title: Preexisting medical conditions in adult day services: an examination of nonmetropolitan and metropolitan admissions.
abstract: BACKGROUND
  It is not known what health conditions are being managed by day services staff because, to date, there is virtually no research on the types of preexisting medical conditions that clients bring to these community-based settings. Furthermore, it is not known whether or how nonmetropolitan clients differ from their metropolitan counterparts.
  
  
  METHODS
  Census data for 1,448 individuals who were admitted to adult day services in Maryland during 1993 were examined. Variables were included for client characteristics, medical diagnoses at admission (based upon ICD-9-CM categories), and adult day center location (metropolitan vs. nonmetropolitan).
  
  
  RESULTS
  Persons admitted to nonmetropolitan centers were more likely than those entering metropolitan centers to be diagnosed as having musculoskeletal, respiratory, cardiovascular, and endocrine conditions and as having a malignant neoplasm. Admissions to metropolitan centers were significantly more likely to be diagnosed with Alzheimer's disease. After using multiple logistic regression to control for a number of client characteristics, location of the facility remained significantly associated with all listed admission diagnoses except musculoskeletal conditions.
  
  
  CONCLUSIONS
  Nonmetropolitan centers are caring for a distinctly different type of long-term care client than metropolitan centers, perhaps because few other long-term care options are available to families in sparsely populated settings. The differences in the medical conditions of their clients should affect most aspects of the day services program, including budgets for appropriate professional staff, staff qualifications, resources for client/family education and counseling, and expected outcomes.
authors.affiliation: College of Nursing, University of Oklahoma, Oklahoma City 73190, USA. shirley-travis@ouhsc.edu
authors.forename: S S
authors.initials: SS
authors.lastname: Travis
authors.forename: W J
authors.initials: WJ
authors.lastname: McAuley
mesh_terms: D000328:Adult; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis; D002017:Budgets; D002318:Cardiovascular Diseases / Q000175:diagnosis; D016009:Chi-Square Distribution; D003376:Counseling; D003631:Day Care, Medical / Q000191:economics; D004194:Disease; D004700:Endocrine System Diseases / Q000175:diagnosis; D005260:Female; D006266:Health Education; D006282:Health Personnel; D006295:Health Resources; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008396:Maryland; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D012140:Respiratory Tract Diseases / Q000175:diagnosis; D012423:Rural Health; D014504:Urban Health; D000078329:Workforce