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Biomedical subjects

D Galinsky

Publications and source records attributed to D Galinsky.

At least 19 recordsLinked to original sources
PubMed2002

Depression and falls among community dwelling elderly people: a search for common risk factors.

STUDY OBJECTIVE: s: Depression and falls are two common conditions that impair the health of older people. Both are relatively underdiagnosed and undertreated problems in primary care. The study objective was to investigate whether there was a common set of risk factors that could predict an increased risk of both falls and depression. DESIGN: This was a cohort study drawn from a primary care clinic, with a one year follow up. Dependent measures included: reporting two or more falls in the past year and a score of 7 or over on the S-GDS (Short Geriatric Depression Scale). A parsimonious set of risk factors was selected that predicted both outcomes based on a series of discriminant function analyses. PARTICIPANTS AND SETTING: The setting was a primary care clinic serving a mixed socioeconomic population, in Beer Sheva, Israel. The sample included 283 General Sick Fund members, aged 60 and over, who completed both baseline assessments and one year follow up interviews. MAIN RESULTS: At the one year follow up, 12% of the sample reported frequent falls in the past year and 25.5% of the sample screened positive for depressive symptoms. A set of five risk factors that included: poor self rated health, poor cognitive status, impaired ADL, two or more clinic visits in the past month, and slow walking speed (g10 seconds over five metres) was successful at discriminating between fallers and non-fallers (86% discrimination) and between those with and without depressive symptoms (76%). For every risk factor added, there was a significant increase in the proportion of respondents who had depressive symptoms. A similar result was found for falls. CONCLUSIONS: These results show that there is a common set of risk factors that increase the risk of two common outcomes in geriatric medicine, falls and depression. For a general practitioner or a geriatric physician, it might be easier to detect these risk factors than to diagnose depression or high risk for falls. When these risk factors are detected in patients the physician can then be more active in direct probing about depression and falls.

Accidental Falls↗
PubMed2000

[Identifying the elderly at risk for falling and accompanying protocols].

Falling is one of the main problems affecting the health of the elderly. A community project was carried out to detect elderly people at high risk for falls. One of its aims was also to develop tools allowing primary care professionals to detect the elderly at risk for falling. Such a screening test in the community-dwelling elderly (EFST) and a protocol for diagnosis and treatment of the elderly at risk for falls is presented.

Accidental Falls↗
PubMed1999

Geriatric Depression Screening Scale (GDS) in patients hospitalized for physical rehabilitation.

OBJECTIVE: To determine the prevalence of symptoms of depression and the factors affecting their presence in an elderly population at the start of rehabilitation. To assess changes in the severity of these symptoms during rehabilitation and the correlation between these changes and corresponding changes in the patient's functional state. DESIGN: A population-based prospective study. SETTING: A geriatric ward in a general university hospital in southern Israel. PARTICIPANTS: Two hundred and seventy-six elderly patients hospitalized for physical rehabilitation, 150 following hip fracture (HF) and 126 after stroke. MEASUREMENTS: Symptoms of depression were measured by the Geriatric Depression Screening Scale (GDS). The functional state was assessed using the FIM scale. A broad spectrum of clinical, functional, social and demographic variables was measured using conventional tests. The association between the GDS and these variables was tested by stepwise multiple regression. RESULTS: One hundred and thirteen patients (41%) showed signs of depressions (GDS>10), with 12 (4%) patients having severe symptoms (GDS>20). No significant difference was found between HF and stroke patients in symptoms of depression. Only four of the 41 variables tested were found to be significantly and independently associated with the GDS: pre-event functional state (beta=-0.311, p<0.001), the self-care component of the FIM scale on admission to the hospital (beta=-0.267, p<0.001), living alone (beta=0.149, p=0.015) and impaired visual acuity (beta=0.137, p=0.026). The total variance in GDS accounted for by these four variables (adjusted R-square) was 0. 24. The severity of depression symptoms decreased significantly during rehabilitation and the GDS at discharge was significantly lower than on admission (p=0.008). This change correlated significantly with the corresponding change in functional state (R=-0.15, p=0.03). CONCLUSIONS: Symptoms of depression are common in elderly patients beginning rehabilitation. These symptoms are affected independently, and almost exclusively, by the functional state of the patient, both prior to the event and after its occurrence. The depressed condition improves towards the end of hospitalization and the degree of improvement is correlated with the corresponding change in the patient's functional state.

Aged↗
PubMed1999

Characterization of elderly patients in rehabilitation: stroke versus hip fracture.

PURPOSE: To compare the characteristics of elderly patients hospitalized for rehabilitation following stroke with those following hip fracture (HF). METHODS: A prospective study in a geriatrics department of a general university hospital in southern Israel. Five hundred and sixteen hospitalized elderly patients were included in the study, 221 following stroke and 295 following HF. The characteristics were compared by univariate and logistic regression analyses. RESULTS: The mean age (+/-SD) of the stroke patients was 71.7+/-7.8 years compared to 77.4+/-7.9 for HF (p < 0.000001). Fifty-three per cent of the stroke patients were women compared to 76% of the HF patients (p < 0.000001). Stroke patients had significantly lower levels of folic acid (p = 0.00002). HF patients had more hearing and visual impairments (p = 0.008 and p = 0.017, respectively), but these were related to age differences between the groups. The Folstein Minimental test result was significantly higher in the HF group (p = 0.002). There were no differences in the symptoms of depression score as measured by geriatric depression screening scale. The Functional Independent Measure scale showed a higher pre-event functional capacity among the stroke patients (p < 0.000001), but there was no difference in this scale on admission to rehabilitation or upon discharge. CONCLUSIONS: There is a difference in the nature of the stroke and HF events. When either event involves an elderly patient with a broad range of limitations and diseases, a new medical condition develops. In this condition the symptoms of depression and the functional state at admission and upon discharge are not significantly different between these groups of patients.

Activities of Daily Living↗
PubMed1999

Factors affecting the results of the clock drawing test in elderly patients hospitalized for physical rehabilitation.

The Clock Drawing Test (CDT) is a recognized and accepted instrument for the early diagnosis of dementia in the elderly. In a prospective study we evaluated the association between the results of this test and a broad range of clinical, functional and sociodemographic variables. The study was conducted on elderly patients hospitalized for rehabilitation following stroke or hip fracture (HF) in the geriatric ward of a university hospital in southern Israel. The administration of the CDT and its scoring system were adapted from Sunderland et al. and Wolfe-Klein et al. The study was conducted on all 425 elderly patients who were hospitalized during the study period and who were capable of completing the test. Stepwise multiple regression was used to evaluate the association between the results of the CDT and the other variables. The mean CDT score (+/- SD) for the entire study population was 7.8 +/- 2.5 and 145 patients (34%) had scores of 6 or below. Of the 41 variables that were tested, significant associations with the CDT were found for the following four variables only: the Folstein minimental test (beta = 0.447, p < 0.0001), the cognition value from the admission FIM (beta = 0.252, p < 0.0001), years of education (beta = 0.183, p = 0.0001), and the patient's age (beta = -0.075, p = 0.037). The total variance of the CDT explained by these four variables (Adjusted R2) was 0.554. We conclude that in the study population there was a significant proportion of patients with low CDT scores. This score, in this population, is influenced in particular by two other measures of cognitive function and by the formal level of education, together with a weaker effect of age.

Aged↗
PubMed1998

Validation of a fall-risk screening test, the Elderly Fall Screening Test (EFST), for community-dwelling elderly.

Falls are the most common type of injury among the elderly, and the source of both functional and psychological morbidity. The aim of this study was to validate the Elderly Fall Screening Test (EFST). In a community primary-care clinic, the members 60 years or older who were functionally independent were screened. Of the 568 elderly persons who met these criteria, 361 were interviewed once and 283 persons were re-interviewed a year later. The EFST, a five-item test, was used to divide participants into low- and high-risk groups. Concurrent criterion validity was assessed by physical examinations conducted by physicians who were blind as to the risk designation. Using data from the follow-up interview, predictive validity was assessed on both fall-related and general health measures. Based on the results of the EFST, 28% of the respondents were designated as being at high risk for falls (i.e. having a score of two or more risk items). The results of physicians' examinations corroborated the screening test results in 75% of the cases, with 83% sensitivity and 69% specificity. In the follow-up interview, the high-risk group, as compared to the low-risk group, was more likely to have high scores on EFST, a fall in the past month or year, frequent near falls, and an injurious fall. Those with high EFST scores were more likely to report four or more sick days in the past six months, a hospitalization in the past year, poor self-rated health, a decline in health in the past 6 months, and symptoms of depression. The EFST has both criterion and predictive validity. It can be useful in community-based prevention programmes with functionally independent elderly people.

Accidental Falls↗
PubMed1997

Analysis of alpha-1 antichymotrypsin, presenilin-1, angiotensin-converting enzyme, and methylenetetrahydrofolate reductase loci as candidates for dementia.

The genetic factors which predispose individuals to dementia in old age have not been fully defined. Although the apolipoprotein E4 allele accounts for a proportion of the genetic risk for late-onset Alzheimer disease (AD), it is neither necessary nor sufficient to cause this disease. Recent suggestions that other loci are involved in dementia risk have been supported by findings of associations of genotypes at the alpha-1 antichymotrypsin (ACT) and presenilin-1 (PS-1) loci with AD. We investigated these loci in two community-based aged Cambridgeshire populations: the rural Ely population (cohort 1) comprised 60 pairs of demented and nondemented elderly individuals, with a mean age of 84.2 years; and the Cambridge city population (cohort 2) comprised 81 pairs all over age 84, with a mean age of 87.3 years. Since vascular risk factors are likely to impact on dementia risk, we also examined the angiotensin-converting enzyme (ACE) and methylenetetrahydrofolate reductase (MTHFR) genes as candidates. ACE, ACT, PS-1, and MTHFR genotype and allele frequencies were not significantly different in cases and matched controls. These data support the doubts which have been raised about the involvement of the PS-1 and ACT polymorphisms in late-onset dementia.

Aged↗
PubMed1997

Analysis of the apo E/apo C-I, angiotensin converting enzyme and methylenetetrahydrofolate reductase genes as candidates affecting human longevity.

Genetic factors are likely to affect human survival, since twin studies have shown greater concordance for age of death in monozygotic compared to dizygotic twins. Coronary artery disease is an important contributor to premature mortality in the UK. Accordingly, we have chosen genes associated with cardiovascular risk, apo E/apo C-I, angiotensin converting enzyme (ACE) and methylenetetrahydrofolate reductase (MTHFR), as candidates which may affect longevity/survival into old age. An association study was performed by comparing allele and genotype frequencies at polymorphic loci associated with these genes in 182 women and 100 men aged 84 years and older with 100 boys and 100 girls younger than 17 years. MTHFR allele and genotype frequencies were similar in the elderly and young populations. Apo C-I allele and genotype frequencies were significantly different in the elderly women compared to the younger sample (P < 0.05). No difference was observed in the elderly men. At the neighbouring apo E gene, we only observed a difference between genotypes in the elderly women and the young sample; however, this did not retain significance when the genotype frequencies of the young sample were adjusted to values expected from the allele frequencies on the basis of Hardy-Weinberg equilibrium and compared to observed genotypes in elderly men and women. In contrast to previous studies, apo E2 was not overrepresented in the elderly men or women. Thus, the proposition that apo E2, E3 and E4 protein isoforms are themselves functionally associated with increasing risks for early death, may be too simplistic. The I/I ACE was depleted in the elderly males but not the elderly females. Furthermore, significant differences were observed between ACE genotypes in elderly men and elderly women. These data suggest that the penetrance of loci which influence survival may vary according to sex. The depletion of the ACE I/I genotype in elderly men is generally consistent with a previous study which found decreased frequencies of the I allele in French centenarians compared to younger controls. However, these results are apparently paradoxical, since others have suggested that the I allele is associated with increased cardiovascular risk. Clarification of the overall effect of a genotype on survival will be vital if therapies are to be considered which target specific genetic variants.

Adolescent↗
PubMed1996

Factors related to successful rehabilitation after hip fracture: a case-control study.

A case-control study was performed to evaluate factors associated with successful rehabilitation in elderly patients who sustained hip fractures. All 170 patients with fractured hips hospitalized in the geriatrics ward of the Soroka Medical Center in Beer-Sheva, Israel between 1987 and 1991 were studied. Success of rehabilitation was determined by staff evaluation of the patient's ability to walk and perform activities of daily living. The independent variables, including sociodemographic and medical variables, and mental and functional assessments, were assessed by chart reviews, staff evaluation and mental tests. One-hundred and twenty-nine patients (75.9%) were successfully rehabilitated. A normal mental state (p < 0.0001), female gender (p < 0.02) and absence of diabetes mellitus (p < 0.008) were associated significantly with successful rehabilitation.

Activities of Daily Living↗
PubMed1990

Gross intellectual impairment among non-institutionalized elderly: difficulties in assessment and risk factors.

Quality of life of both the aged person and his relatives depends, to a large extent, on the capacity of the old person to think and to remember. In an attempt to assess the intellectual capabilities (InC) of the elderly and to identify risk factors associated with intellectual impairment (InI), a community study was carried-out. The study population was ethnically heterogeneous and comprised of a high percentage of immigrants and of people who had never attended school. Some methodological issues related to studying InC of a population with these characteristics are discussed. A stratified random sample of non-institutionalized individuals aged 65+ years was home interviewed using a short, portable questionnaire which can be used by non-professional interviewers. The research tool is comprised of 10 questions which check time and place orientation as well as short and long term memory. Although the validity of the questionnaire needs further study, some conclusions can be drawn. Approximately 16% of the subjects failed to answer correctly at least 5 of the 10 questions. People over 75 years old, single persons, those with low education and low environmental stimulation were identified as high risk groups for InI, as defined in our study. Functional limitation, such as immobility, dependence in daily functions and hearing deprivation seem to affect the InC of the aged, especially of the less educated people. Such findings may suggest the need to plan community-oriented prevention programs for the sake of the growing population of the aged in western countries.

Activities of Daily Living↗
PubMed1990

Acromegaly and proximal femoral fracture in an aged person: bone histomorphometry, vitamin D metabolites and parathormone.

Osteoporosis and fractures are rare in acromegaly. An 84-year-old acromegalic woman sustained a fractured neck of femur in a fall. Histomorphometric analysis of an iliac crest biopsy showed marked osteoporosis and augmented resorption parameters. Cortical plates were very thin and bone volume was 8.5%; 12.5% is the reference value for women at this age. The total resorption surfaces were 23.7% compared with the reference value of 8%. We conjecture that postmenopausal and involutional osteoporosis were far advanced before the development of acromegaly, explaining the coexistence of the two conditions. Parathormone (65 pmol/l) and 24,25-dihydroxyvitamin D (1.34 ng/ml) levels were within normal limits, but those of 25-hydroxyvitamin D (5.6 ng/ml) and 1,25-dihydroxyvitamin D (15 pg/ml) were markedly decreased.

Acromegaly↗
PubMed1988

Self-rated health among the elderly. A comparative analysis of health status measures, leisure activities and social contacts in age/sex groups.

A comparative analysis of self-rated health (SRH) by demographic characteristics, health status measures, leisure activities and social contacts was performed in four age/sex groups of elderly. The relative contribution of each group of variables to the explained variation in SRH was assessed using multiple regression analyses. A stratified sample drawn in an Israeli city led to 606 structured home interviews. The results show that: 1) for all groups the strongest correlates with SRH are health status measures, 2) for all groups the weakest correlates with SRH are demographic variables, 3) a significant relationship is found between SRH and age at immigration only for younger males, and 4) the explanatory power of social contacts and leisure activity variables varies significantly among the different groups. These factors explain relatively more of SRH in the younger age groups, and especially among younger males. Such findings suggest careful analyses of concepts in different socio-demographic groups for theoretical reasons and for purposes of planning health promotion community programs.

Aged↗
PubMed1986

Seasonal variation in serum levels of vitamin D metabolites and parathormone in geriatric patients with fractures in Southern Israel.

In 41 geriatric patients with long bone fractures, a seasonal variation was observed in the serum levels of 25-hydroxyvitamin D (25-OH-D), 1,25-dihydroxyvitamin D [1,25(OH)2D], 24,25-dihydroxyvitamin D [24,25(OH)2D] and parathormone (PTH). The serum concentrations of vitamin D metabolites correlate positively, while that of PTH correlates negatively with day length and global solar radiation in southern Israel. Our data suggest that the higher serum levels of vitamin D metabolites during the summer suppress PTH secretion. During the winter, the reduction of serum levels of vitamin D metabolites due to decreased endogenous production was accompanied by an increase in serum PTH levels.

24,25-Dihydroxyvitamin D 3↗