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Biomedical subjects

M J Graney

Publications and source records attributed to M J Graney.

At least 37 records · Page 2Linked to original sources
PubMed1997

Prevalence of undiagnosed non-insulin-dependent diabetes mellitus and impaired glucose tolerance in a cohort of older persons with hypertension.

OBJECTIVE: To determine the prevalence of undiagnosed non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) in a cohort of older persons with hypertension. To examine the usefulness of screening for NIDDM in this study population. DESIGN: Cross-sectional study. SETTING: University of Tennessee, Memphis and the General Clinical Research Center (GCRC). PATIENTS: Ninety-five participants in the Trial of Nonpharmacologic Interventions in the Elderly (TONE) study who agreed to participate in an ancillary study. MEASUREMENTS: A standard oral glucose tolerance test (OGTT) with insulin and C-peptide levels was performed before the beginning of the TONE intervention. RESULTS: In this cohort, 43 participants (45.3%) had normal glucose tolerance (NGT), 41 (43.2%) had IGT, and 11 (11.6%) had undiagnosed NIDDM. The positive predictive value for NIDDM of a fasting glucose > or = 115 mg/dL in our participants was 57%. Hyperinsulinemia occurred in only one participant, a subject in the IGT group. CONCLUSIONS: Our data demonstrate that undiagnosed NIDDM is common in our cohort of older persons who are being treated for essential hypertension and that impaired glucose tolerance may be more common than in the general population of the same age. Further, our data show that the vast majority of this older, obese, hypertensive cohort did not have fasting hyperinsulinemia. We also infer that a fasting glucose alone has a low positive predictive value for screening of NIDDM in our older cohort. As the prevalence of NIDDM and impaired glucose tolerance in older hypertensive patients in the general population is unknown, we believe that further investigation is needed to characterize the relationship of hypertension, glycemic status, and hyperinsulinemia in the general population.

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PubMed1997

Health status gender differences of newly admitted black nursing home residents.

OBJECTIVES: To investigate gender differences in health status of newly admitted black nursing home residents on the day following admission. DESIGN: Descriptive and comparative cross-sectional study of black residents drawn from a larger prospective longitudinal study on health and functional status of new nursing home residents interviewed on the first full day after admission. SETTING: Eight southern nursing homes: three not-for-profit, three for-profit, one county government-operated, and one federal government-operated. Homes ranged in size from 110 to 575 beds and were licensed for skilled and intermediate care. PARTICIPANTS: Black nursing home residents (N = 224) aged 60 years and older as admitted sequentially to nursing homes. MEASUREMENTS: Health status was assessed by the Short Portable Mental Status Questionnaire, as a measure of mental status, and the Scaled Outcome Criteria, as a measure of ability to perform activities of daily living (ADLs). Morbidity was assessed by the number of medical diagnoses, number of prescribed medications, and the medical diagnoses of hip fracture, dementia, and cancer. Resident classification data assessed the source of entry to the nursing home, payer source, and level of care required. Demographic data assessed included age, education, marital status, and number of living children. RESULTS: Both black men (n = 126) and women (n = 98) newly admitted to the nursing home had health and social deficits. Moreover, women, although not significantly different from men in average age, were more impaired in six of eight ADLs, including grooming, dressing, feeding, ambulating, transferring, and defecating. Women were also less likely to be married. No gender differences were found for five other health status variables, four other demographic variables, five resident classification variables, or five measures of morbidity. CONCLUSION: These data on southern black nursing home residents provide evidence that among older black nursing home residents, women have greater care needs than men. Findings illustrate the need to consider gender in planning nursing home care of black older residents, black women may be at greater risk for health status alterations and require more frequent health status monitoring and intervention.

Activities of Daily Living↗
PubMed1995

Impact of continued geriatric outpatient management on health outcomes of older veterans.

BACKGROUND: Although previous trials have proved inpatient-based geriatric assessment to be beneficial, to our knowledge, the effectiveness of outpatient geriatric assessment has not been established. We examined the effectiveness of an outpatient geriatric evaluation and management (GEM) clinic. METHODS: Hospitalized veterans aged 65 years or older with impairment of activities of daily living, chronic disease, polypharmacy, or two or more hospitalizations in the previous year were randomized to an outpatient GEM team clinic (n = 60) or usual care (n = 68). After an initial comprehensive assessment, they received long-term management in the geriatric clinic. Principal outcomes included health status (mortality, hospitalizations, health perception, and medications), function (activities of daily living, instrumental ADL, and social activity), affect (Center for Epidemiologic Studies-Depression test score and life satisfaction), and cognition (Mini-Mental State examination score). RESULTS: At randomization, no significant differences were noted between the groups. The average age of the patients was 71 years (range, 65 to 93 years). At 1 year following randomization, GEM clinic patients compared with subjects receiving usual care had significantly improved health perception, took fewer medications despite increased number of diagnoses, reported greater social activity, had improved Center for Epidemiologic Studies-Depression scale scores, and had higher life satisfaction scores. There was a trend toward improved performance of activities of daily living for GEM clinic patients. The GEM clinic patients had a 54% lower mortality (6.8% vs 14.9%). Overall, no differences were observed in the total number of hospitalizations between the groups. CONCLUSIONS: The combination of long-term management following comprehensive outpatient assessment significantly improved aspects of health status (including health perception and medications), function (including social activity), and affect (including depression and life satisfaction) for older veterans and may influence mortality and function.

Activities of Daily Living↗
PubMed1995

Black and white female nursing home residents: does health status differ?

BACKGROUND: There will be greater numbers of Black female nursing home residents in the future, but past emphasis has been on the study of Black older adults in the community. The purpose of this study was to assess the health status stability of newly admitted female nursing home residents and to analyze Black-White differences in health status and health status stability. METHODS: Health status (mental status, activities of daily living [ADLs], self-reported mood, self-reported health) of Black (n = 98) and White (n = 260) female nursing home residents was evaluated during their first two weeks of residence. Time, race, and their interaction effects on health status were analyzed using repeated measures multivariate analysis of variance. RESULTS: All health status data showed stability or improvement, but there were significant race differences in both health status and health status stability. Black female residents had worse mental status and worse ADLs, and reported less alert mood, less tired mood, and better health. Race differences in stability were evident for hygiene, dressing, ambulation, and transferring ADLs: Black female residents were less likely to show improvements over time. CONCLUSION: Black female residents are an at-risk population for special care needs in nursing homes.

Activities of Daily Living↗
PubMed1995

Admission health status differences of black and white indigent nursing home residents.

OBJECTIVE: To compare the health status of newly admitted lower socioeconomic status (SES) southern black (n = 81) and white (n = 53) nursing home residents. DESIGN: The study data were part of a larger prospective study on the health of newly admitted nursing home residents. SETTING: A 575-bed, government-funded nursing home providing care for indigent residents in a large southern city. PARTICIPANTS: Newly admitted black and white nursing home residents aged 60 and older. MEASUREMENTS: Mental status was measured using the Short Portable Mental Status Questionnaire, activities of daily living by Scaled Outcome Criteria, and medical status by medical diagnoses and medications. MAIN RESULTS: Blacks entering the nursing home were more cognitively and functionally impaired and had 3.7 years less education than white residents, but average age was not significantly different for black and white residents. CONCLUSIONS: Many common health status measures showed no significant black-white differences for institutionalized older adults when region and SES were constants. However, mental status, self-care activities, and marital status were significantly different. These findings indicate a possible impact of lifelong poverty or low educational attainment on the increased disability of indigent black older adults. Black residents in our study had less spousal support to remain in the community.

Activities of Daily Living↗
PubMed1995

Blunt traumatic aortic rupture: detection with helical CT of the chest.

PURPOSE: To determine the effectiveness of helical computed tomography (CT) as a screening device to detect traumatic aortic rupture. MATERIALS AND METHODS: Helical CT was used to examine 1,518 patients with nontrivial blunt trauma. Of these patients, 127 (8.37%) with abnormal CT scans of the mediastinum or aorta underwent thoracic aortography--89 patients solely for evaluation of mediastinal hematoma depicted at CT. Imaging abnormalities were correlated with surgical or clinical outcome. RESULTS: Twenty-one aortic injuries were identified that ranged from subtle intimal flaps to complete aortic disruption. Helical CT was more sensitive than aortography (100% versus 94.4%, respectively) but less specific (81.7% versus 96.3%, respectively) in detection of aortic injuries in patients who underwent both examinations. The association between CT findings and outcome was phi = 0.62 (chi2 = 49.1, 1 df, P < .01) and between aortography and outcome was phi = 0.85 (chi2 = 92.2, 1 df, P < .001). The P value of the difference between the phi coefficients was .10. CONCLUSION: Helical CT of the chest is effective for screening critically injured patients with possible blunt thoracic aortic injuries.

Adolescent↗
PubMed1994

Influence of diagnostic classification on outcomes and charges in geriatric assessment and rehabilitation.

OBJECTIVE: To determine if diagnostic classification is associated with different outcomes from treatment on a geriatric assessment unit (GAU) compared with usual care for elderly patients with acute illnesses. STUDY DESIGN: Reanalysis after post-hoc diagnostic classification of a randomized clinical trial with one year follow up. SETTING: Community hospital with rehabilitation facility. SUBJECTS: A total of 155 subjects, mean age 78 years and 78% female, of whom 58 subjects had a rehabilitation classification of their diagnoses and 97 had a medical or surgical classification. OUTCOME MEASURES: Mortality, nursing home use, activities of daily living, and charges for subsequent medical services. RESULTS: Mortality was decreased in persons with a rehabilitation classification who had received the GAU intervention. The GAU increased point-prevalence residence in the community for persons with a rehabilitation classification. For persons with a medical-surgical classification, the GAU intervention was associated with decreased cumulative use of nursing homes. However, GAU intervention was also associated with trends for increased charges in both diagnostic classification groups, even when adjusted for differential survival. CONCLUSION: Greater benefit from the GAU intervention on mortality and maintenance of residence in the community was observed in a group with a rehabilitation classification when compared with a group with a medical-surgical classification. These improved outcomes in the rehabilitation group were not accompanied by decreased charges for later medical services that could compensate for initial rehabilitation charges.

Activities of Daily Living↗
PubMed1993

Stability and improvement of health after nursing home admission.

This prospective study investigated stability of residents' mental status, function (activities of daily living), and mood during the first and second week following nursing home admission. New residents (N = 647) in eight urban nursing homes were assessed three times. Mental status was measured using the Short Portable Mental Status Questionnaire, function was measured using Scaled Outcome Criteria, and mood was measured using the Mood Adjective Checklist. A repeated measures multivariate analysis of variance, controlling for admission from hospital and readmission to the nursing home, documented stable mental status during the first and second week of nursing home residence. Hygiene, grooming, dressing, and transferring improved, whereas feeding, ambulation, urination, and defecation were stable. Tired and depressed mood adjectives improved, and angry, cheerful, afraid, lonely, and alert mood adjectives were stable. Residents admitted from a hospital had lower mental status and function scores, and readmitted residents had lower urination scores.

Activities of Daily Living↗
PubMed1993

Predicting outcomes of nursing home residents: death and discharge home.

The purpose of this study was to document prevalence, identify leading indicators, and develop and assess prediction models for nursing home resident outcomes (death, discharge home). New residents (N = 647) in eight nursing homes were evaluated on admission and 3 and 6 months later. Predictor variables tested included 14 health status variables, 5 demographic variables, and 6 other resident and nursing home variables. A cancer diagnosis was the most important risk factor for death at 3 months (OR = 8.0) and 6 months (OR = 10.8). A first nursing home admission was the most important risk factor for discharge to home at 3 months (OR = 9.5) and 6 months (OR = 13.9). Not having a dementia diagnosis was the second most important risk factor for discharge to home at 3 months (OR = 5.8) and 6 months (OR = 4.2). All prediction models demonstrated useful potential for clinical application.

Aged↗
PubMed1993

Mortality in a public and a private hospital compared: the severity of antecedent disorders in Medicare patients.

OBJECTIVES: The objectives of this study were to determine (1) if there were significant differences between patients who died at a public hospital and those who died at a university hospital that functions as a private, community hospital, and (2) if those differences were associated with an increased risk of death. METHODS: Chart review collected variables used by the Health Care Financing Administration in mortality analyses to examine how severity of illness data contribute to accurate predictions of death in a public hospital compared with a university hospital. RESULTS: Compared with patients who died at the university hospital, public hospital patients who died had more comorbid disease, were more severely ill, more likely to be emergently admitted, and more likely to be admitted from an extended-care facility. Inclusion of severity of illness with variables previously used to predict mortality significantly improved the accuracy of mortality prediction models for the public hospital but not for the university hospital. CONCLUSIONS: The results suggest that urban public hospitals provide care to more severely ill patients. Administrative data sets may not be adequate to identify these differences between patient populations.

Adult↗
PubMed1992

Discrepancies in recording systolic blood pressure of elderly persons by ambulatory blood pressure monitor.

Agreements between auscultatory blood pressure measurements and recordings of the Suntech Accutracker II ambulatory blood pressure monitor (ABPM) were examined in 103 participants ages 23 through 91 to estimate influence of age on accuracy of automated recordings. Simultaneous auscultation by two technicians and recording by the ABPM were compared. Technicians demonstrated close agreement in auscultation of blood pressure. Mean systolic blood pressure measured by ABPM was 5.6 mm Hg lower and mean ABPM diastolic blood pressure was 6.3 mm Hg lower than average auscultatory blood pressure measured by technicians (P less than .0001). Discrepancies in systolic blood pressure measurements between technicians and ABPM were associated with age and systolic blood pressure. The age effect, controlled for gender and race, was a 0.15 mm Hg increase in systolic blood pressure discrepancy per year of age. Discrepancies in diastolic blood pressure measurements were associated with race but not with age or body size measurements. Automated recordings of blood pressure by this ABPM may have systematic bias compared to auscultation which exceeds current standards for ABPM instrumentation. For systolic blood pressure, this bias increases with age and may affect interpretation of ABPM recordings in elderly persons.

Adult↗
PubMed1992

Prevalence and predictors of regularly scheduled prescription medications of newly admitted nursing home residents.

OBJECTIVE: The purpose of this study was to identify the prevalence and predictors of commonly prescribed regularly scheduled medications. DESIGN: Data were collected on the first day following nursing home admission in this non-experimental study. SETTING: A stratified, proportional probability sample of eight nursing homes in a large Mid-South city participated in this study. PARTICIPANTS: A consecutive sample of 574 new and readmitted nursing home residents who did not refuse participation. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): Data were collected on regularly scheduled prescription medications and resident and nursing home characteristics. RESULTS: Residents without a diagnosis of dementia were more likely to receive cardiovascular medications (Odds Ratio = 2.34; 95% CI = 1.56-3.49), and white residents were more likely to receive cardiovascular medications (Odds Ratio = 1.74; 95% CI = 1.19-2.53) or central nervous system medications (Odds Ratio = 1.72; 95% CI = 1.18-2.51). Older residents were less likely to receive central nervous system medications (Odds Ratio = 0.97 per year; 95% CI = 0.96-0.99), and females were more likely to receive cardiovascular medications (Odds Ratio = 1.89; 95% CI = 1.30-2.75). CONCLUSIONS: Resident characteristics were the most important predictors for cardiovascular and central nervous system medication prescriptions of new and readmitted nursing home residents.

Adult↗
PubMed1992

Nonpharmacologic intervention to reduce blood pressure in older patients with mild hypertension.

BACKGROUND: Although nonpharmacologic interventions are widely recommended in the therapy of high blood pressure in older adults, surprisingly little data exist to confirm the efficacy of these interventions in older persons. METHODS: We conducted a randomized, controlled clinical trial in persons aged 60 to 85 years with a diastolic blood pressure of 85 to 100 mm Hg. The experimental arm was a nonpharmacologic intervention combining weight reduction, sodium restriction, and increased physical activity. The nonpharmacologic intervention consisted of eight weekly group and two individual sessions during the intensive phase, followed by four monthly group sessions during the maintenance phase. The control group received no treatment during the study. Blood pressure was assessed by certified technicians (blinded to group assignment) using random zero sphygmomanometers. RESULTS: Of 56 participants randomized, 47 completed the entire 6-month trial (21 in the intervention group and 26 in the control group). Attendance at the intervention sessions was excellent. The intervention group lost more weight (-2.1 kg) over 6 months than the control group (+0.3 kg). Trends for decreasing 24-hour urine sodium excretion in both the intervention and control groups, with greater trend in the intervention group, were not statistically significant. The intervention group experienced more reduction in systolic and diastolic blood pressure than did the control group (mean differences between groups at 6 months, 4.2/4.9 mm Hg, respectively). CONCLUSIONS: Our data indicate that a nonpharmacologic intervention will lower systolic and diastolic blood pressure levels in older people with borderline or mild elevations of diastolic blood pressure.

Aged↗
PubMed1991

Impact of a geriatric assessment unit on subsequent health care charges.

BACKGROUND: In a recent randomized controlled trial assessing the efficacy of an inpatient geriatric assessment unit (GAU), we demonstrated that patients assigned to the unit were less likely than those in the usual care group to be admitted to a nursing home and more likely to remain living in the community. Despite evidence of benefits of GAU care, questions remain about its cost. We examine the impact of GAU treatment on subsequent health care charges. METHODS: Sequential referrals of elderly disabled patients considered at risk for institutionalization or likely to improve with rehabilitation were randomized to the GAU or to usual care. Charge data were collected on utilization of a wide variety of health care services starting at the point of randomization. RESULTS: The group randomized to the GAU experienced significantly higher rehabilitation charges per participant ($10,583 vs $2066, P = .0001), but lower mean nursing home charges ($1798 vs $3426, P = .004). Total health care charges per participant over the 1 year follow-up were greater for the GAU group ($28,406 vs $16,444, P = .004). When charges were adjusted per year of life survived, the GAU group still showed a substantial (but nonsignificant, P = .10) increase in total charges. However, when charges were adjusted per day subsequently spent residing in the community, adjusted total charges were similar between the two groups. CONCLUSIONS: Our results indicated that improved outcomes from GAU care require an investment in rehabilitation that is not totally offset by decreased institutional charges in the following year.

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