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Louise B Russell

Publications and source records attributed to Louise B Russell.

8 recordsLinked to original sources
PubMed2006

Lifestyle-related risk factors and risk of future nursing home admission.

BACKGROUND: While risks of disease, hospitalization, and death attributable to lifestyle-related factors such as smoking, inactivity, and obesity have been well studied, their associations with nursing home admission are less well known. These risk factors are usually established by middle age, but nothing is known about how they relate to long-term risk of nursing home admission in this age group. METHODS: Cox proportional hazards regressions were used to analyze risk of nursing home admission over 2 decades of follow-up (1971-1975 to 1992) in a nationally representative, longitudinal survey of community-dwelling adults aged 45 to 74 years at baseline. Middle-aged (45-64 years at baseline) and elderly persons (aged 65-74 years at baseline) were analyzed separately: 230 (6.5%) of 3526 middle-aged respondents and 728 (24.7%) of 2936 elderly ones had 1 or more nursing home admissions. Baseline risk factors included smoking, inactivity, obesity, elevated blood pressure, elevated total cholesterol level, and diabetes mellitus, which were defined according to national guidelines. RESULTS: All lifestyle-related factors, except total cholesterol level, were associated with higher risk of nursing home admission during follow-up in one or both age groups. Risk ratios were higher in middle-aged than in elderly persons. In those aged 45 to 64 years at baseline, diabetes more than tripled the risk of nursing home admission (relative risk, 3.25; 95% confidence interval, 2.04-5.19); smoking, inactivity, and elevated systolic blood pressure had relative risks of 1.56, 1.40, and 1.35, respectively. Obesity was a risk factor for those aged 65 to 74 years at baseline, but not for the middle-aged subjects. Persons with 2 lifestyle-related factors were at greatly increased risk, especially if 1 was diabetes. CONCLUSIONS: Lifestyle factors are important contributors to the long-term risk of nursing home admission. Modifying lifestyle, especially in middle age, may reduce the risk of admission.

Adult↗
PubMed2005

Hospitalizations attributable to arthritis, smoking, and hypertension: a comparison based on NHEFS and NHANES III.

OBJECTIVE: To compare the impact of arthritis, smoking, and residual hypertension on the annual rate of hospital admissions in adults ages 45-74, because arthritis imposes a heavy health burden on individuals and higher medical costs on the nation. METHODS: A simulation model was used to estimate annual hospital admissions attributable to each risk factor for all adults ages 45-74, and for overweight adults in that age bracket, from the Third National Health and Nutrition Examination Survey (NHANES III). RESULTS: Arthritis accounted for 6.2% of annual hospital admissions (8.1 admissions per 1,000 NHANES III adults). Current smoking accounted for a slightly larger share of admissions (7.0% or 9.1 admissions per 1,000 adults) and residual hypertension accounted for a smaller share (2.3% or 3.0 admissions per 1,000 adults). Because arthritis is more prevalent in overweight adults, it accounted for 7.4% of admissions (11.0 admissions per 1,000 annually in this group), compared with 5.8% for smoking (8.6 admissions per 1,000). CONCLUSION: Although the impact of smoking and hypertension receives more attention from the media, the impact of arthritis on hospitalizations is substantial. This finding provides additional support for the goals of the National Arthritis Action Plan.

Aged↗
PubMed2005

Hospitalizations, nursing home admissions, and deaths attributable to diabetes.

OBJECTIVE: To estimate all-cause hospitalizations, nursing home admissions, and deaths attributable to diabetes using a new methodology based on longitudinal data for a representative sample of older U.S. adults. RESEARCH DESIGN AND METHODS: A simulation model, based on data from the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Followup Study, was used to represent the natural history of diabetes and control for a variety of baseline risk factors. The model was applied to 6,265 NHANES III adults aged 45-74 years. The prevalence of risk factors in NHANES III, fielded in 1988-1994, better represents today's adults. RESULTS: For all NHANES III adults aged 45-74 years, a diagnosis of diabetes accounted for 8.6% of hospitalizations, 12.3% of nursing home admissions, and 10.3% of deaths in 1988-1994. For people with diabetes, diabetes alone was responsible for 43.4% of hospitalizations, 52.1% of nursing home admissions, and 47% of deaths. Adjusting for related cardiovascular conditions, which may provide more accurate estimates of attributable risks for people with diabetes, increased these estimates to 51.4, 57.1, and 56.8%, respectively. CONCLUSIONS: Risks of institutionalization and death attributable to diabetes are large. Efforts to translate recent trials of primary prevention into practice and continued efforts to prevent complications of diabetes could have a substantial impact on hospitalizations, nursing home admissions, and deaths and their societal costs.

Aged↗
PubMed2005

Time requirements for diabetes self-management: too much for many?

BACKGROUND: In Crossing the Quality Chasm, the Institute of Medicine laid out principles to improve quality of care and identified chronic diseases as a starting point. One of those principles was the wise use of patient time, but current recommendations for chronic conditions do not consider time spent on self-care or its impact on patients' lives. OBJECTIVE: To estimate the time required for recommended diabetes self-care. METHODS: A convenience sample of 8 certified diabetes educators derived consensus-based estimates of the time required for all self-care tasks recommended by the American Diabetes Association. RESULTS: For experienced patients with type 2 diabetes controlled by oral agents, recommended self-care would require more than 2 extra hours daily. Elderly patients and those with newly diagnosed disease, or those with physical limitations, would need more time. Exercise and diet, required for self-care of many chronic conditions, are the most time-consuming tasks. CONCLUSION: The time required by recommended self-care is substantial. Crossing the Quality Chasm suggests how clinicians and guideline developers can help patients make the best use of their self-care time: elicit the patient's perspective; develop evidence on the health consequences of self-care tasks; and respect patients' time.

Diabetes Mellitus, Type 2↗
PubMed2004

Effects of prehypertension on admissions and deaths: a simulation.

BACKGROUND: The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recently released new clinical practice guidelines that target systolic blood pressure and identify persons with "prehypertension" (systolic blood pressure, 120-139 mm Hg), previously considered normal, as being at elevated risk and in need of intervention. METHODS: We used a simulation model, fitted to longitudinal data from the first NHANES (National Health and Nutrition Examination Survey) Epidemiologic Followup Study, to estimate the effects of prehypertension and residual hypertension (systolic blood pressure, > or =140 mm Hg). The term residual hypertension recognizes that many people with hypertension have lowered their pressures through treatment, but not to less than 140 mm Hg. We applied the model to a representative sample of US adults aged 25 to 74 years from NHANES III. RESULTS: Except for women aged 25 to 44 years, more than a third of each age group in NHANES III had prehypertension. Approximately two thirds of persons aged 45 to 64 years and 80% of persons aged 65 to 74 years had prehypertension or residual hypertension. Together, prehypertension and residual hypertension accounted for 4.7% of hospital admissions per 10 000 adults aged 25 to 74 years, 9.7% of nursing home admissions, and 13.7% of deaths. Prehypertension alone accounted for 3.4% of hospitalizations, 6.5% of nursing home stays, and 9.1% of deaths. Numbers of events attributable to prehypertension are greatest for men aged 45 to 64 years and persons aged 65 to 74 years. CONCLUSIONS: Our results confirm the substantial public health consequences of prehypertension. If prehypertension were eliminated, hospitalizations, nursing home admissions, and premature deaths could decline substantially.

Adult↗
PubMed2002

The impact of drug pricing policies on the health of the elderly.

BACKGROUND: Prices for prescription drugs vary widely in the United States, from the prices charged by retail pharmacies to 50% below average wholesale prices (AWP), depending on the purchaser's bargaining power. At higher drug prices, expenditures for essential preventive interventions, such as those aimed at hypertension and hypercholesterolemia, buy less health for the elderly. The magnitude of this effect, however, is unknown. METHODS: Cost-effectiveness analyses of drug interventions, which estimate their health effects and costs, sometimes include analyses of the impact of drug prices. We use results from studies of preventive drugs used by the elderly to calculate the life-years that could be purchased for $1 million of expenditure at the AWP, and at prices 20% and 40% below the AWP. This range reflects the range of prices in the United States today. RESULTS: Drug prices have a substantial effect on the amount of health that can be purchased for $1 million, especially among elderly people with several health conditions. For example, at 40% below the AWP, $1 million spent on statins yields 90 years of life for patients aged 75 to 84 with a history of myocardial infarction. At the AWP, the number of life-years for $1 million drops to 48--a loss of 42 life-years. CONCLUSIONS: A Medicare drug benefit program that supports prices at the high end of the current range could yield substantially less health for the elderly, and one that promotes differential pricing could promote unequal access to preventive medications--and thus to health--by Medicare beneficiaries across the country.

Aged↗