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Biomedical subjects

D P Kiel

Publications and source records attributed to D P Kiel.

At least 19 recordsLinked to original sources
PubMed1996

The effect of smoking at different life stages on bone mineral density in elderly men and women.

To assess the effect of smoking on bone mineral density (BMD) at different life stages, to examine whether the effect of smoking differs between men and women, and to discover whether its effect in women differs according to history of estrogen use, a cohort study was carried out with single cross-section measurement of BMD by single and dual photon absorptiometry. The setting was the Framingham Study, a population-based cohort study with over 40 years prospectively collected data on smoking. Subjects (n = 1164) consisted of cohort members participating in the 20th biennial Framingham examination (1988-1989). The measurements included in the study were BMD measured at the hip, spine and radius, smoking history ascertained at all Framingham Study examinations since 1948, and other factors affecting BMD (age, weight, estrogen use, caffeine use, alcohol use and physical activity). Neither current smoking, recent (last 10 years) smoking, nor early adulthood smoking resulted in significantly lower BMD at any skeletal site among women who had not taken estrogen. Among women who had taken estrogen, BMD at most sites was lower among current or recent smokers, although the small numbers of smokers made it difficult to find significant differences at all skeletal sites. Among men, a consistently lower BMD at all skeletal sites was observed for smokers regardless of when in their life they smoked (4-15.3% lower), although the effect of smoking during early adulthood was of a lesser magnitude (4-8% lower). Former male smokers who had quit < 10 years ago had lower BMD than men who had quit > or = 10 years ago. In conclusion, in women who had used estrogen, BMD was lower in current or recent smokers than it was in non-smokers. In men, smoking at any stage of life had adverse effects on the skeleton that was independent of weight, alcohol or caffeine use, implying other mechanisms for smoking's effect on bone.

Absorptiometry, Photon↗
PubMed1996

The epidemiology, clinical characteristics, and natural history of older nursing home residents with a diagnosis of Parkinson's disease.

OBJECTIVE: To determine the epidemiology, clinical characteristics and natural history of nursing home residents with a diagnosis of Parkinson's disease (PD). DESIGN: A cohort study with 18-month follow-up utilizing resident assessments from the National HealthCorp 1991-1992 dataset. SETTING: Seventy-one National HealthCorp nursing homes. PARTICIPANTS: A total of 5020 nursing home residents older than age 55 were studied. Residents with primary and secondary diagnoses of PD were identified from the population using the International Classification of Diseases, Ninth Revision, Clinical Modification code 332.0. MEASUREMENTS: Baseline demographic and clinical characteristics were compared for residents with and those without Parkinson's disease. Outcome measures over the course of 18 months included death and functional status. RESULTS: The prevalence of a diagnosis of PD was 6.8%. Significant factors associated independently with PD included: younger age (79 +/- 7 vs 81 +/- 9 years; P < .001), male sex (32% vs 23%; P < .001), severe dependence in activities of daily living (OR = 1.26; 95% CI 1.08-1.46), impared body control (OR = 1.38; 95% CI 1.03-1.68), symptoms of depression (OR = 1.29; 95% CI 1.02-1.64), and the number of daily medications (OR = 1.23; 95% CI 1.08-1.44). Residents with a diagnosis of PD had a faster rate of functional decline over 18 months (P < .001) but did not have a higher mortality rate than residents without PD. CONCLUSIONS: Parkinson's disease is a relatively common diagnosis among nursing home residents and is associated with increased functional disability. There are several potentially modifiable conditions associated with PD that may offer an opportunity to design specific interventions and health services to improve the quality of life and slow functional decline in this frail population.

Activities of Daily Living↗
PubMed1995

Alcohol intake and bone mineral density in elderly men and women. The Framingham Study.

Alcohol consumption has multiple effects on bone, and alcoholic men have a high risk of osteoporotic fracture. The objective of this study was to assess the association between alcohol consumption and bone mineral density in elders. The authors evaluated 1,154 members of the Framingham Heart Study Cohort at biennial examination 20 (1988-1989). Subjects ranged in age from 68 to 96 years. Bone density was assessed at the radius (ultradistal and shaft) and at the proximal femur and spine. Alcohol consumption, assessed every 2 years from examination 12 (1967-1969) through examination 20, was averaged. The association of alcohol intake with bone density was examined after adjustment for age, weight, height, smoking, and, in women, age at menopause and years of estrogen use. Women who drank at least 7 oz (206.99 ml)/week of alcohol had higher bone densities at most sites (4.2-13.0% range with 7.7% average differences across all sites) than women in the lightest category of intake (< 1 oz (29.57 ml)/week). Men who were heavy drinkers (> or = 14 oz (414 ml)/week) also had higher bone densities than light drinkers, but the difference was less than in women (3.9% average across all sites). Lesser amounts of intake did not affect bone density. The authors conclude that alcohol intake of at least 7 oz (206.99 ml)/week is associated with high bone density in postmenopausal women, an effect possibly related to the augmentation of endogenous estrogen levels by alcohol.

Age Distribution↗
PubMed1995

The effects of analytic software and scan analysis technique on the comparison of dual X-ray absorptiometry with dual photon absorptiometry of the hip in the elderly.

As part of a longitudinal comparison of bone mineral density (BMD) results originally obtained using a Lunar dual photon absorptiometry (DPA) scanner and later, using a Lunar dual X-ray absorptiometry (DXA) scanner, we compared femur results between DPA and DXA according to DXA analytic software (versions 1.3y and 1.4), and according to the method of placement of the femoral neck box (software algorithm or operator placement according to the appearance of the pair of images) in 58 elderly men and women. The mean BMD at each of three femoral sites was higher using DXA version 1.3y than DPA, but the use of software version 1.4 brought the BMD value closer to that of DPA at all sites. Of 58 scans, 12 (21%) were changed by the operator, resulting in an overall reduction in mean percent BMD difference between scan pairs of 79% (from 1.24% to 0.29%). Although the differences between the DPA/DXA software-driven analysis and the DPA/DXA operator-driven analysis appeared small (high r2 values and intra-class correlation coefficients), the increase in sample size that would be required for the same power to detect 2-year changes in BMD if the software-driven analysis was used instead of taking the time to perform the operator-driven analysis was 18%. The findings of this study highlight the need to account for upgrades in analytic software. Furthermore, we present a rational approach for the analysis of serial scans that has face validity and that results in smaller differences between pairs of scans performed on the same individual. The decision to adapt these methods must be based on the relative costs of reducing unwanted scan variability.

Absorptiometry, Photon↗
PubMed1995

An epidemiologic study of fall-related fractures among institutionalized older people.

OBJECTIVES: The purpose of this study was to assess the incidence of fall-related fractures, and the circumstances surrounding these events, during a 5-year period among all residents of a long-term care facility. PARTICIPANTS: The study group was composed of residents with radiologically confirmed fractures that were the direct result of a fall occurring between the years 1988 and 1992. This group was 82% female and had a mean age of 89 +/- 6 years. DESIGN: The study was designed as a 5-year retrospective cohort study in a long-term care institution where annual incidence rates of fracture were assessed. RESULTS: There were 296 fall-related fractures during the 5-year period. Annual incidence rates remained fairly constant (72, 86, 84, 70, and 94 per 1000 person-years, respectively) despite a 54% decline in the use of physical restraints during the 5-year period. Hip fractures comprised almost 50% of all fractures. Based on incident reports of these fractures, 42% occurred during the day, 55% took place in the bedroom or adjoining bathroom. 67% occurred while the resident was ambulating, and a wet floor was in evidence in 16% of the incidents. CONCLUSION: Fracture incidence in this long-term care facility has remained stable despite reduced restraint use. The incident reporting system may contribute valuable information to the identification of factors that should receive further attention in studies of risk factors for fracture in the long-term care setting.

Accidental Falls↗
PubMed1994

The outcomes of patients newly admitted to nursing homes after hip fracture.

OBJECTIVES: The outcomes of elderly, hospitalized patients discharged to nursing homes after hip fracture were examined. METHODS: For 2624 hip fracture patients admitted to any of 43 proprietary nursing homes between 1984 and 1988, admission assessments were examined in relation to 1-month outcomes. RESULTS: Mean patient age was 82 +/- 7 y; 85% of the sample were female. Within 1 month after discharge, 24% had returned home, 12% had been rehospitalized, 3% had died, and 61% remained in the nursing home. Characteristics significantly associated with morality included disorientation, functional dependency, neurologic diagnoses, and use of cardiac medications, antidepressants, or narcotics. Rehospitalization was significantly associated with age, gender, living with someone, being ambulatory, and functional dependency. Returning home was associated with younger age, living with someone, being ambulatory, and having no disorientation, functional dependency, or psychiatric or neurologic diagnoses, nor any pressure sores. CONCLUSIONS: Better-functioning persons and those with social support returned home; physically and cognitively impaired persons and those taking narcotics, cardiac medications, or antidepressants were likely to die; and younger men, those with social support, those with functional dependency, and those who were free of disorientation were more likely to be rehospitalized.

Activities of Daily Living↗
PubMed1993

The effect of postmenopausal estrogen therapy on bone density in elderly women.

BACKGROUND: Estrogen therapy prevents bone loss in postmenopausal women who take it early in the postmenopausal period. The risk of fracture is highest much later in life, however. We studied whether bone mass in elderly women was affected by earlier estrogen use and how long women needed to take estrogen for it to have a beneficial effect on bone density later in life. METHODS: In 1988 and 1989, we measured bone mineral density at the femur, spine, shaft of the radius, and ultradistal radius in 670 white women in the Framingham Study cohort (mean age, 76 years; range, 68 to 96). These women had been followed prospectively through menopause and had been asked repeatedly about estrogen therapy. After excluding women who began taking estrogen after a fracture, we investigated whether postmenopausal estrogen therapy affected bone density; in these analyses we adjusted for age, weight, height, cigarette smoking, physical activity, and age at menopause. RESULTS: A total of 212 women (31.6 percent) had received estrogen therapy (mean estimated duration of treatment, 5 years). Only women who had taken estrogen for 7 to 9 years or for 10 or more years had significantly higher bone mineral density than women who had not taken estrogen (7 to 9 years of treatment, P < 0.05 at sites in the femur and the spine; > or = 10 years, P < 0.05 at all sites except the spine). In the women less than 75 years of age who had taken estrogen for seven or more years, the bone density was, averaging all sites, 11.2 percent greater than in women who had never received estrogen. Among women 75 years of age and older in whom the duration of therapy was comparable, bone density was only 3.2 percent higher than in women who had never taken estrogen. CONCLUSIONS: For long-term preservation of bone mineral density, women should take estrogen for at least seven years after menopause. Even this duration of therapy may have little residual effect on bone density among women 75 years of age and older, who have the highest risk of fracture.

Age Factors↗
PubMed1993

The evaluation of falls in the emergency department.

Falls occur commonly among elderly persons and are often evaluated in the ED when they result in either a minor or serious injury. The injury resulting from the fall should not be the sole focus of the physician's evaluation. Rather, a careful history, physical examination, including the observation of simple physical performance measures, and laboratory evaluation should enable the physician to identify a possible cause of the fall. Specific treatment depends on the cause, but certain immediate interventions can be undertaken, or the patient can be followed up or referred to a specialist as appropriate for each situation.

Accidental Falls↗
PubMed1992

Smoking eliminates the protective effect of oral estrogens on the risk for hip fracture among women.

OBJECTIVE: To determine if the association between smoking and osteoporotic fractures is related to the quantity of cigarettes smoked and to determine if smoking modifies the protection by estrogens. DESIGN: Cohort study. SETTING: A population-based cohort study, the Framingham Study. PARTICIPANTS: A total of 2873 women in the Framingham Study followed through examination 19 (1985-1987). MEASUREMENTS: All fractures of the proximal femur sustained by women in the Framingham Study from 1948 to 1987 were ascertained. At almost all examinations, available information on cigarette smoking was used to classify women as "ever smokers" compared with "never smokers," and, among "ever smokers," "current" compared with "former smokers." A similar classification for estrogen use was created. Information on potentially confounding variables was taken from each examination, including age, adiposity (weight/height2), alcohol consumption (ounces per week), and caffeine intake (coffee and tea). RESULTS: Overall, 207 hip fractures occurred among 34,700 woman-examinations of observation. In the entire cohort, current smoking did not appear to increase hip fracture risk (adjusted odds ratio [AOR], 1.22; 95% CI, 0.76 to 1.95; P greater than 0.2). Also overall, current estrogen use appeared to be protective (AOR, 0.38; CI, 0.12 to 1.21, P = 0.10). Among current smokers, however, estrogen use did not protect against fracture (AOR for current use, 1.26; CI, 0.29 to 5.45), whereas estrogen was protective in nonsmokers (AOR for current or past use, 0.37; CI, 0.19 to 0.75; P = 0.005). CONCLUSIONS: Overall, smoking does not appear to increase the risk for hip fracture in women. Although estrogen replacement protects nonsmokers from fracture, smoking may negate the protective skeletal effects of estrogen replacement therapy.

Administration, Oral↗
PubMed1991

Thiazide diuretics and the risk of hip fracture. Results from the Framingham Study.

Thiazide diuretics may preserve bone mass and prevent elderly women's osteopenic fractures, but studies have not distinguished between thiazide preparations or examined former users. We performed a case-control study looking at thiazide use and subsequent hip fracture in postmenopausal female members of the Framingham Study cohort. Cases who had experienced a first hip fracture (n = 176) were compared with age-matched controls (n = 672). Results showed a modest protective effect of any recent thiazide use (not significant). However, recent pure thiazide users experienced significant protection against fracture (adjusted odds ratio, 0.31; 95% confidence interval, 0.11 to 0.88), whereas recent users of combination drugs containing thiazides experienced no protection (adjusted odds ratio, 1.16; 95% confidence interval, 0.44 to 3.05). Combination drugs generally contained only 25 mg of hydrochlorothiazide, suggesting that the small amount of thiazide was insufficient to preserve bone mass. Former thiazide users were not protected against fracture. In sum, recent pure thiazide use in women protects against hip fracture.

Aged↗
PubMed1991

Health care utilization and functional status in the aged following a fall.

Falls in the aged may lead to increases in health care utilization and declines in functional status. The Longitudinal Study of Aging was analyzed to test the hypotheses that use of the health care system is greater in elderly persons subsequent to a fall in the preceding year than in those who have not fallen and that fallers are more likely to decline in function than are nonfallers. One-time fallers and, especially repeated fallers, (2 or more falls in the preceding year) were at greater risk of subsequent hospitalization, nursing home admission, and frequent physician contact than were nonfallers, after controlling for age, sex, self-perceived health status, and difficulties with activities of daily living. Similarly, one-time fallers, and especially repeated fallers, were at greater risk of reporting subsequent difficulties with activities of daily living, instrumental activities of daily living, and more physically demanding activities. These findings highlight the significant impact that falls have on the health care system and on the individual.

Accidental Falls↗
PubMed1991

Falls.

Falls occur commonly enough in community-dwelling elderly, and have sufficient morbidity and mortality, to argue for increased recognition of the problem by physicians. Whereas in the past these falls may have been considered an inevitable part of aging, it is now clear that distinct risk factors can be identified. Physicians can evaluate patients by using relatively simple assessment tools, including the history, physical examination and, most importantly, direct observation of position changes and gait maneuvers used in everyday activities of daily living. Interventions to prevent falls can be based on the individual assessment of risk factors. The implications of effective preventive practices for Rhode Island are substantial given the relatively high percentage of older persons in the state and the limited long term care facilities required to care for the older person whose decline in function follows a fall.

Accidental Falls↗
PubMed1990

Caffeine and the risk of hip fracture: the Framingham Study.

Caffeine increases urinary calcium output and has been implicated as a risk factor for osteoporosis. The authors examined the effect of caffeine on hip fracture risk in 3,170 individuals attending the 12th (1971-1973) Framingham Study examination. Coffee and tea consumption, age, Framingham examination number, weight, smoking, alcohol consumption, and estrogen use were used to evaluate hip fracture risk according to caffeine intake. Hip fractures occurred in 135 subjects during 12 years of follow-up. Fracture risk over each 2-year period increased with increasing caffeine intake (one cup of coffee = one unit of caffeine, one cup of tea = 1/2 unit of caffeine). For intake of 1.5-2.0 units per day, the adjusted relative risk (RR) of fracture was not significantly elevated compared with intake of one or less units per day. Consumption of greater than or equal to 2.5 units per day significantly increased the risk of fracture. Overall, intake of greater than two cups of coffee per day (four cups of tea) increased the risk of fracture. In summary, hip fracture risk was modestly increased with heavy caffeine use, but not for intake equivalent to one cup of coffee per day. Since caffeine use may be associated with other behaviors that are, themselves, risk factors for fracture, the association may be indirect. Further studies should be performed to confirm these findings.

Age Factors↗
PubMed1990

Multiple stumbles: a risk factor for falls in community-dwelling elderly. A prospective study.

To better understand risk factors for falls among community-dwelling elderly, we analyzed data from a sample of elderly Medicare beneficiaries interviewed in 1987 and a year later. Demographic, social, medical, and functional information were obtained by telephone interviews with 736 subjects (68% women) whose average age was 76.5 (range, 65-99). At baseline, 63 subjects reported a fall and 67 reported two or more stumbles without a fall in the past month. At the second interview follow-up information on falls in the past year was obtained on 586 subjects. One hundred twenty-seven (22%) subjects reported one or more falls. Baseline risk factors that were independent predictors of a fall at the second interview included two or more stumbles (adjusted odds ratio [AOR] 2.3, 95% confidence interval [CI], 1.2-4.5), one or more falls (AOR 5.9, 95% CI 2.9-12.2), having spent 4 or more days in bed in the past month (AOR 7.7, 95% CI 1.9-31.0), and self-reported declining health status (AOR 2.0, 95% CI 1.1-3.5). Falls and stumbles are prevalent among community-dwelling elderly. After controlling for covariates, we found subjects who reported two or more stumbles in the past month are at increased risk for a fall in the following year.

Accidental Falls↗
PubMed1989

Sex hormones and lipoproteins in men.

PURPOSE: To clarify the conflicting evidence of an association between endogenous sex hormones and lipoprotein metabolism in men, we examined the relationship between sex hormone levels, total cholesterol, and high-density lipoprotein cholesterol (HDL-C), taking into account the coronary artery disease (CAD) status of the subjects. PATIENTS AND METHODS: Sex hormone levels, total cholesterol, and HDL-C were measured in 67 men with CAD from among 191 consecutive male patients between the ages of 25 and 75 undergoing coronary angiography, in 26 men without angiographic evidence of CAD, and in 55 men who were clinically free of CAD. RESULTS: There was a consistently positive correlation between total estradiol or calculated free estradiol and both total cholesterol and HDL-C, which persisted after adjustment for potential confounders. Total cholesterol was associated with total testosterone after controlling for age, adiposity, and the presence or absence of CAD, but not with calculated free testosterone. No association was noted between total testosterone or calculated free testosterone and HDL-C. A significant interaction was observed between estradiol and testosterone with respect to total cholesterol. CONCLUSION: This study demonstrates an association between sex hormone levels and lipoprotein metabolism, specifically between estradiol levels and both total cholesterol and HDL-C. Unlike most previous investigators, we were able both to control for the CAD status of our subjects and to consider unbound, biologically active hormone levels. In addition, we documented a complex interaction between endogenous testosterone and estradiol in relation to lipoprotein levels; this association should be considered in future studies.

Adult↗