Biomedical subjects

Julie M Chandler

Publications and source records attributed to Julie M Chandler.

6 recordsLinked to original sources

PubMed2005

Magnitude and patterns of decline in health and function in 1 year affect subsequent 5-year survival.

BACKGROUND: Indicators of physical function and health status can predict important outcomes in older persons, but little is known about the meaning of change in these measures. This study assessed the magnitude and patterns of change occurring in 1 year in six measures of health and function and estimated the effects on survival for 5 years. METHODS: This prospective cohort study was based in two health care systems. Data were collected during home visits at baseline and every 3 months for 1 year. Subsequent deaths occurring within 5 years were ascertained using the National Death Index. RESULTS: Of 439 older adults, 88 (20%) died within the subsequent 5 years. The optimal magnitude of decline to predict 5-year mortality was 0.1 meters/second for gait speed, 1 point for the Short Physical Performance Battery, and 0.05 points for Euroqol. Independent contributions were found for decline in gait speed (p =.001 to.002), Short Physical Performance Battery (p =.014 to.026), global health (p <.001), and activities of daily living (p =.005 to.019). More than one half of the episodes of decline were transient. Persistent decline in 1 year consistently predicted death, and transient decline in gait speed and global health increased mortality risk compared with no change. CONCLUSIONS: A decline in gait speed of 0.1 m/s or 1 point in the Short Physical Performance Battery within 1 year increased the subsequent 5-year mortality rate. Transient declines in gait speed and self-reported health are as common as persistent declines and affect mortality risk.

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PubMed2003

Agreement between weekly vs. daily assessment of appetite.

Hunger, satiation, and other aspects of appetite are frequently measured using end-anchored line ratings. This study investigated whether a single assessment of appetite, which covered the prior week, would yield the same results obtained by assessing appetite 3 days during the week. Participants were 51 women and 9 men (age mean 44.1, SD 9.8 years; BMI mean 38.0, SD 5.2 kg/m(2)) in a study evaluating the effectiveness of four weight control programs, three of which used sibutramine (15 mg/d). On three separate days of one week, participants rated appetite for that day. During a subsequent clinic visit, participants completed the same ratings in reference to the past week. The three daily values were averaged. All correlations between weekly and averaged daily values were strongly positive (r=0.63-0.80) and statistically significant (all p<0.001). All mean daily and weekly ratings fell within 3.3-7.2 mm of each other. Thus, good agreement was observed between the average daily assessments and one weekly assessment. The weekly assessment of appetite in the clinic appears to have several benefits, including uniformity of test administration and decreased burden on participants.

Adult↗

PubMed2003

Physical performance measures in the clinical setting.

OBJECTIVES: To assess the ability of gait speed alone and a three-item lower extremity performance battery to predict 12-month rates of hospitalization, decline in health, and decline in function in primary care settings serving older adults. DESIGN: Prospective cohort study. SETTING: Primary care programs of a Medicare health maintenance organization (HMO) and Veterans Affairs (VA) system. PARTICIPANTS: Four hundred eighty-seven persons aged 65 and older. MEASUREMENTS: Lower extremity performance Established Population for Epidemiologic Studies of the Elderly (EPESE) battery including gait speed, chair stands, and tandem balance tests; demographics; health care use; health status; functional status; probability of repeated admission scale (Pra); and primary physician's hospitalization risk estimate. RESULTS: Veterans had poorer health and higher use than HMO members. Gait speed alone and the EPESE battery predicted hospitalization; 41% (21/51) of slow walkers (gait speed <0.6 m/s) were hospitalized at least once, compared with 26% (70/266) of intermediate walkers (0.6-1.0 m/s) and 11% (15/136) of fast walkers (>1.0 m/s) (P <.0001). The relationship was stronger in the HMO than in the VA. Both performance measures remained independent predictors after accounting for Pra. The EPESE battery was superior to gait speed when both Pra and primary physician's risk estimate were included. Both performance measures predicted decline in function and health status in both health systems. Performance measures, alone or in combination with self-report measures, were more able to predict outcomes than self-report alone. CONCLUSION: Gait speed and a physical performance battery are brief, quantitative estimates of future risk for hospitalization and decline in health and function in clinical populations of older adults. Physical performance measures might serve as easily accessible "vital signs" to screen older adults in clinical settings.

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PubMed2002

Effect of fracture on the health care use of nursing home residents.

BACKGROUND: Osteoporotic fractures result in increased health care use. Care following fracture has been characterized for community dwellers but not for nursing home residents, whose fracture rates are as much as 11 times higher than those of age-matched community dwellers. Knowing the amount of care following fracture may help determine the effects of fracture prevention on use and costs in this population. METHODS: A prospective cohort study was conducted, with 18 months of follow-up, of 1427 randomly selected white, female nursing home residents 65 years and older from 47 randomly selected nursing homes in Maryland. RESULTS: After controlling for age, comorbidities, and mobility, nursing home residents who experienced a fracture were hospitalized more than 15 times as often as those who did not in the month following the fracture (relative rate, 15.35; 95% confidence interval, 12.27-19.21) and at a higher rate from 3 through 12 months postfracture. Rates in the first month were higher for persons with a hip fracture (relative rate, 31.01; 95% confidence interval, 26.52-36.24). Rates of emergency department use and contacts with physicians and therapists were increased, the latter two for 12 months following fracture. Also, before the fracture, patients who experienced a fracture visited the emergency department and had more physician contacts; for those with a hip fracture, there were fewer prefracture hospitalizations. CONCLUSIONS: Health care use remained elevated through 1 year postfracture. Comparisons with community patients suggest that this care may be less than what would be provided in other settings. For patients who fractured a hip, higher use decreased after 6 months, similar to community cohorts. Nursing home residents who visit the emergency department may warrant special screening for a fracture.

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PubMed2002

Gastric and duodenal safety of daily alendronate.

BACKGROUND: Isolated case reports of gastric ulcers after alendronate sodium use raised concern about the gastroduodenal safety of daily alendronate. This study was conducted to estimate the excess risk of hospitalizations for gastric or duodenal perforations, ulcers, and bleeding associated with alendronate use. PARTICIPANTS AND METHODS: Study subjects were 6432 men and women, 35 years or older. The subjects were members of 8 health maintenance organizations who were dispensed alendronate from October 1995 through September 1997. There was also a group of 33 176 age-, sex-, and health maintenance organization-matched unexposed persons. Because of concerns that osteoporosis might confound the association between alendronate use and perforation, ulcer, or bleeding, a second comparison group of 9776 women, 60 years or older, who had osteoporotic fractures was assembled. Hospitalizations for gastroduodenal events were identified by discharge diagnosis codes in automated claims records, and confirmed by manual record review. RESULTS: Based on the 14 confirmed events in the alendronate group and 35 in the unexposed group, the crude incidence rate ratio of gastroduodenal perforation, ulcer, or bleeding for the alendronate cohort was 3.0. The incidence rate ratio was 1.8 (95% confidence interval, 0.8-3.9) after control for prior hospitalizations, comorbidity, and recent exposure to prescription nonsteroidal anti-inflammatory drugs and oral corticosteroids. The crude incidence ratio rate for the age, sex, and health maintenance organizations-restricted cohort of alendronate users relative to the fracture cohort was 1.1 and the adjusted incidence rate ratio was 1.1 (95% confidence interval, 0.6-2.2). CONCLUSIONS: Osteoporosis and related factors appear to play an important role in the relationship between alendronate use and confirmed gastroduodenal perforation, ulcer, or bleeding; a substantial fraction of the increased risk we observed for alendronate users in the unadjusted analysis was the result of confounding.

Adult↗

PubMed2002

Prediction of fracture in nursing home residents.

OBJECTIVES: To investigate cross-validated methods of identifying patients at increased risk of fracture in nursing homes using readily available data. DESIGN: Prospective cohort study with 18 months of follow-up. SETTING: Forty-seven randomly selected nursing homes in Maryland. PARTICIPANTS: One thousand four hundred twenty-seven white female nursing home residents aged 65 and older were followed for fracture for 18 months after baseline assessment. MEASUREMENTS: Fracture ascertained by physician note or x-ray from chart abstraction; demographic and baseline data extracted from the Minimum Data Set (MDS). RESULTS: Exploratory analyses on a random subset (67%) of the data (development sample) identified variables that might be important in predicting subsequent fracture and included variables for how the resident moved between locations in her room or adjacent corridor (mobility), age, weight, height, independence in eating and dressing, urinary incontinence, resistance to care, falls in the previous 6 months, a dementia score, and other activities of daily living. A simple scoring algorithm derived from a subset of these MDS variables showed good sensitivity (.70) but low specificity (.39) in the random validation sample. CONCLUSION: A scoring algorithm developed in more than 1,400 white females from 47 nursing homes in the state of Maryland shows high sensitivity for identifying women at increased risk for fracture and may be useful in targeting fracture prevention programs.

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