Comparison of health and effective functioning in Russia and the United States

Figures & data

Table 1 Functional Evaluation Framework

Function	Modifiers of function
	Ability	Motivation	Opportunities
Functional Status *Physical functioning *Social functioning Tasks BADL: Bathing Dressing Continence IADL: Shopping Handling finances Food preparation Housekeeping Using transportation AADL: Employment Participating in political and social activities	Physical *Absence of: Disease (acute or chronic) Disability (congenital or acquired) *Physical maneuvers Lung function *Bodily pain Height, weight, blood pressure	Psychological *Depression Sad mood & pessimistic outlook Lack of mental & physical energy Positive or happy mood Agitation or restlessness Social withdrawal *Vitality Efficacy *Religiosity *Perceived role limitations attributed to emotional problems *Perceived role limitations attributed to physical problems	Individual *Demographics: Age, education, gender, marital status, nationality, race, number of children *Health habits/life styles: nutrition, alcohol, tobacco, and medication use, vaccinations Social support Family structure *Income: Internal and external adequacy of living quarters
	Psychological Absence of: Disease (acute or chronic) Disability (congenital or acquired) *Cognitive function: Orientations, memory and recall, attention & calculation, language ability, and health information knowledge *Mental health *General health perception		Societal Cross-cultural differences: Social support networks *Resources, provision and access to healthcare Cultural values/religion and politics Environmental pollution
Measurements
Part of MOS Physical functioning Social functioning Activities of daily living questions: BADL, IADL, AADL	Part of MOS: Bodily pain Problem list of medical diagnoses and disabilities Measurement of peak flow Physical maneuvers assessment Physical measurements	Part of MOS: Role limitations physical and emotional and vitality Yesavage GDS Political efficacy questions Religiosity questions	Demographic data Vaccination questions Alcohol and tobacco questions Social support questions Hunger questions Income questions Home ownership questions Medication list Description of living quarters questions Living quarters safety questions Social support network questions Access to healthcare questions Air quality measures by site
	Part of MOS: Mental health and general health Problem list of psychological diagnoses and disabilities MMSE Health knowledge questions

* Variables measured in this pilot study.

Abbreviations: AADL, advanced activities of daily living; BADL, basic activities of daily living; GDS, Geriatric Depression Scale; IADL, instrumental activities of daily living; MMSE, Mini-Mental State Examination; MOS, Medical Outcomes Study SF-36 Health Status Questionnaire.

Table 2 Demographic characteristics

	Americans	Russians	p-value
	n=50	n=50
Agea
Mean age (in years)	78.3	67.2
Median age (in years)	76.5	66.0	0.0001
Range in years	67–94	61–84
Genderb			1.0000
Male	16 (32.0%)	15 (30.0%)
Female	34 (68.0%)	35 (70.0%)
Family statusb
Never	3 (6.0%)	3 (6.0%)
Married	18 (36.0%)	29 (58.0%)
Widowed or divorced	29 (58.0%)	18 (36.0%)
Education levelc			0.8936
High school or less	10 (20.4%)	16 (32.0%)
College	25 (51.0%)	21 (42.0%)
Higher degree	14 (28.6%)	13 (26.0%)
Unknown	01	01
Religion
Christian	45 (96.0%)	0
Russian Orthodox	0	32 (84.2%)
Adults living with participantsc			0.0027
One adult (alone)	30 (61.2%)	12 (24.5%)
Two adults	19 (38.8%)	34 (69.4%)
Three adults	0	2 (4.1%)
Four adults	0	1 (2.0%)
Unknown	1	1
Children living in householdc			0.7171
None	49 (100%)	43 (86.0%)
One	0	5 (10.0%)
Two	0	2 (4.0%)
Unknown	1	1

^a p-value from Wilcoxon Rank Sum Test,

^b p-value from Fisher’s Exact Test,

^c p-value from Kolmogorov-Smirnov Test

Table 3 Medical diagnoses

	Americans	Russians	Fisher’s Exact Test p-value
	n=50	n=50
Medical diagnoses
Dementia	1 (2.0%)	0	1.0000
Depression	1 (2.0%)	4 (8.0%)	0.3620
Psychiatric diagnoses	0	1 (2.0)	1.0000
Cardiovascular disease	26 (52.0%)	38 (76.0%)	0.0210
Congestive heart disease	1 (2.0%)	0	1.0000
Cerebrovascular disease	6 (12.0%)	8 (16.0%)	0.7740
Angina	2 (4.0%)	16 (32.0%)	0.0004
Hypertension	18 (36.0%)	31 (62.0%)	0.0160
Coronary artery disease	13 (26.0%)	10 (20.0%)	0.6350
Chronic lung disease	11 (22.0%)	12 (24.0%)	1.0000
Asthma	4 (8.0%)	0	0.1170
COPD	2 (4.0%)	1 (2.0%)	1.0000
Chronic bronchitis	5 (10.0%)	11 (22.0%)	0.1710
Diabetes	3 (6.0%)	4 (8.0%)	1.0000

Abbreviations: COPD, chronic obstructive pulmonary disease.

Table 4 Physical maneuvers

	Americans	Russians	Fisher’s Exact Test p-value
	n=50	n=50
Physical function
Puts hands behind head	50 (100%)	48 (96%)	0.4950
Puts hands behind back	50 (100%)	48 (96%)	0.4950
Touches great toes	47 (94%)	33 (66%)	0.0008
Squeezes hands	49 (98%)	47 (94%)	0.6170
Can hold paper	48 (96%)	43 (86%)	0.1600
Sit to stand	46 (92%)	44 (88%)	0.7410
Stands 5 seconds on 1 leg	31 (62%)	42 (84%)	0.0230

Table 5 Mini-Mental State Examination (MMSE) and Geriatric Depression Scale Score (GDS)

	Americans	Russians	p-value
	n=50	n=50
MMSEa
Mean	27.50	25.84
Median	28.00	26.00	0.0010
Range	14–30	19–30
MMSE cognitive abilitiesb			1.0000
Normal (score 24–30)	45 (90%)	42 (84%)
Mild (score 18–23)	4 (8%)	8 (16%)
Severe (score <17)	1 (2%)	0
GDSa
Mean	1.50	4.92
Median	1.00	4.50	0.0001
Range	0–6	0–13
GDS depression screen			0.000003
Normal (score 0–5)	48 (96%)	28 (56%)
Screened depressed (>5)	2 (4%)	22 (44%)

^a p-value from Wilcoxon Rank Sum Test,

^b p-value from Kolmogorov-Smirnov Test.

Table 6 Comparisons of eight MOS concepts

	Americans		Russians
	n=50		n=50
	Median	Range	Median	Range	Wilcoxon p-value
MOS concepts
Physical functioning	70	10–100	75.0	05–100	0.7142
Social functioning	100	25–100	75.0	12.5–100	0.0001
General health perceptions	77	05–100	50.0	10–87	0.0001
Role disability due to
Physical problems	100	00–100	75.0	00–100	0.0041
Emotional problems	100	00–100	66.7	00–100	0.0001
Bodily pain	82	31–100	51.0	22–100	0.0001
General mental health	96	52–100	60.0	28–96	0.0001
Vitality	70	15–100	47.5	10–95	0.0001

Abbreviations: MOS, Medical Outcomes Study SF-36 Health Survey.