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Biomedical subjects

J M Mossey

Publications and source records attributed to J M Mossey.

11 recordsLinked to original sources
PubMed2000

The effects of pain and depression on physical functioning in elderly residents of a continuing care retirement community.

UNLABELLED: OBJECTIVE. Explore the relationships between pain, depression, and functional disability in elderly persons. DESIGN: A cross-sectional, observational study of 228 independently living retirement community residents. METHODS: Self-report measures of pain (adaptation of McGill Pain Questionnaire), depression (Geriatric Depression Scale [GDS]) and physical functioning (Physical performance difficulties, activities of daily living [ADL], independent activities of daily living [IADL], and 3-meter walking speed) were employed. OUTCOME MEASURES: Physical functioning variables were dichotomized. Individuals in the lowest quartiles of functional performance and of walking speed were contrasted to all others; for ADL and IADL, those needing some help were compared with those independent in activities. RESULTS: Pain and depression levels were strongly related to physical performance; depression levels were related to ADL and walking speed. In multivariate analyses, an interaction effect was observed where the effects of pain were a function of level of depression. Individuals reporting activity-limiting pain and slightly elevated depressive symptom levels, sub-threshold depression, or major depression were significantly more likely (AOR 7.8; 95% CI, 3.07-20.03) than non-depressed persons to be in the lowest quartile of self-reported physical performance. CONCLUSIONS: While both pain and depression level affect physical performance, depressive symptoms rather than pain appear the more influential factor. When seeing elderly patients, identifying, evaluating, and treating both pain complaints and depressive symptoms and disorders may reduce functional impairment.

Journal Article↗
PubMed1996

Effectiveness of a psychosocial intervention, interpersonal counseling, for subdysthymic depression in medically ill elderly.

BACKGROUND: Subdysthymic depression occurs in 20-50% of hospitalized elderly and is associated with physical and social disability, delayed recovery, and excess health service use. Despite this, little is known regarding the nature of such depressive symptomatology, or its responsivity to treatment. To address this, a randomized clinical trial assessing the feasibility and efficacy of Interpersonal Counseling (IPC), a short-term psychotherapy, was conducted. METHODS: Patients 60+ with a Geriatric Depression Scale (GDS) score > 10 not meeting DSM-III-R criteria for major depression or dysthymia were recruited from the acute hospital. Thirty-five individuals were randomized to IPC and 41 to usual care (UC). IPC was delivered following hospital discharge by psychiatric clinical nurse specialists. Interviews were conducted at recruitment and 3, 6, and 12 months later. Primary outcomes were GDS scores, health ratings, and measures of physical and social functioning. RESULTS: At 3 months, IPC group members showed greater improvement than UC members on all outcome variables; between-group differences did not reach statistical significance. At 6 months, a statistically significant difference in the rate of improvement in GDS, indicated by scores of 10 or less, was observed for IPC compared to UC members (60.6% vs 35.1%). Multivariate analyses confirmed a positive treatment effect on depressive symptoms. Similar multivariate analyses showed a statistically significant positive treatment effect on self-rated health but not on physical or social functioning. CONCLUSIONS: IPC appears feasible, acceptable, and effective in short-term depressive symptom reduction and in improvement in self-rated health. Implementation of IPC interventions for subdysthymic hospitalized elderly is recommended.

Activities of Daily Living↗
PubMed1990

The effects of persistent depressive symptoms on hip fracture recovery.

One hundred ninety-six older. White females were followed for 12 months after hip fracture. We examined the effects of persistently elevated depressive symptoms, measured by the Center for Epidemiological Studies Depression (CES-D) scale during a postsurgery interview and 2, 6, and 12 months later, on ambulation, overall physical function, and return to prefracture physical function 12 months after fracture. Age, prefracture physical function, and cognitive status were predictors of recovery. Controlling for these factors, persons consistently reporting few depressive symptoms were three times more likely than those with persistently elevated CES-D scores to achieve independence in walking, nine times more likely to return to prefracture levels in at least five of seven physical function measures, and nine times more likely to be in the highest quartile of overall physical function. These findings emphasize the importance of persistently elevated depressive symptoms for recovery. Routine screening, evaluation, and treatment of depression or depressed mood may be beneficial to the recovering hip fracture patient.

Activities of Daily Living↗
PubMed1989

Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors.

The independent contributions to recovery from hip fracture of psychosocial factors including depression, personality, social connectedness, and self-rated health were studied in 219 women age 59 and older (mean age 78.5) who were community dwelling prior to fracture. Initial assessments were conducted shortly after surgery and follow up assessments 2, 6, and 12 months later. By 12 months, 15 patients had died and 15 had entered a nursing home. Substantial declines in physical functioning though not psychosocial status were observed. Only 21 per cent (compared to 81 per cent prefracture) reported walking independently; fewer than 30 per cent had regained reported prefracture levels of physical function. The proportion with elevated depression scores at 12 months was 20 per cent, down from 51 per cent following surgery; 64 per cent rated their health excellent or good at 12 months, up from 43 per cent after surgery. Poor cognitive status and post-surgical self-rated health were predictive of mortality. Among survivors, age, prefracture physical functioning, and cognitive status were associated with recovery in physical function but not psychosocial status. High post-surgery depression scores, but not the other psychosocial factors, were associated with poorer recovery in both functional and psychosocial status. These findings demonstrate the importance of depressive symptoms as one determinant of recovery from hip fracture and support the need to attend to the affective status of hip fracture patients following surgery.

Aged↗
PubMed1987

Using insurance claims to measure health status: the Illness Scale.

Health insurance systems are generating large numbers of claims filed by physicians and hospitals for reimbursement and accounting purposes. This paper describes and evaluates a measure of health status derived from physician and hospital claims filed for a sample of older Canadians during 1970-1977. Information on the number, type, and seriousness of reported diagnoses and the number and duration of hospitalizations and surgeries during each year were combined to generate annual Illness Scales ranging from 0 to 24. Alpha coefficients, measures of internal consistency, were between 0.82 and 0.84. Consistent with high validity, Illness Scale scores increased with age, were significantly associated with other health measures, and were strongly predictive of death and hospitalization in the following year. The ability to develop valid and reliable health status measures from insurance claims substantially expands the potential use of these data for research and evaluation.

Age Factors↗
PubMed1985

Physician use by the elderly over an eight-year period.

Investigation of ambulatory use of physicians by older persons over an eight-year period reveals that 60 per cent visited physicians with similar frequency for six or more years; 22 per cent regularly made two or less visits and 14 per cent made seven or more visits each year. Analyses reveal cohort effects rather than age effects to be of primary importance in determining an individual's regular pattern of physician use.

Age Factors↗
PubMed1985

Social and psychologic factors related to falls among the elderly.

Studies on falls are reviewed. Little information exists on which social or psychologic factors predispose an older person to fall or to sustain a fall-related injury. Risk of falling appears to be greater among females, the cognitively impaired, and those who use hypnotics, tranquilizers, and diuretics. The potential significance of depression and senile dementia of the Alzheimer's type on the risk of falling is explored. It is suggested that because of the associated impaired judgment, distraction, and psychomotor retardation, the presence of either clinical condition may increase an individual's risk of falling. In the final section of the article, directions for future research are discussed. Development of a systematic research program is suggested including epidemiologic studies of all falls and of medically treated falls. Such studies should be multidisciplinary and include assessment of social and psychologic factors as well as physical and functional health status, ambulatory function, perceptual acuity, and the circumstances surrounding the fall. The psychologic consequences of falling, particularly in the absence of a serious fall-related injury, is identified as an important research area.

Accidents↗
PubMed1982

Self-rated health: a predictor of mortality among the elderly.

Data from the Manitoba Longitudinal Study on Aging (MLSA) were used to test the hypothesis that self-rated health (SRH) is a predictor of mortality independent of "objective health status" (OHS). Subjects were a random sample of non-institutionalized residents of Manitoba aged 65+ in 1971 (n = 3,128). A single item measure of SRH was obtained during a survey conducted in 1971; a baseline measure of OHS was derived from physician and self-reported conditions and health service utilization data. Occurrence and date of death during the years 1971-1977 were known. Analyses of the data revealed that, controlling for OHS, age, sex, life satisfaction, income and urban/rural residence, the risk of early mortality (1971-1973) and late mortality (1974-1977) for persons whose SRH was poor was 2.92 and 2.77 times that of those whose SRH was excellent. This increased risk of death associated with poor self-rated health was greater than that associated with poor OHS, poor life satisfaction, low income and being male. These findings provide empirical support for the long held, but inadequately substantiated, belief that the way a person views his health is importantly related to subsequent health outcomes.

Aged↗
PubMed1978

Intravenous antibiotic therapy at home.

During a 12-month period, 23 patients aged 12 to 78 years were treated for 8 to 40 days (mean, 23 days) at home with intravenous (i.v.) antibiotics. Diseases treated included bone and joint infection (14 patients), blastomycosis (two), actinomycosis (two), staphylococcal bacteremia (two), endocarditis (two), and candidal pyelonephritis (one). After initial in-hospital training, patients self-administered their drugs through a heparin-lock i.v. cannula, which was changed regularly by a visiting home care nurse. Antibiotics administered included cloxacillin, penicillin G, cephalosporins, gentamicin, carbenicillin, and amphotericin B. Patient and family acceptance of the program was good, the program was therapeutically effective, and, apart from a decreased prevalence of phlebitis with the heparin lock at home, side effects were no different from those of in-hospital-treated patients. The cost of home therapy was $ 40 per patient-day compared with an estimated $ 137 had the patients remained in hospital. Most patients were able to resume normal activities while receiving home i.v. therapy.

Actinomycosis↗