Multidisciplinary studies of illness in aged persons: V. A new classification of socioeconomic functioning of the aged

Abstract

The staff of The Benjamin Rose Hospital, a hospital for prolonged illness in Cleveland, Ohio, has had special interest in developing much-needed tools, i.e., “yardsticks,” for the study of the progression and regression of chronic disease. Methods of approaching this problem were designed initially in relation to a study of patients with fracture of the hip and extended subsequently to include patients with recent, initial episodes of cerebral infarction. Previous reports defined and demonstrated the use of an over-all index of independence in activities of daily living, the Index of ADL. 2,3 In the present report, an Index of Independence in Socioeconomic Functioning (Index of ISF) was defined, and its derivation was described. The index is a composite of graded measures of certain factors representative of patient resources, needs, and productivity. More specifically, the factors in the index are agency support, assistive nature of residence, residence ownership, and employment status. The index was used to rank patients and to observe relative differences between various groups, as well as to observe changes in status from one time to another. The concept behind the development of an index of socioeconomic functioning was discussed, as well as its significance in approaching the problems of critical studies of relationships between socioeconomic functioning and disease or disability. Examples of possible uses of the Index of ISF were presented. The following preliminary trends were revealed by these examples: more frequent 6 month deteriorations among patients with lower ISF ratings prior to fracture than among those with higher prior ratings; greater likelihood of deterioration during the first 6 month interval after fracture than in subsequent 6 month intervals; lack of progression and persistence of deterioration when deterioration did occur; more frequent deaths during the first year after fracture among those with lower ISF ratings prior to fracture; more frequent fatalities observed within the year after the occurrence of ISF deterioration than observed in the absence of such deterioration; and more frequent ISF deterioration in the 6 month interval after recent, initial cerebral infarction than in the 6 months after fracture of the hip.