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Biomedical subjects

L Fredman

Publications and source records attributed to L Fredman.

At least 19 recordsLinked to original sources
PubMed2006

Women with hip fracture have a greater rate of decline in bone mineral density than expected: another significant consequence of a common geriatric problem.

INTRODUCTION: Hip fracture is a major public health problem, annually affecting over 350,000 persons in the United States and 1.6 million worldwide. Consequences include decreased survival, loss of independence, and increased risk of subsequent fractures. A substantial decline in bone mineral density (BMD) also occurs, yet the magnitude of the decline specifically attributable to hip fracture has not been documented. METHODS: To determine the amount of BMD decline attributable to hip fracture, the rate of decline in BMD in a cohort of hip fracture patients was compared with that in a cohort of women of similar age and BMD but without hip fracture. All subjects were community dwelling when enrolled. Hip fracture patients in the Baltimore Hip Studies (BHS) came from two hospitals in Baltimore, Maryland, from 1992 through 1995; comparison subjects came from the Study of Osteoporotic Fracture (SOF) enrolled in four areas of the United States during the same period. Eighty-four white, female hip fracture patients 65 years and older from the BHS were compared with 168 SOF participants matched on age, race, and BMD at baseline. BMD of the femoral neck and total hip was measured by dual-energy x-ray absorptiometry. RESULTS: Hip fracture patients had a greater decline in BMD during the 12-month postfracture follow-up than that expected on the basis of the nonfracture cohort: 4.9% vs. 0.4% at the femoral neck and 3.5% vs. 0.7% for the total hip. The decline in BMD in hip fracture patients was 11.8 times the amount expected at the femoral neck (matched on age and baseline BMD and adjusted for between-cohort differences in smoking prevalence) and 4.9 times that expected for the total hip at the end of 1 year after the hip fracture. CONCLUSION: In this sample of older women, bone loss over the year following hip fracture far exceeded that expected and is an important clinical management concern.

Activities of Daily Living↗
PubMed2001

Extending gerontological research through linking investigators' studies to public-use datasets.

PURPOSE: Public-use datasets can extend data collected by individual investigators in various ways: making external comparisons, providing additional data on individual respondents, and creating internal comparison groups. The authors describe the advantages and limitations of these methods and practical and conceptual issues in combining investigator-initiated and public-use datasets. DESIGN AND METHODS: These issues are illustrated with a study of functional decline among 674 patients following hospitalization for hip fracture that was augmented with data from a public-use dataset, the Established Populations for Epidemiologic Studies of the Elderly (EPESE). RESULTS: By creating an internal comparison group of EPESE respondents, frequency matched to hip fracture patients on age, sex, and baseline functional limitations, the authors formed a single dataset and performed multivariable analyses of factors associated with functional decline. IMPLICATIONS: Gerontological research may benefit by applying these methods to program evaluations and longitudinal analyses of health outcomes with numerous public-use datasets.

Activities of Daily Living↗
PubMed1999

Cigarette smoking, alcohol consumption, and screening mammography among women ages 50 and older.

BACKGROUND: The associations among cigarette smoking and alcohol consumption with recent screening mammograms were evaluated among women ages 50 years and older. METHODS: The sample included 946 white and African-American women ages 50 years and older from the 1995 Maryland Behavioral Risk Factor Survey. Bivariate and logistic regression analyses were performed to evaluate the associations between current cigarette smoking and alcohol consumption in the past month (none, 1-7 drinks, >7 drinks) with obtaining a screening mammogram in the past 2 years (recent mammogram), controlling for sociodemographic and health variables. RESULTS: Seventy-eight percent of respondents had recent mammograms, 15% smoked cigarettes, 18% reported 1-7 drinks, and 12% reported >7 drinks in the past month. Smokers had lower mammography rates than nonsmokers (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.30-0.75). Women who drank alcoholic beverages had higher mammography rates than nondrinkers (OR = 1.37, 95% CI = 1.03-1.83). Smokers had the lowest mammography rates, regardless of their consumption of alcohol. An interaction was observed among white but not African-American women: nonsmokers who consumed moderate amounts of alcohol (1-7 drinks) had the highest mammography rates in this subgroup. CONCLUSIONS: To reduce breast cancer mortality, it is important to increase screening mammography among all women over age 50 and especially among smokers and the oldest women.

Black or African American↗
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.

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

Is there a sex bias in choosing editors? Epidemiology journals as an example.

CONTEXT: Editors, authors, and reviewers are influential in shaping science. The careers of women in public health have received less scrutiny than those of women in medicine and other branches of science. The performance of women as editors, authors, and reviewers in epidemiology has not been previously studied. OBJECTIVE: To examine changes over time in the representation of women at the editorial level in US epidemiology journals compared with the proportion of women authors and reviewers. DESIGN AND SETTING: Cross-sectional study of 4 US epidemiology journals, American Journal of Epidemiology, Annals of Epidemiology, Epidemiology, and the Journal of Clinical Epidemiology (formerly the Journal of Chronic Diseases), for 1982, 1987, 1992, and 1994. SUBJECTS: Editors, authors, and reviewers for the selected years. MAIN OUTCOME MEASURES: Sex of editors, authors, and reviewers. RESULTS: We identified 2415 reports associated with 8005 authors. One of 7 editors in chief was a woman, a position she shared with a man. For all journals, the proportion of editors who were women ranged from 5 (6.5%) of 77 in 1982 to 42 (16.3%) of 258 in 1994. Over all journals and all years, women comprised a higher proportion of authors (28.7% [2225/7743]) compared with reviewers (26.7% [796/2982]) or editors (12.8% [89/696]). CONCLUSIONS: Fewer women in public health hold editorial positions than are authors and reviewers. The reasons for this important discrepancy, including the possibility of a selection bias favoring men, should be further investigated.

Authorship↗
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

Associations among caregiving difficulties, burden, and rewards in caregivers to older post-rehabilitation patients.

The associations between self-reported rewards and difficulties of caregiving and burden were examined in a sample of 200 informal caregivers to older post-rehabilitation patients. Sixteen percent (16%) of caregivers reported that caregiving was physically difficult only, 15% reported emotional difficulties only, 11% reported social difficulties only, 17% reported multiple difficulties, and 40% had no difficulties. Each type of difficulty (e.g., social, emotional, and physical) was significantly associated with burden in univariate and multiple linear regression analyses, controlling for confounding characteristics. Caregivers reporting multiple types of difficulty experienced higher levels of burden than caregivers who reported only one type of difficulty. Caregivers who received more rewards from caregiving reported fewer difficulties. Caregiving rewards had no independent effect on burden but modified the associations between social and emotional difficulties and burden. In summary, caregiving rewards and difficulties were not mutually exclusive, and their relationship in turn affected burden.

Affect↗
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.

Aged↗
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.

Aged↗
PubMed1997

Weight change: an indicator of caregiver stress.

This study evaluated weight change and caregiver stress in 200 informal caregivers to elderly patients discharged from a rehabilitation hospital. Previous laboratory and epidemiologic studies have shown that stress predisposes to weight change. Nineteen percent of the caregivers had gained or lost at least 10 pounds since becoming caregivers. Weight change was significantly associated with higher scores on standardized measures of burden and stress (e.g., Burden Interview, Perceived Stress Scale, Geriatric Depression Scale) and with lower education, poorer self-rated health, more psychotropic medication use, and caring for patients with more ADL limitations who had been hospitalized for stroke or a frail elderly condition. Caregivers to patients with a stroke or frail elderly condition reported 2.8 times more weight change than caregivers to patients with a rehabilitation problem. These results suggest that weight change is a valid indicator of stress in caregivers, and they have public health, clinical, and research applications.

Aged↗
PubMed1997

Assessing medical care of dying residents in nursing homes.

Although approximately one of five people in the United States die in nursing homes (NHs), little has been written about their quality of dying, including the quality of terminal medical care. The purpose of this study is to review actual medical practices in NHs to suggest factors important for delivering good quality terminal care. Four NHs were surveyed for management of residents who died in 1992. A convenience sample of charts of newly admitted and longer term residents were abstracted for demographic variables, death, diagnostic categories, and various laboratory and other parameters. Charts of those residents who died were further reviewed using indicators of quality medical care, such as presence of advance directives, control of pain, and control of dyspnea, based upon recent published clinical practice guidelines for terminal care in NHs. Three hundred and seventy-one charts were abstracted. Forty-one charts documented the resident's death. We found that NHs without regulatory difficulties usually had expected deaths that were managed approximately as measured by terminal medical care quality indicators. NHs with a history of regulatory difficulties had a higher prevalence of residents who died suddenly and unexpectedly, often with problems in the quality of care as measured by the same indicators. There was a correspondence between physician certification, antemortem diagnosis of terminal illness, and appropriate terminal care. We conclude that physicians are able to recognize impending death and redirect the medical care of dying NH residents toward goals of terminal care management. This is more likely to occur in a NH environment that places greater emphasis upon total quality management. We suggest that another indicator in providing good NH terminal care is the physician's performance in predicting a short life expectancy.

Aged↗
PubMed1997

Patient-caregiver functional unit scale: a new scale to assess the patient-caregiver dyad.

BACKGROUND AND OBJECTIVES: This study evaluated the reliability and validity of the Patient-Caregiver Functional Unit Scale (PCFUS), a new instrument to assess the stability or endurance of patient-caregiver dyads. METHODS: Patient-caregiver dyads were recruited from a nursing home (NH) (n = 38), a comprehensive geriatric assessment program (CGA) (n = 20), and an ambulatory medical clinic (controls) (n = 85). Caregivers were eligible if they assisted, or were available to assist, the patient with personal and instrumental activities of daily living, without pay. Data were collected by interviewer-administered questionnaires. Inter-rater and test-retest reliability were evaluated among the CGA sample. Validity was assessed by comparing PCFUS scores among the NH, CGA, and control groups and by correlation of PCFUS scores with other standardized caregiver burden measures. RESULTS: The PCFUS had excellent inter-rater and test-retest reliability. Mean PCFUS scores were significantly lower (ie, less stable patient-caregiver dyad) in NH than CGA and control caregivers. PCFUS scores were significantly associated with Burden Interview, Perceived Stress Scale, and Geriatric Depression Scale scores and risk factors for caregiver stress (eg, patient's cognitive impairment, disruptive behaviors). CONCLUSIONS: The PCFUS is a short, easily administered measure with good reliability and validity and is applicable to clinical and research settings.

Activities of Daily Living↗
PubMed1995

Tuberculosis in the homeless.

The prevalence of tuberculosis in the homeless is on the rise. The presence of human immunodeficiency virus and multidrug-resistant tuberculosis in the homeless has contributed to this high prevalence. Several factors, including alcoholism, substance abuse, and psychiatric illness, combine to make it difficult to diagnose and treat tuberculosis in the homeless. Medical providers are likely to encounter homeless individuals in a number of settings, including emergency departments, community and free clinics, public hospitals, and health maintenance organizations. Appropriate screening, prevention, and treatment should be undertaken in collaboration with local health departments. The use of directly observed therapy and of the treatment regimens published by the Centers for Disease Control and Prevention improves treatment outcomes among the homeless.

Drug Resistance, Microbial↗
PubMed1995

Burden among white and black caregivers to elderly adults.

Racial differences in caregiver burden were evaluated among 1,062 White and 159 Black caregivers from the 1982 National Long-term Care Survey and its supplement, the National Survey of Informal Caregivers. Black caregivers performed more caregiving activities and cared for persons with greater functional and cognitive impairment. However, White caregivers reported significantly more burden in linear regression analyses, controlling for covariates. Results of separate, race-specific regression models showed that caregiver demographics (being female, spouse of the care recipient, and poorer self-rated health), caregiving activities (helps with ADLs, extra time spent caregiving, unable to leave care recipient alone), and care recipient needs (IADL limitations, cognitive impairment or proxy interview, recent hospitalization) were significantly associated with burden among White caregivers. When this model was replicated in Black caregivers, the only statistically significant variables were poorer self-rated health, caregiving activities (helps with ADLs, extra time caregiving, unable to leave care recipient alone), and cognitive impairment of the care recipient. These results underscore the importance of caregiving activities in assessments of burden among White and Black caregivers.

Activities of Daily Living↗
PubMed1994

Indicators of quality medical care for the terminally ill in nursing homes.

PURPOSE: To identify medical care indicators for nursing home terminal care. DATA SOURCES: Studies examining care of terminally ill patients were identified using computer, bibliography, and expert searches; input from nursing home medical directors in Maryland; and input from expert geriatricians. STUDY SELECTION: More than 900 articles, books, and abstracts from meetings covering medical care for terminally ill patients were reviewed. Information from more than 100 publications is included. DATA EXTRACTION: Indicators of medical care for terminally ill patients, which can be used to quantify performance with respect to standards, guidelines, and options, were identified initially through review of the literature. DATA SYNTHESIS: Indicators were refined by input from medical directors of Maryland long-term care facilities and subsequent review by expert geriatricians. CONCLUSIONS: Minimum standards for which 100% performance is expected are communication of advance directives, attention to pain control, and attention to relief of dyspnea. Performance indicators for medical care guidelines and options in terminal care of nursing home patients are also described.

Home Care Services↗