What is reasonable is true

WHAT LIFE

SATISFACTION DAY

IS REASONABLE

IS TRUE*

AND FUNCTIONAL DISABILITY HOSPITAL PARTICIPANTS

KAREN R. GRANT’

and

NEEYA

L.

AMONG

CHAPPILL’

‘Department of Sociology, Boston University, Boston. MA 02215. U.S.A. and ‘Centrc on Aging. University of Manitoba. Room 33X. lsblster Building. Winnipeg, Manitoba. Canada R3T IN2 Abstract-

Among the several kinds of health care programs enabling the elder11 to maintain communil) residence is the geriatric day hospital. An investigation was undertaken. utilizing structured interviews. lo determine what factors Influenced life satisfaction and functional disability among the elderly attcnding three day hospitals in Winnipeg. Canada. Findings indicate that the major predictors of functional disabihty include perceived health. Canadian ethnicity and dltrerentlal serwces. Those for life satisfaction (activity. socio-economic status and health) were similar to those cited for elderly generally in the population

GEUERAL LIFE S.ATISFACTIO~ FLlhCTIOUAL DISABILIT\

Social science studies among the elderly frequently focus on measures of overall well-being (life satisfaction, contentment, morale) and of health (particularly favoured are definitions of functional ability). To date many of these studies have focused on captive longterm institutional samples with increasing attention on those elderly living in the community [l-4]. Recent efforts, however. have been made to introduce programs and policies which will provide the elderly with an array of socio-medical services in the community and permit them to remain in their homes. Given the recency of such programs. little data are currently available providing such information on the users of these services. As relatively new but increasingly popular services to the elderly are initiated, it is important to gain an understanding of those receiving such services as well as to document this information so these programs can be compared with the elderly attending other programs. The purpose of the investigation reported here is to examine the factors related to general life satisfaction among those attending one such programday hospitals in Winnipeg, Canada. Originally designed for outpatient psychiatric care in Russia and the British Isles [4], the contemporary day hospital serves the geriatric community. providing assistance in the form of socialization and medical treatment. The basic purpose of the many day hospitals currently in operation is to provide the elderly with preventive care to defer, if not eliminate, the need for long term institutionalization [S].

Please address

all correspondence

,4UII

A considerable amount of attention has been paid to the concept of life satisfaction. Most common are investigations which deal with life satisfaction. general morale or well-being among the general elderly population. or those who are institutionalized [6.7]. There is. in general. a paucity of data on life satisfaction among day hospital patients. no doubt due to the fact that only recently has the number of day hospitals increased 141. The literature available on the day hospital populations and programmes is evaluational in form, dealing primarily with economic feasibility [5]. Nevertheless. some past findings pertaining to life satisfaction among the hospitalized and general geriatric communities are instructive for the purposes of this research. Life satisfaction, the individual appraisal of life past and present. typically refers to well-being. current happiness or general morale. Numerous measurcmcnt instruments have been utilized. most notably the LSIA and LSIZ scales [S-l I] and global questions used as single indicators. Most influential among the factors predictive of lift satisfaction among the elderly are activity level. financial status and health status 16, 7. 12~~15]. Activity level, as well as social interaction with peers and family supports are important particularI> since widowhood and loneliness through the loss of peers are significant problems among the aged. Socio-economic status (SES) is important as a predictor of life satisfaction. however. the relationship is unique in that there is a positive relationship between these variables only at the extremes 1131. Loss of occupational roles adversely affects life satisfaction. but is explained in social rather than economic terms. That is. working provides the individual with a role as a productive citizen. While income undoubtedly eases the transition from working to retired citizen, the loss of the social role may more critically influence perceptions of life satisfaction among some segments of the elderly population [ 131.

to the first author.

Rewed paper presented at the annual meetings of the U’e.stcvn Associatim of Sociology urtd Amhropolog~. Winnipeg, Manitoba. March, 1981. *This research was supported. in part. by a National Health Research Scholar Award (No. 6607-1137-48) to the second author. This study would not have been possible without the co-operation of the Day Hospitals involved~~ the administration. the staff and the participants. 71

KAKF\

72

R. GKAYT

and N~~uA L.

Health status is a significant predictor of life satisfaction to the extent that concerns over illness. chronic disability and hospitalization pose severe threats to the independence of the elderly 17, 13. 141. As Larson concludes after his review of the literature on well-being: among all the elements of an older person’s Ilk situation, health is the most strong]) related to subjective well-being. People who are sick or physically disabled are much less likely lo express

contentment

about

their lives 161.

The intricacies of the effects of different aspects of health are not. however. so clear. For example. in one study, perceived health emerged as a strong predictor of life satisfaction among the elderly living in the community. in subsidized housing. and care institutions. but the number of chronic conditions emerged as a predictor only among the first and last of these groups. Functional disability was unrelated to life satisfaction [15]. Other factors related to life satisfaction include age. sex, marital status. residence and race. Perceptions of general morale have been found to vary by age groupin particular. declining life satisfaction among the over 60 age group seems to be explained by numerous negative factors impinging on the very old (e.g. restricted incomes. loss or reduction in social interaction and stimulation and declining health). When controls are introduced in analyzing the relationship between age and well-being. the relationship disappears [6]. Regarding marital status. single and married individuals tend to express high scores on life satisfaction, while divorced, separated and widowed persons score lower. Widowhood. as a significant predictor, affects different groups in different ways. For example, those widowed less than 5 years express lower morale. as do younger females in contrast to older widows [6]. With the exception of the importance of widowhood, there are no consistent findings regarding sex differences in life satisfaction [Cl. However, the priority of factors affecting life satisfaction seems to differ among men and women. For example. Bharadwaj and Wilkening 1141 found that for women. family life is most predictive; while for men. health, family and community are most crucial to well-being. Sherman rl61 discovered that the desire for nroximity to thelamknities of the city and satisfaction of creature comforts (e.g. security. convenience, availability of doctors, etc.) led to higher life satisfaction scores among urbanites in contrast to a comparable sample of suburban residents. In sum. much literature indicates that life satisfaction is highly influenced by various socio-demographic variables and contingencies of daily experience. SES. activity level and health are among the Moreover perceived most significant predictors. health most consistently emerges as a predictor of life satisfaction when compared with other health indicators [7, 171. Turning now to our second dependent variable, functional disability may be defined as “functional limitations on the performance of normal daily role activities, as a result of illness or injury” [l&20]. As a socio-medical concept 1211, functjonal disability has been utilized to aid the understanding of the degrees

CIIAPPI LL

of limitations experienced and perceived by individuals from all walks of life~~~from young children to the elderly. Shanas and her associates in the United States, as well as Peter Townsend in Great Britain 122,231 were pioneers in the development of functional status measures. Operating on the premise that activism is the norm in today’s society (or conversely that dependence and inactivity are somehow deviant), these social scientists sought to understand the effects of physical limitations on subjective assessments of health. Recognizing that perceived ill health may be understood more in terms of incapacity or limitations than illness or injury pc’r SC.these and other investigators since have focused considerable attention on the subject of functional disability. Functional disability generally includes the inability to perform activities in four key areas: (I) social role activities (e.g. work. household work or school work); (2) self-care activities (e.g. bathing, dressing and feeding oneself): (3) physical activities (e.g. walking and physical movements); and (4) mobility or ability to travel from place to place [19]. Investigations which focus specifically on functional disability. while frequently using different measures, nevertheless provide some consistency of findings. With the exception of Stewart rt trl. [19] and Isaacs and Neville 1241, who found no significant relationship between sex and functional disability. others seem to report differences between men and women. Shanas et al. [22], Markson and Grevert [25], Haber 1261 and Fillenbaum [27] all report greater disability among elderly women than among elderly men. There is some suggestion that men worry more about their health [l9. 27. 281. This is consistent with other findings reporting worse objective conditions among women which they do not translate to the subjective level [ 17, 29. 301. Stewart ut al. [ 191 found that functional limitations were more common among non-whites. In the same study. negative relationships were found between functional disability and education and family income. when age was controlled. A strong relationship was also found between mobility and income. Living arrangements were a salient predictor of disability in a study conducted by Gutman [-ill. Comparing the elderly in retirement housing and non-age segregated settings, she found greater disability among those in retirement housing and greater independence and mobility among those in non-age segregated settings. These findings concur with those of Kraus rt al. 132, 331 and Agirly in Mar~itoho [34]. The findings in relation to age are inconsistent. Stewart et a/. [I91 and Reynolds 01 ctl. 1351 both report curvilinear relationships between functional disability and age. However, Shanas et ~11.122, 231 report a negative correlation with age while Isaacs and Neville [24] find a positive relationship. Markson and Grevert [25] find no relationship. By way of conclusion, this review highlights a number of factors one would intuitively argue are related to functional disability but do not in fact always emerge as significant. Given the apparent contradiction between assumptions and empirical findings, additional research is warranted. While life satisfaction and functional ability are

What

perhaps the two most researched concepts in social gerontology, the recency of programs such as geriatric day hospitals has precluded their inclusion in existing studies. The increasing popularity and apparent trend toward such programs for the future, suggests it is now time to fill this gap in the research literature. Whether or not one would expect great departures among those attending day hospitals, from the findings reported in the current literature. may be unlikely but it remains an empirical question. S-\RlPLE 4\D

73

is reasonable is true Table

1. Sample characteristics

Variable

0

SKY

Female Male Total

34 74 IOX

37

68

I 00

IO6

32 35 33 I 00

35 22 30

3h 73 31

34 37 35

hlETHODOLO<;I’

The impetus for the recent expansion of the day hospital concept has been four-fold: to save bed space and the relevant costs; to enable treatment to be given at an early stage to patients who might be reluctant to accept inpatient care; to provide a better therapeutic instrument in some cases: and to maintain the patients’ continuity with their families and home environment [4]. Finally. the day hospital removed the burden placed on family members involved in the care of the elderly during the day. In Manitoba there are currently three Day Hospitals. which opened between 1961 and 1974, all of which are located in the urban center of Winnipeg. All provide medical supervision and social relief for patients referred from the community as well as those being discharged from active treatment wards of hospitals All draw their patients primarily from Winnipeg but also accept patients from surrounding areas. One of the day hospitals provides services only for war veterans. The facility is referred to as Veterans Day Hospital (a pseudonym). All three day hospitals have staff consisting of individuals with distinct expertise in either the social and;or medical fields. Two of the day hospitals. Veterans and City. operate on a philosophy of continuing support while the third, referred to here as General, admits patients for a specified period of time. after which they leave the program. Data for this study were collected using structured interviews, during the winter of 1979. All respondents were questioned about basic socio-demographic information. as well as their perceptions of their daily lives, and the receipt of hospital and community services. Functional disability was measured using two different indicators. the Index of Living Skills (ILS) and Shanas’s Index of Disability (SID). These two measures are highly but by no means perfectly correlated (r = 0.51) with one another. Both were included here because of an earlier finding that the ILS measures two, not one, underlying constructs (both light and arduous tasks) while the SID tends to measure one unitary construct. Both. however, are frequently employed research measures in social gerontology [IX]. Life satisfaction was measured using the single indicator. “How would you describe your satisfaction with life, in general. at present: excellent. good. fair, poor or bad?” This question has been found to be highly correlated with the LSIA among Manitoba’s elderly 1347. A total of 109 participants of the three day hospitals in Winnipeg. aged at least 60 years. were interviewed (see Table 1). Most (74 or 6X”;,) were male.

0

Efhic~ir~

Canadian British Other Total

109

IO0

.%ftrrirtrl \tutlrY Single Married Separated;divorced Widowed (under 5 years) (5 years or more) Total

I4 45 I3 36 (7) (29) I ox

I3 42 I2 33 (19) (81)

100

Etlucurior~

Elementary (grades l-7) Secondary (grades 8- 12) Post-secondary Total

32 69 105

31 66 3 100

0cclipL7ti011 Professional Semi-professional Mid-management Unskilled labourer Farm labourer Total

IO1

I 00

Dnr /mspittrl Veterans General city Total

39 “I 36 IO9

45 22 ii I 00

2) 41 13 22

If totals do not equal !09. the remaining represent data or non-applicahlc questions.

20 41 I3 21 5

missing

This overrepresentation of males is due to the population served at Veterans Day Hospital, which is almost exclusively male (149 of the I50 patients at the time of the study were male). Patients included in the study ranged in age between 60 and 101 years. with a mean age of 74. The two largest nationality groups were Canadian (46”,,) and British (23”J. with the remainder having origins in Eastern and Western Europe. Most patients are or have been married at one time. although only 42”,, are currently married. Since widowhood is often considered a critical factor contributing to loneliness and lack of social interaction among the elderly 1361. it is important to note that of those who are widowed (36 or 33”,,). an overwhelming majority have been so in excess of 5 years (Xl”,,). Most patients have received education beyond elementary school (66”,), and some have post-secondary education (3”,,). However. given that many of those interviewed grew up during the era between the first and second World Wars. it is not surprising that few have

KAKW R. GKANI and Nttlu~

74

L. CHAPIV I,,.

Table 2. LII’csatisfaction and pet-ccived health

multiple

regresston

analyses

Llfc satisfaction Independent variables Major occupation Perceived health I Health problems)

Unstandardized P

Standardized

-0.10 0.42 (-O.SI)

-0.23 0.3x (-0.26)

Social activities

0.25

I

0.19

rz

F

0.07 0.15 (0.03) 0.04

f3.74* 17.02*** (7x)1)** 4.103

R’ = 0.26: d.f. = 3 and 91; F = 5.02; P < 0.01: *P < 0.05: **I’ < 0.01; ***I’ < 0.001. Note: The variables shown hct-c include only the best predictors. I.C. those Lxplalnlng at lcast 3”,, of the bariancc or having a slatiatlcally significant relationship. Varlablcs cntcrcd into the analysts but unrelated and thcrcfore dclctcd Included for life satisfaction ILS. sex. age. country of birth. number of sibs. number 111area, education. marital status. number of children. number 111area. current employment. frequency friends seen. change in frequency from IO to I _Syears ago. times per week people sew for specific purpose,. change from IO to I5 qears ago. frequency of attendance at social activitlcs, pastimes. Day Hospital. For perceived health country of birth. number of sibs. number in area. education. marital status. number of children. number in area. major occupation. current employment. frequency friends seen. change from IO to 15 years ago. people seen for specific purposes. change from IO to 15 years ago. clubs and social activities, frequency

of attendance. pastimes. acquired university training. Somewhat related. we find that a relatively small segment of our sample have had professional careers (20”,,). Most have held occupational careers commensurate with their educational level (i.e. semi-professional, mid-management and unskilled labour). One of the aims of the study was to explore differences in the two dependent variables, between patients served by the respective day hospital facilities. The sample was drawn from the three day hospitals as follows: Veterans. II = 49 (4S’J. City. II = 36 (33”J. and General. II = 24 (22”~. Of the I50 patients in the program at Veterans Day Hospital. a random sample of 52 was chosen for inclusion in the study. As Table 1 indicates, 49 persons were included in the study. One refused to be interviewed and two were ‘confused’. At City Day Hospital. 36 of the 61 elderly patients were included in the study. Seven were less than 60 years of age. five were in hospital, and others were not included for a variety of reasons: language barriers (6): current illness (2); confusion (7); refusals (1); and other (4). At General Day Hospital. of a possible 29 patients 60 and over. 24 were included in the present sample (4 persons were less than 60 and therefore excluded). Other reasons cited for exclusion: patients were discharged from the program (3): refusals (1); and other (1). The actual refusal rate for the study was only 3”,, of those contacted. Since the study sample from Veterans was randomly chosen and those from City and General represent near total populations of those 60 and over, not considered ‘confused’. English speaking and currently attending the program, it can be assumed that these data are representative of such Day Hospital participants in Winnipeg. To help understand the similarities and diflerences between the day hospitals. all three were compared along numerous characteristics of the participants: perceived health. sex. education, marital status. widowhood. age, country of birth. health conditions. ILS, major occupation and

social activity. Using r-tests. analyses revealed no significant dilrerence in perceived health between City and Veterans. There was a difference between Veterans and General as well as City and General. a difference which is statistically significant for the former but not the latter. Veterans was of course significantly different from both of the other day hospitals in serving only men. The participants of Veterans also reported greater illvolvement in social clubs and activities than those attending City (P < O.OI). Otherwise these two day hospitals did not differ significantly from one another on any of the other characteristics. When these comparisons were applied to Veterans and General it was also clear that significantly more origin of British attended Veterans persons (P < 0.01). City and General did not differ along any of the dimensions, other than perceived health with participants at Veterans and City Day Hospitals more likely to reveal perceptions of better health than was true of those attending the General. In other words, an examination of the patient characteristics suggests more similarity than differences between the day hospital participants. The factors examined varied somewhat depending on the dependent variable being investigated but all were chosen based on past research. All analyses included demographic variables. Other predictors are discussed in the appropriate sections. The data were analyzed using correlational and multiple regression analyses 137. 381. The latter allows for the inclusion of several variables at one time to determine whether each is related to the dependent variable while controlling for the effects of the others.

The results of the analyses (shown in Table 2) suggest these Day Hospital participants are similar in

What

is reasonable

many ways to the community and institutionalized elderly reported elsewhere in the literature 16. 12, 131. specifically in terms of the factors related to their life satisfaction. Among those studied here, major occupation in life, perceived health (and to a lesser extent chronic conditions) and social activities emerged as statistically significant predictors of life satisfaction. Consistent with existing literature, perceptions of health was the strongest predictor, explaining most of the variance (15”~. Those who perceived their health to be better tended to report higher levels of life satisfaction. The number of chronic conditions (measured using the H.I.S. list of conditions, with an internal consistency reliability coehicient in this study of 0.91) was also a significant predictor of life satisfaction, explaining only 3’:,, of the variance. As expected, those with fewer health problems tended to report higher levels of satisfaction. Functional disability. measured using the Index of Living Skills (internal consistency reliability coefficient of 0.79) was unrelated to life satisfaction (/I = -0.09). The fact that chronic conditions but not functional ability was related. might suggest a medical emphasis in these persons’ lives. perhaps due to the Day Hospital setting. However, it should be recalled that studies of other elderly Manitobans [ 15. 171 revealed similar results, suggesting a general tendency toward a medical emphasis among the elderly. This is consistent with the medical emphasis in the Canadian health care system (as well as that found in the United States). Major occupation in life, a standard social science indicator of SES. was also related to life satisfaction, explaining 7”,, of the variance. Those who had been employed in high level management. as semi-professionals or as professionals were more likely to express higher life satisfaction than those working in other occupations. Participation in social clubs or activities was also predictive of life satisfaction, explaining 4”;, of the variance. Those engaged in any social activity (ranging from 1 to 4 activities in this study) were more likely to express higher life satisfaction than those not involved in any such activity. The frequency with which one participated was, however, unrelated. Furthermore. no significant differences in life satisfaction emerged between the sexes nor the three different Day Hospitals. In studying life satisfaction only 26”/, of the variance was explained in total by the significant predictors, Table 3. Multiple Independent variables Household Perceived Canadian Canadian Married On home Crafts

members health by birth ethnic allegiance care

regression

75

is true

The data reported here, investigating the life satisfaction of a group of Day Hospital participants, suggests that these elderly are similar in some ways to other elderly persons. The factors affecting their life satisfaction are similar to those affecting other elderly living in conventional housing in the community and not attending day hospitals, living in subsidized housing and in long-term care institutions 16. 7, 15, 171. SES, social activity and health (especially perceived health) are the main predictors of life satisfaction known to researchers to date. Functional disability it will be recalled, was measured using two different indicators. The results of the analyses for the Index of Living Skills are shown in Table 3. Elderly persons living with other family members are more likely to receive assistance from these persons, with the tasks of daily living than those not living with family members. Similarly those who are married are more likely to have their spouse help with tasks rather than an outside agency. One would expect other household members to be used as resources when they are available. Those who are on home care are more likely to have greater functional disability (i.e. to have more aid with daily tasks) than is true of those not on home care. This is what one would expect considering the mandate of a program like home care. It might be noted here that whether or not an individual was receiving meals-on-wheels, Victorian Order of Nurses services. friendly visitors or other forms of community aid did not discriminate in terms of functional disability as measured by the Index of Living Skills. Perhaps less obvious is the relationship between doing crafts and functional disability. Those who do crafts as a pastime are more likely to have greater functional disability than those who do not do crafts. The explanation for this relationship might lie in the fact that those able to engage in other activities do not engage in crafts. Since other pastime activities such as listening to the radio, watching television, going on outings, doing exercises and reading. do not discriminate among those with more and those with less functional disability, it would suggest that disability does not play an important role in the determination of these activities. It was also found that Canadians tend to be more disabled than non-Canadians. This association of functional disability with nativity and allegiance is similar to the findings reported by Shanas er ul. [22]. analysis

Unstandardized

index of living skills Standardized

P

/r

r*

- 1.73 - 1.62 -2.01 2.68 -2.67 -1.85 - I .75

- 0.24 -0.23 -0.18 0.23 -0.20 -0.15 -0.14

0.16 0.07 0.04 0.04 0.03 0.02 0.02

F 6.66* 6.15* 3.90 7.09** 4.50* 2.86 2.50

R2 = 0.36; d.f. = 7 and 90: F = 7.14; P -c 0.001 ; *P < 0.05: **P -c 0.01. Note: Variables deleted from the analyses because their coefficients were less than 0.10 and they explained less than 1’; of the variance: number of children livmg. number tn area. number of siblings living, number in area. years living in Winnipeg. age, educatton, income. chronic conditions. sex.

KAKI.U K. GKA\T and Ntt-UA L. CHAPIJEI.I

76

Table 4. Multlple

Independent variables Receiving VON Serwccs Perceived health Receiving meals-on-wheels MD referral to day hospital British ethnicity Therapy. treatment and counselltng at day hospital Canadian ethnicity Females

regression

analyses

Unstandardized /i

Shanas’

index of disability

Standardked P

).L

~ 3.02 -2.19 ~ 2.82 -2.01 3.91

~ 0.24 -0.32 - 0.16 PO.18 0.29

0.16 0.0x 0.06 0.03 0.03

-I.% 1.90 1.76

-0.14 0.17 0.15

0.07 0.02 0.02

I.‘ 7.32** 14.39*** 3.61 4.75* 9.99** 2.6X 3.43 2.93

RZ = 0.42: d.f. = 8 and X9; F = 8.15; P < 0.001 : *P < 0.05: **P < 0.01 : ***P < 0.001. Note: Variables deleted from the analyses because their coelficients were less than 0 IO and they explained less than I”, of the variance: number of children living. number living 111 area. other members of the household, receipt of home care serwccs. marital status. age. years living in Winmpeg. number of siblings, education. Income. chronic conditions.

report the highest scores on their Index of Incapacity among the British when compared with those in the United States or Denmark. It is interesting to note that their British sample complained less than their Americans or persons from Denmark. Whether or not our findings suggest a similarity of Canadians with their motherland in this respect is unknown. It should be pointed out that those claiming British origin and allegiance did not emerge as a distinct group in our sample. Lastly, and not surprisingly. those with more disability were more likely to perceive their health as worse than those with less disability. This relationship between functional disability, one measure of objective health status and the individual’s subjective perceptions of his or her health is consistent with much literature available on the topic (see for example C35.391). Just as interesting are the variables which were unrelated to the Index of Living Skills. The functional disability of Day Hospital patients is similar between agencies in Winnipeg. Also unrelated were: sex, education. income and the number of chronic conditions from which the person suffers. The fact that these variables were not statistically correlated with this measure of functional disability is contrary to much of the literature reviewed earlier. particularly that concerning education and income. It will be recalled that the literature on age was inconsistent. One reason which might account for these ditferences is the multivariate analyses used in this study which controlled for several factors at one time. The findings for Shanas’ Index of Disability are reported in Table 4. These findings. like those just discussed for the Index of Living Skills. also confirm ‘the obvious’ in many ways. There are nevertheless some interesting differences between the two indices which are reflected in the different findings for each. For Shanas’ Index of Disability. both those receiving the Victorian Order of Nurses and meals-on-wheels services are more likely to be disabled than those who do not receive such services. For this measure, however, receiving home care services does not discriminate. Not unexpectedly. those referred by medical doctors were more disabled than those referred by some They

other source (such as hospital. self or family referrals). Reynolds et (11. [35] have noted the relationship between being more disabled and having more COP tacts with physicians. Similarly. those who report therapy. treatment and counseling as the major benefits of the Day Hospital program, were likely to be more disabled than those not reporting these benefits. Socialization, exercise. or relief from boredom, as benefits of the program, did not discriminate in terms of functional disability. Like the findings for the Index of Living Skills, those of Canadian ethnicity, but in this instance those of British ethnicity as well. were more likely to have greater functional disability than those of other ethnic groups. Once again. perceived health was related to functional disability. Finally, women tended to be more functionally disabled than men. Age, education. income and the number of chronic conditions of the respondent were unrelated to this measure. Functional disability did not differ significantly among the different Day Hospitals. at least after other factors were controlled. While the variables which emerged as significant explained more of the variance in Shanas’ index of Disability than in the Index of Living Skills (42”,, vs 36”,,). there is still a majority of the variance in each of these dependent variables which remains unexplained. This study therefore did not include a11 of the most important factors aflecting functional disability among Day Hospital participants. In addition, while both of the dependent variables measure functional disability. each measures sorncwhat different aspects of that concept. For example, the Index of Living Skills measures a greater variety of tasks including those which are both less and more strenuous. Shanas’ Index of Disability on the other hand, measures a more homogeneous listing of activties, none of which are particularly arduous [ 1X]. In this context. it is interesting to compare the predictors of each. Only perceived health and Canadian ethnicity emerged as significant predictors of both. Otherwise. different factors were related to each measure. Some form of service was related to each. but different scrvices emerged (home care was related to the Index of Living Skills but meals-on-wheels and Victorian

What

is reasonable

Order of Nurses to Shanas’ Index of Disability). The difference in services is perhaps accounted for by the fact that those requiring help with such tasks as shovelling snow and finances are more likely to be on long-term care (home care) while those on short-term care (VON) are probably being measured with Shanas’ Index of Disability. All of the variables, however, which emerged as significant predictors ‘make sense’ in that the relationship is understandable. Less obvious are the reasons why variables which one would ‘expect’ to be related in fact are not. Much more research needs to be conducted in this area and within programs such as Day Hospitals, before such questions can be answered.

This paper has sought a greater understanding of life satisfaction and functional ability among the elderly who attend day hospital programs in Winnipeg, Manitoba, Canada. While the data reported here do not permit direct comparisons with elderly not attending such a program. they are informative both as documentation of elderly attending these programs and for indirect comparisons with past research and existing litcraturc on other elderly groups. The analyses are also important for offering a multivariate analysis controlling for numerous factors at one time rather than univariate analyses from which conclusions are more difhcult to draw. Furthermore, the data set includes information on factors such as the types of services being received and the types of benefits being derived from the program which are frequently unavailable in data on the two major dependent variables included here. Of notable interest is the finding that type of service being received is related to functional disability. differentially depending on the tasks being measured by the particular functional disability index. The different types of day hospital programs being attended, however. is unrelated to functional disability. Life satisfaction, perhaps one of the most studied concepts empirically in the gerontology literature. revealed findings more or less consistent with past research on the elderly. The best predictors of life satisfaction were pcrccivcd health (chronic conditions to a lesser extent). major occupation in life and social activity. Of particular interest here is the fact that functional disability and the type of day hospital being attended were both unrelated to overall life satisfaction. On this particular variable. the elderly attending day hospetals seem no different from the elderly in institutions or living in the community as reported elsewhere. REFERESCES

Karmel

M. Total

and self-mortiticatton. Socio/o
Dr,rnimr,,t I\.\l,CV

institution

ir7 ,Mcdictr/

is true

77

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