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Biomedical subjects

M Baumgarten

Publications and source records attributed to M Baumgarten.

At least 19 recordsLinked to original sources
PubMed2001

Predictors of improvement in health-related quality of life among elderly patients with depression.

BACKGROUND: Depression is the most prevalent disabling psychiatric syndrome of aging and may lead to important decrements in the elderly depressed patient's health-related quality of life (HRQL). The goal of this study was to determine whether severity of chronic illness at admission, severity of depressive symptoms at admission, or living alone before admission was associated with lack of improvement in HRQL at 3 months postdischarge among elderly depressed inpatients. METHODS: Subjects were 100 consecutive patients admitted to a 26-bed inpatient geriatric psychiatry unit from 1994 through 1997, who were residing in the community and were not demented. At admission, severity of depressive symptoms was assessed using the Geriatric Depression Scale and severity of chronic physical illness was measured using the Cumulative Illness Rating Scale (Geriatrics). HRQL was assessed at admission and again at 3 months postdischarge using the Medical Outcomes Study (MOS) 6-Item General Health Survey. RESULTS: This study found large improvements in all MOS items between admission and 3 months postdischarge. Severity of chronic physical disease was negatively associated with the probability of improvement in three MOS items (role functioning, psychological functioning, and general health perceptions) whereas the severity of depressive symptoms on admission was negatively associated with the probability of improvement in role functioning, social functioning, and bodily pain. Living alone was negatively associated with social functioning but not with any of the other MOS items. CONCLUSION: The results of this study suggest that the inpatient treatment of depression in the elderly brings about improvements in quality of life that persist for at least 3 months following discharge. The patient's initial level of depression and initial level of physical health may be important factors to be considered when evaluating a patient's prognosis.

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PubMed2001

Correlates of nonparticipation in the Canadian Study of Health and Aging.

Correlates of nonparticipation in the community interview component of the Canadian Study of Health and Aging and their impact on bias in the results were analyzed. Characteristics of study subjects, their habitats, and encouragement techniques were analyzed to identify correlates of variation in response rates across the 18 study centers. Refusal rates from 14% to 41% varied by age, gender, city size, number of subjects and length of time for enrollment, and method of approach. Cognitively impaired subjects had higher refusal rates which affected prevalence estimates. At one study site, efforts to "convert" subjects who initially refused to participate in the survey were successful with 26% of those who were recontacted.

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PubMed2001

Resident contact with family and friends following nursing home admission.

PURPOSE: This study explored factors that are related to the level of contact (number of visits and calls) between newly admitted nursing home residents and their family and friends. In addition to reexamining factors studied previously, several new factors were explored: contact level prior to nursing home placement, dementia status, and resident race. DESIGN AND METHODS: Interviews were conducted with the significant others of 1,441 residents from a representative sample of nursing homes in Maryland. RESULTS: Contact decreased by approximately half following admission, compared to reported preadmission contact. Rates of contact are positively related to nonuse of Medicaid, kinship closeness, support network proximity, nondemented status, and White race. After controlling for preadmission contact, postadmission contact is positively associated with kinship closeness, support network proximity, nondemented status, and White race. IMPLICATIONS: The study identifies factors that are useful to consider when designing interventions to increase family involvement with nursing home residents.

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PubMed2000

Undetected dementia in community-dwelling older people: the Canadian Study of Health and Aging.

OBJECTIVE: To estimate the frequency and correlates of undetected dementia in community-dwelling older people. DESIGN: Secondary analysis of data from the Canadian Study of Health and Aging (CSHA) prevalence survey of dementia. SETTING: All 10 provinces of Canada excluding Indian reserves and military units. PARTICIPANTS: A total of 252 community-dwelling older adults diagnosed with dementia in the CSHA survey. MAIN OUTCOME MEASURE: Undetected dementia, defined as occurring in persons who meet standard diagnostic criteria for dementia but who report never having seen a doctor for memory problems. RESULTS: Of the 252 subjects, 64% had undetected dementia. Subjects with mild functional impairment were significantly more likely to have undetected dementia (odds ratio = 2.4, 95% confidence interval 1.2, 5.0). Older subjects and those with mild cognitive impairment showed a trend toward undetected dementia, although the results did not achieve statistical significance. Educational level, number of comorbid conditions, and degree of social support were not significantly associated with undetected dementia. CONCLUSIONS: A large number of older persons are living in the community with undetected dementia. These older people may be at significant risk for delirium, motor vehicle accidents, medication errors, and financial difficulties. As preventive strategies are developed and new cognitive enhancing therapies emerge, we need to reexamine our current guidelines about screening for cognitive impairment in older adults.

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PubMed2000

Agreement between older subjects and proxy informants on history of surgery and childbirth.

OBJECTIVES: To assess the agreement between proxy informants' reports of history of surgery and childbirth and older index subjects' own recall. DESIGN: Interrater reliability study. SETTING: An outpatient family medicine clinic and a provincial electoral district in Montreal, Canada. PARTICIPANTS: Eighty-two subjects aged 65 years and older without cognitive impairment, identified from clinic and community settings, and each index subject's proxy respondent. MEASUREMENTS: Identical questionnaires were administered to index subjects and proxies. RESULTS: Proxies failed to report 39% of non-childbirth surgeries reported by index subjects, but failed to report only 10% of childbirths. Female proxies were significantly less likely than male proxies to underreport non-childbirth surgeries after controlling for age of index subject and interval since surgery. Longer interval since surgery was significantly associated with greater underreporting, whereas age of the index subject and relationship between proxy and index subject were not. Agreement between proxies and index subjects on date of surgery was much higher for childbirths than for non-childbirth surgeries. CONCLUSIONS: Our findings suggest that proxy respondents can provide reliable information on older women's history of childbirth but that use of proxy respondents for history of non-childbirth surgeries may result in substantial underreporting.

Age Factors↗
PubMed1999

Initiation of physical restraint in nursing home residents following restraint reduction efforts.

In this pilot study a one group pretest posttest design was employed to identify resident characteristics and environmental factors associated with initiation of physical restraint. Predictors of restraint initiation for older adults were examined using secondary analysis of an existing data set of nursing home residents who were subjected to a federal mandate and significant restraint reduction efforts. Lower cognitive status (OR = 1.5 [for every 7-point decrease in Mini-Mental State Examination], 95% CI = 1.0, 2.1) and a higher ratio of licensed nursing personnel (OR = 3.7, 95% CI = 1.2, 11.9) were predictive of restraint initiation. Key findings suggest that restraint initiation occurs, despite significant restraint reduction efforts, when a nursing home resident is cognitively impaired or when more licensed nursing personnel (predominantly licensed practical nurses) are available for resident care. Achievement of restraint-free care in nursing homes requires specific and individualized approaches for residents who are cognitively impaired, as well as greater attention to staff mix of registered nurses, licensed practical nurses, and nursing aides.

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PubMed1999

Predictors of continued physical restraint use in nursing home residents following restraint reduction efforts.

OBJECTIVES: To examine predictors of continued restraint use in nursing home residents following efforts aimed at restraint reduction. DESIGN: Secondary analysis of data from a clinical trial using a one-group, pre-test post-test design. SETTING: Three nonprofit, religion-affiliated nursing homes in a metropolitan area. PARTICIPANTS: The sample consisted of 201 physically restrained nursing home residents. Following restraint reduction efforts, 135 of the sample were still restrained. Mean age of participants was 83.9 years. MEASUREMENTS: Physical restraint use was measured by observation and included any chest/vest, wrist, mitt, belt, crotch, suit, or harness restraint plus any sheet used as restraint or a geriatric chair with fixed tray table. Nursing home residents were subjected to any one of three conditions aimed at restraint reduction, including adherence to the mandate of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87), staff education, and education with consultation from a gerontological clinical nurse specialist. Resident characteristics including dependency, health status, mental status, depression, behavior, fall risk; presence of treatment devices and institutional factors were determined. RESULTS: Physical dependency, lower cognitive status, behavior, presence of treatment devices, presence of psychiatric disorders, fall risk, and fall risk as staff rationale for restraint were associated (P < .10) with continued restraint use. Nursing hours, staff mix, prevalence of restraint use by unit, and site were also associated (P < .10) with continued use of physical restraints. Following bivariate analysis, associated resident characteristics were subjected to logistic regression. Lower cognitive status (OR = 2.4 (for every 7-point decrease in MMSE), 95% CI, 1.7, 3.3) and fall risk as staff rationale for restraint (OR = 3.5, 95% CI., 1.5, 8.0) were predictive of continued restraint use. Adding nursing hours, staff mix, and prevalence of restraint use by unit to the logistic regression model was not statistically significant (partial chi-square = 2.79, df = 6, P = .834). Nursing home site was added to the model without changing the significance (P < .05) of cognitive status or fall risk as a staff rationale for restraint use. CONCLUSION: Continued restraint use in nursing home residents in this study most often occurred with severe cognitive impairment and/or when fall risk was considered by staff as a rationale for restraint. Efforts to reduce or eliminate physical restraint use with these groups will require greater efforts to educate staff in the assessment and analysis of fall risk, along with targeted interventions, particularly when cognition is also impaired.

Accidental Falls↗
PubMed1998

Factors associated with symptoms of depression among informal caregivers of demented elders in the community.

This study assessed variables associated with increased severity of depressive symptoms among 321 informal caregivers of demented subjects living in the community identified by a Canadian national population-based survey. Measures included patient and caregiver demographic variables; patient behavioral disturbance, activities of daily living, and cognitive impairment; living arrangement, and duration of disease. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Multiple regression analyses indicated that a higher CES-D score was significantly associated with three caregiver characteristics (being a spouse or child of the patient, self-identified ethnicity other than English and French Canadian, and lower education), and two patient characteristics (greater behavioral disturbance and moderate to severe functional impairment).

Adult↗
PubMed1998

Designing prevalence and incidence studies.

Frequency, impact, and causes of diseases--including wound development--can be examined using prevalence and incidence studies. Understanding basic epidemiologic principles is necessary to avoid misinterpretation of the data and incorrect translation of the results into clinical practice. Definitions and examples of prevalence, cumulative incidence, incidence rate, confidence intervals, and sample size are given. They will help practitioners comprehend these concepts and critically evaluate published research.

Bias↗
PubMed1997

Risk factors for bacterial gill disease in young rainbow trout (Oncorhynchus mykiss) in North America.

A retrospective whole-population survey was used to investigate putative risk factors for bacterial gill disease (BGD) in young hatchery-reared rainbow trout in North America. Three sets of analyses were done. The first analysis included as cases all of the hatcheries in which there was at least one outbreak of BGD during the 2-year study interval, regardless of location of the outbreak in the hatchery. The case group for the second analysis was limited to hatcheries for which the BGD outbreak occurred inside the hatch house. The case group for the third analysis was limited to hatcheries for which the BGD outbreak occurred outside of the hatch house. For the logistic regression that combined all cases of BGD (regardless of location of the outbreak), there was a significant association between mortality from bacterial gill disease and previous experience with BGD outbreaks (odds ratio (OR) = 10.1; 95% confidence interval (CI) = 5.6, 18.2), being a commercial trout hatchery (OR = 5.2; 95% CI = 2.6, 10.4), and being a hatchery with an annual salmonid fish production of > 250,000 fish (OR = 2.9; 95% CI = 1.5, 5.7). For BGD outbreaks that occurred in the hatch house, the presence of fish in the hatch house water supply significantly increased the odds of an outbreak (OR = 5.3; 95% CI = 2.2, 12.6), as did the use of ultraviolet radiation to disinfect the hatch house water (OR = 7.5; 95% CI = 2.2, 25.8), previous experience with bacterial gill disease (OR = 19.3; 95% CI = 7.9, 46.8), and being a commercial hatchery (OR = 7.7; 95% CI = 3.2, 18.6). The odds of a BGD outbreak outside of the hatch house was significantly associated with previous experience with BGD (OR = 4.3; 95% CI = 2.2, 8.6) and with being a hatchery with an annual salmonid fish production > 50,000 pounds (OR = 2.5; 95% CI = 1.2, 5.1).

Animals↗
PubMed1997

Use of physician services among family caregivers of elderly persons with dementia.

It is well known that there is an excess of physical and psychological health problems among family caregivers of elderly persons with Alzheimer's disease and other dementias. The objective of this study was to determine whether the higher level of morbidity translates into a higher level of medical care utilization. Data from a previously completed longitudinal study of caregivers for elderly persons with dementia were merged with data on physician visits obtained from the computerized records of the Quebec Health Insurance Board. Utilization of physician care (adjusted for age, sex, number of chronic diseases, and depression) was no higher for family caregivers of elderly patients with Alzheimer's disease and other dementias than for comparable family members of older persons without dementia. The annual cost of physician care was almost identical among caregivers and noncaregivers. However, the pattern of utilization for the two groups was somewhat different: there was a significantly higher frequency of physician utilization among caregivers for services billed by psychiatrists and internal medicine specialists. In multivariate analysis, physician utilization was significantly associated with having more than one chronic condition and with increased age. Future studies should focus on determining whether caregivers neglect their own health care needs as a result of the exigencies of the caregiving role.

Adult↗
PubMed1997

Effects of a restraint reduction intervention and OBRA '87 regulations on psychoactive drug use in nursing homes.

OBJECTIVES: To describe the changes in psychoactive drug use in nursing homes after implementation of physical restraint reduction interventions and mandates of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87). METHODS: A secondary analysis was conducted using data from a controlled clinical trial that took place in three nursing homes: a control home, one that received an educational intervention, and one that received an educational/consultation intervention. All three homes were influenced by the OBRA mandates. Complete pre- and 6 months' post-intervention data on use of psychoactive drugs and physical restraints were available for 446 resident subjects. Changes were first analyzed with the resident subjects as the unit of analysis and then using the nursing home ward (n = 16) as the unit of analysis. RESULTS: While physical restraint use declined in the home that received the educational/consultation intervention, neither neuroleptic nor benzodiazepine use increased in any of the homes after the interventions. The percentage of residents taking neuroleptics declined in the control home (18.6% to 11.3%, P = .014). Benzodiazepine use, which was more prevalent than described previously in the literature, declined in all three homes (P < .001). Of those residents whose physical restraints were discontinued, only 2% were started on neuroleptics. When the effect of OBRA mandates on appropriateness of neuroleptic use was examined, the percentage of residents on neuroleptics who lacked an OBRA-approved indication declined from 21.3% to 14.6% in the total sample, and from 39.9% to 8% in the control home. CONCLUSIONS: Interventions to reduce physical restraint did not lead to an increase in psychoactive drug use; further, reduction in both can occur simultaneously. OBRA mandates regarding psychoactive drug use were not uniformly effective, but appear, at minimum, to have increased awareness of the indications for neuroleptics.

Aged↗
PubMed1995

Perimalleolar tendon transfer to the os calcis for triceps surae insufficiency in patients with postpolio syndrome.

Twelve patients (14 feet) with the diagnosis of postpolio syndrome underwent patients-specific transfer of perimalleolar tendons to the os calcis for triceps surae insufficiency. One to 5 tendons were transferred, for a resulting mean muscle strength of Grade 3 at a mean followup of 2.7 years. At final followup, 7 patients were restudied with ankle plantar flexion torque measurements, range of motion, and gait analysis. Patients reported subjective improvements in endurance (86%), pain (90%), and ambulatory distance (50%). No progression of foot deformity was noted. Three of 5 patients became brace free. After tendon transfer, patients recorded increased ankle plantar flexion torque strength (80%) and an increase in 1 grade of muscle strength (29%). There was no significant change in gait velocity, stride length, or heeloff time between pre- and postoperative gait analysis. No tenodesis effect was observed. In conclusion, perimalleolar tendon transfers for triceps surae insufficiency in postpolio patients was effective in decreasing subjective complaints, arresting progressive foot deformity caused by muscle imbalance, and increasing plantar flexion strength, whereas the results of gait analysis failed to show significant improvement.

Adult↗
PubMed1994

Health of family members caring for elderly persons with dementia. A longitudinal study.

OBJECTIVE: To estimate the change in depression and physical symptoms during a 1-year period in a group of caregivers for elderly persons with dementia and in a group of comparison participants. DESIGN: Cohort study with a comparison group. SETTING: Outpatient geriatric assessment unit and ophthalmology service in an acute care hospital. PARTICIPANTS: 218 close family members of a consecutive sample of patients with dementia and patients having cataract surgery were interviewed to obtain a baseline assessment. Of these, 86 caregivers (family members of patients with dementia) and 95 comparison participants (family members of patients with cataracts) were interviewed again approximately 1 year later. MAIN OUTCOME MEASURES: Center for Epidemiologic Studies depression scale and Aday and Andersen's 24-item physical symptom checklist. RESULTS: For the Center for Epidemiologic Studies depression score, the difference between caregivers and comparison participants with respect to change during the 1-year study period was 2.1 (95% CI, 1.0 to 5.2); for physical symptoms, the difference was 0.4 (CI, -0.3 to 1.1). A higher level of behavioral disturbance in the patients with dementia at time 1 and institutionalization of the patient between time 1 and time 2 were predictive of worsening caregiver depression and physical symptoms during the study period. The magnitude and direction of changes in caregiver health varied considerably. CONCLUSIONS: Overall mean changes in depression and physical symptoms during 1 year were small. The observed variability in the individual response to the caregiving situation suggests that future research should focus on the identification of salient prognostic factors.

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PubMed1992

The psychological and physical health of family members caring for an elderly person with dementia.

Most elderly persons with dementia are cared for at home, usually by the spouse or an adult child. The objective of the present study was to determine whether there is an excess of psychological and physical health problems among family caregivers (CGs) of elderly persons with dementia. Data were obtained by interview from close family members of dementia patients (CGs), and from a comparison group made up of close family members of patients undergoing cataract surgery (non-caregivers, NCGs). CGs had significantly higher levels of depression and physical symptoms than NCGs. The association between caregiving and the health variables was stronger among subjects who were the patient's spouse than among those who were the patient's child. Furthermore, greater behavioral disturbance in the demented patient was associated with higher levels of morbidity in the CG. The results suggest that CGs might benefit from careful monitoring of their health status, and from greater access to specialized support services.

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