Biomedical subjects

Lawrence R Landerman

Publications and source records attributed to Lawrence R Landerman.

12 recordsLinked to original sources

PubMed2006

Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia.

OBJECTIVE: This study examined whether informal caregiver psychologic distress decreases the likelihood of influenza vaccination for community-dwelling elderly with dementia. A secondary aim was to determine whether psychologic distress mediates the relationship between other predisposing, enabling, and medical need variables and vaccination. METHODS: Data were drawn from the 1998 National Longitudinal Caregiver Survey. The final sample consisted of 1406 community-dwelling male veterans with dementia and their coresiding female informal caregivers. Presence of caregiver psychologic distress was measured using the Boston Short Form of the Center for Epidemiologic Studies Depression Scale. Vaccination was identified by examining Veteran Administration Outpatient Data Files for visits indicating influenza vaccine administration during the 1998 influenza vaccine season (September 1 to December 31). Multivariate path analysis with observed variables was used to estimate direct and indirect probit path coefficients between independent variables, caregiver psychologic distress, and veteran vaccination. RESULTS: As hypothesized, caregiver distress was significantly associated with a decreased likelihood of care-recipient vaccination (unstandardized coefficient [b] = -0.023, P < 0.01). Adjusted for other variables, the predicted probability of vaccination was 37.7% for care-recipients with nondistressed caregivers compared with 29.4% for care-recipients with distressed caregivers. Furthermore, a number of factors significantly influenced vaccination via their influence on psychologic distress. CONCLUSION: We conclude that caregiver psychologic distress may interfere with access to influenza vaccination in persons with dementia. Access to vaccination may be improved directly by detecting and treating emotional health problems in caregivers and indirectly by addressing precursors to caregiver distress.

Aged↗

PubMed2006

Dynamics of patient targeting for care management in Medicaid: a case study of the Durham Community Health Network.

Targeting appropriate patients for care management is crucial to maximizing quality of care and cost-effectiveness in Medicaid care management programs. This study examined patient characteristics predicting selection for care management pre- and postmanagement changes at the Durham Community Health Network (DHCN), one of North Carolina's Medicaid primary care management networks. From the beginning, care managers were directed to target asthmatics, diabetics, and high-volume utilizers of health care, using an array of markers to identify patients who needed management. In 2003, the state reinforced its focus on chronic disease and high utilizers, and new management at DCHN began emphasizing the use of protocols for patient targeting. This study examined the relative effects of patient demographics, diagnoses, PCP group, and health care utilization as predictors of patient selection before and after these changes.

Adolescent↗

PubMed2005

African-American and white caregivers of older adults with dementia: differences in depressive symptomatology and psychotropic drug use.

OBJECTIVES: To examine relationships between race and psychotropic drug use (antidepressant, antianxiety, sedative/hypnotic agents) in informal caregivers with symptoms of depression who provide care for elderly relatives with progressive dementia. Whether racial differences in medication use relate to racial differences on predisposing, enabling, and need factors associated with use of these agents was also examined. DESIGN: National survey. SETTING: Community-based population of informal caregivers of elderly male U.S. veterans with dementia living throughout the 48 contiguous states and Puerto Rico. PARTICIPANTS: Two thousand thirty-two African-American and white female caregivers of elderly male veterans diagnosed with probable Alzheimer's disease or vascular dementia. MEASUREMENTS: Depressive symptoms were measured using a modified version of the Center for Epidemiological Studies Depression Scale. Antidepressant, antianxiety, and sedative/hypnotic agents were indexed using the Veterans Affairs medication classification system. RESULTS: Of caregivers with depressive symptoms, 19% used antidepressants, 23% antianxiety agents, and 2% sedative/hypnotics. African-American caregivers with depressive symptoms were significantly less likely than whites with depressive symptoms to be using antidepressants and antianxiety medications. Caregivers who reported higher levels of social support and more physician visits during the previous 6 months were significantly more likely than others to be taking antidepressants. CONCLUSION: This study found that 81% of caregivers with depressive symptoms were not taking antidepressant medication and that African-American caregivers were less likely than whites to be taking antidepressants. Results suggest that routine screening for depression in dementia caregivers may identify unmet needs for antidepressant therapy. Particular care should be taken to ensure that African-American caregivers are made aware of the potential benefits of such therapy.

Activities of Daily Living↗

PubMed2005

A clinical trial of a rehabilitation expert clinician versus usual care for providing manual wheelchairs.

OBJECTIVES: To determine the effect of differing methods of dispensing wheelchairs. DESIGN: Quasi-experimental by day of week. SETTING: Department of Veterans Affairs Medical Center. PARTICIPANTS: Eighty-four community-dwelling, cognitively intact patients prescribed a standard manual wheelchair. INTERVENTION: A multifactorial intervention consisting of an expert physical/occupational therapist who used a scripted evaluation that included an evaluation based on medical record review and self-reported and physical performance measures; individualization of the wheelchair and initiation of orders for additional occupational/physical therapy, equipment, or home modifications as needed; multimodal patient education; and telephone follow-up at 3 and 6 weeks. MEASUREMENTS: The primary outcome was amount of wheelchair use. Secondary outcomes were shoulder pain, wheelchair comfort and confidence, and home modifications. RESULTS: The intervention group had significantly greater wheelchair use than usual care at 2 weeks, 3 months, and 6 months (P=.01). Wheelchair use declined monotonically over time for the entire study sample (P<.001). There were no significant differences between the two groups in shoulder pain, wheelchair comfort or confidence, or home modifications. CONCLUSION: New wheelchair owners used the wheelchair more often if they received it from an expert therapist using a multifactorial intervention.

Activities of Daily Living↗

PubMed2005

Symptomatic effects of exposure to diluted air sampled from a swine confinement atmosphere on healthy human subjects.

Aerial emissions from a swine house at North Carolina State University's field laboratory were diluted to a level that could occur at varying distances downwind from a confined animal feeding operation (CAFO) both within and beyond the property line, and these emissions were delivered to an environmental exposure chamber. The study design consisted of two 1-hr sessions, one in which 48 healthy human adult volunteers were exposed to diluted swine air and another in which they were exposed to clean air (control). Objective measures of blood pressure, temperature, heart rate, respiratory rate, lung function, nasal inflammation, secretory immunity, mood, attention, and memory were correlated with objective measures of air quality. Ratings of perceived (self-reported) health symptoms were also obtained. The mean levels of airborne constituents in the swine air condition were hydrogen sulfide (24 ppb), ammonia (817 ppb), total suspended particulates (0.0241 mg/m3), endotoxin (7.40 endotoxin units/m3), and odor (57 times above odor threshold). No statistical differences on objective measures of physical symptoms, mood, or attention resulted from the 1-hr exposure to swine emissions in the environmental chamber when compared with clean air for healthy human volunteers. However, subjects were 4.1 (p = 0.001) times more likely to report headaches, 6.1 (p = 0.004) times more likely to report eye irritation, and 7.8 (p = 0.014) times more likely to report nausea in the swine air (experimental) condition than in the control condition. These results indicate that short-term exposure in an environmental chamber to malodorous emissions from a swine house at levels expected downwind can induce clinically important symptoms in healthy human volunteers.

Adult↗

PubMed2004

Histamine2 receptor antagonist use and decline in cognitive function among community dwelling elderly.

PURPOSE: Previous studies have reported mixed results regarding the use of histamine(2) receptor antagonist use and cognitive function. This study evaluated the relationship between the use of histamine(2) receptor antagonists and cognitive decline among community dwelling elderly. METHODS: This cohort study included 2082 subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly who were not cognitively impaired at baseline (1989/90). Histamine(2) receptor antagonist use was determined during in-home interviews. Cognitive function was assessed at 3 and 7 years after baseline by two measures: (1) incident cognitive impairment defined by the short portable mental status questionnaire (SPMSQ); and (2) cognitive decline (increase in two or more SPMSQ errors). Analyzes used multivariable discrete-time hazard models with weighted data adjusted for sampling design and controlled for demographic, health behavior characteristics and health status. RESULTS: At baseline, nearly 5% of participants used a histamine(2) receptor antagonist. During follow-up, incident cognitive impairment occurred in 24.0%, whereas 34.5% increased by two or more errors on the SPMSQ. In multivariable models, current histamine(2) receptor antagonist users compared to never users had a higher risk for cognitive impairment (Adj. RR 1.51; 95%CI 0.93-2.47) and for decline in performance (increase of two or more errors) on the SPMSQ (Adj. RR 1.24; 95%CI 0.74-2.08). A nonsignificant increased risk of cognitive impairment and decline with either higher dose or short-term use was found whereas a nonsignificant protective effect on cognitive decline with current long-term use was seen. CONCLUSIONS: These results suggest no beneficial effects, and perhaps a detrimental effect, of histamine(2) receptor antagonist use on cognitive function in community dwelling elderly.

Aged↗

PubMed2004

Impact of inappropriate drug use on health services utilization among representative older community-dwelling residents.

BACKGROUND: There is limited objective information regarding the impact of drugs identified as inappropriate by drug utilization review (DUR) or the Beers drugs-to-avoid criteria on health service use. OBJECTIVE: The goal of this study was to examine the predictive validity of DUR and the Beers criteria employed to define inappropriate drug use in representative community residents, aged >or=68 years, as determined by the relationship of these criteria to health service use in older community residents. METHODS: Data came from participants in the Duke University Established Populations for Epidemiologic Studies of the Elderly seen in 1989/1990 and for whom information was also available 3 years later. Two sets of inappropriate drug use criteria were examined: (1) DUR regarding dosage, duration, duplication, and drug-drug and drug-disease interactions; and (2) the Beers criteria, applied to drug use reported in an in-home interview. Outpatient visits and nursing-home entry were determined by personal report; hospitalization information came from Medicare Part A files from the Centers for Medicare and Medicaid Services. RESULTS: A total of 3165 participants were available at the fourth interview in 1989/1990. The majority were aged >74 years (51.1%), white (64.8%), women (64.7%), had fair or poor health (77.0%), consistently saw the same physician (86.9%), and possessed supplemental health insurance (62.8%). Use of inappropriate drugs meeting DUR criteria, especially for drug-drug or drug-disease interaction problems, was associated with increased outpatient visits (P<0.05) but not with time to hospitalization or time to nursing home entry. The use of inappropriate drugs according to the Beers criteria was associated with reduced time to hospitalization (adjusted hazard ratio, 1.20; 95% CI, 1.04-1.39) but not to outpatient visits or nursing home entry. CONCLUSIONS: Our data suggest that in representative community residents aged >or=68 years, current criteria for inappropriate drug use should be used with caution in evaluating quality of care because they have minimal impact on use of health services. We found increases only in the use of outpatient services (with DUR) and more rapid use of hospitalization (with the Beers criteria).

Aged↗

PubMed2004

Medication use among black and white caregivers of older male veterans with dementia.

BACKGROUND: Few studies have examined racial differences in medication use among informal caregivers of elderly individuals with progressive dementia. It is important to identify racial disparities in medication use so that these differences can be corrected. OBJECTIVE: The purpose of the current study was (1) to evaluate whether black caregivers were less likely to be taking medication than white caregivers after controlling for specific factors and (2) to examine the relationship between caregiver race and other predisposing, enabling, and need factors, and the use of specific categories of medications. METHODS: A secondary analysis of data was conducted from a national survey of 2032 black and white female caregivers of elderly male US veterans with a diagnosis of Alzheimer's disease or vascular dementia. Caregiver use of specific medications was classified according to the Veterans Affairs medication classification system. The Andersen Behavioral Model of Health Services Use provided a framework for multivariate models predicting racial differences in any medication use and use of specific categories of medications. RESULTS: Black caregivers were significantly less likely to use any medication than white caregivers (adjusted odds ratio [OR]=0.42; 95% CI=0.31-0.57). These differences persisted even after controlling for other predisposing, enabling, and need factors, and for outpatient doctor visits. Black caregivers were significantly less likely than white caregivers to be taking endocrine/metabolic medications (adjusted OR=0.57; 95% CI=0.42-0.77) and central nervous system medications (adjusted OR=0.57; 95% CI=0.39-0.83). CONCLUSION: The results of this analysis suggest that significant racial differences in medication use exist among informal caregivers providing care for elderly male US veterans with progressive dementia.

Black or African American↗

PubMed2003

Is antioxidant use protective of cognitive function in the community-dwelling elderly?

BACKGROUND: The role of oxidative stress in the pathogenesis of diseases such as macular degeneration, certain types of cancer, and Alzheimer's disease has received much attention. Thus, there is considerable interest in the potential contribution of antioxidants to the prevention of these diseases. OBJECTIVE: The objective of this study was to determine whether use of supplemental antioxidants (vitamins A, C, or E, plus selenium or zinc) was associated with a reduced risk of development of cognitive impairment or cognitive decline in a representative sample of the community-dwelling elderly. METHODS: The sample consisted of 2082 nonproxy subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly who were not cognitively impaired at the 1989-1990 interview (baseline for the present analysis). Medication use was determined during in-home interviews. Cognitive function was assessed 3 and 7 years from baseline in terms of incident cognitive impairment, as measured on the Short Portable Mental Status Questionnaire (SPMSQ) using specific cut points (number of errors) based on race and education, and cognitive decline, defined as an increase of > or = 2 errors on the SPMSQ. Multivariate analyses were performed using weighted data adjusted for sampling design and controlled for sociodemographic characteristics, health-related behaviors, and health status. RESULTS: At baseline, 224 (10.8%) subjects were currently taking a supplement containing an antioxidant. During the follow-up period, 24.0% of subjects developed cognitive impairment and 34.5% experienced cognitive decline. Current antioxidant users had a 34.0% lower risk of developing cognitive impairment compared with non-antioxidant users (adjusted relative risk [RR], 0.66; 95% CI, 0.44-1.00) and a 29.0% lower risk of experiencing cognitive decline (adjusted RR, 0.71; 95% CI, 0.49-1.01). CONCLUSION: The results of this analysis suggest a possible beneficial effect of antioxidant use in terms of reducing cognitive decline among the community-dwelling elderly.

Age Factors↗

PubMed2003

Activity restriction among wheelchair users.

OBJECTIVES: To identify factors associated with activity restriction. DESIGN: Cohort study. SETTING: Patients prescribed a new wheelchair at one of two teaching hospitals (one Veterans Affairs and one private hospital). PARTICIPANTS: One hundred fifty-three consecutive, community-dwelling wheelchair users, who had a Short Portable Mental Status Score greater than 6 out of 10 and could be interviewed within 7 to 21 days of receiving the wheelchair. MEASUREMENTS: Dependent variables were self-reported nonmedical visits and medical visits in the preceding week (any vs no visits and the number of visits). Independent variables were self-reported sociodemographic and health characteristics, mobility limitations, and environmental barriers. RESULTS: Study subjects reported, on average, 1.79 mobility limitations, 11.17 hours out of bed, and 5.56 hours of personal assistance per day. Multivariate analyses show that higher income was the only significant sociodemographic factor; it was associated with more medical visits (beta=0.44, P<.01). Of health status characteristics, more comorbid conditions predicted fewer nonmedical visits (beta=-0.14, P<.10) and amputation was associated with fewer medical visits (beta-0.82, P<.05). Regarding mobility limitations, more mobility limitations was associated with lower odds of any nonmedical visit (odds ratio (OR)=0.71, P<.5) and fewer nonmedical visits (beta=-0.28, P<.05); more hours out of bed predicted more nonmedical visits (beta=0.05, P<.5) and lower odds any medical visit (OR=0.92, P<.05). More environmental barriers predicted fewer nonmedical (beta=-0.32, P<.01) or medical visits (beta=-0.21, P<.05). CONCLUSION: Mobility limitations and environmental barriers were associated with restricted participation in diverse activities outside the home.

Activities of Daily Living↗

PubMed2002

Falls in African American and white community-dwelling elderly residents.

BACKGROUND: Few studies have examined the relationship of race to falls. This study evaluated the association between potential risk factors and falls in a representative sample of 1049 African American and 1947 white participants of the second in-person wave of the Duke Established Populations for Epidemiologic Studies of the Elderly. METHODS: Information about sociodemographic characteristics, health-related behaviors, health status, visual function, and drug use was determined during baseline in-home interviews. Three years later, falls in the previous 12 months were assessed by self-report. RESULTS: One or more falls occurred in 22.2% of the participants. Nearly half the fallers reported more than one fall. Multivariable analysis revealed that African Americans were less likely than whites to have any fall (adjusted odds ratio [OR] 0.77, 95% confidence interval [CI] 0.62-0.94). Increased age and education, arthritis, diabetes, and history of broken bones were also significant (p <.05) independent risk factors for any fall. In multivariable analyses comparing those with two or more falls to those with none, again, increased age and education, arthritis, and diabetes were significant (p <.05) independent risk factors while smoking was protective. Race was not a significant predictor of multiple falls (adjusted OR 0.90, 95% CI 0.64-1.26). CONCLUSIONS: Similar sociodemographic characteristics and health problems appear to be important risk factors for any and multiple falls in community-dwelling African American and white elderly residents, with white elders at greater risk of one-time falls.

Accidental Falls↗

PubMedDate not supplied

Improvement of anger at one week predicts the effects of sertraline and placebo in PTSD.

In previous work we demonstrated an early, robust and sustained effect for sertraline vs placebo on irritability and anger in subjects with PTSD. In this report, we explore the same dataset to assess whether a clinician might usefully predict ultimate response to sertraline, on the basis of its effect upon anger after one week. Three hundred and eighteen subjects were assessed. Outcome was measured by whether or not the score was reduced by at least 50% from baseline. Ordinary least squares regression was used to estimate the effects of change in anger at one week. Logistic regression was applied to estimate the effects on odds of a 50% drop in score. Cut points were developed for one-week change scores on anger for sertraline and placebo. The best cut point was selected as predictive of non-response, i.e. a cue suggesting that treatment switch would be in order. An increase in anger of 30% at one-week best predicted the likelihood of not responding to treatment in both the drug and placebo groups. Twenty-five percent of all non-responders were incorrectly identified, while only 7% of all improvers were incorrectly categorized as non-responders using this cutoff. Our findings imply that, for patients similar to those in this study, an increase in anger after one week of treatment might be one factor to consider when making a decision about continuation of the medication.

Adolescent↗