Health Status Of Older People Research Articles

Exploring the implementation of poslansia, Indonesia's community-based health programme for older people.

To explore the implementation of poslansia, a community-based integrated health service implemented across Indonesia to improve the health status of older people through health promotion and disease prevention. Data analysis of 307 poslansia surveyed in the 4th wave of Indonesia Family Life Survey (IFLS-4). We examined the services provided in the programme, resources and perceived problems. The services provided by poslansia focused mostly on risk factor screening and treatment for minor illness, and less on health promotion activities. Lack of support from community health centres, no permanent place for holding poslansia and lack of participant interest in joining the programme were associated with fewer services provided in the programme (P < 0.05). The findings indicate existing support from the community, community health centres and related institutions for poslansia is not adequate for optimal service function. Health awareness among the older population should also be increased for programme sustainability.

Health Care and Hygiene Practices of Older People in Tea Garden: A Study Conducted in Lackatoorah Tea Garden of Sylhet District

The recent changes in demographic structure cause a gradual increase in high proportion of older people in Bangladesh. Health status of the older people is a major concern in Bangladesh. Bangladesh lacks medical facilities and infrastructure to meet the needs of the vast tea garden population not to speak of the older population. The majority of tea garden older people in Bangladesh live in absolute poverty. As a result they deprive health care facilities and other old age services from family and society. The present study was conducted to explore the health care and hygiene practices of older people in tea garden areas and to find out their actual health situation, treatment experiences, health seeking behavior, hygiene, social attitudes towards them, social supports and their valuable recommendation for improving their present conditions. The present study was qualitative in nature. It was carried out on eleven villages (para/plot) at Lackatoorah tea garden area. The data for the study were collected from 20 older people and two focus group discussion with eight older people in each group having age 60 years and above and living in tea garden areas in Sylhet district. Purposive sampling technique was employed for selecting sample from the older people who live in the study areas. In the tea garden areas older people mostly suffer from old age related and communicable diseases due to unhygienic environment and practices. Lack of proper information and awareness and bad experiences in government hospitals, many extremely poor tea garden older people first sought treatment from cheaper or free traditional healers. The poor hygiene situation of tea garden areas in Sylhet district is mainly responsible for present health status and hygiene of older people. In tea garden areas older people lead a troublesome life due to insufficient income and allowances facilities.

Oral health status of older people living in care homes in Wales.

UK adult dental health surveys (ADHS) exclude care home residents from sampling. Aim To understand oral health status of care home residents in Wales using ADHS criteria. Cross sectional survey of care home residents in Wales using a questionnaire and oral examination contemporaneous with, and paralleling, the ADHS 2009. 708 randomly selected participants from 213 randomly selected care homes participated including individuals with and without capacity. 72.8% of residents had tooth decay. Compared to older adults examined in the ADHS, residents are less likely to brush teeth/dentures twice a day (37% vs 63%), more likely to only attend a dentist when they have a problem (63% vs 26%), have more teeth with active decay (3.1 vs 0.9), more have current dental pain (13% vs 5%) and other morbidity (open pulp, ulceration, fistulae, abscess 27% vs 10%). High decay is present in both recently admitted and longer term residents. There was some regional variation in levels of oral hygiene. Oral health status of older people resident in care homes in Wales is poor. Findings suggest more could be done to improve preventive care both before and after admission to the care home.

Self-Reported Health Status of Older Adults in Malaysia and Singapore: Evidence from the 2007 Global Ageing Survey

The aim of this study is to investigate the correlates of self-reported health (SRH) among older adults in Malaysia and Singapore. The study uses data collected in the Global Ageing Study (GLAS) 2007, one of the largest surveys of its kind, specially designed to investigate attitudes towards later life, ageing and retirement. Data were collected from 1002 and 1004 respondents from Malaysia and Singapore respectively. The study found that Singaporeans report a healthier life than Malaysians. The two countries have consistent results with regard to the influences of selected covariates on individual health. Poorer health is more prevalent among people with lower education, among those widowed, divorced or separated, and those working in blue-collar occupations. Although social support is found to be an important determinant of SRH, the effects are partially confounded with other covariates. These findings enhance our knowledge about the health status of older people, and in turn will be useful for governments to ensure effective policy making.

Cohort Profile: The Amirkola Health and Ageing Project (AHAP)

This is the first comprehensive cohort study of the health of older people ever conducted in Iran. The aim of this project is to investigate the health status of older people in Amirkola in the northern part of Iran, near the Caspian Sea. The Amirkola Health and Ageing Project (AHAP) is mainly concerned with geriatric medical problems, such as falling, bone fragility and fractures, cognitive impairment and dementia, poor mobility and functional dependence. It is planned that all participants will be re-examined after 2 years. Data are collected via questionnaire, examinations and venepuncture. AHAP started in April 2011 and 1616 participants had been seen by 18 July 2012, the end of the baseline stage of this study. The participation rate was 72.3%. The prevalence of self-reported hypertension (41.2%) and diabetes mellitus (23.3%) are high. Only 14.4% of older people considered their health as excellent or good in comparison with others at this age. The prevalence of osteoporosis (T score≤-2.5) was 57.4% in women and 16.1% in men, and 38.2 % of older people were vitamin D deficient (<20 ng/ml). Researchers interested in using the information are invited to contact the principal investigator Seyed Reza Hosseini (hosseinim46@yahoo.com).

Self-rated health and associated factors among older South Africans: evidence from the study on global ageing and adult health

Background: Population ageing has become significant in South African society, increasing the need to improve understandings of health and well-being among the aged.Objective: To describe the self-reported ratings of overall health and functioning, and to identify factors associated with self-rated health among older South Africans.Design: A national population-based cross-sectional survey, with a sample of 3,840 individuals aged 50 years and older, was completed in South Africa in 2008. Self-reported ratings of overall health and functioning were measured using a single self-reported health state covering nine health domains (used to generate the Study on Global Ageing and Adult Health (SAGE) composite health state score). Disability was measured using the World Health Organization Disability Assessment Schedule II (WHODAS-II) activities of daily living (ADLs), instrumental activities of daily living (IADLs), perceptions of well-being, and the World Health Organization Quality of Life index/metric (WHOQoL).Results: Overall, more than three quarters (76.8%) of adults rated their health as moderate or good. On balance, men reported very good or good health more often than women (p<0.001). Older people (aged 70 years and above) reported significantly poorer health status than those aged 50–59 (adjusted odds ratio (AOR) 1.52; 95% confidence interval (CI) 1.00–2.30). Indians and Blacks were significantly more likely to report poorer health status at (AOR = 4.01; 95% CI 1.27–12.70) and (AOR = 0.42; 95% CI 0.18_0.98; 30 p < 0.045), respectively, compared to Whites. Respondents with primary education (AOR = 1.83; 95% CI 1.19–2.80) and less than primary education (AOR = 1.94; 95% CI 1.37–2.76) were more likely to report poorer health compared to those with secondary education. In terms of wealth status, those in low wealth quintile (AOR = 2.02; 95% CI 1.14–3.57) and medium wealth quintile (AOR = 1.47; 95% CI 1.01–2.13) were more likely to report poorer health status than those in high wealth quintile. Overall, the mean WHODAS-II score was 20%, suggesting a low level of disability. The mean WHOQoL score for females (Mean = 51.5; SD = 12.2) was comparable to that of males (Mean = 49.1; SD = 12.6).Conclusion: The depreciation in health and daily functioning with increasing age is likely to increase demand for health care and other services as people grow older. There is a need for regular monitoring of the health status of older people to provide public health agencies with the data they need to assess, protect, and promote the health and well-being of older people.

A simple measure with complex determinants: investigation of the correlates of self-rated health in older men and women from three continents

BackgroundSelf-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Perceptions of health are, however, influenced by individual and societal level factors that may differ within and between countries. This study investigates levels of self-rated health (SRH) and correlates of SRH among older adults in Australia, United States of America (USA), Japan and South Korea.MethodsCross-sectional data were drawn from large surveys of older respondents (≥ 65 years) in Australia (n = 7,355), USA (n = 10,358), Japan (n = 3,541) and South Korea (n = 3,971), collected between 2000 and 2006. Harmonized variables were developed to represent socioeconomic, lifestyle and health indicators. We then assessed whether these variables, and their potentially different impact in different countries, could account for cross-national differences in levels of SRH.ResultsSRH differed significantly between countries, with older Koreans reporting much poorer health than those in the other three nations. This was not the result of biases in response patterns (for example central versus extreme tendency). Health-related correlates of SRH were similar across countries; those with more medical conditions, functional limitations or poor mental health gave poorer ratings. After accounting for the differential impact of determinants in different national contexts, Australians reported better SRH than other nations.ConclusionsWe conclude that when examining correlates of SRH, the similarities are greater than the differences between countries. There are however differences in levels of SRH which are not fully accounted for by the health correlates. Broad generalizations about styles of responding are not helpful for understanding these differences, which appear to be country, and possibly cohort specific. When using SRH to characterize the health status of older people, it is important to consider earlier life experiences of cohorts as well as national and individual factors in later life. Further research is required to understand the complex societal influences on perceptions of health.

An investigation of factors associated with the health and well-being of HIV-infected or HIV-affected older people in rural South Africa

BackgroundDespite the severe impact of HIV in sub-Saharan Africa, the health of older people aged 50+ is often overlooked owing to the dearth of data on the direct and indirect effects of HIV on older people’s health status and well-being. The aim of this study was to examine correlates of health and well-being of HIV-infected older people relative to HIV-affected people in rural South Africa, defined as participants with an HIV-infected or death of an adult child due to HIV-related cause.MethodsData were collected within the Africa Centre surveillance area using instruments adapted from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE). A stratified random sample of 422 people aged 50+ participated. We compared the health correlates of HIV-infected to HIV-affected participants using ordered logistic regressions. Health status was measured using three instruments: disability index, quality of life and composite health score.ResultsMedian age of the sample was 60 years (range 50–94). Women HIV-infected (aOR 0.15, 95% confidence interval (CI) 0.08–0.29) and HIV-affected (aOR 0.20, 95% CI 0.08–0.50), were significantly less likely than men to be in good functional ability. Women’s adjusted odds of being in good overall health state were similarly lower than men’s; while income and household wealth status were stronger correlates of quality of life. HIV-infected participants reported better functional ability, quality of life and overall health state than HIV-affected participants.Discussion and conclusionsThe enhanced healthcare received as part of anti-retroviral treatment as well as the considerable resources devoted to HIV care appear to benefit the overall well-being of HIV-infected older people; whereas similar resources have not been devoted to the general health needs of HIV uninfected older people. Given increasing numbers of older people, policy and programme interventions are urgently needed to holistically meet the health and well-being needs of older people beyond the HIV-related care system.

The PAS‐ADD assessments and their continuing conceptual development

PurposeThe PAS‐ADD assessments (Psychiatric Assessment Schedules for Adults with Developmental Disabilities) have their origins in work that was being conducted over 20 years ago on the health status of older people with intellectual disability. Since that time, the assessments have undergone continuous development and refinement, and now encompass children as well as adults. This paper seeks to discuss some of these fundamental issues and how the PAS‐ADD instruments have attempted to meet these challenges.Design/methodology/approachThe paper includes discussion of theoretical and practical issues that have shaped the development of the assessments.FindingsThe fundamental aim of the modern PAS‐ADD system is to improve case detection and assessment by supporting and enhancing the skills of clinical staff, rather than attempting to replace the need for those skills. The assessor makes the final judgement about diagnosis. The PAS‐ADD assessments are based on existing psychiatric classification rules for the general population and are conceptually different from instruments derived from psychometric principles. These factors have major implications, both for instrument design and for the evaluation of effectiveness.Originality/valueThe PAS‐ADD assessments have become widely used in the field of intellectual disability mental health. The theoretical issues discussed here are a central part of the ongoing effort to understand and improve the mental health of people with intellectual disabilities.

Health status of elderly citizens at Siyandhani village of the Limpopo Province, South Africa

There has been an increase in the number of older population in South Africa since the 1980s with the majority of them living in rural areas. An increase in the morbidity and mortality rates due to non-communicable diseases among elderly people in the country has also been observed in the past ten years. This increase is often attributed to inadequacies in the health care services for elderly people especially in rural areas. A quantitative descriptive study was conducted to assess the health status of older people at the Siyandhani village, Limpopo Province. A total of 50 female and male respondents aged between 60 and 97 years participated in the study. A self-administered questionnaire was used to assess the general health, physical function, social, emotional and mental functioning of the respondents. Although more than half of the respondents considered themselves healthy, the majority of them were experiencing some challenges in performing most of the physical activities and experiencing some degree of tiredness at certain times. Almost all respondents had not experienced some problems in bathing and dressing themselves. The majority of those living with pain had no treatment due to inaccessible health care facilities. As continuously untreated bodily pains can influence the physical, emotional and social functioning of an individual, an intervention is necessary to improve the health status of elderly people at Siyandhani village. Thiis will positively influence the people’s perceptions of their own health status.

Oral health status of older people in residential homes in Saudi Arabia

The aim of the study was to de-termine the oral health status and treatment needs of elderly residents of residential homes in Riyadh, Saudi Arabia. Methods: Among 129 elderly residents, 83 (51 males, and 32 females) of them were interviewed and clini-cally examined according to WHO criteria by two calibrated dentists. Results: The mean age of the subjects was 72 ± 8.5. Male subjects had a higher smoking rate than females. Among elderly subjects below 74 years old, 20.8% had a functional dentition (> or = 20), while only 6.7% for those aged greater or equal to 75 years (p = 0.0004). Mean number of the sound teeth in all subjects was 6.7 ± 8.5. The mean number of DMFT was 18.6 ± 12.6. The missing component was the highest (16 ± 13) for both genders. The mean number of decayed roots was 2.75 ± 3.95 in males and 0.63 ± 1.96 in females. Overall, males had more sound and decayed teeth and less filled and missed teeth than females. There was no significant difference between males and females in periodontal problems except the calculus scores. The majority of subjects in need for tooth extraction were male subjects. With no gender difference 63% were in need for restorations, 40% needed upper and lower full dentures. Need for partial dentures was 38% upper and 48% lower. Conclusion: The oral health of the institutionalized elderly population in Saudi Arabia is generally poor and their treatment needs are high.

Frailty and its significance in older people’s nursing

The term frail is commonly used to describe older people, but reports on the care of older adults in hospital highlight that the clinical implications of frailty are not understood fully by all nurses. Frailty can be an indicator of older people's health status and healthcare needs. An understanding of frailty and its mechanisms will help nurses to determine care priorities, particularly the urgency for anticipatory, proactive, preventive and compensatory care to prevent unnecessary mortality and morbidity. This article discusses the significance of frailty in older people's nursing. It highlights the responsibility of registered nurses to recognise deterioration in health as a result of frailty and to implement appropriate interventions.

Assessing balance and mobility to track illness and recovery in older inpatients.

Archetypal symptoms and signs are commonly absent in frail older people who are acutely unwell. This challenges both recognition of illness and monitoring of disease progression in people at high risk of prolonged hospital stays, institutionalization and death. To determine whether bedside assessment of balance and mobility could track acute changes in the health status of older people admitted to hospital. Prospective cohort study. Four hundred nine patients, with a mean age of 81.8years, admitted to general medical and rehabilitation wards at a tertiary care teaching hospital in Halifax, Nova Scotia. No patient refused assessment, and the only exclusion criterion was age. The Hierarchical Assessment of Balance and Mobility (HABAM) was completed daily during the first 2weeks of admission. For each patient, frailty status was measured on admission by a Frailty Index based on a Comprehensive Geriatric Assessment (FI-CGA). Death and discharge destination. Poor performance in balance, transfers and mobility was associated with adverse outcomes. Forty-eight percent of patients with the lowest scores in all three domains died, compared with none with the highest scores. The relative risk of death for people who deteriorated during the first 48 h of admission was 17.1 (95% confidence interval: 4.9-60.3). Changes in HABAM scores were related to the discharge destination: patients discharged home showed the greatest rate of improvement, whereas those discharged to institutions stabilised at a lower level of performance. Fitter patients tended to have better performance on admission and faster recovery. Daily bedside observation of mobility and balance allows assessment of acute changes in the health of older people. Frailty slows recovery of mobility and balance, and reduces recovery potential. By identifying patients most vulnerable to adverse outcomes, the HABAM and FI-CGA may facilitate risk stratification in older people admitted to hospital.

Health Measurement in Population Surveys: Combining Information from Self-reported and Observer-Measured Health Indicators

Our primary aim is to develop and validate a population health metric for survey-based health assessment that combines information from both self-reported and observer-measured health indicators. A secondary objective is to use this index to examine gender and socioeconomic differentials in the health status of older people. We use data from the second wave of the English Longitudinal Study of Ageing (ELSA) conducted in 2004 (N = 8,870). Information from three observer-measured and three self-reported health indicators was combined, using a latent variable modeling approach. A model that decomposed the manifest health indicators to valid health, systematic error, and random error was found to fit the data best. The latent health dimension represented somatic health, and was tested against three external criteria: height, waist-hip ratio, and smoking status. We present the Latent Index of Somatic Health (LISH), as well as a procedure for deriving the LISH in surveys employing both self- and observer-measured health indicators. Observer-measured and self-reported indicators were found to be equally biased in indexing population somatic health, with the exception of self-reports of functional limitations, which was the most reliable somatic health indicator. As expected, results showed that women had worse health than men and that socioeconomic advantage is associated with better somatic health.

A parametric model of the role of nutritional services within the health care system, in relation to cardiovascular disease risk among older individuals

BackgroundThe role of nutritional policy and services on the quality of life of older individuals has not been extensively studied. Thus, the aim of the present study was to evaluate the association between nutritional services within the public health care system and older people's health status. MethodsDuring 2010, information of various nutritional services provided in 9 Greek Islands and Cyprus Republic was retrieved through local health care authorities. With the exception of the Cyprus Republic, a large proportion of dieticians in the rest of the studied islands participated in this survey (n=88). The health status of the referent older population was retrieved from the Mediterranean islands' (MEDIS) study. ResultsAfter various adjustment, islands that had nutritional services offered within the public health care system had lower likelihood of observing the prevalence of hypercholesterolemia, diabetes and obesity above the median rate of the referent population (odds ratio (95% CI), hypercholesterolemia, 0.11 (0.02, 0.55), diabetes, 0.03 (0.02, 0.26), and obesity, 0.10 (0.02, 0.50). Continuous and higher education status of dieticians and the completion of nutrition sessions seem also to contribute to the reduction of the CVD risk burden in these islanders. ConclusionsActive nutritional policy and enhancement of nutritional services within the public health care system may contribute to improved health and quality of life among older populations.

Health status and quality of life among older adults in rural Tanzania

Background: Increasingly, human populations throughout the world are living longer and this trend is developing in sub-Saharan Africa. In developing African countries such as Tanzania, this demographic phenomenon is taking place against a background of poverty and poor health conditions. There has been limited research on how this process of ageing impacts upon the health of older people within such low-income settings.Objective: The objective of this study is to describe the impacts of ageing on the health status, quality of life and well-being of older people in a rural population of Tanzania.Design: A short version of the WHO Survey on Adult Health and Global Ageing questionnaire was used to collect information on the health status, quality of life and well-being of older adults living in Ifakara Health and Demographic Surveillance System, Tanzania, during early 2007. Questionnaires were administered through this framework to 8,206 people aged 50 and over.Results: Among people aged 50 and over, having good quality of life and health status was significantly associated with being male, married and not being among the oldest old. Functional ability assessment was associated with age, with people reporting more difficulty in performing routine activities as age increased, particularly among women. Reports of good quality of life and well-being decreased with increasing age. Women were significantly more likely to report poor quality of life (odds ratio 1.31; p<0.001, 95% CI 1.15–1.50).Conclusions: Older people within this rural Tanzanian setting reported that the ageing process had significant impacts on their health status, quality of life and physical ability. Poor quality of life and well-being, and poor health status in older people were significantly associated with marital status, sex, age and level of education. The process of ageing in this setting is challenging and raises public health concerns.Access the supplementary material to this article: INDEPTH WHO-SAGE questionnaire (including variants of vignettes), a data dictionary and a password-protected dataset (see Supplementary files under Reading Tools online). To obtain a password for the dataset, please send a request with ‘SAGE data’ as its subject, detailing how you propose to use the data, to global.health@epiph.umu.se

Self-reported health and functional limitations among older people in the Kassena-Nankana District, Ghana

Background: Ghana is experiencing significant increases in its ageing population, yet research on the health and quality of life of older people is limited. Lack of data on the health and well-being of older people in the country makes it difficult to monitor trends in the health status of adults and the impact of social policies on their health and welfare. Research on ageing is urgently required to provide essential data for policy formulation and programme implementation.Objective: To describe the health status and identify factors associated with self-rated health (SRH) among older adults in a rural community in northern Ghana.Methods: The data come from a survey on Adult Health and Ageing in the Kassena-Nankana District involving 4,584 people aged 50 and over. Survey participants answered questions pertaining to their health status, including self-rated overall health, perceptions of well-being and quality of life, and self-reported assessment of functioning on a range of different health domains. Socio-demographic information such as age, sex, marital status and education were obtained from a demographic surveillance database.Results: The majority of older people rated their health status as good, with the oldest old reporting poorer health. Multivariate regression analysis showed that functional ability and sex are significant factors in SRH status. Adults with higher levels of functional limitations were much more likely to rate their health as being poorer compared with those having lower disabilities. Household wealth was significantly associated with SRH, with wealthier adults more likely to rate their health as good.Conclusion: The depreciation in health and daily functioning with increasing age is likely to increase people's demand for health care and other services as they grow older. There is a need for regular monitoring of the health status of older people to provide public health agencies with the data they need to assess, protect and promote the health and well-being of older people.Access the supplementary material to this article: INDEPTH WHO-SAGE questionnaire (including variants of vignettes), a data dictionary and a password-protected dataset (see Supplementary files under Reading Tools online). To obtain a password for the dataset, please send a request with ‘‘SAGE data’’ as its subject, detailing how you propose to use the data, to global.health@epiph.umu.se

Household transitions and subsequent mortality among older people in England and Wales: trends over three decades

BackgroundThe past 30 years have seen major changes in the living arrangements of older people and in long-term care policy in England and Wales. Co-resident family care and institutional care...

Modelling social determinants of self-evaluated health of poor older people in a middle-income developing nation

Over the last 2 decades (1988-2007), poverty in Jamaica has fallen by 67.5%, and this is within the context of a 194.7% increase in inflation for 2007 over 2006. It does not abate there, as Jamaicans are reporting more health conditions in a 4-week period (15.5% in 2007) and at the same time this corresponds to a decline in the percentage of people seeking medical care. Older people’s health status is of increasing concern, given the high rates of prostate cancer, genitourinary disorders, hypertension, diabetes mellitus and the presence of risk factors such as smoking. Yet, there is a dearth of studies on the health status of older people in the two poor quintiles. This study examined 1) the health status of those elderly Jamaicans who were in the two poor quintiles and 2) factors that are associated with their health status. A sample of 1,149 elderly respondents, with an average age of 72.6 years (SD = 8.7 years) were extracted from a total survey of 25,018 Jamaicans. The initial survey sample was selected from a stratified probability sampling frame of Jamaicans. An administered questionnaire was used to collect the data. Descriptive statistics were used to examine background information on the sample, and stepwise logistic regression was used to ascertain the factors which are associated with health status. The health status of older poor people was influenced by 6 factors, and those factors accounted for 26.6% of the variability in health status: Health insurance coverage (OR = 13.90; 95% CI: 7.98-24.19), age of respondents (OR = 7.98; 95% CI: 1.02-1.06), and secondary level education (OR=1.82; 95% CI: 1.35-2.45). Males are less likely to report good health status than females (OR = 0.56; 95% CI: 0.42-0.75). Older people in Jamaica do not purchase health insurance coverage as a preventative measure but as a curative measure. Health insurance coverage in this study does not indicate good health but is a proxy of poor health status. The demand of the health services in Jamaica in the future must be geared towards a particular age cohort and certain health conditions, and not only to the general population, as the social determinants which give rise to inequities are not the same, even among the same age cohort.

Health State Profiles and Service Utilization in Community-Living Elderly

We know that health status in older people is heterogeneous and that many need complex care. What is now required is a comprehensive description of this heterogeneity and the estimation of its effects on patterns of service utilization. This study examines the possibility of classifying older people according to their complex health conditions and whether the way in which they consume services differs based on these classes. We used latent class analysis to model heterogeneity and classify community living elderly into homogenous health state categories (ie, health profiles). The number of health profiles present in the sample was revealed using 17 health indicators collected at baseline in the demonstration project of SIPA (French acronym for System of Integrated Care for the frail elderly), a system of integrated care for frail older people (n = 1164). These profiles were then used in 2-part econometric models to study access and costs of several measures of services using data collected prospectively over the 22-months of the SIPA trial. We identified 4 substantially meaningful health profiles (prevalence: 23%, 11%, 36%, 30%) characterized by differences along the physical, cognitive, and disability dimensions of health. Subsequent econometric modeling showed a differential effect of health profiles on use and costs along the continuum of health and social services. For older people with complex care needs, classification into homogeneous health subgroups unmasks differences in utilization patterns that can be used by decision makers in their attempt to improve the trajectory of care and adjust the distribution of resources to the needs of older people.