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Biomedical subjects

J Garrard

Publications and source records attributed to J Garrard.

At least 19 recordsLinked to original sources
PubMed2000

Factors associated with antiepileptic drug use among elderly nursing home residents.

UNLABELLED: BACKGROUND. Epilepsy, a chronic condition defined as two or more recurrent, unprovoked seizures, has the highest incidence at the end of life. Antiepileptic drugs (AEDs) are the primary therapeutic mode. Approximately 10%-11% of elderly nursing home residents receive one or more AEDs, a higher prevalence than would be expected in this age group. In the research literature, there is not a clear explanation of variations in AED use in nursing homes. The purpose of this study was to examine the prevalence and variations in use of AEDs by resident characteristics, AEDs used, drug dosage, and AED combinations in treatment regimens. METHODS: This was a retrospective, cross-sectional study of residents (N = 21,551) in a convenience sample of nursing homes in 24 states and the District of Columbia. The unit of analysis was the individual resident. The study period was a single day in 1995. Bivariate and multivariate analyses were used to test differences. RESULTS: The prevalence of AED use was 10.5% across all elderly residents. In a multivariate analysis, factors associated with AED treatment included seizure indication, age group, and geographic region. AED use by age group showed declining use as the residents aged, from 65-74 to 75-84 to > or =85 years. CONCLUSIONS: The inverse relationship between AED use and age group was unexpected because the incidence of epilepsy increases with advancing age. This finding raises important questions about the future use of these drugs in elderly nursing home residents.

Aged↗
PubMed1999

The role of depression in the association between self-rated physical health and clinically defined illness.

We enrolled 543 elderly participants of a managed care organization in a cross-sectional study to test whether the association between self-rated physical health and clinically defined illness differs for persons who are not depressed compared with persons with minor or serious depression. Depression was measured with the Diagnostic Interview Schedule (DIS). Clinically defined illness was measured with the Chronic Disease Score (CDS), a pharmacy-based measure. Additional variables included age, sex, and self-reported pain and physical function. Self-rated physical health was associated with both minor and serious depression, independent of clinically defined illness; minor depression was no longer significant when self-reported pain and physical function were added to the model. A significant negative correlation between self-rated physical health and clinically defined illness was observed for minor and no depression, but no correlation was seen for serious depression. These results confirm the association between depression and self-rated physical health and emphasize that, for persons with serious depression, self-rated health provides a less accurate picture of clinically defined illness at both ends of the spectrum. Also, a diagnosis of minor depression should not forestall investigation of inconsistencies between patient report and clinical evidence.

Aged↗
PubMed1998

Clinical detection of depression among community-based elderly people with self-reported symptoms of depression.

BACKGROUND: Depression is under-diagnosed and under-treated in the primary care sector. The purpose of this study was to determine the association between self-reported indications of depression by community-dwelling elderly enrollees in a managed care organization and clinical detection of depression by primary care clinicians. METHODS: This was a 2-year cohort study of elderly people (n = 3410) who responded to the Geriatric Depression Scale (GDS) at the midpoint of the study period. A broad measure of clinical detection was used consisting of one or more of three indicators: diagnosis of depression, visit to a mental health specialist, or antidepressant medication treatment. RESULTS: Approximately half of the community-based elderly people with self-reported indications of depression (GDS > or = 11) did not have documentation of clinical detection of depression by health providers. Physician recognition of depression tended to increase with the severity of enrollees' self-reported feelings of depression. Men 65-74 years old and those > or = 85 years old were at highest risk for under-detection of depression by primary care providers. CONCLUSIONS: Clinical detection of depression of elderly people living in the community continues to be a problem. The implications of failure to recognize the possibility of depression among elderly White men suggest a serious public health problem.

Aged↗
PubMed1997

Drug use management in board and care facilities.

The purpose of this study was to describe medication management in board and care facilities throughout Minnesota. A triangulation of data collection methods was used, including mail questionnaires (N = 98 facilities), telephone interviews (N = 64 facilities), and site visits (N = 15 facilities). Major issues examined included characteristics of board and care facilities, staffing, residents, and drug management systems. Results showed that staff in 86% of the board and care facilities surveyed provided medication storage, 83% gave medication reminders, and 69% administered medications to one or more residents. Site visits revealed a wide diversity in the characteristics of managers and their attitudes toward medication administration.

Activities of Daily Living↗
PubMed1995

Does Life Education's drug education programme have a public health benefit?

The Life Education organization offers a drug education programme to an estimated one million Australian primary schoolchildren. It is believed the programme delays experimentation with or initiation into smoking, alcohol use and the taking of analgesics. This study examined the short-term public health effects on 3000 11- and 12-year-old students, of whom 1700 were exposed to 5 consecutive years of the programme. The other 1300 students were not exposed to the programme. After controlling for the known predictors of social drug use there was no evidence that Life Education students, when compared with students receiving conventional school-based drug education, were less likely to have smoked, were less likely to have drunk or were less likely to have used analgesics. Indeed, the evidence suggested that Life Education-students were slightly more likely to use these substances, and that the programme had different effects on boys' and girls' drug use. Given that these findings are consistent with previous research evaluating similar drug education programmes, it is hypothesized they are most likely to do with the design of the programme itself.

Alcohol Drinking↗
PubMed1995

The impact of the 1987 federal regulations on the use of psychotropic drugs in Minnesota nursing homes.

OBJECTIVES: The purpose of this study was to examine prevalence rates of psychotropic drug use by elderly nursing home residents 3 years before and 1 year after implementation of the 1987 Omnibus Budget Reconciliation Act drug regulations throughout the United States on October 1, 1990. METHODS: A cohort study was conducted of elderly nursing home residents, for each of 4 study years (approximately 33,000 residents per year), of all nursing homes (n = 372) in Minnesota certified by Medicare and Medicaid. Data included (1) health status assessment and psychotropic drug use; (2) nursing home and care characteristics; and (3) county geographic and population characteristics. RESULTS: Annual rates of antipsychotic drug use declined by one third over the 4-year period (23%, 22%, 19%, and 15% from 3 years before enforcement of the regulations to 1 year afterward). All differences were statistically significant. Antianxiety use rates were 11%, 12%, 12%, and 12%, respectively, and antidepressant use rates were 14%, 15%, 16%, 16%, respectively, for the 4 years. The latter two classes of drugs were not affected directly by the regulations. CONCLUSIONS: Declines in the rates of antipsychotic drug use appear to be associated with anticipation of the regulations the year before and as the result of the regulations the year after the October 1990 implementation. A hypothesized medication shift to benzodiazepine drugs was not observed.

Aged↗
PubMed1994

Comparison of injuries to children with and without disabilities in a day-care center.

Injury rates and characteristics of children with and without disabilities in separate day-care programs were studied retrospectively through a record review of injury logs. The study focused on three issues: (1) initial injury rates and multiple injury rates, with comparisons by gender and program; (2) the characteristics of children who were injured compared to those who were not injured; and (3) comparisons between programs on characteristics and consequences of injuries. Injury rates were calculated on the basis of children's exposure time in the day-care setting. Results showed that children with disabilities had higher rates of injury than those without disabilities. Injury prevention in day care should be tailored to the characteristics of children and the types of injuries that occur in this setting.

Child Day Care Centers↗
PubMed1993

Injuries to preschool-age children in day-care centers. A retrospective record review.

OBJECTIVES: To increase our understanding of the epidemiologic nature of injuries to children in day-care settings by examining injury logs and to determine appropriate methods for calculating injury rates. DESIGN: Retrospective, with data collected through a review of 1 year's records. SETTING: Four suburban day-care centers in the upper Midwest. PARTICIPANTS: Five hundred twenty-seven preschool-age children, 275 of whom experienced one or more injuries during the study period. SELECTION PROCEDURE: Convenience sample. MEASUREMENTS/RESULTS: Injury rates were calculated based on the number of hours spent in day care in the study year. More than 1000 injuries were reported for 527 children. Injury rates ranged from 0.006 to 0.049 per child per standardized 8-hour day in a day-care center (or six to 49 injuries per 1000 children per 8 hours of exposure). However, most injuries were minor, and none resulted in a fatality or hospital admission. Using this method, injury rates were examined by gender and month. CONCLUSIONS: Future research should determine exposure time based on the actual number of hours a child spends in attendance to determine injury rates. Exposure time should also be carefully considered in determining product- and location-specific rates of injury.

Abstracting and Indexing↗
PubMed1993

Differences between nursing home admissions and residents.

The use of a cross-sectional sample of nursing home residents rather than a sample of admissions to estimate admission characteristics carries a potential bias. The purpose of this study was to fill this void by comparing abstracted records data for an admissions cohort (n = 1,118) and a residents cohort (n = 830) residing in the same nursing homes. Compared to residents, admissions were significantly more dependent in their ability to get around and to dress themselves, received more clinical services, and had a higher rate of medication use. Over a 12-month period, admissions had a fivefold greater likelihood of being discharged to community, but about the same mortality rate as residents. Within both groups, those discharged to the community as well as those who died had expenditures that were almost twice as high as those of their counterparts who remained alive in the nursing home.

Activities of Daily Living↗
PubMed1992

Longitudinal study of psychotropic drug use by elderly nursing home residents.

In this longitudinal study of patterns of use of psychotropic drugs by a cohort of elderly nursing home residents (N = 5,752), drug use was examined upon admission, 3 months later, and at discharge/end of study. At each time point, 17% of the cohort used neuroleptics. Half of the subjects discontinued neuroleptics at each time point; however, a similar number were initiated on the drug. Benzodiazepines were used by 21%, 15%, and 15% at each of the three time points, respectively. Twice as many people were taken off benzodiazepines as initiated on them following admission. The 5% rate of antidepressant use was constant across the three time periods, although only half of those who took antidepressants upon admission were also taking them upon discharge/end of study. The amount of change due to discontinuation of these drugs and adjustment in dosage levels challenges the stereotype of the "neglected psychotropic drug user" in nursing homes.

Aged↗
PubMed1992

Inadequate treatment of depressed nursing home elderly.

OBJECTIVE: To determine the prevalence of antidepressant drug treatment among nursing home elderly with major depression. DESIGN: Survey early and late in nursing home stay. SETTING: Sixty Medicaid/Medicare-certified skilled nursing homes. PARTICIPANTS: Admission cohort of 5,752 residents age 65 or older in 1976 through 1983. MEASURES: Chart review by nurse-abstractors of physicians' diagnoses, drug used, and alertness rating. Diagnosis of depression equivalent to DSM-III-R major depression. RESULTS: Of 868 persons with a diagnosis of depression in the medical record, only 10% were treated with antidepressant drugs. More received neuroleptics and benzodiazepines than received antidepressants, but most (52%) received no psychoactive drug at all. A subset of 258 depressed persons had positive notations in their records supporting a mental status rating of "alert and oriented." Of that subset, only 15% received antidepressants. When followed from admission to discharge or end of study the prevalence rate of antidepressant drug treatment increased by 4%. CONCLUSIONS: In the late 1970's and early 1980's, even when the primary care physician made and recorded a diagnosis of depression, most such nursing home residents remained untreated, incorrectly treated, or inadequately treated.

Aged↗
PubMed1992

Promoting health and evaluating change.

Health promotion is a term that includes a range of approaches aimed at maintaining and promoting the population's health. In its broadest sense health promotion includes: health protection legislation and enforcement; healthy public policy; mass media communications; community development in health; health education; and preventive health services. The use of these approaches has been associated with improved health in Australia, but evaluating the effectiveness of health promotion is not easy. Multi-faceted approaches are most effective, but are difficult to evaluate using experimental or quasi-experimental designs. In addition, health promotion has yet to meet the challenge of measuring progress towards improving health and well-being, as distinct from reductions in disease and in behavioural risk factors for disease. This paper discusses health promotion, its strategies and impacts, and some issues involved in its evaluation.

Accidents, Traffic↗
PubMed1991

Improving primary care in nursing homes.

We conducted a quasi-experiment to evaluate the impact of a Medicare waiver which allowed the use of nurse practitioners (NPs) and physicians assistants (PAs) to deliver primary care to Massachusetts nursing home patients and removed the limits on the reimbursable numbers of visits per month. A carefully matched set of 1,327 Medicaid patients from 95 non-participating homes in the same areas of Massachusetts was compared to 1,324 Medicaid demonstration patients from 75 homes. Information came from specially designed record reviews and the Medicaid and Medicare information systems. Separate analyses were done for newly admitted cases and rollovers. Comparisons of quality of care suggested that the medical groups using NPs and PAs provided as good or better care than did the physicians in the control group. There were no differences in functional status changes or in the use of medications. The demonstration patients received more attention, as reflected in more orders written and an average of one additional visit a month. Demonstration patients showed higher scores on three of seven specially designed quality tracers, congestive heart failure and hypertension for both new administrations and rollovers, and new urinary incontinence for new admissions. Rollovers had significantly fewer emergency and total hospital days. A cost analysis suggests that the use of NPs and PAs saves at least as much as it costs and may save additional money with more sustained use.

Aged↗
PubMed1990

Impact of geriatric nurse practitioners on nursing-home residents' functional status, satisfaction, and discharge outcomes.

This study evaluated the impact of geriatric nurse practitioners (GNP) employed by nursing homes on quality of patient care and residents' outcomes during a 12-month study period. Quality of care was assessed in standardized interviews of 525 residents in five nursing homes with GNPs and 323 residents in five other nursing homes without GNPs. Each resident was interviewed up to four times during the study period (at baseline, and 3, 6, and 12 months later) to determine functional status, satisfaction with care, and physical condition at each of these points. The only significant difference between groups was that fewer newly admitted residents were hospitalized from GNP homes than from those without a GNP. The results of this interview study showed that the GNP as a nursing home employee had little impact on residents' functional status, physical condition, or satisfaction.

Activities of Daily Living↗
PubMed1990

Assessing cost effects of nursing-home-based geriatric nurse practitioners.

Employment of geriatric nurse practitioners (GNPs) is one strategy to improve nursing home care. The effects of GNPs on costs and profitability of nursing homes and on costs of patient medical service use outside the nursing home are examined. Employment of GNPs does not adversely affect nursing home costs or significantly affect profits. There is some evidence of cost savings in medical service use for newly admitted patients but no evidence of savings for continuing residents. GNPs reduce the use of hospital services for both groups, and the reduction is statistically significant for newly admitted patients.

Aged↗
PubMed1989

A comparison of response rate, data quality, and cost in the collection of data on sexual history and personal behaviors. Mail survey approaches and in-person interview.

The authors examined differences in rate of response, data quality, and cost between mail approaches and in-person interview in the collection of data on sexual history and personal behaviors. A sample of women from a midwestern United States university (n = 342) was identified from health service medical records as having been seen for a sexually transmitted disease (cases) or a contraceptive visit (controls) during the latter half of 1985. The women were randomly assigned to one of three data collection strategies. A total of 268 subjects (78%) participated. Results indicated no differences in validity by method of data collection or by case-control status but there were significant differences in completeness, cost, and response rates. In-person interviews resulted in more complete data than mail approaches, although all instruments had low proportions of missing data (0.001-0.006). Response rate differences were not found when data collection methodologies were compared (75-82%) but were found in case-control analyses. Cases were consistently less likely to participate and significantly less likely to respond by mail (p less than 0.05). The cost of the in-person interview was approximately four times that of the mail survey for the data collection. Implications of the case-control response rate difference suggest that mail methodologies, although low in cost, may introduce sampling bias in studies of sexually transmitted diseases.

Adolescent↗
PubMed1989

Effects of a geriatric nurse practitioner on process and outcome of nursing home care.

We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care.

Activities of Daily Living↗