PubMed Health⌕ Search

Biomedical subjects

D E Rodell

Publications and source records attributed to D E Rodell.

12 recordsLinked to original sources
PubMed2000

Program review of community residential care.

This article provides an overview of the Department of Veterans Affairs Community Residential Care Program and summarizes key literature about programs developed in the United States. Descriptive data for 1995 and 1996 are provided to assist program planners in comparing and contrasting client characteristics and services. The authors conclude that, in addition to being cost effective, the residential care program strengthens relationships between the health care facility and the community it serves.

Community Health Services↗
PubMed1998

Obstacle course performance and risk of falling in community-dwelling elderly persons.

OBJECTIVE: To determine the efficacy of obstacle course performance scores in predicting persons at risk for falls, after adjusting for age, sociodemographic, health-status, and physiologic variables. DESIGN: Correlational descriptive study design utilizing a logistic regression model. SETTING: Community setting. PATIENTS OR PARTICIPANTS: A convenience sample of 352 community-dwelling elderly individuals at sites in a metropolitan area. MAIN CRITERION MEASURE: Number of falls reported prospectively during a 2-year follow-up period. RESULTS: Obstacle course performance, fall history, symptoms of balance dysfunction, and activity level distinguished those who fell and those who did not 12 and 18 months later. At 24 months, range of motion and number of medications also were significant. In multivariate logistic regression, only history of a fall was a significant predictor of future falling at 12 and 18 months; at 24 months, the presence of balance dysfunction symptoms was the significant predictor of those who fell. CONCLUSIONS: The obstacle course, as a predictor of future falls, is not superior to the question of whether or not an individual has fallen in the previous year, and is not recommended to predict future falls. The obstacle course may be better as a short-term indicator of response to a rehabilitation program for balance and mobility.

Accidental Falls↗
PubMed1998

Comparison of a functional obstacle course with an index of clinical gait and balance and postural sway.

BACKGROUND: Older adults commonly experience falls because of balance and mobility problems. Better assessment methods are needed to understand and correct balance and mobility disorders. METHODS: We used a low technology, functional obstacle course (FOC) to measure balance and mobility in 352 community-dwelling elderly participants. To establish concurrent validity of the FOC, we compared performance on the FOC with two established measures of balance and mobility: performance on the Tinetti Index (TI) and postural sway area measured on a force platform. RESULTS: Bivariate correlation analyses revealed significant inverse correlations between FOC completion time, the TI balance and gait subscores, and the TI total score (r = -.73 to -.78). The FOC quality scores and TI balance and subscores gait and TI total scores (r = .76 to .82) were significantly positively correlated. FOC time had significant, but small, positive correlations with sway area with eyes open (r = .18) and closed (r = .17) and nonsignificant correlation with sway area with visual feedback. FOC quality also had significant, but smaller, inverse correlations with sway area with eyes open (r = -.024) and closed (r = -.015), and nonsignificant correlation with sway area with visual feedback. Regression analysis showed that TI gait and balance measures accounted for most of the variance found in FOC performance. CONCLUSIONS: Our findings support the position that the FOC and the TI measure dynamic balance, whereas postural sway measures a different aspect of balance. Advantages of the FOC include the evaluation of environmentally influenced falls and balance problems.

Accidental Falls↗
PubMed1996

Rehabilitation of elderly fallers: pilot study of a low to moderate intensity exercise program.

OBJECTIVE: The role of exercise in the prevention of falls and fall-related injuries among elderly persons is unclear. The objective of this study was to assess the response to an exercise-based rehabilitation program intended to improve balance and mobility and reduce or prevent falls. DESIGN: Pretest-posttest experimental design with repeated measures at baseline, immediately postintervention, and 6 months postintervention. To assess the effect of repeated exposure to our main outcome measure (the obstacle course), half of the participants (randomly selected) were allowed to practice on the obstacle course. SETTING: A veterans affairs medical center. PARTICIPANTS: Elderly, ambulatory, community-dwelling volunteers recruited from among local outpatients at our medical center. INTERVENTION: Sixty-five volunteers completed a 6-week supervised low to moderate intensity program of stretching, postural control, endurance walking, and coordination exercises designed to improve balance and mobility. Participants were divided into 2 groups: 34 participants who did not practice on the obstacle course during their exercise program and 31 participants who practiced on the obstacle course in addition to their otherwise identical exercise program. MAIN OUTCOME MEASURES: Performance on a functionally oriented obstacle course and self-reported falls and fall-related injuries. RESULTS: No significant performance differences were found between the two groups. After intervention, mean qualitative obstacle course scores improved modestly (5%) and mean obstacle course completion time decreased by 15% from baseline. These postintervention pairwise performance differences were clinically important but not statistically significant. Relative to baseline levels, postintervention falls and injuries did not change significantly. CONCLUSIONS: Our exercise intervention may have the potential to improve functional performance. However, some modifications are necessary to enhance efficacy. The obstacle course may be a useful tool in the evaluation of elderly persons with balance and mobility impairment in the rehabilitation setting.

Accidental Falls↗
PubMed1992

Outcomes and costs of two VA inpatient treatment programs for older alcoholic patients.

One hundred thirty-seven older alcoholic patients were randomly assigned to two different inpatient treatment programs at a Veterans Affairs medical center and followed for one year after discharge. The older alcoholic rehabilitation (OAR) program was operated by a tolerant staff that specialized in treating elderly alcoholics. Treatment included reminiscence therapy with goals of developing patient self-esteem and peer relationships. The traditional care program emphasized confrontation to focus on patients' past failures and present conflicts. Patient care costs were slightly lower (2.5 percent lower) in the OAR program than in the more traditional program, and OAR patients were 2.1 times more likely to report abstinence at one year. Response to the OAR program was best for patients over 60 years of age.

Aged↗
PubMed1990

Methodologic and compliance issues in postcoronary bypass surgery subjects.

Persons who engage in preventive health behaviors may reduce the progression of coronary artery disease. The immediate objective of this pilot study was to assess adherence to behavioral lifestyle changes in patients after coronary artery bypass graft surgery by analyzing self-reported responses using objective measures. Data on adherence to diet, exercise, and smoking were collected from questionnaires completed by each subject. Carbon monoxide index, serum cholesterol, pre- and postambulatory pulse rates, and pre- and post-stair-climbing pulse rates were measured. All tests were conducted before discharge and at a one-month follow-up visit. Analysis of objective data showed a statistically significant reduction in total serum cholesterol, decreased smoking behavior, and increased ambulation from before discharge to one-month follow-up. Analyses showed that self reports of adherence to diet, activity, and smoking cessation were consistent with objective measures in at least 50% of subjects. Serial objective measures provide valuable indicators of patient adherence and assist staff in developing individually tailored patient education.

Aged↗
PubMed1985

An evaluation of an inpatient cardiac patient/family education program.

A study to (1) evaluate the impact of a patient education program on the patient's knowledge regarding his/her illness and (2) identify obstacles to compliance behavior after discharge was conducted over a 2-year period. A population of 342 patients with ischemic heart disease was assigned to an inpatient cardiac patient education program consisting of five daily 1-hour classes. The following patient data were gathered: (1) assessment of the individual's knowledge of his/her illness; (2) selected sociodemographic information, (3) measures of general intelligence and problem-solving ability, and (4) motivation to alter risk factors. A measure of compliance with the prescribed treatment plan was obtained by telephone for all patients 4 weeks after discharge. Patients were randomly assigned such that one group received a pretest and a posttest assessment of knowledge while a second group received only the posttest assessment. A difference score t test on knowledge scores was statistically significant. A regression analysis of predictors of overall compliance scores after discharge demonstrated that indicators of motivation were most highly correlated with compliance. It was concluded that additional research is needed to identify: (1) types of information that enhance the patient's awareness of his/her illness and (2) program structures and techniques that enhance patient motivation to comply with a prescribed treatment plan.

Adult↗
PubMed1981

Similarities and differences between an urban and a rural hospital based home care program.

Over a 3 month period, 116 patients assigned on the basis of geographical proximity to an urban or rural Hospital Based Home Care Program were examined to determine whether services provided by an urban-based HBHC team could be extended by a rural-based team to a similar but rural, chronically ill patient population. Variables reflecting medical and socio-economic patient characteristics and level of services provided were gathered to test for significant differences between the two programs. Two-tailed difference of group means t-tests of the data revealed that only number of medications and supplies dispensed attained significance; patients in the urban program received more than their rural counterparts, a result probably due to the greater proximity of the program physician to the urban-based team. The results appear to indicate that it is possible to maintain severely disabled patients in their own homes in rural as well as urban settings.

Analysis of Variance↗
PubMed1979

Discharge planning for hospitalized older veterans.

A random sample of 175 patients in six nursing and personal care settings at the Veterans Administration Medical Center, Little Rock, Arkansas was drawn in order to develop a model for the classification of patients for the purpose of effecting more efficient and effective hospital discharge planning. Data that might effect significant changes in the placement dispositions and outcomes of patients were gathered and subjected to stepwise discriminant function and multiple regression analyses. It was found that the patient's socioeconomic status and the extent of social worker involvement in disposition rather than the patient's medical/psychiatric condition, constituted the best predictors of placement and success in placement. The model accurately predicted 90 percent of all dispositions and could provide a useful basis for assigning to placements a significant minority of patients who are not placed in accordance with the correlates of optimum placement and placement outcome as determined by the model.

Aftercare↗
PubMedDate not supplied

Use of an obstacle course to assess balance and mobility in the elderly. A validation study.

An obstacle course, consisting of a series of 12 simulated functional tasks, has been developed to aid in the evaluation of rehabilitation interventions for elderly individuals with balance and mobility dysfunction. The validity of the obstacle course as a measure of balance and functional mobility was tested by comparing obstacle course performance scores of a sample of 237 community-dwelling veterans, aged 67 to 93 yr, with clinical indicators of balance and mobility including age, history of falls, symptoms of balance dysfunction, medication use, orthostatic blood pressure changes, neurologic examination abnormalities, muscle strength, joint range of motion, self-reported activity level, and functional status. Significant correlations were found between obstacle course scores and all clinical indicators except blood pressure changes and age. Multiple regression analysis of selected variables showed that activity level and neurologic abnormalities best determined both qualitative and quantitative obstacle course performance. Non-fallers performed significantly better on the obstacle course than fallers. These results suggest that the obstacle course is valid and has potential as a useful tool in the evaluation of older persons with balance and mobility impairment.

Aged↗
PubMedDate not supplied

Balance, mobility, and falls among elderly African American women.

OBJECTIVE: To compare balance, mobility, recent falls, and injuries among elderly African American and white women. DESIGN: This was a nonexperimental study. Participants, who were older than 65 yr of age, able to walk at least 30 ft, not residing in a nursing home, and with no acute medical problems, were recruited from 17 senior citizens' community centers. RESULTS: Compared with white women (n=180), African American women (n = 118) took fewer medications, had greater body mass indexes, had less muscle strength, and had more medical conditions and neurologic abnormalities. Additionally, these women were less active and had poorer performances on an obstacle course. The two groups had a similar histories of falls and injuries. For both groups, activity level and neurologic findings were predictors of obstacle course performance. For white women, muscle strength was an additional predictor of obstacle course performance. An additional predictor for African American women was range of motion. CONCLUSION: The poorer balance and mobility of African American women compared with white women may have consequences such as their functional dependence, resulting in their greater use of hospitals and formal and informal health services.

Accidental Falls↗