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Biomedical subjects

David Reuben

Publications and source records attributed to David Reuben.

6 recordsLinked to original sources
PubMed2006

Perceived causes of disability added prognostic value beyond medical conditions and functional status.

OBJECTIVE: This study's objective was to determine the incremental benefit of respondent subjective attribution of functional decline beyond relying solely on disease burden in predicting survival. STUDY DESIGN AND SETTINGS: A total of 9447 older adults from the Second Longitudinal Study on Aging, a probability sample of community dwelling adults aged 70 or older, were evaluated. Survival was based on status at follow-up interview 3-4 years after baseline interview. Logistic regression was performed using demographic variables and coexisting diseases as a baseline, then adding functional status measures (ADL, IADL) and individual subjective attribution of functional limitation in subsequent models. RESULTS: The predictions improved significantly with the addition of functional status measures (P<0.001) and the individual subjective attribution of functional limitation (P<0.001). For example, the probability of mortality for individuals with cancer was 17.3%, but 28.8% of those with cancer and functional limitations died as did 50% of those with cancer who reported functional limitations attributable to cancer. CONCLUSION: Among persons who can make a specific attribution of their functional limitation, the attribution may have value as a marker of severity of disease and serve as a good predictive measure for mortality, especially in specific illnesses such as cancer.

Activities of Daily Living↗
PubMed2006

Is cataract surgery cost-effective among older patients with a low predicted probability for improvement in reported visual functioning?

INTRODUCTION: Although cataract surgery has been demonstrated to be effective and cost-effective, 5% to 20% of patients do not benefit functionally from the procedure. This study examines the cost-effectiveness of cataract surgery versus watchful waiting in a subgroup of patients who had less than a 30% predicted probability of reporting improvements in visual function after surgery. METHODS: Randomized trial (first eye surgery vs. watchful waiting) of 250 patients who based on a cataract surgery index (CSI) were felt to have less than a 30% probability of reporting improvements in visual functioning after surgery. Cost was estimated using monthly resource utilization surveys and Medicare billing and payment data. Effectiveness was evaluated at 6 months using the Activities of Daily Vision Scale (ADVS) and the Health Utilities Index, Mark 3 (HUI3). RESULTS: In terms of overall utility, the incremental cost-effectiveness of surgery was Dollars 38,288/QALY. In the subgroup of patients with a CSI score > 11 (< 20% probability of improvement), the cost-effectiveness of cataract surgery was Dollars 53,500/QALY. Sensitivity analysis demonstrated that often this population of patients may not derive a utility benefit with surgery. CONCLUSION: Cataract surgery is cost-effective even in a subpopulation of patient with a lower, < 30%, predicted probability of reporting improved visual functioning after surgery. There may be a subgroup of patients, CSI > 11, for whom a strategy of watchful waiting may be equally effective and considerably less expensive.

Activities of Daily Living↗
PubMed2006

Longitudinal trajectories of heavy drinking in adults in the United States of America.

AIMS: To estimate age, period, cohort and other demographic influences on heavy alcohol consumption and trajectories of heavy drinking in American adults. DESIGN: Prospective cohort of 14 127 participants, aged 25-74 years at baseline. Generalized estimating equations to model longitudinal change in the probability of heavy drinking and its association with demographic factors. Setting National, population-based sample of non-institutionalized civilians. MEASUREMENTS: Heavy alcohol consumption (usual number of drinks per occasion >or= five for men; >or= four for women) at baseline (1971-74) and three follow-ups until 1992. FINDINGS: Heavy alcohol consumption declined with increasing age (age effect) and tracked national average consumption (period effect). There was no cohort effect. Higher probability of heavy drinking was associated with male gender (relative risk: RR = 2.4), being not married (RR = 1.4), having less than high school education (RR = 1.7), having annual income below the median (RR = 1.5), not living in the South-east (RR = 1.7), and smoking (RR = 3.4). Getting married and quitting smoking during the study were each associated with reduction in heavy drinking (RR = 0.55 and 0.61, respectively). Slower age-related decline in the probability of heavy drinking was seen in men (P < 0.0001), married individuals (P = 0.03), and smokers (P = 0.05). CONCLUSIONS: Demographic predictors of trends in heavy drinking are different from those for trends in average alcohol consumption. The likelihood of heavy drinking declined more slowly with increasing age in men and smokers, suggesting that the negative health effects of alcohol in older ages may be greatest in these groups.

Adult↗
PubMed2006

Alcohol use, comorbidity, and mortality.

OBJECTIVES: To examine the combined influence of alcohol use and comorbidity on 20-year mortality in older adults (average age 66 at the time of the baseline survey). DESIGN: Longitudinal analysis of a national probability sample-based cohort study. SETTING: Data sources were the National Health and Nutrition Examination Survey I (NHANES I), 1971-1974, and the NHANES Epidemiologic Followup Survey, 1992. PARTICIPANTS: Four thousand six hundred ninety-one adults aged 60 and older who provided data on alcohol use. MEASUREMENTS: The prevalence of at-risk drinking in older adults in the United States and the 20-year all-cause mortality risk associated with it. At-risk drinking status was determined from amount of alcohol consumed and comorbidities, using a previously validated method. RESULTS: The prevalence of at-risk drinking in the United States between 1971 and 1974 in older adults was 10% (18% of men, 5% of women). The majority of at-risk drinkers were identified as such because of their use of alcohol in amounts deemed risky in the presence of relevant comorbidities (69%) (e.g., drinking 2-3 drinks per day and having gout or anxiety or taking a medication for pain). In men, at-risk drinking was associated with higher mortality rates than not-at-risk drinking (hazard ratio=1.20, 95% confidence interval=1.01-1.41); abstinence was not associated with greater mortality. In women, neither abstinence nor at-risk drinking was associated with greater mortality rates. CONCLUSION: In this first, large population-based study of older adults examining the mortality risks of alcohol use and comorbidity, at-risk drinking was associated with greater mortality rates in men. These findings suggest that a lower threshold of alcohol use should be recommended for older adults with specific comorbidities to reduce mortality risks.

Aged↗
PubMedDate not supplied

How important are psychosocial predictors of mammography receipt among older women when immediate access is provided via on-site service?

PURPOSE: The purpose of the study was to examine the relative importance of psychosocial variables (i.e., health beliefs, knowledge, barriers) in predicting mammogram receipt compared with providing access through a mobile mammography unit among older women who participated in a mobile mammography intervention. DESIGN: The data were collected during a randomized trial involving 499 women (60 to 84 years old) recruited from 60 community sites. SETTING: The study was conducted at 60 sites in Los Angeles where seniors gather, including meal sites, senior centers, and recreational clubs. SUBJECTS: Participants were older women (60 to 84 years old) who spoke English or Spanish, had a telephone, had no significant cognitive deficits, and had not received a mammogram during the past 12 months. MEASURES: The baseline survey assessed demographics and psychosocial factors (i.e., health beliefs, knowledge, barriers). A follow-up telephone survey at 3 months assessed mammography receipt. RESULTS: Results support the importance of behavioral intentions in predicting mammogram receipt, even among women able to access a mammogram through the mobile unit. However, other recognized psychosocial factors failed to predict screening receipt among women randomized to the mobile mammography intervention. Results suggest that the importance of psychosocial predictors might be diminished when a major access barrier has been removed, and they highlight the importance of convenience. CONCLUSION: Future interventions should focus on not only removing obvious concrete and psychosocial barriers but also on enhancing convenience.

Aged↗