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Biomedical subjects

J Magaziner

Publications and source records attributed to J Magaziner.

At least 55 records · Page 3Linked to original sources
PubMed1998

Outcome after hemiarthroplasty for femoral neck fractures in the elderly.

A prospective outcome study was performed on 270 patients, 65 years of age and older, who sustained a femoral neck fracture and underwent hemiarthroplasty. The treatment compared was the use of a noncemented unipolar versus either a cemented or a press fit bipolar prosthesis. The outcome variables assessed included the occurrence of a postoperative complication, length and cost of hospitalization, and function in various quality of life measurements. Patients who underwent bipolar hemiarthroplasty with either a cemented or a press fit prosthesis had better pain relief and function than patients who had a noncemented unipolar prosthesis at a minimum of 24 months after surgery. However, the mean hospitalization cost for patients who had a bipolar prosthesis was $12,290 compared with $8876 for a unipolar prosthesis.

Activities of Daily Living↗
PubMed1997

Proxy reporting in five areas of functional status. Comparison with self-reports and observations of performance.

Proxy ratings of functional status were compared with subject self-reports in five domains relevant to the study of older persons and with observations of subject performance in two areas (physical and instrumental functioning). Data were derived from 233 proxy-subject pairs evaluated in a prospective study of hip fracture patients aged 65 years or more in Baltimore, Maryland (1990-1991). Agreement between proxy and subject reports was highest for a summary measure of instrumental functioning and lowest for a measure of depression. Proxies tended to report more disability than did subjects, although bias varied by function. Patterns of agreement for proxy reports versus observations of performance compared with patterns for proxy reports versus subject reports were lower for measures of instrumental functioning, and bias was generally more extreme for instrumental and physical functioning measures. The authors conclude that agreement and bias differ by functional domain, by the way summary measures are created and scored, and by the criterion against which proxy reports are compared.

Activities of Daily Living↗
PubMed1997

Relation of social network characteristics to 5-year mortality among young-old versus old-old white women in an urban community.

This study examines age-related differences in the association between social network characteristics and mortality for aged white women. Subjects include a community-dwelling sample of white women aged > or = 65 years (n = 806), who lived in northeast Baltimore, Maryland, in 1984. Three characteristics of social networks were measured: availability of network resources; contact with network resources; and integration into the neighborhood. The association of social network with 5-year mortality was examined with a proportional hazards model adjusting for perceived health status, impairment in physical activities of daily living, number of chronic conditions, and years of education. Analyses were stratified by age (65-74 years, > or = 75 years). Elements of social network contact and neighborhood integration were associated with reduced mortality among women aged > or = 75 years, but not among women aged 65-74 years. In the > or = 75 years group, women who had no contact with children, friends, and group organizations showed hazard ratios (95% confidence intervals (CI)) of 3.1 (1.2-7.5), 2.2 (1.0-4.9), and 2.8 (1.2-6.5), respectively. Women who had lived < or = 10 years in the neighborhood and women who had no interaction with local merchants showed hazard ratios of 2.5 (95% CI 1.3-4.8) and 2.2 (95% CI 1.2-3.9), respectively. Thus, both age and specific aspects of network structure were found to influence the association between social networks and mortality in elderly women.

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PubMed1997

The economic cost of hip fractures in community-dwelling older adults: a prospective study.

OBJECTIVES: To evaluate the incremental cost in the year after hip fracture. DESIGN: Prospective cohort study. SETTING: Baltimore, Maryland. PARTICIPANTS: 759 community dwelling older patients who sustained a hip fracture and participated in the Baltimore Hip Fracture Study. MEASUREMENTS: Resource use for direct medical care, formal nonmedical care, and informal care in the 6 months before and the year after fracture was estimated from interviews with patients or proxy respondents. Costs in 1993 dollars were estimated by multiplying resources times national unit cost estimates. RESULTS: The annualized costs in the year before the fracture ranged between $18,523 and $20,928. The costs in the year after the fracture equaled $37,250. The incremental costs in the year after the fracture, compared with the costs in the year before the fracture, ranged between $16,322 and $18,727. The largest cost differences were attributable to hospitalizations, nursing home stays, and rehabilitation services. CONCLUSIONS: Because we compared the costs after a fracture with costs before, our estimates of the incremental cost of a hip fracture are lower than others in the literature. These results, obtained from interviews with patients enrolled in a cohort study, or their proxies, provide the best data available to date on the economic cost of hip fractures among community-dwelling older persons.

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PubMed1997

A longitudinal examination of functional recovery among older people with subcapital hip fractures.

OBJECTIVE: Few studies have examined the time-dependent change in functional recovery along with the factors that affect the change among older hip fracture patients. The focus of this study is to examine the predictors of functional recovery in community-dwelling older people with subcapital fractures using longitudinal data analysis methods. DESIGN: A 1-year prospective study. Information was obtained through structured interviews following surgery and at 2, 6, and 12 months after hospital discharge and from medical chart review. SETTING AND PATIENTS: The sample consisted of 312 community-dwelling older adults, admitted to one of the seven Baltimore area hospitals with a subcapital fracture, who received either internal fixation or hemiarthroplasty. RESULTS: The longitudinal data analysis using mixed-effects regression indicates that time and prefracture physical activities of daily living (PADL) had a significant association with PADL functional recovery over the course of 1 year. Among those 85 years and older, those who were disoriented after surgery had poorer PADL functional recovery over time than those who were not disoriented. Also, recovery in instrumental activities of daily living (IADL) was associated significantly with time, prefracture IADL function, unsteady gait prefracture, hospital length of stay, and discharge to an institution. The type of surgical procedure performed was not associated significantly with either PADL or IADL functional recovery. CONCLUSIONS: The factors that are related to functional recovery in this study shed light on the complexity of the recovery process in hip fracture patients. The rate of recovery in postsurgical PADL and IADL function is not constant over time; postsurgical IADL function among disoriented patients (without dementia) continues to deteriorate over time compared with the nondisoriented group; this difference in trends of deterioration on IADL function is most profound in the oldest-old aged group, those 85 and older. The types of surgical procedure performed was not significantly associated with postsurgical functional recovery.

Activities of Daily Living↗
PubMed1997

Proxies' decisions about clinical research participation for their charges.

OBJECTIVE: To examine the process by which proxies decide about their charges' participation in clinical research. DESIGN: Using eight hypothetical research studies encompassing a variety of risks and benefits, we interviewed 315 competent persons > or = 65 years old (charges) and, separately, the individuals who would be designated as their proxies if the charges were to become incompetent. The proxies were asked what they thought their charges would decide and what decisions they would make for their charges and for their own participation. SETTINGS: A medical house-call program, two apartment complexes, and three nursing homes. PARTICIPANTS: Charges > or = 65 years old and their proxies. MAIN OUTCOME MEASURE: Comparison of decisions made by charges and by proxies for their charges. RESULTS: The agreement between the proxies' and charges' decisions was not significantly different from random agreement (range of kappa statistics, 0.05-0.15). Rather, proxies' decisions for their charges were significantly related to the proxies' decisions for themselves (kappas, 0.52-0.86). When the paired proxies' and charges' decisions differed, the proxies were protective, more frequently refusing their charges' participation in the perceived riskier research studies. CONCLUSIONS: Proxies did not know what their charges would decide. Their choices for the charges related more to the proxies' decisions about their own participation (which they knew) than to the decisions of their charges (which they didn't know). This is similar to the process of a reasonable person making the decision, a characteristic of decisions made in the best interests of the patient.

Adult↗
PubMed1997

Excess mortality attributable to hip fracture in white women aged 70 years and older.

OBJECTIVE: The purpose of this study was to estimate the excess mortality attributable to hip fracture. METHODS: The 6-year survival rate of community-dwelling White female hip fracture patients aged 70 years and older entering one of seven hospitals from 1984 to 1986 (n = 578) was compared with that of White female respondents aged 70 years and older interviewed in 1984 for the Longitudinal Study on Aging (n = 3773). RESULTS: After age, education, comorbidity, and functional impairment were controlled, the mortality differential between the two groups accumulated to an excess among hip fracture patients of 9 deaths per 100 women 5 years postfracture. Among those with three or more functional impairments or one or more comorbidities, the excess was 7 deaths per 100: the effect of the fracture had disappeared in these groups by 4 years. In contrast, those with two or fewer impairments and those with no comorbidities had a continuing trend of increased mortality, with an excess of 14 deaths per 100 by 5 years. CONCLUSIONS: There is an immediate increase in mortality following a hip fracture in medically ill and functionally impaired patients, whereas among those with no comorbidities and few impairments, there is a gradual increase in mortality that continues for 5 years postfracture.

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PubMed1997

Use of proxies to measure health and functional outcomes in effectiveness research in persons with Alzheimer disease and related disorders.

As the focus in the study of Alzheimer disease moves from the laboratory and research-oriented care setting to the broader array of community settings where effectiveness research takes place, it becomes necessary to rely less on medical records and reports of health care professionals experienced in following research protocols and more on observers who are not trained to interpret and report their observations in a standardized way. The present paper targets the use of proxy interviews to obtain information about health and functional outcomes for effectiveness research. Included are indications of the type of information that may be obtained from proxies, a discussion of issues surrounding the use of proxies in research on older persons with cognitive impairment, a summary of the current state of knowledge in this area, identification of practical strategies researchers may employ when using proxies, and recommended directions for further research.

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PubMed1996

Use of proxies to measure health and functional status in epidemiologic studies of community-dwelling women aged 65 years and older.

Proxy and subject responses to survey questions about chronic conditions, health symptoms, and physical and instrumental functioning were compared to determine the extent of disagreement, the direction of nonrandom discrepancies (i.e., bias), and how disagreement and bias vary by proxy and subject characteristics. Subjects included 538 community-dwelling women aged 65 years and older who participated in the third home interview of a health survey in Baltimore, Maryland, 1986, and a self-designated proxy for each. The authors observed kappa values of > 0.6 (i.e., substantial to almost perfect agreement) for five of nine chronic conditions, no health symptoms, six of seven physical tasks of daily living, and seven of seven instrumental tasks of daily living. With few exceptions, proxies were more likely than subjects to report the presence of a condition, symptom, or functional problem. Variations in agreement and bias were noted by subject and proxy characteristics, with different patterns observed for different measurement areas. When using proxy reports in place of self-reports, it is important to evaluate the impact that using proxies has on study results.

Activities of Daily Living↗
PubMed1996

A portable neuromuscular function assessment for studying recovery from hip fracture.

OBJECTIVE: To determine the reliability and applicability of a portable, performance-based assessment of balance and gait in characterizing recovery after hip fracture in elderly persons. DESIGN: The assessment was developed as part of a prospective, observational study of hip fracture recovery among elderly persons. Reliability was assessed in 24 subjects by administering the tasks twice within 1 week. SETTING: In-home assessments were performed on community-dwelling elderly. PATIENTS: Randomly selected subset of hip fracture patients, 65 years and older, admitted to 1 of 8 Baltimore hospitals between January 1990 and June 1991. Twenty-four patients were asked to repeat the gait and balance assessment at the 6-month follow-up visit. MAIN OUTCOME MEASURES: The evaluations included: (1) sitting balance, (2) arising from an armless chair, (3) standing balance, eyes open and closed, (4) one leg standing balance, (5) sitting down, (6) gait, and (7) range of motion in the knee and hip. RESULTS: The assessment took 15 to 20 minutes to complete and was feasible to perform for recent hip fracture patients, except for single leg standing. Interrater reliability was good for most tasks, with agreement between evaluators being 74% to 100% for tasks involving standing balance, chair rise, gait, and range of motion; kappas = 0.4 to 0.9. Single leg standing, knee extension, and balance while sitting were the least reliable tasks; 59% to 73% agreement, kappas = 0.1 to 0.4. CONCLUSIONS: We conclude that this instrument is a reliable measure of physical ability that will provide a clear indication of mobility impairment in patients recovering from a hip fracture. This instrument should prove useful in assessing patients with lower extremity difficulties.

Activities of Daily Living↗
PubMed1996

Ascertaining dementia by expert panel in epidemiologic studies of nursing home residents.

A new method for ascertaining dementia in epidemiologic research and the results of a study to evaluate it are described. The method relies on an expert panel of clinicians reviewing clinically relevant information collected by lay evaluators to arrive at a diagnosis based on DSM-III-R criteria. The approach was developed to study dementia in a statewide sample of over 2400 new admissions to 59 nursing homes in Maryland. Expert panel ascertainment of dementia was compared to that obtained by direct clinical evaluation for 100 nursing home residents. Agreement between the panel and direct assessment was 76% (kappa = 0.59) using a three-category classification of dementia, no dementia, and indeterminate. This ascertainment strategy provides an alternative to methods currently in use and is particularly well-suited for populations with a high prevalence, in those dispersed over large geographic areas, and when timely, cost-effective evaluations are required.

Aged↗
PubMed1996

The predictors of surgical procedure and the effects on functional recovery in elderly with subcapital fractures.

BACKGROUND: It has been demonstrated that the majority of hip fracture patients do not regain their prefracture level of functioning and usually decline in function following fracture. Little is known about the effectiveness of surgical procedure performed (hemiarthroplasty vs internal fixation) on functional recovery of subcapital fracture patients. This study examines the factors related to the type of the surgical procedure chosen and the effect of this selection on physical activities of daily living (PADL) and instrumental activities of daily living (IADL). METHODS: The sample consists of 312 patients with subcapital fractures age 65 and older admitted from the community to one of seven Baltimore area hospitals between 1984 and 1986. Baseline information was obtained during hospitalization through structured interviews with both patients and their significant others (proxy). The follow-up interviews were administered to proxies at two months, six months, and one year after discharge from hospital. Information on disease diagnoses, fracture severity, and surgical procedures performed was obtained from medical charts. RESULTS: Patients with a displaced fracture were seven times more likely to receive a hemiarthroplasty (OR = 7.0, 95% CI 3.7-13.1). During the short-term recovery (2 months after surgery), patients who received hemiarthroplasty were doing better in transferring, meal preparation, and shopping than those who received internal fixation. For the long-term functional recovery (one year), the overall PADL and IADL functions were not statistically significantly different between the two surgical procedures performed. CONCLUSIONS: The severity of fracture was found to be the most important determinant of surgical procedure. Patients with a subcapital fracture who received hemiarthroplasty tended to have a better functional recovery in the short term. Further study of other benefits of using as hemiarthroplasty is needed.

Activities of Daily Living↗
PubMed1996

Markers of failure to thrive among older hip fracture patients.

OBJECTIVES: To determine whether there is a group of recent hip fracture patients who exhibit the signs of failure to thrive and to identify potential precursors to their decline in physical functioning. DESIGN: Prospective (nonintervention) study of hip fracture recovery; patients were assessed in the hospital and at 2, 6, 12, 18, and 24 months post-fracture. SETTING: Hip fracture patients admitted to one of eight Baltimore area hospitals from the community with a new fracture of the proximal femur between January 1, 1990, and June 15, 1991. PARTICIPANTS: Patients were 65 years of age and older and lived in the community before the fracture. A total of 804 patients were eligible for the study; the present study analyses were restricted to the 252 patients who survived 1 year and had a self-report assessment at 6 and 12 months post-fracture. MEASUREMENTS: A questionnaire administered during hospitalization assessed pre-fracture functional and health status and current affective and cognitive status. In-home interviews post-fracture ascertained dependence and difficulty with physical and instrumental activities of daily living. Abstraction of the medical records provided information about comorbidities, surgical procedure, and hospital length of stay. RESULTS: Patients who declined in ability to walk from 6 to 12 months post-fracture had greater use of health resources (more hospitalizations) and poorer physical functioning up to 2 years post-fracture. Impaired function in physical activities of daily living at 6 months, high glucose, calcium, and CO2 at admission, and low BUN and creatinine at admission were more prevalent among decliners than among non-decliners. CONCLUSIONS: Findings indicate that certain older hip fracture patients begin to exhibit signs and symptoms of failure to thrive. About 10% of patients who survived at least 1 year after fracture could not retain their recovery level of functioning after 6 months and began to decline further. High glucose and CO2 and low BUN and creatinine on hospital admission were associated with later functional decline among hip fracture patients, but their clinical significance is uncertain.

Activities of Daily Living↗
PubMed1996

Severity of radiographic findings in hip osteoarthritis associated with total hip arthroplasty.

OBJECTIVE: The decision to perform total hip arthroplasty (THA) in patients with osteoarthritis (OA) of the hip is based largely on patients' reports of pain and disability and not on radiographic findings of OA. We determine the severity of radiographic OA and its association with disability in patients undergoing THA. METHODS: Individual radiographic features (osteophytes, joint space narrowing, sclerosis, cysts, deformity) and global severity of hip OA were assessed in 95 consecutive elderly patients with hip OA undergoing THA who were enrolled in a Patient Outcome Research Team (PORT) project. RESULTS: Eighty-seven patients (91.5%) had either severe or moderate OA in the hip to be replaced; 17% of these had a previous contralateral THA. Only 8 patients (8.4%) had mild or no signs of OA in the hip to be replaced and 4 (50%) of these patients had their opposite hip replaced previously. CONCLUSION: These data indicate that radiographic features of moderate to severe hip OA are associated with clinical findings and the necessity to perform THA in the majority of patients. Patients who have had a prior hip replacement, however, may be more likely to have a contralateral replacement done earlier (p = 0.03), before radiographic signs are evident.

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PubMed1995

Abdominal pain in an HMO.

BACKGROUND: Previous surveys have found that 14%-25% of the population report abdominal pain. Only one study examined the age-gender specific prevalence of abdominal pain in the population, and no study has examined the self-reported causes of abdominal pain. METHODS: To describe the epidemiology of abdominal pain in a large health maintenance organization population, 6,199 randomly selected members were contacted and interviewed by telephone about the occurrence of abdominal pain and related health care in the past year. RESULTS: Of those interviewed, 27% reported abdominal pain in the past year, while 38% of those individuals saw a physician for their pain. Women were more likely than men to have had pain and to have seen a physician for their pain. Fewer older individuals reported abdominal pain, but when pain occurred, they sought medical care more often than younger individuals. CONCLUSIONS: Women and younger individuals report abdominal pain more frequently. Women and older individuals are more likely to seek care for their pain.

Abdominal Pain↗
PubMed1995

Organ-limited autopsies. Obtaining permission for postmortem examination of the urinary tract.

OBJECTIVE: To develop a systematic pre- and postmortem program for obtaining permission for autopsies limited to the urinary tract. DESIGN: Comparison versus historical control of autopsy permission using a new process comprising premortem education, modification of the permission process, and autopsy limited to the urinary tract. PARTICIPANTS AND SETTING: Patients, family members, and healthcare providers associated with a nursing home. INTERVENTION: Education of healthcare providers and family members and modification of autopsy consent and performance. MAIN OUTCOME MEASURE: Permission rate and demographic characteristics of patients and family members giving permission. RESULTS: Of the 361 patients who died during the study, we received permission for postmortem examination of the urinary tract for 129 (36%). This was substantially better than the autopsy rate in the year prior to the study, 0.6%. A significantly higher permission rate was associated with patients and contact persons of white race, a higher level of education of the contact person, a nonrelative contact person, and two or fewer individuals making the decision. CONCLUSION: Permission for organ-limited autopsies can be obtained with a systematic approach.

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PubMed1994

Methodological issues in measuring patient-reported outcomes: the agenda of the Work Group on Outcomes Assessment.

The primary goal of the Inter-PORT work group on Outcomes Assessment is to foster methodological knowledge about the implications of various measure and design decisions for studies of the outcomes of treatment. A number of key methodological issues currently are unresolved and are in need of further study. These include: 1) the best questions to ask to assess how patients are affected by their treatments; 2) the comparative advantages of various study designs, including prospective cohorts, retrospective studies, and randomized clinical trials; 3) the way data collection decisions, such as mode of data collection and use of proxy respondents, affect study results; and 4) the best way to assess the significance of observed effects from patient, provider, and public policy perspectives. Studies conducted by the Patients Outcomes Research Teams (PORTs) are using diverse designs, measures, and data collection procedures. They provide a unique opportunity to further knowledge about methods of obtaining information about treatment outcomes. Through meetings, conferences, and publications, the Inter-PORT work group on Outcomes Assessment is trying to stimulate analyses aimed at methodological issues summarized in this paper and to ensure that new knowledge about methods is disseminated to a wide audience.

Cohort Studies↗