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Biomedical subjects

A H Myers

Publications and source records attributed to A H Myers.

16 recordsLinked to original sources
PubMed2001

Factors associated with time to first hip fracture.

OBJECTIVE: To examine the relationship between risk factors associated with first hip fracture ever and its time to first fracture. METHODS: Data were from the Longitudinal Study on Aging. Of the 7,527 participants, 334 sustained a first hip fracture between 1984 and 1991. RESULTS: Results from the Cox proportional hazards model indicate the time to first fracture was inversely related to the number of risk factors involved. The risk factors significantly associated with first fracture were increasing age, female, Caucasian race, history of falls, insufficient exercise, infrequent church attendance (a likely proxy for outside the home activities), hospitalization in the year before the study, and low body mass index. CONCLUSION: As the number of risk factors increases, the estimated time to fracture becomes shorter; thus, the window of opportunity for prevention is smaller. To reduce the incidence of first hip fracture and to prolong the time to first fracture, interventions should focus on modifiable risk factors identified: increasing exercise, increasing outside-the-home activities, and improving or maintaining body mass index.

Age Factors↗
PubMed1999

Back injury in municipal workers: a case-control study.

OBJECTIVES: The purpose of this study was to identify factors associated with acute low back injury among municipal employees of a large city. METHODS: For each of 200 injured case patients, 2 coworker controls were randomly selected, the first matched on gender, job, and department and the second matched on gender and job classification. In-person interviews were conducted to collect data on demographics, work history, work characteristics, work injuries, back pain, psychosocial and work organization, health behaviors, and anthropometric and ergonomic factors related to the job. Psychosocial work organization variables were examined with factor analysis techniques; an aggregate value for job strain was entered into the final model. Risk factors were examined via multivariate logistic regression techniques. RESULTS: High job strain was the most important factor affecting back injury (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.28, 3.52), and it showed a significant dose-response effect. Body mass index (OR = 1.54, 95% CI = 1.08, 2.18) and a work movement index (twisting, extended reaching, and stooping) (OR = 1.42, 95% CI = 0.97, 2.08) were also significant factors. CONCLUSIONS: Results suggest that increasing workers' control over their jobs reduces levels of job strain. Ergonomic strategies and worksite health promotion may help reduce other risk factors.

Accidents, Occupational↗
PubMed1997

Urinary continence changes after hip-fracture repair.

Hip fractures can adversely affect an older adult's functional well-being. Little is known about the changes in continence status after hip-fracture repair. To investigate postoperative complications, the authors reviewed a convenience sample of 100 medical records of adults ages 55 years and over who were admitted to two metropolitan Baltimore hospitals for surgical repair of a fractured hip. There were data regarding postoperative incontinence for 95 individuals. Prevalence of urinary incontinence significantly increased from the preoperative rate of 20% to 43% postoperatively. That is, 19 individuals were incontinent preoperatively, and 41 individuals were incontinent postoperatively. Two individuals who had been incontinent preoperatively became continent postoperatively. Men were more likely to become incontinent than women, as were cognitively impaired individuals compared to cognitively intact individuals.

Aged↗
PubMed1996

Prevention of falls in the elderly.

The purpose of these symposium presentations was to examine the role of physical activity as a means of preventing hip fractures through the prevention of falls. Risk factor identification is necessary to develop preventive strategies. Risk factors related to physical activity and other risk factors for falls were identified. Intervention studies aimed at reducing, preventing or delaying falls were identified and discussed. A literature search from 1976-1994, identified 52 studies examining risk factors for falls, recurrent falls and/or falls resulting in injury. Nine intervention studies were identified with the primary outcome of falls. Physical activity-related risk factors for falls include limitations in general functioning, such as ambulation and mobility problems, difficulty or dependence in activities of daily living, and exposures to the risks of falling as indicated by the nature and frequency of daily activities. Impairments in gait and balance as well as neuromuscular and musculoskeletal impairments frequently underlie changes in physical activity in old age. Reduced activity level may occur as a result of these impairments, leading to further declines in physical functioning and an increased risk of falls. A relatively high level of activity in old age is also associated with risk of falls. Other risk factors for falls, such as cognitive impairment, visual deficits and medication use, may combine with physical activity-related risk factors to increase the risk of falls. Intervention studies directed at nursing home populations did not prevent falls but had other statistically and clinically significant outcomes. Studies among the community dwelling that targeted potential or current risk factors and included an exercise component reported a significant reduction in falls, prevented the onset of new disabilities and reduced baseline risk factors. Prevention of falls and subsequent injuries in the institutionalized population remains a challenge. Further development of interventions for community-dwelling elders that facilitate maintenance of physical activity without unduly increasing the risk of falls is also critical. The potential for maintenance of benefits gained from all fall interventions needs further examination.

Accidental Falls↗
PubMed1996

Mobility in older patients with hip fractures: examining prefracture status, complications, and outcomes at discharge from the acute-care hospital.

The purpose of this study was to examine the relationships among prefracture status, development of complications, mobility outcomes at discharge, and disposition at discharge. We singled out a case series of consecutive noninstitutionalized elderly persons hospitalized for hip fracture (ICD 820.0-820.9) at two Baltimore hospitals during 1992-1993. Data were abstracted from the medical records for the following variables: sociodemographic information, prefracture status, selected medical conditions, injury and surgical treatment, complications, functional mobility and assistance needed at discharge, and disposition. Factors associated with four complications were identified from multiple logistic regression analyses. (a) Prefracture needs for assistance with activities of daily living (ADL), and age > or = 80, were associated with the development of pressure ulcers. (b) Male gender and prefracture urinary incontinence (UI) were associated with pneumonia. (c) Prefracture UI and weight-bearing status were associated with UI after removal of an indwelling catheter. (d) Age > or = 80 was associated with urinary retention. The amount of assistance needed for mobility tasks at discharge was associated with prefracture need for assistance with ADLs, gender, weight-bearing status, and hospitals with shorter lengths of stay and fewer physical therapy sessions. Patients who were older and had shorter lengths of stay and less physical therapy were more likely to go to another health facility than directly home. Prefracture status (ADL, prefracture UI) was significantly associated with the development of complications. Prefracture needs for assistance with ADL and complications were associated with mobility outcomes at discharge. These prefracture factors have an effect on outcomes and need to be addressed in the development of critical pathways for case treatment. Specific protocols for subgroups of patients may need to be designed and evaluated.

Activities of Daily Living↗
PubMed1994

Nonoperative management of blunt hepatic injuries: safe at any grade?

Nonoperative management of blunt hepatic injury (BHI) has become more widely accepted. A prospective trial was undertaken to test the belief that clinical state could identify the patients with BHI confirmed by computed tomography (CT) who could be safely managed without a surgical operation. Patients were excluded from nonoperative management only if they manifested hemodynamic instability, the presence or suspicion of any other injury requiring laparotomy, or would be unavailable for controlled monitoring. Of 60 patients treated for BHI, 30 were managed nonoperatively. The 30 who had laparotomies served as a comparative group. The groups were statistically similar in age, sex, and Injury Severity Score (ISS). The group managed nonoperatively had significantly more severe BHI. There were no deaths or delayed laparotomies in the nonoperative management group. The groups had similar ICU and total hospital stays when analyzed as independent variables or with control for BHI grade and ISS. Transfusion requirements were significantly lower for the nonoperative management group when analyzed independently or when controlled for BHI grade, ISS, and the number of non-abdominal injuries. Nineteen (63%) patients managed nonoperatively were followed until their CT scans showed complete resolution. None had complications. We conclude that nonoperative management of BHI is a safe and effective technique applicable to hemodynamically stable patients who lack other indications for laparotomy and who can be adequately monitored.

Adolescent↗
PubMed1994

Can injurious falls be prevented?

The resident population in facilities changes over time. In some facilities there may be a large turnover of residents; in other types of facilities some residents will remain, age in place and become more frail. In addition, some medical conditions and intrinsic factors cannot be changed. Since there is not a single set of factors that can guide nursing staff as to which residents are at high risk for serious injurious falls, taking some general protective actions is appropriate. Some examples are: Monitoring the use of psychotropic medications through the MDS. Assessing the environment to determine potential risks that can be minimized or abolished. Using hip protectors to reduce hip fractures among elderly residents who fall.

Accidental Falls↗
PubMed1991

Hip fractures among the elderly: factors associated with in-hospital mortality.

Factors associated with mortality were examined for 27,370 hip fracture patients aged 65 years or older in Maryland hospitals, using discharge data for 1979-1988. Variables of interest included sociodemography, principal medical and injury diagnoses, E-code, year, disposition, and hospital. For both white males and white females, the hip fracture rate doubled with each 5-year increment in age. The overall proportion who died during hospitalization was 4.9% (n = 1,339). After multivariate adjustment, there remained a substantially increased risk of death for males. The relative odds (RO) of dying for males versus females were 1.6. Other factors associated with high relative odds of dying during hospitalization included the diagnosis of septicemia (RO = 12.3), pneumonia/influenza (RO = 4.9), and digestive system disorder (RO = 3.6). The RO of dying doubled in the presence of cardiac, neoplastic, or cerebrovascular disease. Patients with diagnoses of nervous system or mental disorder, hypertension, anemia, musculoskeletal system disease, or urinary tract infection were at decreased risk of dying. Results of the study suggest that the prevention or early diagnosis and treatment of serious infections in the elderly patient with a hip fracture remain an important challenge to clinicians.

Black or African American↗
PubMed1991

Risk factors associated with falls and injuries among elderly institutionalized persons.

A case-control study among 184 matched pairs of patients 65 years of age and older was undertaken to identify risk factors associated with falls and injuries in a long-term care facility in Baltimore, Maryland, in 1984-1985. Patients were matched on length of stay. Variables of interest included sociodemography, functional status, medications, and diagnoses. For all levels of care combined, the following factors were associated (p less than or equal to 0.01) with increased falls: being able to walk (relative odds (RO) = 4.0), age 90 years and older (RO = 3.8), a history of falling (RO = 5.0), and taking a vasodilator (RO = 3.0). Among the 184 fallers, the diagnosis of dementia (RO = 7.5) or taking a diuretic (RO = 7.2) was positively associated with injury (p less than or equal to 0.01). In each of the analyses, medications were associated with falls or injuries, suggesting a feasible intervention. The combination of a history of falling, being able to walk, and being 90 years of age or older increased the relative odds to 51.9 and could alert clinicians to identify and monitor high-risk elderly persons in need of preventive measures.

Accidental Falls↗
PubMed1990

Variation in risk for falls by clinical department: implications for prevention.

To examine rates of falls and injuries by clinical department, a retrospective analysis was performed of 874 inpatient falls during a one-year period in a 1,000-bed acute-care hospital. Incident reports were reviewed, and for those patients injured, medical records were abstracted. Fall rates were calculated by age, sex and service using total patient days as the denominator. During 1983, 874 falls occurred during 282,713 adult patient days (31/10(4) days). Fall rates were significantly higher (odds ratio = 2.12; 95% confidence interval [CI]: 1.84, 2.45) in the neuroscience and psychiatry departments (53/10(4) days) compared with other adult services combined (25/10(4) days); this difference persisted after direct adjustment for age. Differences by clinical department persisted throughout four additional years of surveillance, although fall rates for the oncology service increased. Injuries following falls occurred among 200 (22.8%) patients. These data indicate that falls are not random events, and that falls and injury prevention programs can be more appropriately focused by consideration of clinical department.

Accidental Falls↗
PubMed1990

Epidemiology of falls among patients in a rehabilitation hospital.

Falls in institutional settings have been associated with considerable morbidity. Although risk factors for falls have been described for acute care and geriatric settings, data from the rehabilitation setting are sparse. To provide a descriptive epidemiology, incident reports of falls were reviewed at a 151-bed rehabilitation facility. Of 567 patients admitted between January 1 and December 31, 1984, 71 (12.5%) experienced at least one fall; most (75%) of the falls occurred in patients using wheelchairs. Risk for falls was associated with increasing age (p less than 0.05), a diagnosis of stroke, or lower extremity amputation (p less than 0.05). Of the 71 fallers, 31% experienced repeat falls which tended to occur more frequently with older age, disorientation, and nonambulatory status at first fall. Nearly 13% sustained injuries, which tended to occur more frequently among disoriented and wheelchair or bedfast patients. These data suggest that groups of patients who are at high risk for falls within the rehabilitation setting can be identified for the purposes of prevention, and targeted for preventive measures.

Accidental Falls↗
PubMed1987

Medications and diagnoses in relation to falls in a long-term care facility.

The association between falls, drugs, and diagnoses in elderly residents of a long-term care facility was explored using case-control methodology. The odds of being a faller rather than a control were significant (P less than .01) for those taking antidepressants, sedatives/hypnotics, or vasodilators, and for those with osteoarthritis or depression. When drug/diagnosis subgroups were examined, these same drug classes and diagnoses had high-odds ratios in the largest numbers of subgroups. In general, risk of falling appeared to be more strongly associated with drugs than with diagnoses.

Accidental Falls↗
PubMed1987

Smoking behavior among participants in the nurses' health study.

We analyzed smoking behavior of 91,651 married female nurses, aged 30-55 years in 1976. The prevalence of smoking was similar among all birth cohorts. The largest percentage increase in starting to smoke occurred between ages 15 and 25 years; by age 25, 50 per cent had started smoking. The cessation rate was lowest in earlier birth cohorts and among nurses starting to smoke at earlier ages. The cessation rate increased substantially between 1963-73 compared with the period 1948-58.

Adult↗
PubMed1986

Smoking behavior and attitudes toward smoking among hospital nurses.

We examined smoking prevalence, smoking behavior, and attitudes toward smoking in hospitals in 1,380 respondents among 1,719 registered nurses in a large urban teaching hospital. In this group, current prevalence of smoking in hospital nurses (22 per cent) was less than women in the general population (29 per cent). Smoking nurses were more likely than nonsmokers to hold attitudes which potentially reduce their efficacy in helping patients to stop smoking.

Adult↗
PubMedDate not supplied

Prevention of hip fractures in the elderly: receptivity to protective garments.

A case study was undertaken to determine perceptions about protective garments for the prevention of recurrent hip fractures. We studied 169 patients with hip fractures, over 50 years of age, who were admitted to four university-affiliated hospitals. Proxy respondents were interviewed for 36% (n = 61) of the patients. Significant differences were found in the two groups; therefore, only the analyses from 108 patients who were interviewed are reported. Seventy percent of the patients were willing to wear a padded garment prescribed by a doctor. Factors associated with a positive response were no previous hip fracture, and an intrinsic cause of the fracture (P <or= 0.05). Over half (55%) of the patients were willing to wear an inflatable garment. Being female and fracturing the hip away from home were two factors that were associated with a positive response. Characteristics of the protective garment that patients thought were a concern or very important were effectiveness (83%), fit (82%), comfort (78%), laundering (66%), cost (57%), not showing (55%) and looked well (54%). These findings may assist investigators in the design of protective garments and thereby increase the receptivity and compliance among elderly patients.

Journal Article↗