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Biomedical subjects

J Magaziner

Publications and source records attributed to J Magaziner.

At least 37 records · Page 2Linked to original sources
PubMed2000

Outcome expectations for exercise scale: utility and psychometrics.

OBJECTIVES: The purpose of this study was to develop a measure of outcome expectations for exercise specifically for the older adult (The Outcome Expectations for Exercise [OEE] Scale), and to test the reliability and validity of this measure in a sample of older individuals. This scale was developed based on Bandura's theory of self-efficacy and the work of prior researchers in the development of measures of outcome expectations. METHODS: The OEE scale, which was completed during a face-to-face interview, was tested in a sample of 175 residents in a continuing care retirement community. RESULTS: There was support for the internal consistency of the OEE scale (alpha coefficient of .89), and some support for reliability based on a structural equation modeling approach that used R2 estimates, although less than half of these were greater than 0.5. There was evidence of validity of the measure based on: (a) a confirmatory factor analysis in which the model fit the data (normed fit index [NFI] = .99, root mean square error of approximation [RMSEA] - .07, chi2/df = 2.8); (b) support for the hypothesis that those who exercised regularly had higher OEE scores than those who did not (F = 31.3, p < .05, eta squared = .15); and (c) a statistically significant relationship between outcome expectations and self-efficacy expectations (r = .66). DISCUSSION: This study provides some initial support for the reliability and validity of the OEE scale. Outcome expectations for exercise were related to exercise behavior in the older adult, and the OEE scale can help identify older adults with low outcome expectations for exercise. Interventions can then be implemented to help these individuals strengthen their outcome expectations, which may subsequently improve exercise behavior.

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PubMed2000

The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: diagnosis by expert panel. Epidemiology of Dementia in Nursing Homes Research Group.

This study estimated the prevalence of dementia in 2,285 new admissions age 65+ to a statewide sample of 59 nursing homes in Maryland, 1992-1995. Dementia was ascertained according to DSM-III-R criteria by an expert panel of geriatric psychiatrists, neurologists, and a geriatrician using detailed information collected by trained lay evaluators from residents, family, staff, and medical records. Admissions to Maryland nursing homes are similar to admissions to nursing homes elsewhere in the United States. The prevalence of dementia was 48.2% (CI: 43.6-52.8) with an upper bound estimated at 54.5% (CI: 49.9-59.1). Prevalence is highest in facilities with <50 beds versus 200+ beds (65.5% vs 39.6%) and those in urban versus rural areas (50.0% vs 39.1%). Those who are non-White, married, and with fewer years of education are more likely to be demented. Prevalence is highest among those with 4+ physical impairments versus 0-1 (60.3% vs 27.7%) and lowest in those with 4+ comorbidities versus 0-1 (44.8% vs 52.0%). There was considerable overlap in the comorbid status of demented and nondemented admissions, and both groups contained members with only a few functional limitations. Results suggest that the level of medical supervision provided in nursing homes may not be required for some residents with dementia.

Activities of Daily Living↗
PubMed2000

The validity of the minimum data set in measuring the cognitive impairment of persons admitted to nursing homes.

OBJECTIVES: This study examined the construct validity of two cognitive scales from the federally mandated Minimum Data Set (MDS) of the nursing home Resident Assessment Instrument. DESIGN: A cross-sectional comparisons of the MDS measures, with scales provided by the resident, a proxy person, and nursing staff. SETTING: Subjects residing in 59 nursing homes (NHs) in Maryland from 1992 to 1995. PARTICIPANTS: Subjects were 1939 new admissions to NHs, aged 65 and older, with complete MDS information at admission. MEASUREMENTS: Two MDS scales, the Cognitive Performance Scale (CPS) and the MDS Cognition Scale (MDS-COGS), were compared with the Mini-Mental State Examination (MMSE) and the staff rating on the Psychogeriatric Dependency Rating Scale (PGDRS) Orientation scale, as well as measures of functioning and functional decline. RESULTS: The CPS and the MDS-COGS were highly correlated (r = 0.92). Both correlated moderately well with the MMSE (r = -0.65 and -0.68) and with staff's rating on the PGDRS Orientation scale (r = 0.63 and r = 0.66). Correlations with the MMSE (r < 0.70) are lower than previously reported (r > or = 0.80). The proportion of cognitively impaired residents in this NH admission cohort was higher using the MDS-COGS than the CPS (65% vs 57%), but both MDS scales produced lower proportions than the MMSE (70%) and higher proportions than the PGDRS (47%). The internal consistency of the CPS was better without the comatose item (alpha = 0.80 vs 0.70). The MDS-COGS had higher internal consistency (alpha = 0.85) and was simpler to compute. CONCLUSIONS: This is the first study to examine the validity of the MDS in a large sample of residents and NHs in situations where the MDS was not completed by research-trained staff. Compared with other instruments, the MDS-COGS and the CPS had moderate and similar validity for assessing cognitive impairment. Differences in the scales could provide different estimates of impairment among persons admitted to nursing homes.

Activities of Daily Living↗
PubMed2000

Racial differences in the prevalence of dementia among patients admitted to nursing homes.

OBJECTIVE: The purpose of this study was to determine the prevalence of dementia among black and white residents on admission to nursing homes and to determine whether demographic and health characteristics known to be associated with dementia were correlated with dementia in this population. METHODS: Data from medical records and structured interviews with family members, nursing staff, and nursing home residents were gathered for 2,285 persons newly admitted to nursing homes in Maryland from 1992 to 1995. A stratified sample of 59 nursing homes was used. An expert panel of five physicians classified each resident as demented, nondemented, or indeterminate. Associations between dementia status, race, and selected characteristics were examined. RESULTS: Black residents (77 percent) were significantly more likely than white residents (57 percent) to be classified as demented. Older age was associated with dementia in both races. Less education, male gender, and a history of a cerebrovascular accident were associated with an increased prevalence of dementia among white residents only. After demographic and health characteristics associated with dementia were controlled for, black race remained independently associated with a diagnosis of dementia. CONCLUSIONS: The rate of dementia on admission to nursing homes was higher among black residents than among white residents, a finding that has implications for the delivery of care. The higher rate may be due to psychosocial factors operating differently in blacks and whites that influence the timing of admission to a nursing home.

Black or African American↗
PubMed2000

Spinal anesthesia versus general anesthesia for hip fracture repair: a longitudinal observation of 741 elderly patients during 2-year follow-up.

The Baltimore Hip Studies, a multicenter, noninterventional, observational trial, provided an opportunity to investigate the effects of anesthetic technique on the long-term outcome of elderly patients after hip fracture repair. Detailed interviews assessing functional status and pain were conducted during the hospital stay. Out-of-hospital evaluations were repeated after the procedure at 2, 6, 12, 18, and 24 months with a portable gait and balance laboratory. Multivariate analysis was done to determine the effects of anesthetic technique on functional and other outcomes, after controlling for multiple baseline variables. Of 741 enrolled patients who completed the study, 430 and 311 patients received spinal anesthesia or general anesthesia, respectively. Subgroup analysis of three spinal anesthetics, tetracaine, lidocaine, and epinephrine, was also done. In the present large observational study, general anesthesia was at least as efficacious as spinal anesthesia, and possibly better, in affording good long-term outcome.

Activities of Daily Living↗
PubMed1999

The prevalence of osteoporosis in nursing home residents.

This study describes the prevalence of osteoporosis in a statewide sample of nursing home residents. Composite forearm bone mineral density (BMD) (including the distal radius and the distal ulna) of 1475 residents aged 65 years and older from 34 randomly selected, stratified nursing homes was assessed. BMD was expressed with reference to World Health Organization diagnostic criteria. Trends with age, gender and race were consistent with other populations. However, prevalence estimates were higher than community-based age-specific rates. The prevalence of osteoporosis for white female residents increased from 63.5% for women aged 65-74 years to 85.8% for women over 85 years of age. Only 3% had composite forearm BMD within 1 standard deviation of the young adult mean. The significance of the high prevalence of low BMD in nursing home residents is the increased fracture risk it may confer. In community cohorts of white women, the risk of hip fracture increases approximately 50% for every 1 standard deviation decrease in bone mass. However, the degree to which BMD contributes to fracture risk in this population has not been well established.

Black or African American↗
PubMed1999

Measurement of distal forearm bone mineral density: can different forearm segments be used interchangeably ?

Many different forearm sites have been used for the measurement of bone mineral density (BMD) and prediction of risk of future fracture among community dwelling populations. In populations where bone densitometry of peripheral sites may be the most cost effective and practical means of measuring BMD, such as the nursing home population, knowing the characteristics of forearm BMD measures would be beneficial. The purpose of this study was to assess the relationship of four common commercially available measures to each other and to estimate the inter- and intrarater reliability of the measures in a sample of nursing home residents as a first step toward identifying appropriate forearm measurement sites. These sites were the distal radius, the distal ulna, a composite of the distal radius and distal ulna, and the ultra distal radius. BMD measurements on 48 nursing home patients were obtained using single X-ray absorptiometry. Inter- and intrarater reliability was excellent at all four sites (interclass correlation coefficients > 0. 85). Moderate to high correlations (0.84-0.91) between the distal radius and ultra distal radius sites of the forearm suggest that these measures may be interchangeable. Although not directly assessed here, differences in bone composition among forearm sites may partially explain moderate rather than high correlations between sites and may affect the ability of each site to predict future fractures. Thus, different forearm sites may be used interchangeably for diagnostic purposes; however, the prognostic value of each site remains unknown.

Absorptiometry, Photon↗
PubMed1999

Intertrochanteric versus femoral neck hip fractures: differential characteristics, treatment, and sequelae.

BACKGROUND: More than 220,000 persons 65 years and older fracture a hip every year in the United States. Although hip fractures have been considered as a single, homogeneous condition, there are two major anatomic types of proximal femoral fractures: intertrochanteric and femoral neck. The present study's objective was to determine if the two types of hip fracture have different patient characteristics and sequelae. METHODS: A prospective study of 923 elderly patients admitted to seven Baltimore hospitals for a hip fracture between 1984 and 1986. RESULTS: Patients with intertrochanteric fractures were slightly older, sicker on hospital admission, had longer hospital stays, and were less likely at 2 months postfracture to have recovered activities of daily living than femoral neck fracture patients. Intertrochanteric fracture patients also had higher mortality rates at 2 and 6 months after fracturing. Long-term recovery (1 year) did not differ between fracture type. CONCLUSIONS: It appears that intertrochanteric fracture patients have intrinsic factors (older age, poor health) impacting upon their risk of fracture and ability to recover. Differences in patient characteristics and sequelae do exist between femoral neck and intertrochanteric hip fracture patients that impact upon recovery.

Activities of Daily Living↗
PubMed1999

Serum concentrations of steroids, parathyroid hormone, and calcitonin in postmenopausal women during the year following hip fracture: effect of location of fracture and age.

BACKGROUND: Hip fracture in the aged is a major health problem, especially considering the increasing proportion of the elderly in the population. This study examines changes in circulating levels of hormones, which are purported to affect bone metabolism, in response to hip fracture in postmenopausal women. METHODS: Patients consisted of women ages 65 and older who had surgery within 2 days of fracture. Serum samples were obtained at 3, 10, 60, 180, and 360 days postfracture. Healthy women without hip fractures from the same age range served as a control group (n = 17). Hormones were determined by radioimmunoassay. Subjects with fractures in the neck region of the femur (n = 78) were compared to subjects with fractures in the trochanteric region (n = 88). RESULTS: Estrone concentration (47.6 +/- 5.7 pg/mL; mean +/- SEM) at 3 days postfracture was elevated (p < .001) compared to control levels of 20.7 +/- 4.6 pg/mL. By 2 months, levels had declined to control levels. Androstenedione and the adrenal hormones, DHEAS and cortisol, displayed similar responses. Parathyroid hormone (PTH) levels were not significantly different from the control concentration at 3 days following fracture, but increased (p < .001) during the year following fracture. Calcitonin concentrations were much higher (p < .001) 3 days postfracture (42.1 +/- 3.7 pg/mL) compared to controls without fracture (9.8 +/- 3 pg/mL). Except for testosterone, no differences could be attributed to fracture location. Only PTH, with concentrations higher in the older age groups (p < .001), showed an age-related response. CONCLUSIONS: Following hip fracture, there are some dramatic responses in hormones that purportedly are mechanistically important in bone metabolism. These changes include transient increases in steroid hormones, chronic elevations in calcitonin, and rising levels of PTH during the year after fracture.

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PubMed1999

Weight, weight change, mortality in a random sample of older community-dwelling women.

OBJECTIVE: To evaluate the relationship between measured weight, weight change, and 6-year mortality risk in a random sample of 648 community-dwelling women aged 65 and older from Baltimore, Maryland. MEASUREMENTS: Data were collected using a standardized questionnaire and administered in person by trained interviewers. Questionnaires were completed annually from 1984 to 1986, and body weight was measured at each interview. Weight was defined as body mass index (BMI) of low (< 23 kg/m2), average (> or = 23 kg/m2 to < or = 28 kg/m2), and high (> 28 kg/m2). Four mutually exclusive categories of weight change of at least 4.5% in BMI over the three annual interviews were developed to describe all possible weight change patterns: weight gain, weight loss, no change, and weight cycling. RESULTS: During the follow-up period, 106 women (16%) died. Women with low baseline BMI, regardless of weight change, and those who lost weight, regardless of baseline BMI had increased mortality risk. Women with average baseline BMI and weight loss had a very high mortality risk (hazard ratio (HR) 3.84, 95% Confidence interval (CI) 2.14-6.89). Women who weight cycled had increased mortality risk at low and high baseline weights, and a nonsignificant increased risk at average baseline weight (P = .069). Analyses were adjusted for age, education, smoking, alcohol usage, and pre-existing illness and included an interaction between weight change and baseline BMI. CONCLUSIONS: These results suggest that white, older, community-dwelling women are at an increased risk of mortality if they are underweight, lose weight, or weight cycle.

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PubMed1999

Correlates of bone mineral density in nursing home residents.

PURPOSE: To explore correlates of bone mineral density (BMD) in nursing home residents, examining factors associated with BMD in community cohorts and factors prevalent among nursing home residents. METHODS: A cross sectional study of 2156 elderly residents from a representative state-wide sample of 47 nursing homes in Maryland. Data consisted of BMD scans of the distal radius and ulna; information on comorbidities, activities, behavior and medications abstracted from medical charts and interviews; and observation of cognitive and neuromuscular performance. RESULTS: Forty-two percent of the variance in BMD was explained by age, gender, race and weight. Fracture, use of steroids and seizure medications, and alcohol use were also related to low BMD. Other factors prevalent in nursing home populations, such as cognitive impairment and depressive symptomatology, were not strongly associated with low BMD. CONCLUSIONS: Despite the diversity of the nursing home population, their older age and greater dependency and comorbidity, the factors most closely related to low BMD in nursing home residents were comparable to those in community-dwellers. Demographic information, along with other clinical factors such as fracture and use of steroid and seizure medications, may aid health care providers in identifying high risk individuals in nursing homes.

Aged↗
PubMed1999

Depressive symptoms and 6-year mortality among elderly community-dwelling women.

Depression is associated with an increased risk of mortality in studies that included adults of all ages, but results of studies restricted to older adults are less consistent. This study evaluated the association between depressive symptoms and mortality among 764 white women aged 65+ years in Baltimore, Maryland, and examined methodologic and conceptual issues regarding this association. The Center for Epidemiologic Studies-Depression Scale (CES-D) was administered in face-to-face interviews in 1984. Mortality data were collected through 1990. The 6-year risk of death was 14.5% among women with CES-D scores of 0-1, 24% to 28% among women with scores of 2-24, and 47% among those with scores over 24. The adjusted hazards ratio (RR) comparing women with the highest (25-58) vs lowest (0-1) scores was 1.77 (95% confidence interval (CI) = 0.91-3.42). Depressive symptoms were only weakly associated with mortality when using the CES-D scale dichotomized at the traditional cutpoint of 16 (RR = 1.10, CI = 0.73-1.66), or when the follow-up period was 2 years. Furthermore, depressive symptoms were associated with mortality only among women in poor health. The association between depressive symptoms and mortality risk appeared to be affected by baseline physical health, length of follow-up, and measurement of depression.

Aged↗
PubMed1998

Prospective study on the relation between living arrangement and change in functional health status of elderly women.

Limited prospective data exist on how living arrangements are associated with change in functional health. This study evaluated whether elderly women living alone were less likely to experience functional decline when compared with women who lived with others. A total of 619 community-dwelling, white women from Baltimore, Maryland, aged 65-99 years at baseline were questioned annually from 1984 to 1986. Functional health was measured as the sum of limitations in seven physical and seven instrumental activities of daily living (Instrumental ADL). A total of 148 women experienced functional decline over the 2 years, primarily as a deterioration in Instrumental ADL. The association between living arrangement and change in Instrumental ADL depended on the level of physical impairment. Among women without severe impairment, Instrumental ADL deterioration was significantly less for those living alone compared with those living with spouses (odds ratio (OR) = 0.60, 95% confidence interval (CI) 0.45-0.92) or nonspouse others (OR = 0.62, 95% CI 0.45-0.96). For women with severe impairment, however, those living alone had a greater decline in Instrumental ADL, especially when compared with those living with nonspouse others (OR = 5.13, 95% CI 1.23-21.28). These results suggest that, unless severely physically impaired, women living independently have less deterioration in functional health when compared with peers in alternate living arrangements.

Activities of Daily Living↗
PubMed1998

A pilot randomized trial comparing symptomatic vs. hemoglobin-level-driven red blood cell transfusions following hip fracture.

BACKGROUND: The indications for transfusion have never been evaluated in an adequately sized clinical trial. A pilot study was conducted to plan larger clinical trials. STUDY DESIGN AND METHODS: Hip fracture patients undergoing surgical repair who had postoperative hemoglobin levels less than 10 g per dL were randomly assigned to receive 1) symptomatic transfusion: that is, transfusion for symptoms of anemia or for a hemoglobin level that dropped below 8 g per dL or 2) threshold transfusion: that is, patients receive 1 unit of packed RBCs at the time of random assignment and as much blood as necessary to keep the hemoglobin level above 10 g per dL. Outcomes were 60-day mortality, morbidity, functional status, and place of residence. RESULTS: Among 84 eligible patients enrolled, mean (+/- SD) prerandomization hemoglobin was 9.1 (+/- 0.6) g/ dL. The median number of units transfused in the threshold transfusion group was 2 (interquartile range, = 1-2), and that in the symptomatic transfusion group was 0 (6; interquartile range, = 0-2) (p < 0.001). Mean hemoglobin levels were approximately 1 g per dL higher in the threshold group than in the symptomatic group: for example, on Day 2, 10.3 (+/- 0.9) g per dL versus 9.3 (+/- 1.2) g per dL, respectively (p < 0.001). At 60 days, death or inability to walk across the room without assistance occurred in 16 (39.0%) of the symptomatic transfusion group and 19 (45.2%) of the threshold transfusion group. Death occurred by 60 days in 5 (11.9%) of the symptomatic transfusion group and 2 (4.8%) in the threshold transfusion group (relative risk = 2.5; 95% CI, 0.5-12.2). Other outcomes were similar for the two groups. CONCLUSIONS: Symptomatic transfusion may be an effective blood-sparing protocol associated with the transfusion of appreciably fewer units of RBCs and lower mean hemoglobin levels than are associated with the threshold transfusion policy. However, it is unknown whether these two clinical strategies have comparable mortality, morbidity, or functional status. A definitive trial is needed.

Adult↗
PubMed1998

Mobility after hip fracture predicts health outcomes.

OBJECTIVES: Balance and gait are essential to physical functioning and the performance of activities of daily living. The objective of this study was to determine the predictive value of a balance and gait test on subsequent mortality, morbidity, and healthcare utilization among older hip fracture patients. DESIGN: A prospective study of hip fracture recovery. SETTING: Patients with a new hip fracture admitted from the community to one of eight Baltimore hospitals and followed in their homes for 2 years postfracture. PARTICIPANTS: A total of 306 patients with hip fracture, 65 years of age and older, who completed a gait and balance assessment at 2 months postfracture. MEASUREMENTS: The relationship between gait and balance test performance at 2 months postfracture and mortality, physician visits, rehospitalizations, nursing home placement, and falls up to 24 months postfracture was assessed by Cox proportional hazards and least squares regression. RESULTS: After adjusting for age, sex, race, and comorbidity, the balance score and the summary mobility score predicted mortality. A 17% increase in the risk of mortality was demonstrated for each unit decrease in the balance score (range 0-17), and a 10% increase was demonstrated for each decrease in the summary score (range 0-26). Unsteady balance during immediate standing, turning, sitting down, and rising from a chair were associated significantly with increased mortality. Poor balance, but not poor gait, was associated with an increase in hospitalizations up to 24 months postfracture. Both poor balance and poor gait were associated with nursing home placement, with 20% and 17% increased odds, respectively. Mobility did not predict future physician visits or falls. CONCLUSIONS: These findings demonstrate that balance and gait are predictive of future health outcomes for older hip fracture patients.

Aged↗
PubMed1998

Accuracy of medical records in hip fracture.

OBJECTIVE: To determine the accuracy of diagnoses and procedure codes in medical records for hip fracture patients. DESIGN: A validation sample of hip fracture medical records was used to compare the facesheet data with progress notes, operative reports, and discharge summaries for patients in a prospective study of functional recovery. SETTING: Eight Baltimore hospitals with the highest volume of older hip fracture patients. PATIENTS: Study subjects were 343 community-dwelling patients, 65 years of age and older, admitted to one of eight Baltimore hospitals between January 1990 and June 1991 with a diagnosis of hip fracture. MAIN OUTCOME MEASURES: Facesheet diagnosis codes were compared with admitting notes, discharge summary, and/or progress notes. The abstracted surgical procedure was compared with postoperative radiographs. RESULTS: Excess coding of diagnoses on the hospital facesheet was evident in 12% of charts. In 17% of charts, a complication identified in the chart was not coded on the facesheet. More complications with low severity were omitted. Agreement between the abstractor's procedure review and radiograph readings for arthroplasty was 84%. In 15% of patients, the abstractor coded total arthroplasty when hemiarthroplasty was done. CONCLUSIONS: Discrepancy between the hospital facesheet and the medical record and between the abstracted surgical procedure and radiographs was found for hip fracture patients. This may make findings from health outcomes research relying on administrative databases uncertain and reimbursement inaccurate.

Aged↗
PubMed1998

The relationship between insomnia and mortality among community-dwelling older women.

OBJECTIVES: To investigate the relationship between insomnia and 6-year survival among older, community-dwelling, white women. DESIGN: Longitudinal study. SETTING: The sample was selected randomly from a 20-census tract area of Baltimore, Maryland. PARTICIPANTS: In 1984, 778 women aged 65 years and older participated in the baseline survey; 613 were re-interviewed in 1985; 596 were reinterviewed in 1986. MEASUREMENTS: Insomnia was measured as self-report of at least one of three sleep complaints: trouble initiating sleep, waking at night and trouble falling back to sleep, and waking too early. Cox proportional hazards models were used to assess the relationship between insomnia, as reported at the most recent of three interviews, and mortality. RESULTS: Twenty-nine percent of the sample reported trouble initiating sleep, 22.4% reported waking at night and having trouble falling back to sleep, and 26.6% reported waking too early. Of the sample, 43.2% had insomnia at the baseline interview; 23.2% percent of respondents with insomnia at baseline died during the follow-up period compared with 22.0% of those without insomnia at baseline. Recent insomnia was not associated significantly with mortality in either crude analyses (Hazards Ratio (HR) = 1.11, 95% CI, 0.78-1.60) or analyses adjusted for age, prescription medication use, functional limitations, self-rated health, and number of chronic conditions (HR = 0.74, 95% CI, 0.50-1.09). CONCLUSION: Our results, combined with the results from previous studies, suggest strongly that insomnia is not an indicator of approaching mortality in older community-dwelling populations.

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