 percent of the deaths of

elderly patients in hospitals. Although deaths occurring in hospitals were largely among the elderly, the

majority of elderly women (and men) discharged

from the hospitals were alive. In 1978, 88 percent of

elderly women discharged were alive at the time of

Table P. Average length of stay of women discharged from short-stay hospitals, by age of patient and selected first-1 isted diagnoses:

United States, 1978

Age

First-listed diagnosis and ICDA codel 15-44 45-64 65-74 75-84 85 yaars

years years years years and over

Avarage length of stay in days

Malignant neoplasms:

All forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-208 9.2 12.3 13.7 15.0 12.9

Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...174. 199.2 9.2 10.5 11.6 13.5 11.3

Uterus and female ganital organs . . . . . . . . . . . . ...180-184. 199.3, 199.4 6.1 9.6 11.5 12,5 12.7

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250 6.4 10.4 11.3 13,3 14.0

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...374 3.2 4.5 4.4 4,3 4.5

Chronic ischemic heart disease.. . . . . . . . . . . . . . . . . . . . . . . . . . . ...412 6.5 8.9 9.8 11.2 12.2

Congestive heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..427.0 *

9.6 10.5 11.3 11.8

Cerebrovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430438 10.9 14.6 15.0 14.3 12.8

Pneumonia, all forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .480-486 7.2 9.0 10.0 12.6 12.5

Osteoarthritis, other arthritis, rheumatism, and allied

conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ’....710-718 7.0 9.4 13.8 13.3 11.6

Fractures, all sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-829 7.4 10.7 13.9 17.6 18.7

lSee reference 15.

21
discharge; only 6 percent were discharged dead. For 6

percent of elderly female discharges, however, the

discharge status was not stated on the face sheet of

the medical record. Thus the percent of elderly

women discharged dead is only a conservative estimate of the mortality in hospitals. In addition, the

percent of deaths occurring in hospitals relative to the

Table Q. Average length of stay of women 65 years of age and over

discharged from short-stay hospitals, by surgery status and aga of

patient: United States, 1978

Hospital Hospital

Aga discharges discharges

wr”thsurgery without surgery

Average length of stay in days

65years And over . . . . . . . . . . . 13.3 10.5

65-74 years . . . . . . . . . . . . . 12.2 9.8

75-84 years . . . . . . . . . . . . . 14.2 10.9

85years And over . . . . . . . . . 16.1 11.0

Table R. Average length of stay of women 65 years of age and over

discharged from short-stay hospitals, by marital status: United 8tates, 1978

Marital sia tus

Average length of

stay in days

number of persons hospitalized is understated because multiple live discharges due to readmission can

occur, but deaths in hospitals occur only once.

Nevertheless, the proportion of discharges who died

(or hospital fatality rate (HFR)) does suggest different mortality patterns in hospitals for the elderly.

As expected, the HFR for women increased with

age. The HFR rose from 2 percent for women aged

45-64 years to 11 percent for women aged 85 years

and over. The HFR for men exceeded that for women

in all of the age categories over 45 years (table S).

Figure 18 indicates that among elderly women

discharged, the HFR was greater for black and all

other women (8 percent) than for white women (6

Table S. Hospital fatality rates of patients discharged from short-stay

hospitals by sex and age of patient: United States, 1978

Sex

Age

Female Male

Hospital fatality

rate’

45-64 years . . . . . . . . . . . . . . . . . . . . 2.1 2.7

65-74 years . . . . . . . . . . . . . . . . . . . . 4.3 6.4

75-84 years . . . . . . . . . . . . . . . . . . . . 6.9 9.2

85years and over . . . . . . . . . . . . . . . . 10.7 12.8

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.4

Single

wdowed’::ll:::::l::nj::l:; :::;:::

13.2

11.7

Divorced orseparated . . . . . . . . . . . . . . . . . . 10.5

Not stated . . . . . . . . . . . . . . . . . . . . . . . . . 10.3

1

(

Number of deaths

)

Total number of patients discharged

x 100.

14 fWhite 81ack and Race not

all other stated

Race “

Figure 17. Average length of stay of women 65 years of age and over

discharged from short-stay hospitals, by race: United States, 1978

‘r

8

7

6

5

4

3

2

1

n

White Black and Race not

all other stated

Race

Figure 18, Hospital fatality rate for women 65 years of age and over

discharged from short-stay hospitals, by race: United States, 1978

22
percent). This difference may indicate that the

conditions for which elderly black and all other

women enter hospitals are more serious and are

perhaps at later stages of illness than they are for

white women. Deaths in hospitals were more likely

for elderly women with diagnoses in the ICDA

diagnostic categories of neoplasms (12 percent),

infective and parasitic diseases (11 percent), diseases

of the circulatory system (11 percent), and diseases

of the respiratory system (7 percent). In contrast, the

HFR was much lower for elderly women with mental

disorders (2 percent), symptoms and ill-defined conTable T. Number and percent distribution of patients 65 years of age

and over discharged from short-stay hospitals, by sex of patient

and discharge status: United States, 1978

Number of Percent

Sex and discharge status discharges distriin thousands bution

Female

All discharge statuses . . . . . . . . . . . . . . 4,833 100.0

Routine discharge to home . . . . . . . . . . 3,662 75.8

Left against medical advice . . . . . . . . . . 12 0.2

Transferred to another facility or

organ ization . . . . . . . . . . . . . . . . . . . 507 10.5

Referred to organized homecare service . . 76 1.6

Died . . . . . . . . . . . . . . . . . . . . . . . . . 301 6.2

Not stated . . . . . . . . . . . . . . . . . . . . . 275 5.7

Male

All discharge statuses . . . . . . . . . . . . . 3,875 100.0

Routine discharge to home . . . . . . . . . . 3,009 77.6

Left against medical advice . . . . . . . . . . 19 0.5

Transferred to another facility or

organ ization . . . . . . . . . . . . . . . . . . . 288 7.4

Referred to organized homecare service . . 37 1.0

Died . . . . . . . . . . . . . . . . . . . . . . . . . 310 8.0

Notstated . . . . . . . . . . . . . . . . . . . . . 212 5.5

ditions (4 percent); and accidents, poisonings, and

violence (2 percent) (table 11).

Surgery was performed on 30 percent of the

elderly women and only 4 percent died among them.

For elderly women with surgery, the HFR was

greatest for those who had vascular and cardiac

surgery (13 percent), thoracic surgery (9 percent),

neurosurgery (7 percent), abdominal surgery (6 percent), and otorhinolaryngology (6 percent) (table 12).

Discharge status and location. –In 1978, 4.2

million (or 88 percent) elderly women were known to

have been discharged alive. Table T shows that the

majority (76 percent) were routinely discharged to

their homes. The next most likely location of

discharge was to another facility or organization (11

percent). Because of the age range of these women it

may be assumed that this other facility was a nursing

home or similar institution. Although the estimate of

507,000 elderly women placed in nursing homes from

short-stay hospitals was likely to be an overestimation

(because the exact type of facility was unknown), it

indicates the hospitals’ role in the placement of

elderly women in nursing homes. Data from the

resident sample of the 1977 NNHS show that

832,000 elderly female residents were in nursing

homes during the survey and that hospitals were the

second most likely location from which nursing home

residents were placed.zs (A private residence was the

most likely location from which residents entered

nursing homes.)

Table T also shows that a larger proportion of

elderly women (11 percent) than elderly men (7

percent) were transferred to another facility for

continued care. The greater use of nursing homes by

elderly women is discussed in the section entitled

“Nursing home care.”

23
Nursing home care

Patient characteristics

In 1977, elderly women were twice as likely as

elderly men to reside in nursing homes (figure 19).

Although use of nursing homes increased with advancing age for both sexes, women used nursing

homes at significantly higher rates than men did

regardless of the age group. This pattern of use was

especially true in the oldest age group where 1 in 4

women 85 years of age and over resided in nursing

homes compared with 1 in 7 men of the same age. A

longer life expectancy and a greater tendency among

persons without spouses to enter nursing homes

reflect this greater utilization by elderly women.zs,2 Q Because abcut half (52 percent) of civilian

noninstitutionalized women 65 years of age and over

were widowed (compared with 14 percent of men of

the same age), they faced this problem to a greater

extent than men did.

The marital status distribution of nursing home

residents also reflects this pattern of use. In 1977, 78

percent of elderly female nursing home residents were

widowed compared with only 46 percent of elderlyzs

male residents.

In 1977, white women were more likely to reside

in nursing homes than black and all other women

were, The rate of nursing home use by elderly white

women (62 per 1,000 population) was about 72

percent greater than that for elderly women of black

and all other races (36 per 1,000 population) (figure

20). This lower use is not only due to the shorter life

span of black and all other women (71 years

compared with 77 years for white women),z Q but

also may be due to the greater substitution of

informal home care for formal nursing home care.

Because elderly black women are more likely to

maintain an extended family household, informal

home care is also more likely to be available to them.

Moreover, elderly persons of Asian and Pacific Islands

ethnicity have traditionally been cared for in the

home.zs In addition, the shortage of beds funded by

Medicaid may result in the lower use of nursing

homes by black and all other elderly women.z G

Medicaid is a joint Federal-State program providing

medical benefits to low income groups. Because

elderly black women are more likely to have low

incomes, their use of Medicaid as a source of payment

for nursing home care is greater than that of elderly

white women. In 1977, a greater proportion c)fblack

than white residents relied on Medicaid as their

primary source of payment forcare.23

Nursing home utilization was examined in the

preceding discussion by using cross-sectional data on

nursing home residents collected from the 1977

NNHS. In addition to the resident sample, th~e1977

NNHS also included a sample of all discharges (alive

and dead) from nursing homes during the 1976

calendar year. Data on discharges were collected by

interviewing the nume most familiar with the relevant

medical records. In the remainder of this section,

only data from the discharge sample will be examined

because it allows examination of completed length of

stay and outcome of care for persons discharged from

nursing homes. Demographically, the characteristics

of persons discharged from nursing homes are similar

to those of residents currently residing in the nursing

home. The average age of all elderly women discharged from nursing homes in 1976 was 8:2 years

and about 78 percent of all elderly discharged women

were widowed (table U). Data on race or ethnicity,

however, were not collected in the discharge survey

and thus will not be included in further discussions.

In 1976, 640,900 elderly women were discharged

(both alive and dead) from nursing homes. As in the

resident sample, the use of nursing homes by elderly

women in 1976 (47 discharges per 1,000 population)

was greater than that by elderly men (36 discharges

per 1,000 population). However, the nursing home

utilization rate for elderly women as measured by the

discharge survey (47 discharges per 1,000 population)

was not as high as that measured by the resident

survey (60 residents per 1,000 population); the

24
H Male

❑ Female

300 r

250

200

150

100

50

0

251.5

140.0

. 60.6

59.7

47.4

30.7

12.7

15.9

I I I

65 and over 65-74 75-64 85 and over

Age in years

Figure 19. Number of nursing home residents per 1,000 population 65 years of age and over, by sex and age: United States, 1977

reverse was true for the utilization rate for elderly

men (36 discharges per 1,000 population compared

with 31 residents per 1,000 population). These

differences in utilization rates illustrate the differences in the populations measured by the two

surveys. The resident survey was more heavily

weighted with long-term residents in nursing homes

because of the methodology with which all persons

on the facility roster were sampled on the night

before the survey. In contrast, the discharge sample

was more likely to include short-term residents of

nursing homes than the resident sample because all

discharges from the nursing home during a calendar

year were sampled.z 7 Thus the previously discussed

differences in utilization rates by sex seem to imply

that elderly women were more likely to use nursing

homes on a long-term basis than elderly men who

were more likely to use nursing homes for relatively

shorter stays.

Patient condition

Primary diagnosis at admission. –Diagnosis is commonly used by physicians as a basis for defining and

organizing patient care services. As collected in the

discharge survey, diagnosis was the one condition

among those listed on the medical record that

appeared to cause the patients to need nursing home

care at the time of admission. In cases where the

primary condition was unknown, the first-listed

diagnosis was considered primary. In 1976, about 48

percent of discharged women were admitted to

nursing homes with a diagnosis related to diseases of

the circulatory system; frequently, *hese diseases

were arteriosclerosis (21 percent) or stroke (12

percent). Another 9 percent were admitted with

mental disorders or senility without psychosis, while

42 percent were admitted because of other diagnoses

(table 13).

25
El Black and all other

•1 Whitel

70 r 62.1

.=~ 60

Jg

a

o. 0

CL 50

0

0

0.

40 .[1- 36.0 I

w

0.

!5

Male Female “

Sex

llnclude~ Persons Of Hispanic origin.

Figure 20. Number of nursing home residents per 1,000 population 65

years of age and over, by race and sex: United States, 1977

Table U, Percent distribution of women 65 years of age and over

discharged from nursing homes, by age and marital

status: United States, 1976

Age and marital status

Percent

distribution

Age

Allages, 65years and over . . . . . . . . . . . . . . . . . 100.0

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.4

75-84 years . . . . . . . . . . . . . . . . . . . . . . . . . . . 46.4

85yearsand over . . . . . . . . . . . . . . . . . . . . . . . 37.2

Marital status

All marital statuses . . . . . . . . . . . . . . . . . . . . . . 100.0

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.4

Widowed. . . . . . . . . . . . . . . . . . . . . . . . . . . . 77.8

Divorced orseparated . . . . . . . . . . . . . . . . . . . . 2.7

Nevermarried . . . . . . . . . . . . . . . . . . . . . . . . . 8.1

‘Includes a small number with unknown marital status.

Among women 65-74 years of age, the most

frequent category of primary diagnosis at admission

was stroke, followed by arteriosclerosis, fractures,

neoplasms, diabetes, and chronic brain syndrome. For

women 75-84 years of age, arteriosclerosis was the

most frequent category and stroke wasnext, followed

by fractures, neoplasms, heart attack and ischemic

heart disease, and congestive heart failure. The

leading diagnosis for women 85 years of age and over

was arteriosclerosis, followed by fractures, stroke,

congestive heart failure, arthritis and rheumatism, and

chronic brain syndrome.

Primary diagnosis: comparison with hospitals. –

Certain conditions among the elderly may precipitate

hospitalization that ultimately leads to a nursing

home stay for either recuperative or other lomg-term

care. The diagnoses for elderly women discharged

from hospitals and nursing homes suggests such a

link. Of the 10 leading diagnoses for elderly women

discharged from short-stay hospitals and from nursing

homes, five were common both in hospitals and

nursing homes. These diagnoses were malignant neoplasms, fractures, cerebrovascular disease, congestive

heart failure, and diabetes (table W). These diagnoses

except for congestive heart failure, were also found in

a study of Medicare episodes of illnesses to be

associated with relatively high utilization of posthospital care (in skilled nursing homes and home

health agencies).zs This study also found that persons

who used post-hospital care were more likely to be

female and older than persons who used hospital care

only. Table W also shows that, as expected, heart

attack and ischemic heart disease were diagnoses that

were more likely to be treated in hospitals than in

nursing homes. Arteriosclerosis, however, was much

more likely to be a diagnosis in a nursing home than

in a hospital.

Chronic conditions or impairments. –Data on the

chronic conditions or impairments of discharged

women reflect both the primary diagnosis al admission and other coexisting diagnoses listed on tlhe medical record. In 1976, most discharged wom[en had

multiple chronic conditions. About 73 percent had a

chronic condition involving diseases of the circulatory

system, 39 percent had a chronic mental disc)rder or

senility without psychosis, and 73 percent had other

chronic conditions (data not shown).

Table W. Percent of women 65 years of age and over clischarged

from short-stay hospitals and from nursing homes, by salected

diagnoses: United States, 1978 and 1976

Hospital

Nursing

Diagnosis and ICDA code’

discharges

home

discharges

Percent

Malignant neoplasms . . . . . . , 140-209 8.3 6.2

Diabetes mellitus . . . . . . . . . . . .250 2.B 4.1

Psychoses . . . . . . . . . . . ...290-299 1.1 2.2

Hypertensive disease . . . . . . .400404 1.6 2.2

Heart attack, chronic ischemic

heart disease . . . . . . . . . . .410, 412 10.4 4.1

Congestive heart failure . . . . . 427.0 2.9 6.1

Cerebrovascular disease . . . . .430-438 5.6 11.6

Arteriosclerosis . . , . . . . . . . . .440 0.7 2!1.0

Fractures, all sites . . . . . . . . .800-829 6.3 12.4

Fracture of neck of femur . , . .820 2.8 9<7

All other sites . . <800-819,821-829 3.5 2.7

lSee reference 15.

2Data from the Ig78 National Hospital Discharge Survw.

3Data are for 1976.

26
Because of the greater age of women discharged

from nursing homes as compared with their noninstitutionalized counterparts and perhaps of the selection

factors at the time of admission to nursing homes,

elderly women discharged from nursing homes had a

greater prevalence of chronic conditions than elderly

noninstitutionalized women had. Chronic conditions

most prevalent among discharged elderly women were

arteriosclerosis (47 percent), heart trouble (38 percent), senility (24 percent), chronic brain syndrome

(20 percent), stroke (20 percent), arthritis and

rheumatism (18 percent), and hypertension (17 percent). Only 3 percent of discharged elderly women

reported no chronic conditions or impairments. In

contrast, the conditions most common among noninstitutionalized elderly women were arthritis (52 percent), hypertension (30 percent), visual impairments

(23 percent), hearing impairments (26 percent) and

diabetes (9 percent) (tables 14 and 1).

The prevalence of chronic conditions among

elderly discharges showed patterns by sex similar to

those found in the civilian noninstitutionalized population. Discharged elderly women had higher rates of

arteriosclerosis, hypertension, senility, arthritis and

rheumatism, cataracts, hip fractures and other bone

fractures than their male counterparts had. Discharged

elderly men had higher rates of stroke, missing arms,

legs, or extremities, cancer, chronic respiratory disease, and kidney trouble than women had (table 14).

Differences were found in diagnoses commonly

present (chronic conditions or impairments) among

discharged elderly women versus their admitting

diagnosis. In general, at admission a high correlation

exists between extant diagnoses (chronic conditions)

and the admitting diagnosis when diseases of the

circulatory system, hip fractures, and cancer are

involved. About two-thirds of those with these

conditions were admitted to the nursing home with

the same primary diagnosis (table 15). Other chronic

conditions such as senility, chronic brain syndrome,

arthritis and rheumatism, and diabetes tended to be a

coexisting condition rather than a primary reason for

admission to a nursing home. For example, only 28

percent of discharged women with ckonic diabetes

were admitted with that condition as a primary

diagnosis. Similarly, only 27 percent and 18 percent

of discharged women with chronic brain syndrome

and senility, respectively, had an admitting diagnosis

involving mental disorders and senility without

psychosis.

Functional limitations. –Discharged women suffered from functional limitation as a result of these

many conditions. About half of the discharged

elderly women were incontinent (48 percent) or were

either chairfast or bedfast (49 percent). Although

about half (47 percent) of the discharged women

could walk (with or without assistance), mechanical

aids commonly were used to perform this activity; 25

percent used a wheelchair, 15 percent used a cane, 30

percent used a walker, and 3 percent used crutches or

braces for assistance in walking (table Y). About 59

percent of the discharged women used eyeglasses,

which was another indication of the visual impairments prevalent among elderly women. The actual

level of impairment (with or without glasses) was not

available in the medical records of discharges.

In general, the prevalence of chronic conditions

and functional impairments previously mentioned

increased with age (table 16). The proportion of

discharged elderly women with arteriosclerosis, heart

disease, chronic brain syndrome, and hip fractures increased with age (figure 21), as did the proportions

of those who were incontinent or chairfast or bedfast

(figure 22), and of those who used eyeglasses, a

wheelchair, or a walker (figure 23). The prevalence of

cancer among elderly women in long-term care

facilities, however, decreased with age probably because patients with cancer were likely to be terminal

in nursing homes.

Patient management

As in hospitals, patient management in nursing

homes is multidisciplinary, involving nursing care

services, physician services, therapy services, and

dietary services. Because of the older population in

nursing homes and the greater rates of chronic illness,

the care received in nursing homes is largely continuing or maintenance. Nursing homes also provided a

substantial volume of restorative care to convalescing

patients.

Table Y. Percent distribution of women 65 years of age and over .--’

discharged from nursing homes, by selected functional statuses:

United States, 1976 ?

Functional status

Percent

distribution

Mobility

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

Walks, with or without assistance. . . . . . . . . . . . . . . 46.6

Mechanical assistance:l

Wheelchair . . . . . . . . . . . . . . . . . . . . . . . . . 25.0

Cane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.1

Walker . . . . . . . . . . . . . . . . . . . . . . . . . . . 30.4

Crutches or braces . . . . . . . . . . . . . . . . . . . . 2.7

Chairfast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27.0

Bedfast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.8

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.5

Continence

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0

No difficulty controlling bowels and bladder . . . . . . . 48.6

Difficulty controlling bowels . . . . . . . . . . . . . . . . . 2.6

Difficulty controlling bladder . . . . . . . . . . . . . . . . . 6.4

Difficulty controlling both bowels and bladder . . . . . 28.6

Ostomy in either bowels or bladder . . . . . . . . . . . . . 10.1

Unknown as to both bowels and bladder . . . . . . . . . 3.8

‘ Patient may have used more than 1 special aid or device.

27
60 —

50 —

40 –

30 –

20 –

10 –

— Arteriosclerosis

---- Heart trouble

—— Chronic brain syndrome

..-— Hip fractures

-—-— Cancer

------ --

-—-—-—- ___

---+-

0

I I I 1

Under 65 65-74 75-84 85 and

over

Age in years

60 r[

(-J~J

Under 65 65-74 75-84 85 and

cwer

Age in years

Figure 21. Percent of women discharged from nursing homes, by

Fiaure 22. Parcent of women 65 vears of age and over discharged

selacted chronic conditions and impairments, by age: United

Statas, 1976

Level of nursing cure. –Data collected on the level

of nursing care services received by discharged elderly

women within the 7 days prior to discharge revealed

that about 3 out of 5 discharges (58 percent) had

received intensive nursing care services, defined as one

or more of the following: bowel or bladder retraining,

catheterization, full bed bath, intravenous injections,

or oxygen therapy. About a third (33 percent) received other nursing care such as application of sterile

dressing or bandages; blood pressure reading; enema;

hypodermic injections; irrigation; and checking temperature, pulse, and respiration. Only about 9 percent

received personal care services (i.e., the administration of medications prescribed by a physician, a rub

or massage, or a special diet) or more of the services

previously listed (table 17).

Intensive nursing care services were received more

often by persons severely limited in mobility and

continence. A greater proportion of women who were

chairfast or bedfast received intensive nursing care

(73 and 87 percent, respectively) than those who

walked (40 percent) (figure 24). Similarly, a greater

proportion of women who had difficulty controlling

bladder only (63 percent), controlling both bowels

and bladder (82 percent) or who had an ostomy in

either bowels or bladder (88 percent) received intensive nursing care compared with 41 percent of women

28

- from nursing homes who were chairfast-or bedfast, or incontinent, by age: United States, 1976

who had no difficulty controlling both bowels and

bladder.

Physician services. –The receipt of nursing care

services was also accompanied by more frequent

physician visits and increased services received at the

most recent visit. Fifty-two percent of women who

received nursing care in the last week also saw a

physician at that time compared with 25 percent

who did not receive nursing care services. The location of the physician visit is not known fc)r the

discharge sample. However, for the resident sample,

83 percent were seen by a physician inside the

facility.z A Eighty-two percent of women who received nursing care services also received an examination at the last physician visit compared with 51

percent of women not receiving nursing care services.

The proportion of discharged women who received

treatment or had lab tests arranged increased with the

level of nursing care received. Women who received

intensive nursing care services were twice as likely as

others were to receive a prescription or refill at the

last physician visit (table 17).

Special diet. –Nursing care services were also

coordinated with the receipt of a special diet. The

proportion of discharged women who received a

special diet was greater for those receiving nursing

care services. Forty-eight percent of women who
— Eyeglasses

---- Wheelchair

70 r

-—-—Walker

20

1

----

----

----- ---

/

.0-

-0

10 -’

Under 65 65-74 75-84 85 and

over

Age in years

Figure 23. Percent of women 65 years of age and over discharged

from nursing homas who used eyeglasses, wheelchair, or walker,

by age: United States, 1976

received intensive nursing care and 41 percent of

those who received other nursing care were given a

special diet compared with 20 percent of women who

did not receive nursing care.

Outcome

As in hospitals, outcome is discussed by length of

stay and discharge status.

Length of stay.–The length of stay in nursing

homes reflects the long-term nature of the care

received in the institution as well as the age and

severity of the illness presented by the patient. In

1976, the average length of stay for discharged

elderly women was 401 days (or 1.1 years). As in

hospitals, the age of the discharged women was

associated with longer stays—a reflection of the increasingly serious problems associated with aging.

Elderly women, on the average, had longer stays (401

days) than their male counterparts had (293 days)

(table Z).

Examination of the length of stay by primary

diagnosis at admission also showed a shorter stay for

women with diagnoses of cancer (185 days) and

certain bone fractures (126 days) (table 18). Diagnoses for which the average length of stay figure was

unreliable and for other diseases of the circulatory

system, hip fractures, diseases of the respiratory

system, and other or unknown diagnoses were exceptions to this finding. The average length of stay for

women with mental disorders and senility without

psychosis (76 1 days) was longer than that for women

admitted with a diagnosis involving diseases of the

circulatory system (424 days).

Longer stays were also associated with several

conditions that increased with age. For example, of

the elderly women who were discharged within 1

month of admission, 43 percent were bedfast or

chairfast; however, of those who were discharged

after at least a 6-month stay, 55 percent were

bedfast or chairfast (figure 25). Similarly, the proportion of women who were incontinent, senile, or had

chronic brain syndrome increased with the increasing

length of stay in the facility (figures 25 and 26). This

increase may indicate that the underlying causes of

these conditions do not improve with the length of

time spent in the nursing home. It may also indicate

that elderly women who are incontinent, senile, or

have a chronic brain syndrome may be held in the

nursing home because of the condition.

In contrast to hospital care where the length of

stay is related to short-term curative care, the length

of stay in nursing homes is largely related to the

long-term custodial care provided. In some cases,

nursing homes provide short-term recuperative posthospital services. However, even for those receiving

post-hospital care, the type of care may change.

Research has shown that the 6-month length of stay

can be critical for patients recovering in nursing

homes.z g The proportion of discharged women who

received physical therapy during the last month was

one indicator of the change from rehabilitative to

custodial care. Figure 27 shows that the proportion

of elderly women who received physical therapy after

6 months (12 percent) was lower than the comparable proportions among elderly women who were in

the facility from 1 month to less than 6 months

(24-33 percent), respectively. While physical therapy

services received in nursing homes tended to decrease

with length of stay, the likelihood that custodial

services will be received increased with the length of

stay. For example, the proportion of elderly women

who received intensive nursing care services increased

with the length of stay (figure 28).

As in hospitals, the length of stay for an elderly

woman in a nursing home is shortened if she has a

spouse or other family member to provide care in her

home. In 1976, the average length of stay was

shortest for discharged elderly women who were

married (219 days). In contrast, figure 29 indicates

that the average lengths of stay were considerably

longer for discharged elderly women who were

widowed (41 1 days), divorced or separated (438

days), or never married (554 days).

29
Bedfast

EXl

Chairfast

zzl

Walks, ❑

Unknown

with or

without

assistance

87.2

Mobility

I i 28.8

Ostomy in either

I!E!

Difficulty

Izzl

Difficulty

bowels or bladder controlling both controlling bladder

bowels and bladder

❑

Difficulty

E

No difficulty ❑

Unknown

control Iing controlling

bowels bowels and

bladder

88.1

Continence

o 10 20 30 40 50 60 70 80 90 1(00

Percent

Figure 24. Percent distribution of women 65 years of age and over discharged from nursing homes who received intensive nursing care, by mobility

and continence status: United States, 1976

Table Z. Average length of stay of patients 65 years of age and over

discharged from nursing homes, by sex, age, and marital status:

United States, 1976

Sex

Age and marital status

Female Male

Average length

of stay in days

All discharges . . . . . . . . . . . . . . . . . . . . . . . . . 401 293

Age

65-74years . . . . . . . . . . . . . . . . . . . . . . . . . . 262 190

75-84years . . . . . . . . . . . . . . . . . . . . . . . . . . 335 290

85yearsandover . . . . . . . . . . . . . . . . . . . . . . 544 408

Marital status

Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 146

Widowed’ . . . . . . . . . . . . . . . . . . . . . . . . . . . 411 375

Divorcedorseparated . . . . . . . . . . . . . . . . . . . 438 399

Nevermarried . . . . . . . . . . . . . . . . . . . . . . . . 554 492

1

Includesa small number with unknown marital status,

30

Discharge status.–In 1976,72percent ofeMerly

women were discharged alive; 28 percent were discharged dead. As expected, elderly women who were

discharged dead were older, on the average (84years

of age), than elderly women discharged alive (81

years ofage). Longer stays were also characteristic of

women discharged dead; the average length of stay

for elderly women discharged dead was 644 days

compared with 305 days for elderly women discharged alive. This difference in length of stay by

discharge status increased sharply with increasing age

(table AA), and also held for all primary diagnoses at

admission with the exception of cancer (table 18).

Among discharged elderly women, certain conditions appear to be associated with a greater likelihood

that they will be discharged dead. For example,

elderly women admitted to the nursing home because

of cancer were more likely than others were to be

discharged dead. About 52 percent of elderly women

with a primary diagnosis of cancer were discharged
60 -

50 — -/”

Bedfast or chairfast ,-’

g

g 40

,/

2

30 –

Less than 1 month to 3 months to 6 months

1 month less than 3 less than 6 or more

Length of stay

40

r

30

v

/’

,/’

Senility ,/

,/

E

g 20

/

n

/’

- /’ ./ ./ ./

./-’Chronic brain syndrome

.0

./

Less than 1 month to 3 months to 6 months

1 month less than 3 less than 6 or more

Length of stay

Figure 25. Percent of women 66 years of age and over discharged from Fiqure 26. Percent of women 65 vears of age and over discharged from

nursing homes who were incontinent and bedfast or cha~fest, by

Iength of stay: United States, 1976

dead compared with 18 percent of women admitted

with a hip fracture and 28 percent of women

admitted with heart attack or ischemic heart disease

(table 19).

In addition, the proportion of elderly women

discharged dead increased from 11 percent for those

who walked (with or without assistance) to 61

percent of those who were bedfast. Thus the chances

of a discharge because of death for bedfast women

was about 5Yztimes greater than that for those who

could walk. Similarly, women who were incontinent

of both bowels and bladder (50 percent) or had an

ostomy in either bowels or bladder (47 percent) were

5 times more likely to be discharged dead than

women who were continent (11 percent) (table 19).

The majority of discharges from nursing homes,

however, were alive rather than dead. In 1976,

459,000 elderly women were discharged from nursing

homes alive. Most of the elderly women were

nursing homes with chronic conditions of senility and chronic

brain syndrome, by length of stay: United States, 1976

discharged to another health facility for continued

care (43 percent). Usually this other health facility

was a short-stay hospital (32 percent); about 9

percent of elderly women were discharged to another

nursing home. About 26 percent of elderly women

returned to their homes or to a semiprivate residence

such as a boarding or retirement home. The average

stay for elderly women returning to a private or

semiprivate residence (105 days) was shorter than

that for those transferred to another health facility

(426 days) (table BB).

Elderly women discharged from nursing homes to

short-stay hospitals were transferred for acute care

and sometimes for terminal care. Of the 203,100

elderly women discharged to a hospital, 22 percent

were known to have died in the hospital. The

comparable proportion among those transferred to

another nursing home, in contrast, was 9 percent.

31
40

24.1

33.4

23.6

la Physical therapy

El

Recreational therapy

❑ Occupational therapy

14.4

Lees than 1 month 1 month to less than 3 3 months to less than 6 6 months or more

Length of stay

Figure 27, Percent of women 65 years of age and over discharged from nursing homes, by type of therapy received, by length of stay:

United States, 1976

32
70

[

60

50

40

T

54.2

I

58.1

D

57.4

62.5

Less than 1 month to 3 months to 6 months

1 month leas than 3 less than 6 or more

Length of stay

Figure 28. Percent of women 65 yeara of age and over discharged from

nursing homes who received intensive nursing care, by length of

stay: united States, 1976

600 r 554

500

100

0

438

411

219

Married Widowedl Divorced or Never

separated married

Marital status

1, nclude~ ~ Smal I number of unknowns.

Table AA. Average age by discharge status and average length of stay

of women 65 years of age and over discharged from nursing

homes, by discharge status and age of patient: United States, 1976

Discharge status

Age

Total’ Aliva Dead

Average age in years

All women, 65 years and over . . . . . . . . 82 81 84

Avaraga length of stay

in days

65years and over . . . . . . . . . . . . . . . . . 401 305 644

65-74 years . . . . . . . . . . . . . . . . . . 262 250 310

75-84 years . . . . . . . . . . . . . . . . . . 335 277 511

85yearsandover . . . . . . . . . . . . . . 544 375. 850

11n~lude~ a .SmaII number with unknown discharge *tUs.

Figure 29. Average length of stay of women 65 years of age and over

discharged from nursing homes, by marital status: United States,

1976 -

33
Table BB, Number, percent distribution, and average length of stay of women 65 years of age and over discharged from nursing homes, Iby living

arrangement after discharge: United States, 1976 ,

Living arrangement after discharge Number of Percent

Average

discharges distribution

length of

stay in days

All arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Private orsemiprivate residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anotherhealth facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anothernursinghome ..,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General orshort-stay hospital. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherhealth facilityorunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown orotherarrangement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dledordischarge statusunknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

840,900

164,400

277,800

60,100

203,100

+

11,500

16,800

182,000

100.0

25.6

43.3

9.4

31.7

*

1.8

2.6

28.4

40’1

I OS

426

4111

445

+b

+,

260

6441

34
Discussion

This report has examined health care resource

utilization by elderly women beginning with a.n#ulatory care in physicians’ offices through hospital care

to nursing home care. Because the units of measurement were patient events (office visits or discharges

from hospitals and nursing homes), rather than

unduplicated patient counts, rates of use do not

permit tracing movement of people among these

three health care settings. Nevertheless, these rates do

point to the general course of treatment sought by

the older women. Ambulatory care in physicians’

offices, for example, is the most likely care sought by

older women. The visit rate to physicians’ offices was

421 visits per 100 population in 1978. In contrast,

there were 34 discharges from short-stay hospitals per

100 population of women 65 years of age and over in

1978 and there were 5 discharges from nursing homes

per 100 population of women 65 years of age and

over in 1976.

Implicit in this report’s findings is the progression

of the severity of illness as women age and the

relationship between these illnesses and the type of

care provided in each setting or institution. Treatment in a physician’s office was most likely to be for

chronic conditions such as hypertensive disease,

diabetes, and osteoarthritis and allied conditions that

require monitoring but are not necessarily life threatening. Use of short-stay hospitals, on the other hand,

was generally for episodes of illness requking acute

medical care (such as chronic ischemic heart disease,

congestive heart failure, cerebrovascular disease, and

pneumonia) or surgical intervention (such as malignant neoplasms, fractures, and gastrointestinal conditions). Use of nursing homes was for conditions such

as arteriosclerosis, senility, and chronic brain syndrome, which require constant nursing care services

and monitoring. Transfers between nursing homes

and hos~als, however, appear to be frequent for

diagnoses of fractures, malignant neoplasms, cerebrovascular disease, and diabetes.

This report has also examined differences in

utilization patterns of the three major health care

settings by elderly men and women. Elderly men

appear to have a higher degree of morbidity because

they enter hospitals more often and use more hospital

resources. Elderly men, however, have proportionately fewer visits to physicians’ offices and thus may

also seek less preventive care than elderly women.

This factor may relate to the higher morbidity of

men.

Among the elderly, a hospital stay may be

followed by a stay in a nursing home. This pattern,

however, applies more often to elderly women than it

does to elderly men. Post-hospital care in the home

would appear to be more available to elderly men

because elderly men are more likely to have a spouse.

The lower likelihood that elderly wornen would

receive informal care in the home (either post

hospital or as a substitute for long-term care), along

with the older woman’s longer life expectancy, may

lead to their greater utilization of nursing homes by

elderly women than by elderly men.

Among elderly women, the utilization of the

three health settings varied by race. Black and all

other women made proportionately fewer visits to

physicians’ offices, were discharged from short-stay

hospitals less often, and were residents of nursing

homes less often than elderly white women were.

However, black and all other women had longer

lengths of stay and were more likely to be discharged

dead from short-stay hospitals than white women

were. These patterns of use may result partially from

the tendency of black and women of all other races

to delay treatment until later stages of illness as well

as from problems of accessibility to services.

This report has explored the utilization of only

three sources of health care for elderly women.

Patterns of use in other settings may differ from

those described in this report. Examples of other

health care settings are hospital outpatient departments, hospital emergency rooms, community health

centers, and mental hospitals.

.

35
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2Rice, D.: Long life to you. Amer. Demogr., Vol. 1, No. 9,

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3Social Security Administration: Income and resources of the

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Printing Office, Jan, 1980.

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Pub. No. (PHS) 79-1549. Public Health Service, Washington.

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Vital and Health Statistics, Series 10-No. 109. DHEW Pub. No.

(HRA) 77-1536. Health Resources Administration. Washington. U.S. Government Printing Office, Mar. 1977.

‘National Center for Health Statistics: Prevalence of selected

chronic digestive conditions: United States, 1975, by T. Drury

and L. Howie. Vital and Health Statistics, Series 10-No. 123.

DHEW Pub. No. (PHS) 79-1588. Public Health Service. Washington. U.S. Government Printing Office, July 1979.

1°National Center for Health Statistics: Prevalence of chronic

skin and musculoskeletal conditions: United States, 1976, by

G. Bonham. Vital and Health Statistics, Series 10-No. 124.

DHEW Pub. No. (PHS) 79-1552. Public Health Service. Washington. U.S. Government Printing Office, Nov. 1978.

11National Center for Health Statistics: Prevalence of selected

impairments: United States, 1977, by B. Feller. Vital and

Health Statistics, Series 10-NO. 134. DHHS Pub. No. (pHS)

81-1562. Public Health Service. Washington. U.S. Government

Printing Office, Feb. 1981.

12National Institutes of Health: Cancer Incidence and Mortality in the United States, 1973-76. DHEW Pub. No. (NIH)

78-1837.

13Moore EC.: Women and health: United States, 1980. Public

Health Rep., Suppl. to September-October 1980. pp. 80-81.

14National Center for Health Statistics: Acute conditions, @cidence and associated disability: United States, July 1977-June

1978, by P. Ries. Vital and Health Statistics, Series 10-No.

132. DHEW Pub. No. (PHS) 79-1560. Public Health Service.

Washington. U.S. Government Printing Office, Sept. 1979.

15National Center for Health Statistics: Eighth Revision

International Classification of Diseases, Adapted for Use in the

United States. PHS Pub. No. 1693. Public Health Service.

Washington. U.S. Government Printing Office, 1967.

16National Center for Health Statistics: Office visits by

women, by B. Cypress. Vital and Health Statistics, Series

13-No. 45. DHEW Pub. No. (PHS) 80-1796. Public Herdth

Service. Washington. U.S. Government Printing Office, Mar.

1980.

17National Center for Health Statistics: Utilization of shortstay hospitals, annual summary for the United States, 1978,

by B. Haupt. Vital and Health Statistics, Series 13-No. 46.

DHEW Pub. No. (PHS) 80-1797. Public Health Service. Washington. U.S. Government Printing Office, Mar. 1980.

18National Center for Health Statistics: The National Nursing

Home Survey: 1977 summary for the United States, ‘byJ. Van

Nostrand, A. Zappolo, E. Hing, B. Bloom, B. Hirsclh, and D.

Foley. Vital and Health Statistics, Series 13-No. 43. DHEW

Pub. No. (PHS) 79-1794. Public Health Service. Washington.

U.S. Government Printing Office, July 1979.

19National Center for Health Statistics: Physician visits: Volume and interval since last visit: United States, 19:75, by A.

Gentile. Vital and Health Statistics, Series 10-No. 128. DHEW

Pub. No. (PHS) 79-1556. Public Health Service. Washington.

U.S. Government Printing Office, Apr. 1979.

20 National Center for Health Statistics: Use of selected medical procedures associated with preventive care: Unitc!d States,

1973, by A. J. Moss and M. H. Wilder. Vital and Health Statistics, Series 1O-NO. 110. DHEW Pub. No. (HRA) 77-1538.

Health Resources Administration. Washington. U.S. Government Printing Office, Mar. 1977.

36
21 Gonella, J. S., Louis, D. Z., and McCord, J. J.: The staging

concept, an approach to the assessment of outcome of ambulatory care. Medical Care. 14:13-21, 1976.

22 Office of Health Resources Opportunity: Health status of

minorities snd low-income groups, by M. H. Rudov and N.

Santangelo. DHEW Pub. No. (HRA) 79-627. Health Resources

Administration. Washington. U.S. Government Printing Office,

1979.

23 Nation~ Center for Health Statistics: chZraCteriStkX of

numing home residents, health status and care received,

National Nursing Home Survey, May-December 1977, by E.

Hing. Vital and Health Statistics, Series 13-No. 51. DHHS Pub.

No. (PHS) 81-1712. Public Health Service. Washington. U.S.

Government Printing Office, Apr. 1981.

24 National Center for Health Statistics: Final mortality statistics, 1978. Monthly Vital Statistics Report.? Vol. 29, No. 6,

Suppl. (2). DHHS Pub. No. (PHS) 80-1120. Public Health

Service. HyattsvMe, Md. Sept. 17, 1980.

25 Special Committee on Aging, United States Senate, 1972.

Trends in Long-Term Care (Part 20-Access of Minority Groups

to Nursing Homes). Washington. U.S. Government Printing

Office. Aug. 10, 1972. pp. 2458-2475.

26 Scardon, W., Difederisco, E., and Stassen, M.: Long-term

care: Current experience and a framework for analysis. The

Urban Institute. Washington. 1979. pp. 26-33.

27 National Center for Health Statistics: A comparison of nursing home residents and discharges from the 1977 National

Nursing Home Survey: United States, by E. Hing and A.

Zappolo. Advance Data from Vital and Health Statistics, No.

29. DHEW Pub. No. (PHS) 78-1250. Public Health Service.

Hyattsville, Md. May 17, 1978.

28 Young, K. snd Fisher, C.: Medicare episodes of illness: A

study of hospital, skilled nursing facility, and home health

agency care. Health Care Fin. Rev. Fall 1980. pp. 1-23.

29 Katz, S,, Heiple, K. G., Downs, T., Ford, A. B. and Scott,

C. P.: Long term course of 147 patients with fracture of the

hip. Surgery, Gynecology and Obstetrics. Vol. 124, pp.

1219-1230, June 1967.

37
P

List of detailed tables

1. Prevalence rates per 1,000 population of selected chronic

conditions and impairments for noninstitutional ized women,

by age of patient: United States, 1978 . . . . . . . . . . . . . . .

2. Number and percent distribution of office visits made by

woman by principal diagnostic category, according to age of

patient: United States, 1978. . . . . . . . . . . . . . . . . . . .

3. Numbar, percent distribution, and cumulative parcent of

office visits made by women 65 yaars of aga and over, by

most frequent principal diagnoses: United States, 1978. . . .

4, Percent of office visits made by women, by age of patient

and diagnostic and therapeutic sawices ordered or provided:

Unitad States, 1978 . . . . . . . . . . . . . . . . . . . . . . . .

5. Number and percent distribution of women discharged from

short-stay hospitals, by age of patient and selected most

frequent first-listed diagnoses: United States, 1978 . . . , . .

6. Number and percent distribution of women 65 years of age

and over discharged from short-stay hospitals, by race of patient and selected most frequent first-listed diagnoses: United

States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Numbar and rate of patients 65 years of age and over discharged from short-stay hospitals, by sex of patient and 25

selected most frequent first-1 isted diagnoses: United States,

1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Number and parcent distribution of selectad most frequent

all-l istad surgical procedures for women discharged from

short-stay hospitals, byageof patient: United Stites, l978. . .

9. Number and percent distribution of selected most frequent

all-l istad surgical procedures for women 65 years of age and

over discharged from short-stay hospitals, by race of patiant:

United States, 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. Average length of stay of women 65 yaars of age and over

39 11.

40 12.

40 13.

41 14.

42 15.

43

16.

44

17.

45

18.

46

19.

discharged from short.stay hospitals, by 20 selectecl most

frequent surgical procedures: United States, 1978 . , . . . . .

Hospital fatality rate of women 65 years of age and ovar

discharged from short-stay hospitals, by first-iisted dia!mostic

category: United States, 1978 . . . . . . . . . . . . t . . . . .

Number and hospital fatality rate of women65 years of age

and over discharged from short-stay hospitals, by discharge

status andsurgicai category: United States, 1978 . . . . . . .

Percent distribution of women65 years of age and over discharged from nursing homes by primary diagnosis at admission, according toagaof patient: United States, 1976. . . . .

Number and rate per l,OOOpatients 65years ofage and over

discharged from nursing homes, by sex of patient and chronic

condition and impairment: United States, 1976 . . . . . . . .

Percent distribution of women65 years of age andoverdischarged from nursing homes byselected prirnar ydiagnosesat

admission, according to selected chronic conditions and impairments: United States, 1976. . . . . . . . . . . . . . . . . .

Number and rate per 1,000 women discharged from nursing

homes, by age of patient and chronic condition and impairment:United States, 1976... . . . . . . . . . . . . . . . . .

Numb’er and percent distribution of women 65 years of age

and over discharged from nursing homes by selected health

services received, according to level of care and length of

stay: United States, 1976.... . . . . . . . . . . . . . . . . .

Average length of stay of women 65 years of age and over

discharged from nursing homes, by discharge status and primary diagnosis at admission: United States, 1976 . . . . . . .

Parcent distribution of women 65 yaars of age and over discharged from nursing homes by discharge status, according to

selected health statuses: United States, 1976 . . . . . . . . .

47

47

48

49

50

51

52

53

54

54

38
Table 1. Prevalence rates par 1,000 population of selected chronic conditions and impairments for noninstitutionalized women, by age of patient:

United States, 1978

Chronic condition and impairment and ICDA code’

Age

17-44 45-64 65 years

years years and over

Circulatory conditions

Heart conditions.........,.. . . . . . . . . . . . . . . . . . . . . . . . . 390-398,402,404,410429,782.1

Hypertensive heartdisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...402. 404

Coronary heartdisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...410-414

Hypertensive disease,N.E.C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...400.401. 403

Cerebrovasculardisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...430-438

Varicoseveins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...454.456

Digestive conditions

Ulcerofstomach andduodenum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..531-534

Frequentconstipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...564.0

Hernia of abdominal cavity.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550-553

Functional and symptomatic upper gastrointestinal disorder2 . .536,784 .0,784.1,784.3,7B4 .7,785.4pt

Gallbladder condition3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...574.575. 576.0,676.1,576.9

Gastritisandduodenitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...535

Diverticula ofintestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...562

Chronicenteritis andulcerative colitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..563

intestinal condition2,4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .564.1,584.9,785.4pt

Genitourinary, nervous, endocrine, metabolic and blood-forming systems,

and other selected conditions

All thyroid conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240.241.242.0. 242.1,243-246

Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

All anemia conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280, 281,282-284, 285.0, 285.8,285.9

Migraine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...346

All diseasesofthe urinarysystem . . . . . . . . . . . . . . . . . . . . . . 580-584,590,591,592, 593,595-599

All femaletroublesexceptbreast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...612-625. 626-629

Impairments

Visual impairments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. XOO-X05

Hearing impairments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .X06-X09

Orthopedic impairments (except paralysis or absence):

Back orspine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .X70-X72.X80-X81

Upper extremity andshoulder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .X73.X74.X86-X88

Lower extremity andhip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X75-X77.XB2-X85

Other multiple, N.E.C. oflimb,back, andtrunk . . . . . . . . . . . . . . . . . . . . . . . . . . X78,X79,X88

Respiratory conditions

Chronic bronchitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490.491

Emphysema ...,...,..,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...492

Chronicsinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...503

Skin and musculoskeletal conditions

Neoplasmsof theskin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...172-173. 216,232.2

Cornsand callosities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...700

Diseasesof nail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...703

Arthritis, N.E.C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-715

Rateper 1,000 population

40.5

4.9

●

58.6

*

41.8

15.5

18.7

5.5

16.5

8.0

7.8

1.7

7.0

8.6

20.4

10.7

23.4

49.7

41.1

34.0

18.9

33.3

51.5

4.8

22.6

5.0

30.5

*

136.0

3.2

15.9

16.9

54.3

105.5

38.5

28.4

198.3

10.8

84.0

29.V

37.3

42.5

26.0

17.7

14.0

21.0

16.8

15.5

50.7

59.4

23.9

45.2

42.9

21.8

60.3

97.8

69.5

16.0

38.3

11.6

41.3

11.1

150.3

5.6

55.4

35.3

304.0

190.4

45.0

78.8

302.1

34.6

97.4

23.5

74.9

49.8

49.2

29.5

17.4

40.7

18.2

20.4

41.8

93.9

35.1

18.1

70.8

8.2

231.0

259.1

84.6

28.7

70.9

16.8

55.2

20.2

134.0

21.7

69.0

61.7

522.1

lFor~~ding~f chr~nic conditions, seereference 15. FOr CCJdin90f irS’Wairments# seereferencell -

2Gas (pains) instornach wascodedto lCDAcode 536; inintestines, tol CDAcode 564

31ncludes gallbladder trouble, N.O.S.

‘$lncludes intestinal or bowel trOuble, N.O.S.

NOTE: N.E.C.=notelsewhere classified; N.O.S. =nototherwise specific.

SOURCE: Unpublished data from the 197B National Health Interview Survey. These deta are based on a 1/6 subsample of households. Estimates

below 215,000 areconsidered statistically unreliable. .

39
Table2. Number andpercent distribution of office visits made bywomen byprincipal diagnostic category, according toage of patient:

United States, 1978

Principal diagnostic category and ICDA codeq

Age

45-64 55-74 ,75 yeayears years igndover

Number of visits in thousands

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83,996 35,258 20,971

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100,0

Infectiveand parasiticdiseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..000-136 2.3 1.5

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239 4.5 5.1

Endocrine, nutritional,and metabolic diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240-279 7.3 6.5

Mental disorders......,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290-315 4.7 3.1

Diseases ofthenervoussystem and senseorgans . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...320-389 8.8 11.8

Diseases of thecircuiatory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...390-458 12.7 24.1

Diseases ofthe respiratorysystem . . . . . . . . . . . . . . . . . . . . . . .,................460-519 10.9 8.2

Diseasas ofthedigestivesystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520-577 4.7 3.8

Diseases ofthegenitourinary system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...580-629 8.4 4.7

Diseases oftheskin andsubcutaneous tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..680.7Cl9 5.2 4.4

Diseases of the musculoskeletal system and connective tissue . . . . . . . . . . , . . . . . . . . . . . .710-738 8.9 9.5

Symptomsand ill-definedconditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...780-796 5.1 4.8

Accidents,poisonings,and violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-999 6.3 ,5.0

Special conditions and examinations without sickness . . . . . . . . . . . . . . . , . . . . . . . . . . YOO-Y13 6.9 4.1

All other2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. residual 3.4 3.4

‘See reference 15.

21nclud@ 28 0-28g, diseases of the bloOdand blood-forming organs; blank diagnosis; noncodable diagnosis; and illegible diagnosis.

100.0

1.4

3.9

4.4

1.7

14.7

30.4

5.8

3.6

3.1

4.3

10.0

4.8

,4.9

2,6

4.5

Table3. Number, percent distributionr and cumulative percent of office visits made bywomen 65years ofageand over, bymostfrequer]t principal

diagnoses: United States, 1978

Principal diagnosis and ICDA code 7

Numberof

Percent visits in Cumulative

thousands distribution percent

All diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Essential benign hypertension. . . . . . . . . . . . . . . . . . . . . . .,, . . . . . . . . . . . ...401

Chronic ischemic heartdisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...412

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25o

Osteoarthritis and alliedconditions . . . . . . . . . . . . . . . . . . . . . . . .,...,..,...713

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...374

Arthritisrunspecified . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . ...715

Medical orspecial examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..YOI)

Symptomatic heartdisease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Otherdiseases ofeye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .378

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375

Neuroses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300

Refractive errors, .,,..., . . . . . . . . . . . . . . . . . . . . . . .,...............370

Medical andsurgical aftercare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..YIO

Synovitis, bursitis,andtenosynovitis . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . ...731

Acute upper respirato~ infection ofmuitiple or unspecified sites . . . . . . . . . . . . . . .465

Malignant neoplasmofbreast . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . ...174

Other hypertrophic and atrophic conditions of skin . . . . . . . . . . . . . . . . . . . . . . . .701

bronchitis, unqualified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490

Rheumatoidarthritisandallied conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . ...712

Cystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...595

Othereczema anddermatitls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...692

Angina pectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...413

Acute but ill-definad cerebrovascular disease . . . . . . . . . . . . . . . . . . . , . . . . . . . . .436

Otherdiseases of respiratorysystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...519

Otherand unspecifiedanemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...285

Arteriosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440

Other diseases ofretinaandoptic newe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...377

Other malignant neoplasmofskin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...173

Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. residual

56,230

6,160

3,428

2,224

1,870

1,684

1,192

1,024

1,003

967

897

851

728

705

630

629

602

556

553

493

484

466

462

446

442

438

379

370

363

26,184

100.0

11.0

6.1

4.0

3.3

3.0

2.1

1.8

1.8

1.7

1.6

1.5

1.3

1.3

1.1

1.1

1.1

1.0

1.0

0.9

0.9

0.8

0.8

0.8

0.8

0.8

0.7

0.7

0.7

46.6

100.3

‘11 .0

‘17.1

:21.1

:24.4

27.4

29.5

31.3

:13.1

:34.8

:36.4

37.9

:39.2

40.5

41,6

42.7

43.8

44.8

45.8

46.7

47.6

48.4

49.2

50.0

50.8

51.6

52.3

53.0

53.7

1CIO.3

‘See reference 15.

40
Table4. Percent ofoffice visiwmade bywomen, bya~ofpatient anddiagnostic andtherapeutic sewices ordered orprovided:

United States, 1978

Diagnostic and therapeutic services

Age

All 45-64 65-74 75 years

ages years years and over

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diagnostic services

Nona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Limitedexamination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Paptest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Clinical labtest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EKG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vision tast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood pressurecheck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Therapeutic services

None . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Immunization ordesensitization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugs (prescription ornonprescription) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dietcounseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical counseling .,...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Officesurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychotherapy ortherapeutic listening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

349,244

8.7

61.6

21.3

8.1

22.7

7.0

2.7

4.6

1.0

37.5

4.1

20.0

7.2

52.6

8.2

2.2

19.8

3.2

6.7

5.5

2.4

Number ofvisits in thousands

83,996 35,258

Percentq

10.2 6.0

60.6 84.6

19.2 17.9

8.2 4.8

19.2 23.0

9.6 9.1

4.4 6.3

5.1 7.6

1.1 1.4

41.5 48.8

4.5 4.9

17.6

5.7

57.3

8.5

‘0.4

19.9

4.5

6.2

5.9

3.3

17.4

5.5

62.5

8.9

20.9

3.7

5.8

4.7

3.3

20,971

3.B

66.5

18.6

2.2

21.6

9.2

5.6

9.2

*1.2

51.1

4.6

15.8

4.7

62.9

5.2

23.4

2.8

7.0

3.5

3.7

lpercant~ will “otaddt~qoo,o because more thanl service meyhava been rendered durin9 a visit.

41
Tabla5. Number andpercent distribution of women dschar~d from shoti+tay Rdspitals, byageof patient andselected most frequent fimt-listed diagn,2ses:

United States, 1978

Number of

Age, first-listed diagnosis, and ICDA code I discharges Percent

in thousands distribution

45-64 years

All discharges...........,.. . . . . . . . . .

Chronic ischemic heart disease . . . . . . . .412

Diabetes mellitus, . .,..,,.,, , .,,,..250

Cholelithiasis . . . . . . . . . . . . . . . . . . ...574

Malignant neoplasm of breast . . . . . 174, 1gg.2

Uterine fibromyoma and other benign

neoplasmsofuterus . . . . . . . . , . . ,218,219

Pneumonia, all forms . . . . . . . . . . .480-486

Malignant neoplasm of uterus a“d Other female

genital organs . . . . . . .180-164,199 .3, 188.4

Psychoses . . . . . . . . . . . . . . . . . ...290-299

Hypertensive disease . . . . . . . . . . , ..400404

Lkerovaginal prolapse . . . . . . . . . . . . ...623

Cerebrovascular disease . . . . . . . . . . .43r)q38

Displacement of intervertebral ~s~ . . . . .725

Diseasesofbreast. . . . . . . . . . . ...610.611

Intermenstrual bleeding . . . . . . . . . . . .626,6

Osteoarthritis andallied conditions . . . . . .7I3

Ulcer of stomach; ulcer of duodenum; peptic

ulcer, site unspecified; and gastrojejunal

ulcer . . . . . . . . . . . . . . . . . . . ...531.534

Other hernia ofabdominal cavity . . .. 551.553

Benign neoplasm of other and unpacified IX@”S

and tissues and neoplasms of unspecified

nature . . . . . . . 210-217,222-233,234.1 -239

Sprains andstrains of back (including

neck) . . . . . . . . . . . . . . . . . . ...846.847

Alcoholism ...,.....,.. . . . . . . . . ..3o3

Acute myocardial infarction . . . , . . . . . ,4IO

Gastritis andduodenitis . . . . . . . . . . . . .535

Other diseases of

uterus . . . . . . . . . . . 622.0,624,625,626,6

Bronchitis, chronic andunqualified . ..490491

Other fracture of Iower limb . . . . . .. 821.829

Cataract . . . . . . . . . . . . . . . . . . . . . ...374

OiVerticula Ofintastine . . . . . . . . . . , .562

Diseases of the ear and mastoid

process . . . . . . . . . . . . . . . . . . .,380-389

Acute bronchitis and bronchiolitis . . , . . .466

Asthma . . . . . . . . . . . . . . . . . . . . . ...493

Another . . . . . . . . . . . . . . . . . . ..re~idual

65-74 years

All discharges . . . . . . . . . . . . . . . . . . . . . . .

Chronic ischemic hewtd isease . . . . , . . ,412

Cerebrovascular disease ., . . . . . , , . .43fJA138

Diabetasmellitus . . . . . . . . . . . . . . . . ..25o

Cataract . . . . . . . . .. . . . . . . . . . . . . ...374

Pneumonia, all forms . . . . . . . . . . . .48r)-486

Malignant neoplasm of braast . . . . . 174, 1gg.2

Cholelithiasis . . . . . . . . . . . . . . . . . . . .574

Acute myocardial infarction . . . . . . . . . .4IO

Congestive heart failure . . . . . . . . . . . ,427.(J

Osteoarthritis and allied conditions . . . . . .713

Hypertensive disease . . . . . . . . . . . , .400404

Diverticula ofintestina , . . . . . . . . . . . .562

Other ischemic heart disease . . . .411, 4134114

4,403

151

125

114

109

85

61

78

75

72

72

71

70

~

60

59

68

49

48

48

45

43

42

42

41

39

39

36

34

34

2,448

2,305

159

89

79

75

55

53

48

46

46

43

39

39

37

100.0

3.4

2.8

2.6

2.5

1.9

1.8

1.8

1.7

1,6

1.6

1.6

1.6

1.6

1.5

1.4

1.3

1.3

1.1

1.1

1.1

1.0

1.0

1.0

1.0

0.9

0.9

0.9

0.8

0.8

0.8

55.6

100.0

6.9

3.9

3.4

3.3

‘2.4

2.3

2.1

2.1

2.0

1.9

1.7

1.7

1.6

Numberof

Age, first-/isted diagnosis, and/CDAcodel discharges Percent

distribution in thousands

65-74 years–Con.

Malignant neoplasm of uterus and other fema(e

genital organs . . . . . . .180-164,199,3, 199.4

Fracture ofnackoffemur . . . . , . . . . . . .82rJ

Other arthritis and

rheumatism . . . . . . . . . . .710.712,714.718

Malignant neoplasm Of large intestine and

rectum . . . . . . . . . . . . ...153.154. 197.5

Other hernia ofabdominal cavity . ...551.553

8en ign neoplasm of other and unspecified organs

and tissues and naoplasms of unspecified

nature . . . . . . .210-217,222-233, 234.1 -239

Uterovaginal prolapse ., , . . . . . . . . . . . .623

Another . . . . . . . . . . . . . . . . . . .. residual

75-84 years

All discharges . . . . . . . . . . . . . . . . . . . . . . .

Chronic ischemic heart disaase . . . . . . ...412

Cerebrovasculardisaase . . . . . . . . , ..430438

Cataract . . . . . . . . . . . . . . . . . . . . . ...374

Pneumonia, all forms . . . . . . , . . . .. 480486

Fracture ofneck of femur . . . . . . , . . . . .820

Cong-astive heart failure . . . . . . . . . . . . .427.(I

Diabetesmeliitus . . . . . . . . . . . . . . . . ..z5o

Acute myocardial infarction . , . . , . . . . .4IO

Osteoarthritis andallied conditions , . . ., .713

Fracture of other and multiple

sites . . . . . . . . . . . . . . . . . . . . . ..so643o9

Diverticula ofintestine . . . . . . , . . . . . . .562

Malignant neoplasm of breast . . . . . 174, 1gg.2

Cholelithiasis . . . . . . . . . . . . . . . . . . . . 574

Anemias . . . . . . . . . . . . . . . .,....280.285

Hypertensive disease . . . , . . . . . . . . .400404

Malignant neoplasm of large intestine and

rectum . . . . . . . . . . . . . . . 153-154,197.5

Another’. . . . . . . . . . . . . . . . . . ..rasidual

85 years and over

Alldischarges . . . . . . . . . . . . . . .. . . . . . .. . .

Chronic ischemic heart disease . . . . . . , .412

Cerebrovascular disease . . . . . . . . . . .430438

Fractureof neckoffemur . . , . . . . , . . . .820

Congestive heart failure . . ., , . . . . . . ..427.0

Pneumonia, all forms . . . . . . . . . , .480-~6

Cataract . . . . . . . . . . . . . . . . .,.....,374

Fracture of other and multiple

sites . . . . . . . . . . . . . . . . . . . ...805.809

Acute myocardial infarction . . . , . . . ...410

Fracture ofupperlimb . . . . . . . . ...810.819

Hypertensive disease . . . . . . . . . . ..400.404

Diabetesmellitus . . . . . . . . . . . . . . . . ..z5o

Anemias . . . . . . . . . . . . . . . . . . , ..280-285

LWarticulaof intestine ., . . . . . . , . . . . .562

Arteriosclerosis ., .. . . . . . . . . . . . . . . ..44o

Osteoarthritis andallied condition$ . . . . . .713

Cholelithiasis . . . . . . . . . . . . . . . . . ...574

Another. . . . . . . . . . . . . . ., . . .. residual

34

34

34

33

32

32

31

1,261

1,804

166

120

72

63

59

E

37

37

27

27

27

27

25

24

24

971

723

76

60

41

41

36

22

15

14

13

13

11

11

11

10

10

9

330

1.5

1.5

1.5

1.4

1.4

1.4

1.3

L, ‘“’

.)100.0

9.2

6.7

4.0

3.5

3.3

2,9

2.6

2.1

2.0

1.5

1.5

1.5

1.5

1.4

1.3

1,3

53.8

100.0

10.5

8.3

5.7

5.7

5.0

3.0

2.1

2.0

1.9

1.9

1.5

1.5

1.5

1,4

1.4

1.2

45.6

lSee reference 15.

42
Table6, Number andpercent distribution of women 65yeamof ageandover dscharged from shofi.stay hospitals, byraceof patient andselected most frequent tirst-listed

dia9n0SeS: United States, 1978

Number of

Race, first-listed diegnasis, and ICDA code 1 discharges

Percent

distribution

in thousands

White

All discharges . . . . . . . . . . . . . . . . . . . . . . .

Chronic ischemic heart disease . . . . . . . . .412

Cerebrovascular disease . . . . . . . . ...430-438

Cataract . . . . . . . . . . . . . . . . . . . . . ...374

Pneumonia, all forms . . . . . . . . . ...480486

Fracture ofneckoffemur . . . . . . . . . . ..820

Congestive heart failure . . . . . . . . . . . ...427

Diabetesmellitus . . . . . . . . . . . . . . . . ..25o

Acute myocardial infarction . . . . . . . ...410

Osteoarthriti.s andallied conditions . . . ...713

Cholelithiasis . . . . . . . . . . . . . . . . . . . . 574

Malignant neoplasm of breast . . . . . 174, 1gg.2

Oiverticula ofinteetine . . . . . . . . . . . . . .562

Hypertensive disease . . . . . . . . . . . ..400404

Fracture ofothar and multiple sites . ..805-609

Fractureof upperlimb . . . . . . . . ...810-619

Ulcer of stomach; ulcer of duodenum;

peptic ulcer, site unspecified; and

gastrojejunal ulcer . . . . . . . . . . ...531-534

Malignant neoplasm of large intestine and

rectum . . . . . . . . . . . . ...153-154. 197.5

Psychoses . . . . . . . . . . . . . . . . . ...290-299

Anemias . . . . . . . . . . . . . . . . . . ...280.285

Other hernia ofabdominal cavity . ...551.553

Malignant neoplasm of uterus, and other female

genital organs . . . . . . .180-184, 199.3,199.4

Gastroenteritis and colitis, except ulcerative

of noninfectious origin . . . . . . . . . . . . .%1

Neoplasm of lymphatic and hematopoietic

tissue . . . . . . . . . . . . . . . . . . 196,200-209

Intestinal obstruction without mention of

hernia . . . . . . . . . . . . . . . . . . . . . ...560

Uterovaginal prolapse . . . . . . . . . . . . ...623

Acute bronchitis and bronchiolitis . . . ...466

Bronchitis, chmrsica ndunqualified . ..490491

Gastritis andduodenitis . . . . . . . . . . . ..535

Influenza . . . . . . . . . . . . . . . . . ...470474

Arteriosclerosis . . . . . . . . . . . . . . . . ...440

Benign neoplasm of other and unspecified orgsns

and tissues and neoplasms of unspecified

nature . . . . . . .210-217,222-233,234.1 -239

Another . . . . . . . . . . . . . . . . . . ..rasidual

Black and all other

All discharges . . . . . . . . . . . . . . . . . . . . . . .

Chronic ischemic heart disease . . . . . . . .. 412

Cerebrovascular disease . . . . . . . . . .. 430438

Diabatesmellitus . . . . . . . . . . . . . . . . ..25o

Hypertensive disease . . . . . . . . . . ...400404

Congestive heart failure . . . . . . . . . . ...427.0

Pneumonia, all forms . . . . . . . . . ...480486

Cataract . . . . . . . . . . . . . . . . . . . . . ...374

Malignant neoplasm of uterus and other female

genital organs . . . . . . .180-164,199.3,189.4

3,664

321

209

130

125

114

110

102

64

71

68

66

60

55

z

48

46

43

42

41

41

41

38

37

36

33

32

28

26

24

24

1,686

328

30

26

19

12

11

10

9

6

100.0

6.3

5.4

3.4

3.2

2.9

2.8

2.6

2.2

1.8

1.8

1.7

1.5

1.4

1.3

1.3

1.2

‘1.2

1.1

1.1

1.1

1.1

1.1

1.0

0.9

0.9

0.9

0.8

0.7

0.7

0.6

0.6

43.4

100.0

9.2

8.1

::

3.5

3.0

2.6

1.9

Numberof

Race, first-listed diagnosis, andlCDAcodel discharges

Percent

distribution

in thousandc

Black and all other–Con.

Malignant neoplasm of breast . . . . . 174, 199.2

Anemias . . . . . . . . . . . . . . . . . . ...280-285

Acute myocardial infarction . . . . . . . . . .41o

Psychoses . . . . . . . . . . . . . . . . . ...290.299

Osteoarthritis andallied conciitions . . . ...713

Cholelithiasis . . . . . . . . . . . . . . . . . ...574

DNerticulao fintestine . . . . . . . . . . . . . . 562

Ulcer of stomach; ulcer of duodenum; peptic

ulcer, site unspecifie~ and

gastrojejunal ulcer . . . . . . . . . . . .. 531.534

Intestinal obstruction without mention of

hernia . . . . . . . . . . . . . . . . . . . . . . ..56o

Fractureofneck offemur . . . . . . . . . . . .820

Another . . . . . . . . . . . . . . . . . . ..rasidual

Race not stated

All discharges . . . . . . . . . . . . . . . . . . . . . . .

Chronic ischemic heart disea$e . . . . . . ...412

Cerebrovascular disease . . . . . . . . . .. 430-438

Cataract . . . . . . . . . . . . . . . . . . . . . ...374

Pneumonia,all forms . . . . . . . . . ...480486

Congestwe heart failura . . . . . . . . . . ...427.0

Fracture ofneckoffemur . . . . . . . . . . ..82o

Oiabetesmellitus . . . . . . . . . . . . . . . . . . 250

Clsteoarthritis andallied conditions . . . . ..713

Oiverticula ofintestine . . . . . . . . . . . . . . 564

Cholelithiasis . . . . . . . . . . . . . . . . . . . . 574

Malignant neoplasm of breast . . . . . 174, 199.2

Acute myocardial infarction . . . . . . . . . .410

Fracture of other and multiple sites . ..805-809

Anemias . . . . . . . . . . . . . . . . . . . . . 280-285

Hypertensive disease . . . . . . . . . . ...400405

Malignant neoplasm of large intestine and

rectum . . . . . . . . . . . . ...153-154. 197.5

Other hernia ofabdominal cavity . ...551.553

Fractureofupper limb . . . . . . . . ...810-319

Ulcer of stomach; ulcer of duodenum; peptic

ulcer, site unspecified; and

gastrojejunal ulcer . . . . . . . . . . ...531-534

Arteriosclerosis . . . . . . . . . . . . . . . . ...440

Gastroenteritis and colitis, except

. .

ulcerative of noninfectious ongm . . . . . . 561

Malignant neoplasm of urinary

organs . . . . . . . . . . . .188-189, 198. O-19B.1

Uterovaginai prolapse . . . . . . . . . . . . ...623

Acute bronchitis and bronchiolitis . . . . . .466

Ckherfractureoflowerl imb . . . . ...821-829

Bronchitis, chronic andunspacified . ..490491

Diseases of nervas and peripheral

ganglia . . . . . . . . . . . . . . . . . ...350-358

Influenza . . . . . . . . . . . . . . . . . ...470474

Psychoses . . . . . . . . . . . . . . . . . . .. 290.299

Another . . . . . . . . . . . . . . . . . . .. residual

6

5

5

5

4

4

3

3

3

12

622

51

35

30

18

18

18

16

14

13

12

11

10

9

9

9

8

7

6

6

6

6

6

6

6

6

5

5

5

5

266

1.8

1.6

1.5

1.5

1.2

1.1

1.0

1.0

1.0

1.0

50.0

100.0

8.2

5.6

4.8

2.9

2.9

2.9

2.6

2.3

2.1

1.9

1.8

1.6

1.5

1.4

1.4

1.3

1.1

1,0

1.0

1.0

1.0

1.0

1.0

1.0

1.0

0.9

0.8

0.8

0.8

42.8

‘See raference 15.

.

43
Table7. Number and rate of patients 65year~ of ageandover discharged from short-atay hospitals, by sex of patient and25$elected most frequent fimt-Iisted diagnoses:

United States, 1978

Number of

Discharge

Sex, first-listed diagnosis, and ICDA codeq discharges

rate per

1,000

in thousands n0rxJati0n2

Number of

Discharge

Sex, first-listed diagnosis, and ICDA codeq discharges

rate per

1,000

in thousands i>0rwlati0n2

Female

All discharges . . . . . . . . . . . . . . . . . . . . . . .

Chronic ischemic heart disease . . . . . . .412

Cerebrovascular diaease . . . . . . . .430438

Cataract . . . . . . . . . . . . . . . . . . . . . ...374

Pneumonia,all forms . . . . . . . , . . . ,480-486

Congestive heart failure . . . . . . . . . .427.0

Diabetea mellitus . . . . . . . . . . . . . . . ...250

Fracture ofneckoffemur . . . . . . . . . . .820

Acute myocardial infarction . . , . . . . .4IO

Osteoarthritis andallied conditions ., . . .713

Malignant neoplasm of breast . . . . 174, ’lgg.2

Cholelithiasis . . . . . . . . . . . . . . . . . ...574

Oivertlcula of intestine . . . . , . . . . ., ,562

Hypertensive disease . . . . . . . . . . .. 400-404

Fractura ofother and multiple sites . .805-809

Ulcer of stomach; ulcer of duodenum;

peptic ulcer, site unspecified; and

gastrojejunal ulcer . . . . . . . . . . , .531.534

Fractureof upper limb . . . . . . . . ..810-819

Anemlaa . . . . . . . . . . . . . . . ., . ...280.285

Malignant neoplasm of Iarga intestina and

rectum . . . . . . . . . . . . ...153-154. 197.5

Psychoses . . . . . . . . . . . . . . . , ..,.290.299

Malignant neoplasm of uterus andcrtherfenwde

genital organ$ . . . . . .180-184, 199,3,199.4

Other hernia ofabdominal cavity . ..551, 553

Gastroenteritis and colitis, except ulcerative

or noninfectious origin . . . , . . . . . . . .561

Neoplasm of lymphatic and hematopoietic

tissue . . . . . . . . . . . . . . . ...196. 200.209

Intestinal obstruction without mention of

hernia, . . . . . . . . . . . . . . ,, .,.....560

4,833

402

270

169

153

139

137

135

99

90

85

83

76

76

62

5a

57

56

55

52

52

49

49

45

44

338.5

28.2

18.9

11.8

10.7

9.8

9.6

9.4

6.9

6.3

5.9

5.8

5.4

5.3

4.4

4.0

4.0

3.9

3.9

3.7

3.6

3.5

3.4

3.2

3.1

Male

All discharges . . . . . . . . . . . . . . . . . . . . . . .

Chronic ischamic heart disease . . . . , . . . .412

Cerebrovasculardisease . . . , . . . . . . .430438

Hyperplasia ofprostate . . . . . . . . . . . . . .600

Pneumonia, all forms . . . . . . . . . . .480486

Acute myocardial infarction . ., , . , , . . ,410

Congestive heart failure . . . . . . . . . . . ..427.0

Cataract . . . . . . . . . . . . . . . . . . . . . ...374

Inguinal hernia . . . . . . . . . . . . . ...550.552

Malignant neoplasm ofproatate . . . lg5,199.5

Malignant neoplasm of thoracic

organ . . . . . . . . . . . . . 162-163, 197-197.3

Oiabatesmellitus . . . . . . . . . ,., . . . . ..25o

Ulcerofstomach ;ulcerofduodenum; peptic

ulcer, site u nspacified; and gastrojejunal

ulcer . . . . . . . . . . . . . . ...,....531.534

Malignant neoplasm of urinary

organs . . . . . . . . . . . . . 188-168, 198-198.1

Malignant neoplasm of large intestine and

rectum . . . . . . . . . . . . ...153-154. 197.5

8enign naoplasm of other and unspecified

organs and tissuas and neoplasm of unspecifiednature . . . .210-217,222-233,234.1 -239

Cholelithiasis , ...,.....,.....,..,574

Hypertensive disease . . . . . . , . . , . , .400-404

Osteoarthritis and allied conditions . . . . . .713

Neoplaam of lymphatic and hematopoietic

tissues . . . . . . . . . . . . . . . ...198.200.209

Anemias, . . . . . . . . . . . . . . . . . ...280-285

Diverticula of intestine . . . . . . . . . . . ...562

Fractureof neckoffemur . . . . . . . . . . .,820

Bronchitis, chronic and unqualified . ..490491

Arteriosclerosis . . . . . . . . . ., . . . . . ...440

Acute bronchitis and bronchiolitis . . . . . ,466

3,875 396.3

315 32.2

196 20!0

163 18.7

158 16,1

122 12.4

117 12.0

91 9.3

90 9.2

89 9.1

77 7.8

71 7.2

62 6.3

60 6.1

57 5.8

42 4.3

41 4.2

39 4.0

37 3.8

37 3.8

36 3.7

32 3.2

31 3.2

30 3.0

28 2.9

28 2.9

lSae rafarence 15.

2Based o“ population data from the u.S. Buraau of the Cansus: Estimates of thapopulation oftha United States, bya9e, sex, andraca:l976*0 1978. Current population

Reports, Series P-25, No. 800. Washington. U.S. Governmen tPrintingOffice, 1979,
Table 8. Number and percent distribution of selected most frequent all-listed surgical procedures for women discharged from short-stay hospitals, by age

of patient: United States, 1978

Age, surgical procedute, and ICDA codal

Numbar Percent

in thousands distribution Age, surgfcalprocedure, and ICDA coda; Number Percent

in thousands distribution

45-64 years

Allprocadures . . . . . . . . . . . . . . . . . . . . . . .

Dilation and curettage of uterus,

diagnostic . . . . . . . . . . . . . . . . . . ...70.3

Biopsy . .’ . . . . . . . . . . . . . . . . . . . ..AI-A2

Hysterectomy . . . . . . . . . . . . . . ..69.I-69.5

00phOractOmy: Salpingooophoractomy . . . . . . . . . . . . . . 67.2-67.5

Cholecystectomy . . . . . . . . . . . . . . . ...43.5

Excision of lesion of skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . 92.1-92.2

Plastic repair of cystocde and/or

rectocele . . . . . . . . . . . . . . . . . . . ...71.4

Partial mastectomy . . . . . . . . . . . . . . ..65.2

Operations on muscles, tendons, fascia,

andburaa . . . . . . . . . . . . . . . . . . ...38-39

Exploretory Iaparotomy orceliotomy . ...39.1

Complete and radical mastectomy . ..65.3-65.6

Operations onperipheralnervas . . . . . . ...04

Cardiac catheterization . . . . . . . . . . . . . .3o.z

Repair of hernia other than

inguinal . . . . . . . . . . . . 38.0-38.1,38.6-38.9

Reduction of fracture with fixation . . . . . .82.2

Repair and plastic operations on joints of

footandtoes . . . . . . . . . . . . . . . . ...87.2

Extraction of lens . . . . . . . . . . . . . 14.4-14.6

Excision of bone, partial . . . . . . . . . . . . .gO.4

Hemorrhoidectomy . . . . . . . . . . . . . . . .51.3

Closed reduction of fracture without

fixation . . . . . . . . . . . . . . . . . . . . ...82.0

Resection of small intestine of

colon . . . . . . . . . . . . . . . . . . . .47.447.6

Oilationofurethra . . . . . . . . . . . . . . ...57.5

Another . . . . . . . . . . . . . . . . . . .. residual

65-74 years

Allprocedures . . . . . . . . . . . . . . . . . . . . . . .

biopsy . . . . . . . . . . . . . . . . . . . . . ..AI-A2

Extractionoflens . . . . . . . . . . . . . 14.4.14.6

Cholecystectomy . . . . . . . . . . . . . . . ...43.5

Reduction of fracture with fixation . . . . ..82.2

Excision of Iasion of skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . 92.1-92.2

Dilation and curettage of uterus,

diagnostic . . . . . . . . . . . . . . . . . . ...70.3

Hysterectomy . . . . . . . . . . . . . ...69.1-69.5

Resection of small intastineor

colon . . . . . . . . . . . . . . . . . . . .47.4-47.6

Completeand radical mastectomy . ..65.3-85.6

Plastic repair of cystocele and/or

rectocele . . . . . . . . . . . . . . . . . . . ...71.4

Closed reduction of fracture without

fixation . . . . . . . . . . . . . . . . . . . . ...82.0

Exploratory laparotomy orceliotomy . ...39.1

Cardiac catheterization . . . . . . . . . . . . ..30.2

Oophorotomy: salpingooophorotomy . . . . . . . . . . . . . . . 67.2-87.5

Repair of hernia othar than

inguinal . . . . . . . . . . . .38.0-38.1,38.4-38.9

I nserCion or replacement of electric heart

device . . . . . . . . . . . . . . . . . . . . 30.4-30.5

Other operations on peripheral blood

vessels . . . . , . . . . . . . .24.0-24 .3,24.5-24.9

Arthoplastyofhip . . . . . . . . . . . . . . ...87.0

Operations on peripheral nerves . . . . . . ...04

Operations on muscles, tendons, fascia, and

bursa . . . . . . . . . . . . . . . . . . . . . . ,88-69

Repair and plastic operations on joints of

footandtoes . . . . . . . . . . . . . . . . ...87.2

partidmastectomy . . . . . . . . . . . . . ...65.2

Dilation ofuretfwa . . . . . . . . . . . . . . ...57.5

Repair and plastic operations on othar

joints . . . . . . . . . . . . . . . . . . . . . . ..87.3

3,012

266

255

197

148

113

73

68

54

50

50

50

48

47

43

42

41

40

36

34

31

31

31

1,280

1,177

107

79

44

42

34

31

30

30

24

23

22

m

m

20

18

17

16

15

15

14

13

13

12

11

100.0

8.5

8.5

6.5

4.9

3.7

2.4

2.2

1.8

1.7

1.7

1.7

1.6

1.5

1.4

1.4

1.4

1.3

1.2

1.1

1.0

1.0

1.0

42.5

100.0

9.1

6.7

3.7

3.6

2.9

2.7

2.6

2.6

2.1

2.0

1.9

1.7

1.7

1.7

1.5

1.5

1.2

1.1

1.1

1.0

1.0

65-74 yeara-Con.

Local excision and destruction of lasion of

bladder . . . . . . . . . . . . . . . . . ..56.1-56.2

Skin graft except lip and mouth . . . . . . . . . 01

IIeostomy, colostomy, and other

enterostomy . . . . . . . . . . . . . . . .47.747.9

Hemorrhoidectomy . . . . . . . . . . . . . . . . 51.3

Thyroidectomy, . . . . . . . . . . . . ...22.1-22.2

Excision of bone, pa~ial . . . . . . . . . . ...60.4

Another . . . . . . . . . . . . . . . . . . .. residual

75-64 years

Allprocedures . . . . . . . . . . . . . . . . . . . . . . .

Extractionoflens . . . . . . . . . . . . . 14.4-14.6

M3PSY. . . . . . . . . . . . . . . . . . . . . ..AI-A2

Reduction of fracture with fixation . . . . ..82.2

Insertion or replacement of electric heart

device . . . . . . . . . . . . . . . . . . . . 30.4-30.5

Cholecystectomy . . . . . . . . . . . . . . . ...43.5

Resection of small intestine or

colon . . . . . . . . . . . . . . . . . . . .47.447.6

Closed reduction of tlacture without

fixation . . . . . . . . . . . . . . . . . . . . . . .82.0

Excision of lesion of skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . 92.1.92.2

Complete andradical mastectomy . ..65.3-65.6

Exploratory laperotomy orceliotomy . ...39.1

Dilation and curattage of uterus,

dia9n=tic . . . . . . . . . . . . . . . . . . . ..7o.3

Local excision and destruction of leaion of

bladder . . . . . . . . . . . . . . . . ...56.1-56.2

Dilation of urethra . . . . . . . . . . . . . . ...67.5

Repair of hernia other than

inguinal . . . . . . . . . . . .38.0-38.1,38.4-38.9

Hysterectomy . . . . . . . . . . . . . ...69.1-69.5

Ileoatomy,colostomy, and other

enterostomy . . . . . . . . . . . . . . . .47.7-47.9

Arthroplasty of hip . . . . . . . . . . . . . . . .87.0

Slcingraf texceptlipandmouth . . . . . . ...01

Other operations on peripheral blood

vessels . . . . . . . . . . . . .24.0-24.3,24.5-24.9

Partial mastectomy . . . . . . . . . . . . . ...65.2

Oophoractomy: salpingaoophoractomy . . . . . . . . . . . . . . 67.2-67.5

Repair ofinguinal hernia ., . . . . ...38.2-38.3

Another . . . . . . . . . . . . . . . . . . ..raaidual

85 years and over

All procedures . . . . . . . . . . . . . . . . . . . . . . .

Reduction offracture with fixation . . . . ..82.2

Extractionoflens . . . . . . . . . . . ..14.4-14.6

Insertion or replacement of electric

heart . . . . . . . . . . . . . . . . . . . ..30.4-30.5

Siopay . . . . . . . . . . . . . . . . . . . . . ..A1-A2

Closed reduction of fracture without

fixation . . . . . . . . . . . . . . . . . . . . . . .82.0

Excision of lesion of skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . 92.1-92.2

Cholecystectomy . . . . . . . . . . . . . . . ...43.5

Exploratory laparotomy orceliotomy . ...39.1

Resactionof.small inteatineor

colon . . . . . . . . . . . . . . . . . . . .47.447.6

Other operations on peripheral blood

vessels . . . . . . . . . . . . .24.0-24.3,24.5-24.9

Local excision and destruction of lesion of

bladder . . . . . . . . . . . . . . . . . . .56.1-56.2

Repair of hernia other than

in9uinal . . . . . . . . . . . .38.0-38.1,38.4.38.9

Ileoatomy,colostomy, andother

enterostomy . . . . . . . . . . . . . ...47.7-47.9

Another . . . . . . . . . . . . . . . . . . .. residual

11

10

10

9

8

8

451

686

73

63

62

28

22

19

17

16

14

13

11

9

8

8

8

8

8

8

7

7

6

6

264

210

39

22

13

12

8

7

6

5

4

4

4

3

3

80

0.9

0.8

0.8

0.8

0.7

0.7

38.3

100.0

10.7

9.1

9.0

4.0

3.2

2.8

2.4

2.3

2.0

1.9

1.7

1.3

1.2

1.2

1.2

1.1

1.1

1.1

1.0

1.0

0.9

0.8

36.5

100.0

78.6

10.5

6.0

5.8

3.9

3.2

3.0

2.4

2.1

1.8

1.7

1.5

1.5

38.1

‘8s.s raferenca 15.

45
Table 9. Number and percent distribution of selected most frequent all-listed surgical procedures for women 65 years of age and over discharged from

short-stay hospitals, by race of patient: United States, 1978

Race, surgical procedure, and /CDA code 1

Number Percent

in thousands distribution Race, surgical procedure, and ICDA codel

Number Percent

in thousands distribution

White

Allproceduras ..,........,.. . . . . . . . . .

Biopsy . . . . . . . . . . . . . . . . . . . . . .. AI-A2

Extraction of lens , . , . . . . . . . . , . 14.4 -14.6

Reduction of fracture with fixation . . . . , .82.2

Cholacystactomy . . . . . . . . . . . . . . . ...43.5

Excision of lesion of skin and subcutaneous

tissue . . . . . . . . . . . . . . . ., ..,92.1-92,2

I mertion or replacement of electric heart

device . . . . . . . . . . . . . . . . . . ..30.4-30.5

Resection of small intestine or

colon . . . . . . . . . . . . . . . . . . . .47.447.6

Closed reduction of fracture without

fixation . , . . . . . . . . . . . . . . . . . . . . .82.0

Dilation and curettage of uterus,

diagnostic . . . . . . . . . . . . . . . . . . ...70.3

Complete and radical mastectomy , . ,65.3-85.6

Hysterectomy 1 ...,........,..69.1-89.5

Exploratory laparotomy orceliotomy . ...39.1

Plastic repair of cystocele andlor

rectocele . . . . . . . . . . . . . . . . . . . ...71.4

Oophorectomy, salpingooophoractomy . . . . . . . . . . . . . . 67.2-67.5

Cardiaccatheterization . . . . . . . . . . . ...30.2

Arthroplasty ofhip . . . . . . . . . . . . . ...87.0

Dilationofurethra . . . . . . . . . .,,.....57.5

Local excision and destruction of lesion of

bladder . . . . . . . . . . . . . . . . . ..56.1-56.2

Ileostomy, colostomy, and other

anterostomy . . . . . . . . . . . . . . . .47.7-47.9

Partial mastectomy . . . . . . . . . . . . . ..,65.2

Operations ofperipheralnarves ., . . . . ...04

Repair and plastic operations on joints of

footandtoas . . . . . . . . . . . . . . . . ...87.2

Operations on muscles, tendons, fascia,

and Burma . . . . . . ., . . . . . . . . . . ...88-69

SIdngraft axceptlip and mouth . ..93.2-93.6

Repair ofinguinal hernia . . . . . . . . . 38.2-38.3

Another . . . . . . . . . . . . . . . . . . .. residual

81ack and all other

All procedures..,..,..,.. . . . . . . . . . . . .

1,671

150

134

120

59

47

47

41

41

37

34

33

29

25

22

22

19

16

16

17

16

16

15

15

15

12

669

117

100.0

9.0

8.0

7.2

3.5

2.8

2.8

2.4

2.4

2.2

2.1

2.0

1.8

1.5

1.3

1.3

1.2

1.1

1.1

1.0

1.0

0.9

0.9

0.9

0.9

0.7

40.0

100.0

81ack and all other-Con.

biopsy . . . . . . . . . . . . . . . . , . . . . ..AI-A2

Extractionoflens . . . . . . . . . . . , . 14.4-14.6

Insertion or replacement of electric heart

device . . . . . . . . . . . . . . . . . ...30.4.30.5

Excision of lesion of skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . ...92.1-92.2

Exploratory laparotomv orceliotomy . ...39.1

Reduction of fracture with fixation . . . ...82.2

Cholecvstectomv . .,...............43.5

Dilation and curettage of uterus,

diagnostic . . . . . . . . . . . . . . . . . . ...70.3

Another ... . . . . . . . . . . . . . . . .. residual

Race not stated

All procedures . . . . . . . . . . . . . . . . . . . . . . .

Extraction of lens . . . . . . . . , , . . 14.4-14.6

BIOPSY . . . . . . . . . . . . . . . . .,. ,., ,AI-A’2

Reduction of fracture with fixation , . . . . .82.2

Resection of small intestine and

colon . . . . . . . . . . . . . . . . . . . . 47.4-47.6

Cholecvstectomy . . . . . . . . . . , . . . . ...43.5

Insertion or replacement of electric haart

device ..,.....,.,,.. . . , . . . 30,4-30.5

Excision of lesions of skin and subcutaneous

tissu e . . . . . . . . . . . . . , .,...92.1-92.2

Closed raduction of fracture without

fixation . . . . . . . . . . . . . . . , . . . . ...82.0

Loaal excision and destruction of lesion of

bladder . . . . . . . . . . . . . . . . . ..56.1-56.2

Exploratory’ laparotomy orceliotomy . ...39.1

Hysterectomy . . . . . . . . . . . . . . . . 69.1-69.5

Operationson muscles, tendons, fascia,

andbursa . . . . . . . . . . . . . . . . . . ...88-89

Complete and radical mastectomy. . . . ...65.2

Dilation andcurettage, diagnostic . . . . ...70.3

Arthroplastyofhip . . . . . . . . . . . . . ...87.0

Plastic repair of cystocele andlor

rectocele ..,..,..,.. . . . . . . . . ...71.4

Another . . . . . . . . . . . . . . . . . . .. residual

11

10

4

4

4

4

4

3

73

284

30

20

19

10

9

7

6

5

5

5

5

4

4

4

3

3

145

9.4

8.3

3.6

3.4

3.4

3.4

3.0

2.7

62.4

100.0

10.6

7.2

6.8

3.6

3.2

2.4

2.1

1.7

1.7

1.6

1.6

1.5

1.4

1.4

1.2

1.1

51.1

lSea rafarenca 15.

46
Table IO. Average length of stay of women 65 years of age and over

discharged from short-stay hospitals, by 20 selected most frequent

surgical procedures: United States, 1978

Surgicat procedure and ICDA codel

Average

length

of stay

in days

All procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . .. AI-A2

Extraction oflens . . . . . . . . . . . . . . . . . ...14.4-14.6

Reduction of fracture with fixation . . . . . . . . . ...82.2

Cholecystectomy . . . . . . . . . . . . . . . . . . . . . ...43.5

Insertion or replacement of electric

heart device . . . . . . . . . . . . . . . . . . . . ...30.4-30.5

Excision of Iasion of skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . . ...92.1-92.2

Resection of small intestineorcolon . . . . . . . 47.4-47.6

Closed reduction of fracture without fixation . . . ...82.0

Dilation andcurettage ofuterus, diagnostic . . . . ...70.3

Complete and radical mastectomy . . . . . . . . . 65.3-65.6

Hysterectomy . . . . . . . . . . . . . . . . . . . ...69.1-69.5

Exploratory laparotomy orceliotomy . . . . . . . . . ..39.1

Plastic repair ofcystocele and/or rectocele . . . . . . ..71.4

Oophorectomy, salpingo-oophorectomy . . ...67.2-67.5

Cardiac catheterization . . . . . . . . . . . . . . . . . . ..30.2

Arthroplasty of hip . . . . . . . . . . . . . . . . . . . . ...87.0

Local excision and destruction of lesion of

bladder . . . . . . . . . . . . . . . . . . . . . . . ...56.1-56.2

Dilation of urethra . . . . . . . . . . . . . . . . . . . . ...57.5

I Ieostomy, colostomy, and other

enterostomy . . . . .. o.... . . . . . . . . ...47.7-47.9

Partial mastectomy . . . . . . . . . . . . . . . . . . . . ...65.2

14.2

13.9

4.8

21.3

15.8

14.7

11.2

24.6

13.2

6.7

12.0

11.8

18.8

10.4

15.2

13.4

2.3

10.0

13.1

28.3

7.1

‘See reference 15.

Table Il. Hospital fatality rate of women 65 years of age and over

discharged from short-stay hospitals, by first-listed diagnostic

category: United States, 1978

Hospital

First-listed diagnostic category and ICDA code’ fatality

ra te2

All discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infective and parasitic diseases . . . . . . . . . . .. 000-136

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . .140-239

Endocrine, nutritional, and metabolic

diseases . . . . . . . . . . . . . . . . . . . . . . . ...240-279

Diseases of the blood and blood-forming

organs . . . . . . . . . . . . . . . . . . . . . . . . ...280-289

Mental disorders . . . . . . . . . . . . . . . . . . . ...290-315

Diseases of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . . . . . ...320-389

Diseases of thecirculatory system . . . . . . . . . .390458

Diseases of the respiratory system . . . . . .. . . ..460-519

Diseases of the digestive system . . . . . . . . . . . .520-577

Diseases of the genitourinary system . . . . . . ..580-629

Complications of pregnancy, childbitih, and the

puerperium . . . . . . . . . . . . . . . . . . . . . ...630-678

Diseases of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . . . . . ...680-709

Diseases of the musculoskeletal system and

connective tissue . . . . . . . . . . . . . . . . . . . . 710-738

Congenital anomalies . . . . . . . . . . . . . . . . ..740-759

Certain causes of perinatal morbidity and

mortal icy . . . . . . . . . . . . . . . . . . . . . . ...760-778

Symptoms and ill-defined

conditions , . . . . . . . . . . . . . . . . .780 -792, 794-796

Accidents, poisonings, and violence . . . . . . . ..800-899

Special conditions and examinations without sickness

or tests with negative findings . . . . . . .793, YOO-Y13

6.2

11.3

11.9

3.0

1.9

1.6

1.1

11.3

7.2

2.9

2.3

*

2.3

0.6

*

*

3.6

1.8

z.lSee reference 15.

(

Number of deaths

)

x 100.

Totel number of patients discharged

47
Table 12. Number and hospital fatal ity rate of women 65 years of age and over discharged from short-stay hospitals, by discharge status iand surgical

category: United States, 1978

Discharge status’

Hospital

Surgical categor}~ and ICDA code’ Not fatality

Alive Dead sta teo- rate

All operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neurosurgery ...................................................01-05

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..06-14

Otorhinolaryngology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...16-21

Operations on thyroid, parathyroid, thymus, and adrenals. . . . . . . . . . . . . . . . . . . .22-23

Vascularand cardiac surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...24-30

Thoracic surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...32-35

Abdominal surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...3848

Proctological surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...50-52

Urological surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...54-61

Breastsurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...65

Gynecological surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...67-72

Obstetrical procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...74-78

Orthopedicsurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,, . . . . . . . . . ...80-90

Plastic surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...92-94

Oral and maxillofacial surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...95-98

Dental surgery........,.. . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . ...99

Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..AI-A2

Number of discharges

in thousands

1,317 58 82 4,0

26 2 2 6.5

204 1 12 0.4

24 2 2 6.2

10 1

103 17 7 13.4

24 3 2 9.1

201 14 12 6.2

27 1

64 2 3 2.8

1 2 1.2

1:! 5

* * * *

296 11 18 3.5

67 4

10

10 1

111 5 9 3.6

‘See reference 15.

2

(

Number of deaths

)

x 100.

Total number of deeth discharges

48
Table 13. Percent distribution of women 65 years of age and over discharged from nursing homas by primary diagnosis at admission, according to aga

of patient: United States, 1976

Female Age

Prima~ diagnosis at admission 1

discharges

65 yaars 65-74 75-84 85 years

and over years years and over

Parcent distribution

All discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

49.4

5.4

20.4

2.1

13.8

5.7

2.0

7.8

●

*

4.5

*

*

*

40.4

2.4

*

12.0

4.5

7.0

2.4

2.4

100.0

49.9

8.0

26.2

2.3

8.2

3.0

2.2

8.2

*

*

4.2

*

*

39.8

4.9

*

14.1

2.6

4.2

2.3

●

Diseases of the circulatory system

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47.5 36.5

Congestive heartfailure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Arteriosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Heartattack, ischemic heartdisaase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.1

21.0

2.2

11.6

4.1

2.5

*

10.9

*

12.9

*

*

Mental disorders and senility without psychosis

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.6 11.6

Senilepsychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherpsychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronic brainsyndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senility withoutpsychosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental retardation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alcoholism andothermental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.2

1.0

4.6

1.0

*

*

*

5.5*

*

* *

Other diagnoses2

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41.8 50.3

Diseases of tha musculoskeletal systam and connective tissue:

Arthritis andrheumatism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of tha nervous system and sense organs:

Parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Accidents, poisonings, and violence:

Fracturas,all sites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrina, nutritional, and metabolic diseases:

Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neoplasms:

Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the respiratory system:

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.3

0.9

12.4

4.1

6.2

2.7

*

*

9.8

6.4

8.8

*

Diagnoses unknown

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1 *

lSee referance 15.

2OnIy diagnoses of sufficient megnitude are noted.

49
Table 14. Number and rate per l,OOOpatients 65 years of ageandover discharged from nursing hem*, bysaxof patient andchronic condition and

impairment: United States, 1976

Sex

Chronic condition and impairment 82

Female Male

Number of discharges

640,900 340,300

Rate per 1,000 discharges

All discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the circulatory system

Arteriosclerosis .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Paralysis orpalsy,other thanarthritis, relatedtostroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Heart trouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders and senility without psychosis

Mental illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronic brain syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental retardation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugaddiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other chronic conditions or impairments

Diseases of the musculoskeletel system and connective tissue:

Arthritisand rheumatism.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronic back, spine problems, excluding stiffness and deformity . . . . . . . . . . . . . . . . . . . . . . . . . . .

Permanent stiffness or deformity of back, arms, legs, or extremities, including feat,

toes, hands,orfingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Missing arms, legsr orextremities, includingfeet, toes, hands, orfingers . . . . . . . . . . . . . . . . . . . . . .

Diseases of the nervous system and sense organs:

Blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cataracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deafness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Paralysis or palsy, other than arthritis, unrelatedtostroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Accidents, poisonings, and violence:

Hip fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherbonefracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Endocriner nutritional, and metabolic diseases:

Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neoplasms:

Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the respiratory system:

Chronic respiratory disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the digestive system:

Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the blood and blood-forming organs:

Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the skin and subcutaneous tissue:

Bedsores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other:

Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Kidney trouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

None of thase conditions

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Conditions unknown

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

470.0

169.5

197.4

41.4

379.4

416.5

127.8

252.1

59.9

369.1

38.7

196.5

244.7

*

*

*

29.2

186.7

188.8

*

41.0

●

13.3 14.8

184.8

30.6

110.3

18.7

62.1

18.7

58.0

47.8

42.3

2YI.8

56.5

45.1

25.2

*

45.0

*

35.7

55.8

35.1

18.0

147.5

69.1

69.5

37.9

143.9 142.7

84.2 149.5

69.4 133.5

52.0 32.1

65.2 55.3

34.0 30.9

101.5

88.5

79,5

148.1

31.4 25.2

9.7 *

lSea referance 15.

2patiant may have had more than I repOrted condition Or impairment.
Table 15. Percent distributicmof women 65years ofageand ova ftischarged from nursing homes bvselected primawdiagnoses atadmission, xcording toselmted chronic conditions

and impairments: United States, 1976

Chronic condition and Impairment 1

Diseases of the circulatory system

Mental disorders and senility

without psychosis Other chronic conditions and impairments None of

Primary diagnosis @ admission 1

these

Arterio- Hyper- Heart

Chronic Arthritis cOnTotal Total brain Senility Total and Hip

sclerosis tension trouble fractures

Diabete$ Cancer ditions

syndrome rheumatism

All discharges . . . . . . . . . . . . . . .

Diseases of the circulatory system

Total . . . . . . . . . . . . . . . . . . . . .

Congestive heart failure . . . . . . . . .

Arteriosclerosis . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . .

Stroke . . . . . . . . . . . . . . . . . . . .

Heart attack, ischemic haart

disease . . . . . . . . . . . . . . . . . . .

Mental disorders and senility

without psychosis

Total . . . . . . . . . . . . . . . . . . . . .

Other diagnoaesz

Total . . . . . . . . . . . . . . . . . . . . .

Diseasas of the musculoskeletal

system and connmtive tissue:

Arthritis and rheumatism . . . . . .

Accidents, poisonings, and violence:

Hip fracturas . . . . . . . . . . . . . .

Endcaine, nutritional, and

metabolic diseases:

Diabates . . . . . . . . . . . . . . . . .

Naoplasms:

Cancer . . . . . . . . . . . . . . . . . .

Diagnoses unknown

Total . . . . . . . . . . . . . . . . . . . . .

I 00.0

84.7

8.4

28.6

3.0

15.8

5.6

6.1

28,6

1.9

7.1

3.7

3.4

●

100.0

66.0

6.7

44.7

1.7

7.6

2.9

6.9

26.4

1.9

7.3

3.5

3.3

●

100.0

66.4

8.1

21.6

13.1

18.1

●

4.6

28.4

●

7.0

●

●

●

100.0

70.1

16.2

24.1

●

10.5

10.8

3.6

25.3

●

5.2

3.5

2.8

●

100.0

48.3

5.1

26.4

20.0

9.6

4.1

21.8

29.2

2.7

6.3

3.8

2.6

●

100.0

47.5

4.5

28.7

●

8.3

5.1

27.2

25.1

●

6.1

,

●

●

Percent dlstributim

100.0

51.7

5.9

28.5

●

11.1

●

17.9

29.6

3.5

6.6

4.0

*

●

100.0

40.5

5.6

18.5

2.0

10.0

2.6

6.4

52.1

4.5

13.2

5.6

8.5

●

100.0

48.7

7.4

25.5

.

8.4

●

6.1

44.4

17.9

4.3

●

.

●

100.0

20.8

●

11.0

●

,

●

●

74.1

●

65.6

●

.

+

100.0

42.2

6.0

16.5

.

13.8

●

5.4

51.5

●

.

28.4

●

●

100.0

11.5

●

●

●

.

*

.

84.3

.

*

*

74.0

●

100.0

●

●

●

.

.

.

●

57.0

.

●

27.2

‘%a rafarence 15.

‘Only diagnoses of sufficimt magnitude are notad.

51
Table 16. Number andrate perl,OOO women discharged from numinghomes, byageof patient andchronic condition andimpairmerlt:

United States, 1976

Chronic condition and impairment $2

Age

All ages

Under 65-74 75-84 85 years

65 years years Years and over

All discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,

Diseases of the circulatory system

Arteriosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Paralysis orpalsy, other than arthritis, relatedtostroke . . . . . . . . . . . . . . . . . . . . . . .

Hearttrouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders and senility without psychosis

Mental illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronic brainsyndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental retardation .,..... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alcoholism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugaddiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other chronic conditions or impairments

Diseases of the musculoskeletal system and connective tissue:

Arthritis andrheumatism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chronic back, spine problems, excluding stiff nessand deformity . . . . . . . . . . . . ., .

Permanent stiffness or deformity of back, arms, legs, or extremities,

includingfeet,toes, hands, orfingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,

Missing arm, legs, orextremities, including feet, toes, hands, or fin@rs . . . . . . . . , . ,

Diseases of the nervous system and sense organs:

Blindness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Glaucoma, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cataracts, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deafness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

parkinson’s disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Paralysis orpalsy, other than atihritis, unrelated to stroke . . . . . . . . . . , . . . . . . . .

Accidents, poisonings, and violence:

Hip fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other bone fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Endocrine, nutritional, and metabolic diseases:

Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neoplasms:

Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the respiratory system:

Chronic respiratory disease . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the digestive system:

Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the blood and blood-forming organs:

Anemia, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the skin and subcutaneous tissue:

Bedsores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other:

Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Kidney trouble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

None of these conditions

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Conditions unknown

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

709,800

432.6

164.6

189.6

42.1

353.8

58.4

187.2

226.3

12.9

10.6

3.0

15.6

172.9

32.9

63.1

17.8

40.0

22.6

52.0

41.3

24.7

14.5

141.2

67.9

141.6

90.9

65.1

50.0

62.3

32.9

97.5

87.9

37.1

9.5

Number of discharges in thousands

68,800 105,000 297,200

Rate per 1,000 discharges

84.2

119.1

117.0

*

114.7

242.6

100.9

*

73.4

+

*

*

*

*

72.7

*

*

*

*

*

*

81.5

82.6

*

119.5

153.6

*

*

*

*

*

82.6

89.6

*

319<7

185.9

194.1

64.2

283.7

79.9

198.3

160.9

*

*

*

*

132.1

*

64.1

*

*

*

*

*

*

*

103,0

*

205.9

100.9

86.3

55.2

48.7

*

81.8

86.5

*

*

455.6

179,1

227.1

44,4

392.1

42.9

180.7

213.7

*

*

*

*

167,1

30.8

56.5

26.0

24.7

29.6

57.3

39.2

31.4

*

136.7

60.8

151.3

91.5

59.8

45.4

63.0

37.1

98.0

90.7

31.9

*

:~3&700

554.1

150.3

162.0

27.4

405.8

.

215.3

320.2

*

+

*

*

230.2

29.1

68.1

14.0

64.7

28.2

75.5

64.0

*

*

180.5

92.3

107.6

67.7

74.0

58.8

75.1

33.9

114.5

86.5

26.7

*

‘See reference 15.

2pa~ient maYhavehad~ore than 1 raported condition or impairment.

52
Table 17. Number andpercent distribution of women 65 years age and over discharged from nursing homes, by selected health services received,

according tolevel ofcareand length of stay: United States, 1976

Level of care during last 7 days Length of stay

Health service received Nursing care Personal Less 1 month 3 months 6 months

care or than to less to less or

Intensive Other none T month than 3 than 6 more

Alldischargas . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . .

Physician service

Time since last physician visit:

Less than l week . . . . . . . . . . . . .

Iweekor more . . . . . . . . . . . . . .

Nophysician visit while in facility . .

Unknown ifany physician visits . . .

Services received at last physician visit:’

Examination . . . . . . . . . . . . . . . .

Treatment . . . . . . . . . . . . . . . . .

Prescription . . . . . . . . . . . . . . . .

Orders for laboratory tests . . . . . . .

Otherservices . . . . . . . . . . . . . . .

Therapy service

Notharapy serviceorunknown . . . . . .

Therapy servica during last month . . . .

. . . . . . . . . . . . . . . 374,700

. . . . . . . . . . . . . . . 100.0

. . . . . . . . . . . . . . . 51.6

. . . . . . . . . . . . . . . 37.7

. . . . . . . . . . . . . . . 4.8

. . . . . . . . . . . . . . . 5.8

. . . . . . . . . . . . . . . 81.7

. . . . . . . . . . . . . . . 51.6

. . . . . . . . . . . . . . . 18.1

. . . . . . . . . . . . . . . 18.0

. . . . . . . . . . . . . . . 8.1

. . . . . . . . . . . . . . . 64.1

. . . . . . . . . . . . . . . 35.9

Number of discharges in thousands

208,500 57,700 200,200 121,500

Percent distribution

100.0 100.0 100.0 100.0

46.9 24.7 58.5 48.2

40.0 39.4 21.3 40.7

6.1 8.9 13.0 5.0

7.0 27.0 7.1 6.2

80.0 51.3 70.3 81.5

44.5 35.3 47.7 46.1

8.8 9.4 12.4 14.3

13.2 9.4 15.1 13.8

6.6 *

7.1 5.8

62.9 70.7 64.5 53.7

37.1 29.3 35.5 46.3

77,500

100.0

36.2

56.8

*

*

83.6

51.9

16.5

17.2

6.8

60.7

39.3

241,700

100.0

42.0

46.1

*

10.8

81.8

47.4

15.2

16.5

8.4

70.6

29.4

Other health service

Special diet received last 7 days:

No special diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51.9 59.0 80.4 53.2 57.9 56.7 59.2

Special diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48.1 41.0 19.6 46.8 42.1 43.3 40.8

‘Percents will notaddto 100.0 because more thanl service may have been rendered.

53
Table 18. Average length of stay of women 65 years of age and over

discharged from nursing homes, by discharge status and primary

diagnosis at admission: United States, 1976

Table 19. Percent distribution of women 65 years of age and over

discharged from nursing homes by discharge status, according to

selected health statuses: United States, 1976

Discharge status

Primary di~gnosis at admission q

Tota12 Alive Dead

Discharge status

Health status

Total’ Alive Dead

All discharges . . . . . . . . . . . . . . . . . . . . .

Diseases of the circulatory system

Total . . . . . . . . . . . . . . . . . . . . . . . . . . .

Congestive heart failure . . . . . . . . . . . . . . .

Arteriosclerosis . . . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . .

Stroke . . . . . . . . . . . . . . . . . . . . . . . . . .

Heart attack, ischemic heart disease . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . .

Mental disorders and senility

without psychosis

Total . . . . . . . . . . . . . . . . . . . . . . . . . . .

Senile psychosis . . . . . . . . . . . . . . . . . . . .

Otherpsychosis . . . . . . . . . . . . . . . . . . . .

Chronic brain syndrome , . . . . . . . ., ,. , ,

Senility without psychosis . . . . . . . . . . . . .

Mental retardation . . . . . . . . . . . . . . . . . .

Alcoholism and other mental disorders . . , .

Other diagnoses3

Total . . . . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the musculoskeletal system

and connective tissue:

Arthritis and rheumatism . . . . . . , . . . ,

Diseases of the nervous system and

sense organs:

Parkinson’s disease .,..... . . . . . . . . .

Accidents, poisonings, and violence:

Hip fracture.....,..,.. . . . . . . . . .

Otherbonefracture . . . . . . . . . . . . . . .

Endocrine, nutritional, and

metabolic diseases:

Diabetes . . . . . . . . . . . . . . . . . . . . . .

Neoplasms:

Cancer . . . . . . . . . . . . . . . . . . . . . . . .

Diseases of the respiratory system:

Total . . . . . . . . . . . . . . . . . . .. . . . . . . . .

Diagnosis unknown

Total . . . . . . . . . . . . . . . . . . . . . . . . . . .

Average length of

stay in days

401

424

398

483

498

381

340

253

761

836

725

724

578

*

*

298

464

696

289

126

426

185

266

472

305

318

285

367

341

279

281

207

601

571

660

571

*

*

*

238

398

*

231

109

31 ‘1

183

210

402

844

642

558

725

1,018

562

491

*

1,044

1,231

*

942

*

*

*

513

*

*

564

*

*

187

*

*

All discharges . . . . . . . . . . . . . . . . . . . . .

Selacted primary diagnosis

atadmission

Diseases of the circulatory system:

Congestiv eheartdisease . . . . . . . . , . . .

Arteriosclerosis . . . . . . . . . . . . . . . . . .

Stroke . . . . . . . . . . . . . . . . . . . . . . . .

Heart attack, ischemic heart

disease . . . . . . . . . . . . . . . . . . . . . .

Mental disorders and senility

without psychosis:

Chronic brain syndrome . . . . . . . . . . . .

Other diagnoses:

Hipfractures . . . . . . . . . . . . . . . . . . .

Cancer . . . . . . . . . . . . . . . . . . . . . . . .

Selected chronic conditions

and impairments

Cancer . . . . . . . . . . . . . . . . . . . . . . . . . .

Bedsores . . . . . . . . . . . . . . . . . . . . . . . . .

Mobility

Walks, with or without assistance . . . . . . . .

Chairfast, . . . . . . . . . . . . . . . . . . . . . . .

Bedfast . . . . . . . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . . . . . . . . .

Continence

No difficulty controlling bowels or

bladder . . . . . . . . . . . . . . . . . . . . . . . .

Difficulty controlling bowals . . . . . . . . . . .

Difficulty controlling bladder . . . . . . . . . . .

Difficulty controlling both bowels and

bladder . . . . . . . . . . . . . . . . . . . . . . . .

Ostomyin aitherbowels orbladder . . . . . . .

Unknown astoboth bowelsand bladder . . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

71.6

5B.4

67.7

63.6

71.6

58.7

82.5

47.7

49.5

54.6

88.8

66,7

38.8

81.9

88.7

76.0

70.5

50.0

52.7

64.4

28.3

41.6

32.3

36.2

28.4

41.3

17.5

52.3

50.5

45.4

11.1

33.3

61.0

17.6

11.3

22.8

29.2

49,9

47.0

35.0

1,nclude~ a ~mall number with unknown discharge statua.

‘See reference 15.

2, “Clude$ ~ SmaII number with unknown discharge status.

30nly diagn~~es of sufficient magnitude are noted.

54
Appendixes

Contents

1. Definitions of terms used in the National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating tothesurvey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating tothe Patient Record form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Il. Definitions of terms used in the National Hospital Discharge Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hospitals and hospital characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating tohospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating to diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relating tosurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Demographic terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

III. Definitions ofterms usedinthe National Nursing Home Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms relatingto facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Terms reiatingto discharges.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IV. Questionnaires used in the National Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the

National Nursing Home Survey.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Patient Record and Patient Log.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discharged Resident Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

56

56

56

59

59

59

59

59

60

61

61

61

63

63

64

65

55
Appendix L Definitions of terms

used in the National Ambulatory

Medical Care Survey

Terms relating to the survey

0~’cc(s).–Premises identified by the physician as

locations for his ambulatory practice. The responsibility over time for patient care and professional services

rendered there generally resides with the individual

physician rather than with any institution.

Ambulatory patient. –An individual seeking personal health services, who is neither bedridden nor

currently admitted to any health care institution on

the premises.

Physician. –Classified as either:

in scope: All duly licensed doctors of medicine

and doctors of osteopathy currently in practice

who spend time in caring for ambulatory patients

at an office location.

Out o.fscope: Those physicians who treat patients

only indirectly, including specialists in anesthesiology, pathology, forensic pathology, radiology,

therapeutic radiology, and diagnostic radiology,

and the following physicians:

Physicians in military service.

Physicians who treat patients only in an institutional setting (e.g., patients in nursing

homes and hospitals).

Physicians employed full time by an industry

or institution and having no private practice

(e.g., physicians who work for the Veterans

Administration, the Ford Motor Company,

etc.).

Physicians who spend no time seeing ambulatory patients (e.g., physicians who only teach,

are engaged in research, or are retired).

Patients. –Classified as either:

h scope: All patients seen by the physician or a

member of his staff in his office(s).

Out o.f scope: Patients seen by the physician in a

hospital, nursing home, or other extended care

institution, or the patient’s home. [Note: If the

physician has a pn”vate office (fitting the definition “office”) located in a hospital, the ambulatory patients seen there are considered in scope. ]

‘The following types of patients are considered

out of scope:

Patients seen by the physician in an institution (including outpatient clinics of hospitals)

for whom the institution has the primary responsibilityy over time.

Patients who telephone and receive advice

from the physician.

Patients who come to the office only to leave

a specimen, pick up insurance forms, or pay

their bills.

Patients who come to the office only to pick

up medications previously prescribed by the

physician.

Visit.–A direct, personal exchange between an

ambulatory patient and a physician (or members of

his staff) for the purpose of seeking care and rendering health services.

Physician specialty. –Principal specialty (including

general practice) as designated by the physician at

the time of the survey. Those physicians for whom a

specialty was not obtained were assigned the principal

specialty recorded in the master physician fries maintained by the American Medical Association or the

American Osteopathic Association.

Terms relating to the Patient Record form

Age. –The age calculated from date of birth was

the age at last birthday on the date of visit.

Color or race. –On the Patient Record form, color

or race includes four categories: white, Negro or

black, other, and unknown. The physician was instructed to mark the category, which in his judgment,

was most appropriate for the patient based on observation and prior knowledge or both. The category

56
“other” was restricted to Orientals, Amefican Indians,

and persons of other nonwhite, non-Negro races.

Patien t‘s complain t(s), symptom(s), or other reason(s) for this visit (in patient’s owrz words). –The patient’s principal problem, complaint, symptom, or

other reason for this visit as expressed by the patient.

Physicians were instructed to record key words or

phrases verbatim to the extent possible, listing that

problem first which, in the physician’s judgment, was

most responsible for the patient’s visit.

Principal diagnoses. –The physician’s diagnosis of

the patient’s principal problem, complaint, or symptom. In the event of multiple diagnoses, the physician

was instructed to list them in order of decreasing importance; “principal” refers to the first4isted diagnosis. The diagnosis represents the physician’s best

judgment at the time of the visit and may be tentative, provisional, or definitive.

Other significant current diagnosis. –The diagnosis

of any other condition known to exist for the patient

at the time of the visit. Other diagnoses may or may

not be related to the reason for that visit.

Seriousness of problem. –Seriousness includes

four categories: very serious, serious, slightly serious,

and not serious. The physician was instructed to

check one of the four categories according to his own

evaluation of the seriousness of the patient’s problem

causing this visit. Seriousness refem to the physician’s

clinical judgment as to the extent of the impairment

that might result if no care were given.

Diagnostic services this visit. –Physicians were

instructed to check any of the following services that

were ordered or provided during the current visit:

Limited exam or history: History and physical

examination or both that is limited to a specific

body site or system or is concerned primarily

with the patient’s chief complaint, for example,

pelvic or eye examinations.

General exam or history: History and physical

examination or both of a comprehensive nature,

including all or most body systems.

Pap test: Papanicolaou test, self-explanatory.

Clinical lab test: One or more laboratory procedures or tests, including examination of blood,

urine, sputum, smears, exudates, transudates,

feces, and gastric content, and including chemistry, serology, bacteriology, and pregnancy test

(excludes Pap test).

X-ray: Any single or multiple X-ray examination

for diagnostic or screening purposes. Radiation

therapy is not included in this category.

EKG: Electrocardiogram, self-explanatory.

Vision test: Visual acuity test.

Endoscopy: Examination of the interior of any

body cavity, except ear, nose, and throat, by

means of an endoscope.

Blood pressure check: Self-explanatory.

Other: All other diagnostic services ordered or

provided that are not included in the preceding

categories.

Therapeutic services this risit.–Physicians were

instructed to check any of the following services that

were ordered or provided during the current visit:

Immunization or desensitization: Administration

of any immunizing, vaccinating, or desensitizing

agent or substance by any route, for example,

syringe, needle, oral, gun, or scarification.

Drugs (prescription or nonprescription): Drugs,

vitamins, hormones, ointments, suppositories, or

other medications ordered or provided, except

injections and immunizations. Includes both prescription and nonprescription (over-the-counter)

medication.

Diet counseling: Instructions, recommendations,

or advice regarding diet or dietary habits.

Family planning: Services, counseling, or advice

that might enable patients to determine the

number and spacing of their children. Includes

both contraception and infertility services.

Medical counseling: Instructions and recommendations regarding any health problem, including advice or counsel about change of habit or

behavior. Physicians were instructed to check this

category only if the medical counseling was a

significant part of the treatment. (Excludes diet

and family planning counseling.)

Physiotherapy: Any form of physical therapy

ordered or provided, including any treatment

using heat, light, sound, or physical pressure or

movement, for example, ultrasonic, ultraviolet,

infrared, whirlpool, diathermy, cold therapy, and

manipulative therapy.

Office surgery: Any surgical procedure performed

in the office this visit, including suture of

wounds, reduction of fractures, and draining of

abscesses, application of supportive materials for

fractures and sprains, and all irrigations, aspirations, dilatations, and excisions.

Psychotherap.v or therapeutic listening: All treatments designed to produce a mental or emotional

response through suggestion, persuasion, reeducation, reassurance, or support, including psychological counseling, hypnosis, psychoanalysis, and

transactional therapy.

Other: Treatments ordered or provided that are

not included in the preceding categories.

Disposition this visit. –Eight categories are provided to describe the physician’s disposition of the

case as follows:

No followup planned: No return visit or tele57
phone contact was scheduled for the patient’s

problem.

Return at specified time: Patient was told to

schedule an appointment or was instructed to

return at a particular time.

Return if needed, P.R.N.: No future appointment

was made, but the patient was instructed to make

an appointment with the physician if the patient

considered it necessary.

Telephone followup planned: Patient was instructed to telephone the physician on a particular day to report on his progress or to telephone

if the need arose.

strutted to consult or seek care froml another

physician. The patient may or may not return to

this physician at a later date.

Returned to referring physician: Patient was

referred to this physician and was now instructed

to consult again with the physician who referred

him.

Admit to hospital: Patient was instructed that

further care or treatment would be provided in a

hospital. No further office visits were expected

prior to that admission.

Other: Any other disposition of the case not

included in the previous categories.

Referred to other physician: Patient was in58
Appendix IL Definitions of

terms used in the National

Hospital Discharge Survey

Hospitals and hospital characteristics

Hospitals. –Short-stay speciai and general hospitals having six beds or more for inpatient use and an

average length of stay of less than 30 days. Federal

hospitals and hospital units of institutions are not

included.

Terms relating to hospitalization

Patient. –A person who is formally admitted to

the inpatient service of a short-stay hospital for

observation, care, diagnosis, or treatment. In this

report the number of patients refers to the number of

discharges during the year including any multiple

discharges of the same individual from one short-stay

hospital or more. Infants admitted on the day of

birth, directly or by transfer from another medical

facility, with or without mention o~, a disease,

disorder, or immaturity are included. All newborn

infants, defined as those admitted by birth to the

hospital, are excluded. The terms “patient” and

“inpatient” are used synonymously.

Discharge. –The formal release of a patient by a

hospital; that is, the termination of a period of

hospitalization by death or by disposition to place of

residence, nursing home, or another hospital. The

terms “discharges” and “patients discharged” are

used synonymously.

Discharge rate. –The ratio of the number of

hospital discharges during a year to the number of

persons in the total resident population on July 1 of

that year.

Days of care.–The total number of patient days

accumulated at time of discharge by patients discharged from short-stay hospitals during a year. A

stay of less than 1 day (patient admission and

discharge on the same day) is counted as 1 day in the

summation of total days of care. For patients

admitted and discharged on different days, the

number of days of care is computed by counting all

days from (and including) the date of admission to

(but not including) the date of discharge.

Average length of stay. –The total number of

patient days accumulated at time of discharge by

patients discharged during the year divided by the

number of patients discharged.

Terms relating to diagnoses

Discharge diagnoses. –One or more diseases or

injuries (or special conditions and examinations without sickness or tests with negative findings) that the

attending physician assigns to the medical record of

patients. In the NH.DS all discharge (or final) diagnoses listed on the face sheet (summary sheet) of the

medical record for patients discharged from the

inpatient service of short-stay hospitals are transcribed in the order listed. Each sample discharge is

assigned a maximum of five 3- or 4-digit codes

according to the Eighth Revision International Classification of Diseases, Adapted for Use in the United

States (ICDA),1s and coding modifications for use in

the NHDS. The number of principal or first-listed

diagnoses is equivalent to the number of discharges.

First-listed diagnosis. –The coded diagnosis either

identified as the principal diagnosis or listed first on

the face sheet of the medical record. The number of

first-listed diagnoses is equivalent to the number of

discharges.

All-1isted diagnoses. –First-listed diagnosis and all

other diagnoses in positions 2-5 on the face sheet of

the medical record.

Terms relating to surgery

Discharges with surgery. –The estimated number

of surgically treated patients discharged from nonFederal short-stay hospitals during the year.

Operation. –One or more surgical operations, procedures, or special treatments that are assigned by the

physician to the medical record of patients discharged

59
from the inpatient service of short-stay hospitals. In

the NHDS, all terms listed on the face sheet (summary sheet) of the medical record under the captions

“operation, ” “operative procedures,” “operations

and/or special treatments,” and the like are transcribed in the order listed. A maximum of three

3-digit codes is assigned per sample discharge according to ICDA and NHDS directives.

All-listed operations. –All coded operations listed

in positions 1-3 on the face sheet of the medical

record exclusive of certain obstetrical procedures,

diagnostic endoscopy and radiography, radiotherapy,

and certain other treatments not generally considered

as surgery.

Demographic terms

Age. –Patient’s age refers to age at birthday prior

to admission to the hospital inpatient service.

Race. –Patients are classified into two racial

groups, “white” and “black and all other. ” The black

and all other classification includes all categories

other than white. Mexican and Puerto Rican are

included in the white category unless specifically

identified as all other.

60
Appendix Ill. Definitions of

terms used in the National

Nursing Home Survey

Terms relating to facilities

Facility. –Nursing homes included in the 1977

National Nursing Home Survey were those classified

by the 1973 Master Facility Inventory (MFI) as

nursing care homes, personal care homes with nursing, personal care homes, and domiciliary homes.

Also included are nursing homes that opened for

business between the time the 1973 MFI was conducted and December 1976. A nursing home must

have three beds or more and may be either freestanding or a distinct unit of a larger facility.

Terms relating to discharges

Discharge. –A discharge is a person who was

formally discharged from a nursing home during

1976. Both live and dead discharges are included.

Theoretically, the same person can be counted more

than once if he was discharged more than once from a

nursing home during 1976.

Age. –The age of a discharge is his age at the time

of discharge.

Discharge status. –The discharge status is whether

the person was discharged from the nursing home

alive or dead.

Length of stay. –The length of stay is the period

of time between the date of admission and the date

of discharge.

Living arrangement after dzkcharge for live discharge.—The living arrangement after discharge refers

to the residence where the person lives after being

discharged.

Another nursing home. –Another nursing home

includes domiciliary or personal care facilities,

intermediate care facilities, and skilled nursing

facilities.

Other health facility. –Other health facility includes chronic disease, rehabilitation, geriatric

and other long-term care hospitals, and facilities

for the mentally retarded.

Private or semiprivate residence. –Private or semiprivate residence includes houses or apartments,

rented rooms, boarding houses, and retirement

homes.

Marital status at time of discharge. –Marital status

is the marital situation of the discharge at the time of

his release from the nursing home.

Health Services

Level of care received. –These levels of care are

defined by the nursing services actually received

by the discharge during the 7 days prior to the

discharge date. Based on the services listed in item

11 and responses to item 10b of the Discharged

Resident Questionnaire, the following classifications were made. Each succeeding level is exclusive of the previous levels:

Intensive nursing care.–Intensive nursing care

includes receiving at least one of the following

services:

Bowel/bladder retraining

Catheterization

Full bed bath

Intravenous injections

Oxygen therapy

Note that tube or intravenous feeding, included in

the comparable definition for residents, is not

included in this definition.

Other nursing care.–Other nursing care includes

receiving at least one of the following services:

Application of sterile dressings or bandages

Blood pressure reading

Enema

Hypodermic injections

Irrigation

Temperature, pulse, or respiration check

Personal care or none. –Personal care includes

receiving at least one of the following services:

Medication prescribed at last physician visit

Rub or massage

Special diet

61
None includes those discharges who received none

of the preceding services.

Note that the medication service in this

definition is not identical to that for residents

(administration of treatment or medications).

Furthermore, help with bathing, dressing, or

eating (included in the comparable definition

for residents) is not included in this definition.

Therapy service. –Therapy service refers to

whether the discharge received any therapy services provided by a licensed, registered, or professional y trained therapist during the calendar

month prior to the discharge. These services may

have been provided either inside or outside the

facility.

Time since last physician visit. –This is the length

of time between the date of discharge and the last

time the person saw a physician (M.D. or D,O.)

while still a resident of the facility for treatment,

medication, or examination.

Health Status

Activities of daily living. –The activities of daily

living were collected for discharges in the areas of

continence and mobility only, based on information on the medical record concerning performance at the time of discharge.

Continence

No difficulty controlling bowels or bladder. –The discharge did not have any

difficulty in controlling either ~is bowels

or bladder at the time of dischafge.

Difficulty controlling bowels. –The discharge had difficulty controlling his bowels at the time of discharge.

Difficulty controlling bladder. –The discharge had difficulty controlling his bladder at the time of discharge.

Ostomy in either bowels or bladder. –The

discharge had undergone a surgical procedure that resulted in the creation of an

artificial opening for the elimination of

waste.

Mobility

Walks with or without assistance. –The

discharge was able to walk at the time of

discharge, either with or without assistance of special equipment or another

person. This category excludes those discharges who were chairfast, bedfast, or

whose status was unknown.

Bedfast. –The discharge was confined to a

bed when discharged.

Primary diagnosis at admission. –The primary diagnosis at admission was the one

condition reported by the nursing staff

respondent as the major diagnosis noted

at the time of admission. The list of

conditions corresponds to the Eighth Revision International Classification of Diseases, Adapted for Use in the United

States (ICDA), 15 The respondent reported the information based on the

discharge’s medical record.

Chronic conditions and impairments. –

Chronic conditions and impairments include those long-term physical and mental

problems of the discharge selected by the

nursing staff respondent from a list of37

conditions and impairments (see item 8 of

the Discharged Resident Questio:nnaire).

The respondent based the selection on a

check of the medical record. More than

one condition or impairment ccmld be

reported.

Special aids or devices used. –This category

includes only those special aids or devices used on

a regular basis (see list in item 13 of the

Discharged Resident Questionnaire). Definitions

for selected special aids and devices are presented:

Cuffs. –Cuffs are hand or foot devices consisting of a fabric cuff that is placed around the

waist or ankle, with a second strap attaching

the cuff to a side rail or belt. It is used to

protect the resident from injuring himself.

Geriatric chair. –A geriatric chair is a padded

chair or a combination chair and table with

small wheels and with a high back., It is

designed to support the resident.

Mechanical feeding device. –A mechanical

feeding device is any adaptive equipment that

helps the resident to feed himself.

Posey belt or similar device. –A posey belt or

similar device is an apparatus that may be

used either in a bed or a wheelchair tc~secure

chest, waist, or legs.

Walker.–A walker is a device that the resident

uses on his own to support himself while

walking.

Other. –Other special aids or devices include

slings, artificial limbs, orthopedic shoes,

shower chairs, page turners, and devices other

than those listed in the tables.

Chairfast. –The discharge was confined to

a chair when discharged.

62

NOTE: A list of references follows the text.
Appendix IV. Questionnaires

used in the National

Ambulatory Medical Care

Survey, the National Hospital

Discharge Survey, and the

National Nursing Home Survey

4’

. .

Patient Record and Patient Log

PATIENT LOG

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I

PATI ENT’S NAME I

TIME OF

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CONTINUE LISTING PATIENTS

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ASSUHANCE 06 CONFIC&NTIALITY -All Inl., rn,,,cm whkh would w,rn,, i,id.’,f~,,c.n d ~ $nd,.,duml.

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1. DATE OF vISIT PATIENT RECORD

/ / NATIONAL AMBULATORY MEDICAL CARE SURVEY

M. ,’04”I Y,

2. OATE OF BIRTH 3. Ssx 4. SOLOR OR 5. WAS ●ATIENT 6. PATIENrS COMFLAIFAT(S),SYMPTOM4SI. OR OTHER

RACS REFERRED FOR REASOFAIStFOR THIS VISIT

THIS VISIT W on .airmll’I owl WWIA)

,. 1 n WHITE I AHOWEFS

Ez%--- 1 n FE M41.E

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* ❑ f4EGFL0/

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PNYSICIAN? s. MOST

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. 0 MALE * o YES

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I . ❑ UNKNOWNI 8rlr.Jo I

!

7. TIME SINCE OMSET

OF CON? UINTI

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I ❑ LESS THAN 1 DAY

1 D 14 OAYS

* n 1.3 WECKS

. 0 14 MONTHS

80 MORE THAN

3 M0N7Hs

B. ●HYSKmN%OIAGNOSES 9. mvE YW SEEN 10. SERIOUSNESS OF

PATIENT ●EFORE? COtiDITION IN

. . WIINCIPAL OIAGNOSISIPBODLEM ASSOCIAT60 WITH ITEM & fClnck and

ITEM 6. 1 ITI YES 10NO

+ I ❑ VERY S!3R10-

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a ❑ Sfnlovs

b. OTHER SIGNIFICANT CURRENT OIAGNOSES ITEM w , •1 ::”:J&#

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s ❑ NOT SERIOUS

I

11. OIAGFN)STIC SERVICES THIS

VISIT l-k ●ll wcbd or m?wdm+i

, D NONE

, ❑ LIMITED EXAMII’IISTORY

, ❑ G6NE13AL EXAMIIWSTORY

‘ D PAP TEST

s ❑ CLINICAL LAa TEST

4 0 X. RAY

, ❑ EKG

. D VISION TEST

. 0 ENOOSSGPY

o 0 OLOOD PRESSURE CHECK

, 0 OTHSR 1~,(”)

12. TIiEMFEuTIC SERVISESTHIS

V&lT ldnck al{ ordwsdorprnvrdtd)

I ❑ NONE

1 0 1A3AUN48ZATION1

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* o bMuGS IPRESCR1PTIONI

NONPRESCRIPTION)

. ❑ WETCOUNSELING

s ❑ FAM, LY PUNNING

. ❑ ME OICAL COVfWEL.lNG

t Ki tIiYSIOTHERAPY

● ❑ OFFICE SURGERY

● ❑ ?SVCHOTHERAPYI

TMLFIAPt UTIC LISTENING

,. U OTHER&/.c,/yJ

0E?Aft7MEN7 OF HEALTH, EOUCATII

*UBLIC MEALTH SERVl

HEALTH RESOURCES AOMINI:

NATIONAL CENTER FOR HEALTI

I I

13. OIS?OSIIIOMTHIS VISET

(cImck4 thw a71NY)

1 D NO FOLLOW.UP ●LANNED

‘ O RETURN AT *ECIFIEO TIME

m O RETURN IF NE EOEO, ●.m.N.

4 0 TELEPMONE FOLE.OW.UP ●LANNED

‘ O ftEFERflEO TO OTHER ●HYSICIAN

. ~ :;:8;:: 10 REFERRING

T ❑ AOUIT TO HOSPITAL

‘ o OTHER f.%a2fYl

1AND wELFARE

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14. OUflAT~ OF

THIS VISIT

vi- Uwdlv

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63
-.

CONFIDENTIAL

Form Approved: 0.M.13. No. 68+C520

- All infotmarion which would permit identification of an individual or of an establishment will lbe held

confidential, will be used only by persons engaged in and for the purposes of the survey, and will not be disclosed Or released TO

xher persons or used for any other purpose.

FORM HDS-I

,~ 2-la-75)

QEPARTMEN7 OF H=LTU, EDUCATtON. ANO WELFARE

PUELIC t$EALT14 SERVICE

HEALT!4 REsOURCES ADMINISTRATION

NATIONAL CENTER FOR HEAL?H STATISTICS

MEDiCAL ABSTRACT - HOSPITAL DISCHARGE SURVEY

A. PATI!ENT !DENTIFICAT:ON Month

1. Hospital number . . . . . . . 11111 4. Date of admission . . .m-EdT

2. HDS number . . . . . . . . . . 5. Date of discharge . . .m-m-m 3.Medical Record number 6; Residence ZIP Code

B. PATIENT CHARACTERISTICS I

Month Day

1 ~ Years

Year

m-m-m ~’” m{ ‘%eLy;%:t;:{;Jn) ~-0“n”s313W. 2 ~ Months

7. Date of birth. . . .

9. Sex (Mark one) I t ~ Male I 2 ❑ Female 3,~ Not stated

i

10. Race or Color (Modt one) ~ I ‘~ whi~e 2 ~ Black 3 ~ Other 40 Noc stated

I

1?. Marital Status (Mark one) i I ~ Married 2 ~ single 3 ❑ Widowed 4 ~ Divorc-d s ❑ Somrated 6 ~ Not stated

12. Expected Source(s) of payment 13. Disposition of Patient (Mark one)

Principal Other

(Mark On.9) (Mark all that apply)

In ~ Self-pay

2D

1 ~ Roucina dischsrge/discharged home

~ Workmen’s Compensation

30 ~ Medicare 2 ~ Left against medical ●dvice

40 Q Medicaid 3 ~ Discharged/transfused to another

so ~ Other government payments

facility or or@nization

6~ I_J 81ue Cross 4 Q Discharged/roforred to organized

7~ ~ Othw private or commercial insurance home car. service

Bn ~ No charge 5 ‘~ Diti

s~ D Other (Speo/ty)

100 0 Not stated 6 ~ Not stated

C. DIAGNOSES

Principal:

Other/additional:

O See reverse side —

D. SURGICAL AND DIAGNOSTIC PROCEDURES Date: —

Month Day Year

Principal: m-m-m

Other/additional: m-men

m-m-m m-m-lm

m-m-m QNONE O See reverse side

~ompleted by Date

#?tlS 00VitRMMS?WT ?MNTING O,*U$R t974_--

64
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE OMB # 68-S7S02S

Health ResourcesAdministration 1

A~ROVAL EXPIRES 12-31.77 I

National Canter for Health statistics DISCHARGED RESIDENT UUESTIONNAIRE

1977 National Nursing Home Survey Control No. 1!! 111

Confidential Information

Information containad on this form which would permit identification of any individual or a~blishment ha$ bewr colkted with a guar.

antee that it will be haid in strict confidence, will be used only for pur~ ~tad for this study, and will not b. disclosedor releasedto

others without the consent of the individual or the establishment in asdanoa with won 30S (d) of the Public Heaith service Act

, (42 USC 242m).

A. Raaident I&w No. B. Date of Interview C Date of Discharge

[1111 mmlil mam

MO, Day Year MO. Day Year

I

D. Intarvicwer Nams E. Stm Tim.

llJam

Zopm

1. WHAT WAS THE OATE OF ADMISWON PRIOR TO THE OISCHARGE OATE OF (Data of Didratye)?

I.dww

Mo. Day Yeer

2 WHAT WAS THE SEX OF THIS RESIOENT?

1 a Male z a female

3. WHAT WA~llATE OF BIRTH?

WWILU-Llor LUJ

Mo. Day Year Age

4. WHAT WA~ AtWTAt. ~ATUS AT UISCHARGE?

I n Merriad 2 n Widowad 30 Divorced 4 Cl Sapamtad s a Nwer Married 90 Don’t know

5. WAs —OISCHARGEO ALIVE?

10 Yes

20 No (W%t to instructionAow Q-7)

9 a Don’t know (S&tl?m instruction ●bow U}

65
k WHERE OIO~AYIMMEOIATELY AFTER OISCHARGE FROM THlSFAClLlTY?

I aPrivata residence (housa or apartment) (Skip toinarruction dwwQ.7)

2 a Rmted r~m, bowding house (Skip to instructiofl @howG7)

3 ~ Retirement home {Skip to inauuczion abow CL7)

4 a AISOthW health care facility

s 0 Other mrangamante, SIAN [Skip to inmruction abow CL7)

9 a Don’t know {Skip m inwvction Aww Q.7)

b. I Show Fhahcard #l I WHAT TYPE OF FACIMTY WAS IT?

I 0 Domiciliary or parsonal car. facilitv

2 a lntertitate Car* Facility (ICF)

30 Skilled Nursing Facility (SNF)

4 ❑ Facility for mentaily retarded

s ❑ Gcnerai or short term hospital

60 Mental hcmitd

7 a Chronic disaase,rehabilitation, geriatric or odwr long-term care hospital

00 Other, Specify {SW to instruction abwa CL7)

9 ~ Don’t know (Skip m insuuctbs abow. 0.7)

es 010—fllE IN THIS OTHER HEALTH CARE FACILITY?

I O Yes 2 U.NO 9 a Don’t know

Intarviaww, Reed: ‘3MCE THIS RGSIOENT HAS 8EEN DISCHARGEII, THE REMAINING QUESTIONS REFER TO HEALTH

STATUS AT———THE TIME —OF OISCHARGE, THAT 1$ ON (Data of Dikitarge in itamCJ.”

{NTER VIEWER NOTE: /f the raw”dentwvain the home leasttran nwiw month prior m diachwga, mark this box O and skip to Q.8.

otharuha,. wntinua WI”iha7a.

7& 010—RECEiVE A FIU SHOT WITHIN THE lWELVE MONTHS PRIOR TO (Qata of oischa@?

10YLIS 2 a NO (Skip m Uc) 9 ❑ Don’t Know. No Record (Skip m 0.7c4J

k WHEN 010 —RECEIVE THE FLU SHOT?

a, 010—CATCH THE FLU DURING THE NINE MONTHS PRIOR TO (Data of~ischaqm)?

lcJYas 2 a NO (Skip m a8) 9 a Don’t Know - No Record (skip m G8.)

& WHEN 010 —CATCH THE FLU?

~ W aDon’t know

mo. yr.

66
8. Show Fkbcd #2 010 —HAVE ANY OF THE FOLLOWING CONDITIONS OR IMPAIRMENTS? (Mark (X) ail rht

~plyj -

❑ None of the conditions

A. Mentai Conditions/impairments

a (1] SeniliW

O (2} Mental Retardation

O (3) Mmtal Illness

n (4) Chronic Brain Syndrome

INTERVIEWER NOTE: If the ~ondent reporu that the rest-dentm both mentally retarded

and mentaify ill, mark this &wx ~d red: HAVE i RECORDED CORRECTLY THAT—

WAS MENTALLY ILL ANO MENTALLY RETARDED? If necesswy, correct.

B. Phvsicai Conditions/impairments

(3 (5)

o (6}

c1 (7)

c1 (8}

c1 (9)

0(10}

Cl(n)

❑ (121

13 (-!31

0(14)

❑ (15)

c1 (16)

0(17)

~ (18)

0(19)

n (20)

U(21)

o m

O (23)

a (24)

~ :25;

a (27)

0.(28]

o (29)

n (30)

Hardening of the Arteries

Stroke

Hypertension

Heart Trouble

Edame (Fluid Retention)

Arthritis/Rhaumti”sm

paralysisor Palsy other than arthritis - stroke related

Peralysisor Palsy other than afihritis - unralatad to stroke

Parkinson’s Oheasa

Kidnev Trouble/Chronic Urinary Tract Infections

Constipation

Insomnie

Diabetes

Cancer

Deafness

81indness

Glaucoma

Cataracts

Chronic Respiratory Disaasa

Anemia

Bedsores

HipFractures

Other Fraotums

Alcoholism

Drug Addiction

Chronic Sack/Spine Problems (excIuding Stiffms and Deformitv)

permanent Stiffness or Deformity of:

U (31) back

: pi :

a (34) extremities (feat, toes, hands or flngarsl

Missing Limbs or Extremities:

lZl (35) arms

a (36) legs

O (37) extremities (feet, toes, hands or fingers]

O Don’t know

67
8. 9tow F!adtcad #3 ACCORDING TO~EOICAL REiXIRO, WHAT WAS THE PRIMARY DIAGNOSIS AT THfi TIME

OF ADMISSION, THAT IS, ON (Oatwof Admkh in Q 1)?

A. Heart and Other CXrouletoryProblwrra

oi O Congestive Hewt Failure (C.H.F.)

02 ~ Hardening of the Artaries (Artarioschrosi$. A.S.H.D.)

oa U Haert Attack, Ischemic Heart Oisaase(Acute MYocardial InfarctionW.I.)

os O High Blood Pressure(Hypertension)

OS ~ PhMitis

06 U Puimorrarv Embolism

07 a Rheumatic Hesrt Disease

Oe o Stroke (Carabrovasodar Oiseme<.VA.)

09 a0th9r Circulatory Probkms, Specify

8. Mental Disorders

10 Cl Chronic Brain Wdrome

II n Mental Retardation

12 0 Naurosis

13 0 Psvchosis(Schizophrenia, Paranoie, Manic Depression, etc.)

140 Senils %2hosis (Senile Oementie)

is 0 senile, Not Psvchotic

I c o Other Mentai Disorders, Speafy

C. Other Oiagnosas

17

la

19

20

21

22

23

24

25

26

27

28

23

30

31

32

33

34

3s

36

37

3a

39

40

41

42

99

~ ;:+fism

O Arthritis/Rheumatism

~ Asthme

~ Blindness

n 8one Fracture, other than HiP

n Bronchitis

~ Cancer (Malignant Neoplasm)

Cl Cataracts

D Cirrhosisof tha Liver

0 Deafness

a Diabixes

O Orug Addiction

O Emphysema

o Epilepsy

O Glaucoma

a Gout

a Hip Fracture

O Mtdtipie %ierosis

Cl Parkinson’s Oiseasa

0 Pneumonia

Q Polio

a Respiratory, other than Pneumonia

O Syphdis

c1 Ulcws

a Other, Spacifv

o Oon’t know

68
I@ DURING THIS PARTICULAR STAY. WHEN 010 —LA= SEE A PHYSICIAN FOB TREATMENT, MEDICATION, OH

FOR AN EXAMINATION7

~ W U or Cl *rsaw a doctor during this stav (Sk@ iv Qfl) ao~’t know (skip’ m Q.11~

Mo. Oajt Year

IL AT THAT TIME OIO~ECEIVE

{1) AN EXAMINATION?

~ ~o Oon’t Know

la 20 9(J (~A PRESCfNtTIOti (INCLUDING REFILLS)? 10 20

(3) TREATMENT?

90

(4) ORtlERS FOR LABORATORY TESTS?

ICI 2!3 90

(5)ANY OTHER SEHVICES?

la Za 9cl

la 2a 90

{

SPdfv

11. ShOw Fiad)card#4 ] WRING THE LASI’7 DAYS BEFORE DISCHARGE, THAT 1S, FROM (Data 7days pr;or to discharge

&ta) TO mata of Diachar#,WHiCti OF THESE SERVICES OID— /3ECEiVE? (Mark (X) all that amly)

Cl a BIWd prasurereading

a b. Temperature-puke-respiration

n G Application of sterile dressingsor bandages

ad. Full bad-bath

~ e. Rub or massage

a f. Enema

0 g. Catheterization

n h. Bowel ratraining

~ i. Bladder retraining

Cl j. irrigation

U k. Oxygen therapy

aLIntravenous inbction

am. Hypodermic injection

Cl n. Administration of other medical treatment by staff

00. special diet

i

(1} WHAT TYPE OF DIET WAS IT? (Mark

na. diabetic ab. low sodium

Uf. weight loss O g. weight gain

D None of the above servicesreceived

n Don’t know

(x)all thatapply)

O c. bland ad. soft 13e. tow cholesterol

ah. Other, Specify

69
la DURING {Last ca{mdw monrh futi dixhr@ OF 1976,010 —RECEIVE ANY THERAPY SERVICES EITHER INSIDE

OR OUTSIDE OF THIS FACILITY FROM A LJcENsEf), REGl~ERE~, OR P~aFE~/ONALLy TRAINED THEMP!ST?

1 c1Y9S 20 No {~itl ZU ~ 13) 9 Cl Oon’t IUIOWSkb m a13)

h Show fhshatd #5 WHICH TYPES OF THERAPY 010 —RECEIVE DURING THAT MONTH? (h4wk (X) dt rhar

apply)

(1) Phyaicai therapy a

(2I Occupational thwapy c1

(3) Racraationai therapv a

(4) Spaach and haaring therapy c1

(S) Counseling/tharapy by a psvchkriat, paychokgi~t, or othar mwxai haalth workw o

(6) Counselingby social workar c1

(7) Rdity orimtation o

(8) Other thuapy sarvib, SpadfV 0

13. 9row Fladcad #$ 0[0 —REGULARLY USE AtiY OF THESE Al OS? (Uuk {X) dl thatwply)

~ a. Eya ghasas ~ i. Artificial limb

a b. Hearing *id ~ j. Maohanical fading dwica

Cl c. Wheelchair n k. t%thof.mdic the@

ad. Cana Cl L Griatric chair

O e. Walker um. Posav bait or similar dwkat

c1 f. Crutchaa 0 n. Cuffs

O g. Bracas Cl o. Othar aidior dwicas, Spacify

ah. SNnga

~ No akhuaad

O Don’t know

70
I&. W~EDFAST?

1 C3 Yaa (skip to a 1s) 20No 9 n Don’t know

b. WAS====CflAIRFAST?

10YOS 2nNo s 0 Oon’t know

16s olo— HAVE AMY DIFFICULTY IN CONTROLLING~OWELS?

layw

2DN0

3 a Not dwiicablo, had an 02tO~

s D Oon’t know

16. DIO— HAVE ANY DIFFICIJLTY IN CONTRtJLLING— 8LADDEFI?

liJYas

aati

3 D Not applicabio, had oatorny, indwlllng cathatar, or cxtarnai davica

s n Don’t know

hwwvicwwr, Rti: THE REMAINING QUESTIONS DEAL WITH CHARGES ANO PAYMENT SOURCES.00 YOU HAVE THIS

INFORMATION?

1 ay@~Gg~mti~~f7~

a a No (L?aumim wi?o/m infdmmion and Am you fraw comphtcd ail tic Dkhged Rasidant@astionnaires,intaniew tiat

m * th9infbrmatfonuain@FKwnptCad #l 1.)

1 am

F. End Tim— a mm 01ap32d u Minutaa

ZaPm

H. Start Tim

1 am

-Zam 4

INTERVIEWER NOTE: BmbmProcadhs, * m h adm- data in Q 1. If m“tit w admittada tiw fht day of tie cahf~

monthpmwcfing th datw of diach~, nwd thisbox a uuf skip w Q I& OtWwia, continw with a 17.

17. FOR THE MONTH OF (ht abndarmonth beforedi’L WHAT WAS THE TOTAL CHARGE 51LLED Fil R—CARE.

l~CLUOING ALL CHARGES FQR PRIVATE DUTY NU*ING, DRUG% ANO SPECIAL MEDICAL SUPPLIES?

/

sm.ocl par

{

D No thaw made for ara, Explain:

x a facility aswmad cost

2 •l Initial paynttndlife cam arrangwnant

30 Othar, SK”*

2aQaY

aaw~

4~Month

30 Othar padod,Specify

c! Oon’t know (Not billad Yat, 8W.)

EEzl

71
It FROM (Oataof Adtnitaibn) THROUGH (oam of Oi&a#, WHAT WAS THE TOTAL CHARGE BILLED FOR —CARE,

INCLUOING ALL CHARGES FOR PWATE OUTY NURSING, ORUGS, AftU SPECIAL ME~WAL SUPillES?

{

10 Entira rwortintj period

2 n Day

$m.oo * 30 Weak

4 u Month

s c1 otherPwiod, sPacifY

O No ohsrgamada for oaro,.xplain:

I o Faciliw assunwdcost

20 Initial paymantllifa am arrwrgmrent

3aothor,sP3cifY.

a Don’t know (Not billad Yet, MG)

1% [~] WHAT WERE w THE SOURCES OF PAYMENT FOR—CARE DURING THIS TIME? (Mark (X)

dl tfwt4?p&)

D& Own incoma, family support, haaith insuranc#, a g. VA contract

mtiramant funds, social sacurity, ct~ ~ h. Initial paymant.4ifc oara funds

~ b. Madhro O L No otrargcmad. for owe (F3cility assumadcost)

a c, Modlaid.t~ nursing O j. Psymant sourcanot dstermirwd (Skip to nom

~ d. Mdicaid.intarmadiaQ care -w Q.21)

Cl c. Other govammant asaistana or waifwa ~ k. Qtlwr, $wcifv

Of. Religiousorgwtizations, foundations, voluntnr

a Don’t know --

a [’%Gxxzq WHAT WAS THE PRIMARY SOURCE OF PAYMENT FOR —CARE DURING THIS TIME?

03a a. Ovm incoma, famiiy support, hcaith insuranc8, 07~ g, VA ~n~~ 9

ratiramnt funds. social s8curity, ate. 0.0 h. Initial payment-lifa am f~ds

oa~ b. Madicara w n i. No chargomade for care (Facility assumedcost)

@O c. Mcdiaid- nursing 10U j. Payment sourca not determinw. (Skip ro nom

oaO d. Madicaid-intarmediaq carQ &&w Q.2?)

0sas. Ottmr gov4mmont assistanw or wcifaro II D k. Other, %acifv

m O f. Rtiigious organizatiotw, foundations, vokmtaar

agancias M ~ Don’t know

21. WHAT WAS THE AMOUNT PAID BY THE PRIMARY SOURCE OF PAYMENT OURING THIS TIME?

s~.rnl a Don’t know

INTERVIEWER NOTE: Be wre w fill in rhoittwts balow and continue to next Di&amrd Rm”dent Chsstionnaira.

,

1 03m

L End Tin J. Tim. Elapsad ~ Minutas

2Clpm

&

72
‘ital and Health Statistics series descriptions

=RIES 1.

‘RIES 2.

~RIES 3.

=RIES 4.

ZRIES 10

ERIES 11

:RIES 12.

SRIES 13,

Programs and Collection Procedures. -Reports describing

the general programs of the National Center for H~alth

&EItiStiC5 and itS offices and divisions and the data .x+

Iection methods used. They also include definitions and

other material necessary for understanding the data.

Data Evaluation and Methods Resaarch.-Studles of new

stati$t!cal m,?thodology includ[ng experimental tests of

new suwey methods, studies of vital statistics collection

methods, new analytical techniques, Ob]ective evaluations

of relatability of collected data, and contributions to statistical theory.

Analytical and Epidemiological Studies. –Reports preSent)rrg an~lytic~l or interpr~tive studiesbasedon‘Vital

and health statistics, carrying the analysis further than

the expository types of reports in the other series.

Documents and Committee Reports. –F!nal reports of

major committees concerned with vital and health statistics and documents such as recommended model vital

registration laws and revised birth and death cert!flcates.

Data From the National Health Interview Survey .-Stat! stlcs on Illness, accidental !njurles, d!sabtiity, use of hospital, medical, dental, and other services, and other

health-related top[cs, all based on data collected In the

continuing national household interwew survey.

Data From the National Health Examination Survey and

the National Health and Nutrition Examination Survey.–

Data from direct examination, testing, and measurement

of national samples of the civilian nonlnstitut]onal tzed

papulatlon provide the basis for (1) estimates of the

medtcally defined prevalence of speclhc diseases In the

Umted States and the dlctr!butlons of the population

with respect to physical, physiological, and psychological character! stlcs and (2) analysis of relationships

among the various measurements v~!thout reference to

an cxpllclt fmlte universe of persons.

Data From the Institutionalized Population Survey s,- Dtscontinued in 1975, Reports from these surveys are in.

eluded in Series 13.

Data on Health Resources Utilization.–Stat]stics on the

utllizat!on of health manpower and facilities provid!ng

SERIES 14.

SERIES 15.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

long-term care, ambulatory care, hospital care, and family

planning services.

Data on Health Resources: Manpower and Facilities.–

Statistics on the numbers, geographic distribution, and

characteristics of health resources including physicians,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facilities.

Data From Special Surveys.-Statistlcs on h,ealth and

health-related topics collected in special surv?ys That

are not a part of the continuing data systems of the

National Center for Health Statumcs.

Data on Mortality .–Various statistics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other demographic variables; geographic and time series analyses;

and statistics on characteristics of deaths not available

from the vital records based on sample surveys of those

records.

Data on Natality, Marriage, and Divorce. –Var[ous statistics on natality, marriage, and divorce other than as

included in regular annual or monthly reports. Special

analyses by demographic variables; geographic and time

:eries analy~e~; studies of fertility; and statistics on

characteristics of births not available from the vital

records based on sample surveys of those records.

Data From the National Mortality and Natality Surveys.–

Discontinued in 1975. Reports from these sample sumeys

based on vital records are included tn Series 20 and 21,

respectwely.

Data From the National Survey of Family Growth. –

Statistics on fertility, family formation and-dissolution,

family planning, and related maternal and infant health

topics derwed from a periodic survey of a nationwide

probability sample of ever-married women 1544 years

of ags.

For a list of titles of reports published in these series, write to:

Scientific and Technical Information Branch

National Center for Health Statmtlcs

Public Health Service

Hyattsville, Md. 20782
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Office of Health Research, Statistics, and Technology

National Center for Health Statistics

3700 East-West Highway

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

POSTAGE AND FEES PAID

U.S. DEPARTMENT OF HHS

r

/;

HHS 396 A

Third Claw :

from the Office of Health Research, Statstlcs, and Technology

D1-lliS Publication No. (PHS) 81-1720, Series 13, No. 59

for listings of publications in the VITAL AND HEALTH STATISTICS series, call 301-436-NCHS