PubMed Health⌕ Search

Biomedical subjects

M Stommel

Publications and source records attributed to M Stommel.

At least 19 recordsLinked to original sources
PubMed2002

Predictors of depressive symptomatology of geriatric patients with colorectal cancer: a longitudinal view.

Colorectal cancer constitutes a major health problem for elderly patients. The disease and its stage, treatment, and attendant symptoms can have significant negative impact on the mental functioning of these patients. As part of a larger longitudinal study, 158 patients 65 years of age or older with an incident diagnosis of colorectal cancer were recruited from 23 sites within a Midwestern state. Random effects regression analysis techniques were used to analyze how age, gender, race, presence of a family caregiver, co-morbid conditions, stage of disease at diagnosis, and the time-dependent variables marital status, employment status, symptoms, physical functioning, social functioning, and treatment predict depressive symptomatology at four assessments over the 1st year following diagnosis. Gender, race, co-morbid conditions, physical functioning, social functioning, and symptoms were significant predictors of depressive symptomatology over the four waves of the study. Female patients, African Americans, and patients with two or more co-morbid conditions exhibited more depressive symptomatology. Both more symptoms and more restricted physical and social functioning corresponded to higher levels of depressive symptomatology. At a clinical level of patient care, these findings mandate early identification of psychosocial difficulties experienced, an individualized symptom management plan and the application of other interventions, such as information giving, reassurance and referral to other resources, with particular attention to African American and female patients.

Activities of Daily Living↗
PubMed2001

Predictors of pain and fatigue in the year following diagnosis among elderly cancer patients.

Using data obtained from an inception cohort of 841 patients aged 65 or older newly diagnosed with breast, colon, lung, or prostate cancer, and observed at 6-8, 12-16, 24-30, and 52 weeks, three questions related to patients' experiences with pain and fatigue were posed. First, how do numbers of patients reporting neither pain nor fatigue, either symptom, or both change during the observation year? Second, did number of comorbid conditions, site and stage of cancer, treatment modalities, symptom management medication, and time affect the presence of these two symptoms? Third, do pain and fatigue predict the numbers of co-occurring other symptoms? Findings indicate that during the year patients improved with respect to their reports of pain and/or fatigue. Stage, more comorbidity, and lung cancer were related to both pain and fatigue. Chemotherapy was related to reports of fatigue, but did not have an extended effect on fatigue.

Aged↗
PubMed2001

Cardiac rehabilitation for community-based patients with myocardial infarction: factors predicting discharge recommendation and participation.

Although there is substantial evidence that cardiac rehabilitation is beneficial for post myocardial infarction (MI) patients, such programs are currently under utilized. This study examined systematic criteria predicting physician referral to and patients' participation in cardiac rehabilitation programs. Patients discharged for MI were interviewed in-hospital and at 6-12 weeks post discharge to determine referral, participation, and completion. Stepwise logistic regression analyzed factors associated with rehabilitation. Factors associated with referral to rehab were catheterization (p < 0.001), bypass surgery (p < 0.01), cardiologist/cardiac surgeon appointment (p < 0.02), and age (p < 0.01). Participation was increased for those with bypass surgery (p < 0.001), and referral to cardiologist or cardiac surgeon (p < 0.001). Type of provider significantly influences referral to and participation in cardiac rehabilitation. This suggests that encouragement plays a strong role in attendance for rehabilitation. The same strong encouragement should be given to the broader range of MI patients who stand to benefit from cardiac rehabilitation.

Adult↗
PubMed2000

Symptomatology and loss of physical functioning among geriatric patients with lung cancer.

In this study of 129 geriatric patients with lung cancer, we investigated how symptom severity varied according to treatment type, stage of disease, and gender; how change in physical functioning (prediagnosis versus post-hospital discharge) was predicted by symptomatology, prior physical functioning, comorbidity, and age; and whether differences exist according to stage of disease, treatment status, or gender. Data were gathered through patient interviews and audits of patient records. Analysis of variance (ANOVA) techniques revealed that there were no significant differences in average symptom severity scores by gender, treatment categories, or stages of disease. Significant predictors of loss of physical functioning were symptom severity, prior physical functioning and patient age. Characteristics of a profile for elderly lung cancer patients at high risk of suffering substantial losses in physical functioning include higher prior levels of physical functioning, higher levels of current symptomatology, and lower age.

Activities of Daily Living↗
PubMed2000

Comparison of changes in physical functioning of elderly patients with new diagnoses of cancer.

BACKGROUND: Controversy surrounds the impact of site of cancer and treatments on functioning of elderly cancer patients. OBJECTIVES: This research determines (1) whether age, gender, comorbid conditions, site and stage of cancer, and treatments are related to losses in physical functioning at 4 observations during the year after diagnosis; (2) whether symptoms are a mediating variable between treatment and function; and (3) which indicators account for true change in functioning in the year after diagnosis. METHODS: An inception cohort of 907 patients aged > or =65 years and newly diagnosed with breast, colon, lung, or prostate cancer were accrued from 24 community oncology programs. Stage and treatment data were obtained from medical records. Physical functioning was measured with the SF-36 subscale. Interviews were conducted at 6 to 8, 12 to 16, 26 to 30, and 52 weeks after diagnosis. RESULTS: Men scored 10 points higher on physical function than women at all observation points. Patients with > or =3 comorbid conditions scored lower in functioning. Interactions between site of cancer and treatment modalities were observed. Pain, fatigue, and numbers of symptoms were independent predictors of loss of function. Surgery, female gender, and number of symptoms predicted reliable change in function. CONCLUSIONS: Elderly patients with cancer report levels of function similar to other chronic conditions. Scores on physical function varied by site of cancer; the pattern of change was similar among sites. Age, comorbidity, treatment modalities, and symptom reports each had an independent effect on loss of functioning. Untreated breast cancer patients had lower functioning, suggesting a possible treatment bias.

Aged↗
PubMed2000

Interstitial cystitis: a retrospective analysis of treatment with pentosan polysulfate and follow-up patient survey.

To evaluate the efficacy and safety of pentosan polysulfate sodium (PPS) in relieving symptoms of interstitial cystitis, the authors retrospectively reviewed charts of 260 patients in whom interstitial cystitis had been diagnosed. Subsequently, they conducted a follow-up phone interview or mail survey of those patients who were treated with PPS to investigate changes in the patients' symptoms, adverse effects, and change in quality of life. The control group consisted of patients whose interstitial cystitis had been diagnosed at cystoscopy and had a duration of at least 1 year and who had taken at least one or more oral medications for their symptoms. The average length of treatment was 9.3 months among the 27 subjects on PPS therapy. The mean length of time that they had diagnosed interstitial cystitis was 35.63 months and 48.78 months for the PPS-treated and control groups, respectively, with no statistically significant difference. Changes in frequency, urgency, and pain were greater in the treatment group and statistically significant (P = .11, P = .49, and P = .004, respectively). No change occurred in the rate of nocturia in the PPS-treated group compared with that in the control group. Symptoms of both groups improved over time, but improvement was statistically significantly greater in the treatment group (P = .001) over the treatment interval. The most common side effect attributable to PPS was diarrhea in 15% of subjects. Pentosan proved to be an efficacious option for reducing the debilitating symptoms of interstitial cystitis.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1999

Predictors of physical functioning among geriatric patients with small cell or non-small cell lung cancer 3 months after diagnosis.

This study investigated how treatment options, symptom severity, prediagnosis levels of physical functioning, comorbidity, gender, and age predicted current physical functioning in geriatric patients with small-cell or non-small-cell lung cancer, 12 weeks after their diagnosis. The study involved 146 patients aged 65 years and over with an incident diagnosis of lung cancer. Analysis of covariance revealed no significant differences in physical functioning according to treatment type, small-cell versus non-small-cell classification or gender. Significant predictors of current physical functioning were symptom severity and prior physical functioning. The characteristics of a high-risk profile for disruption in physical functioning of elderly lung cancer patients 12 weeks after their diagnosis would include preexisting physical impairment and high levels of symptomatology.

Aged↗
PubMed1999

Mismatch of classroom furniture and student body dimensions: empirical findings and health implications.

PURPOSE: To examine possible mismatch between the individual body dimensions of students and the classroom furniture they use. METHODS: A total of 74 (37 male and 37 female) sixth-through eighth-grade students in a Michigan school district participated in the study; their ages ranged from 10 years, 11 months to 14 years, 3 months. Anthropometric measurements (including elbow height, shoulder height, upper arm length, knee height, popliteal height, buttock-popliteal length, and stature) were gathered in several physical education classes, each during a single session. In addition, the furniture dimensions were measured for three styles of chairs and three styles of desks prevalent in the students' classrooms. Based on both the information about student body dimensions and furniture dimensions, measures of fit or mismatch were constructed. RESULTS: The data indicate a substantial degree of mismatch between the students' bodily dimensions and the classroom furniture available to them. Fewer than 20% of students can find acceptable chair/desk combinations. Most students are sitting in chairs with seats that are too high or too deep and at desks that are too high. Even after controlling for body stature, girls are less likely to find fitting chairs. CONCLUSIONS: Based on the evidence presented, many sixth through eighth graders must endure seating arrangements in their classrooms that are not conducive to learning.

Adolescent↗
PubMed1999

The impact of new demands for assistance on caregiver depression: tests using an inception cohort.

Family caregivers of patients facing high numbers of new demands for assistance following hospital discharge were more likely to experience increased levels of depression in the following six months compared with caregivers facing similar overall demands but few new demands for assistance following hospital discharge. New demands for assistance had a significant independent effect upon the levels of depression and were independent of family relationship (spouse vs nonspouse) and caregiver gender. These findings provide insight into theories of caregiver stress, begin to specify the interaction of time following the onset of a stressful event and caregivers' subsequent reactions, and suggest which caregivers may require some assistance following discharge of their patients.

Aged↗
PubMed1999

The influence of symptoms, age, comorbidity and cancer site on physical functioning and mental health of geriatric women patients.

This article focuses on how cancer site, age and comorbid conditions of elderly women cancer patients influence their reporting of symptoms; how these variables in turn impact their physical functioning and mental health; and whether there are differences according to the site of the cancer. For the study, a sample of 299 women, age 65 and above, was selected from an on-going longitudinal study of cancer patients recruited from six cancer treatment centers in Michigan and who were recently diagnosed with breast, colon or lung cancer. Age, comorbidity and cancer site were predictors of symptom severity. Age, comorbidity, symptom severity and cancer site were significant predictors of physical functioning, while mental health scores were only predicted by symptom severity. Lung cancer patients reported greater losses in physical functioning than either breast or colon cancer patients, however there were no significant differences in average mental health scores among the three cancer sites. A systematic and comprehensive approach to self-care management of symptom distress provided by oncologists and other health care professionals may enable patients, especially elderly patients with comorbid conditions, to successfully alleviate or reduce the impact of symptoms on their lives.

Age Factors↗
PubMed1997

Loss of physical functioning among geriatric cancer patients: relationships to cancer site, treatment, comorbidity and age.

This study investigated differences in physical functioning and physical role limitations according to cancer site and treatment modality in a sample of 590 patients 65 years and older diagnosed with breast, colon, lung or prostate cancer. Analysis of covariance procedures were utilised to test for differences in levels of physical functioning and physical role limitations according to cancer site and treatment modality, adjusting for differences in age, comorbid conditions and retrospective physical functioning. Physical functioning and physical role limitations were measured using two subscales of the Medical Outcomes Studies MOS 36-item Short Form Health Survey (SF-36). Physical functioning prior to diagnosis, and to a lesser degree comorbidity, contributed significantly to current levels of physical functioning and physical role limitations. Patients with lung cancer reported lower physical functioning and physical role limitation scores than patients with prostate cancer, and patients treated with surgery only reported lower physical functioning and physical role limitation scores than patients treated with neither surgery nor radiation. No gender differences were observed among the reduced sample consisting of patients with colon or lung cancer. It is important not only that physicians and oncologists are cognizant of the fact that some cancers (particularly lung cancer) may be more physically debilitating than others, but that the patient's history of comorbid conditions and pre-existing physical limitations may be important factors in predicting current physical functioning.

Activities of Daily Living↗
PubMed1997

Changes in living arrangements of functionally dependent older adults and their adult children.

This study investigated health and sociodemographic variables associated with co-residency patterns among older patients and their adult children following discharge from an acute care hospital. Data for the analysis were obtained from 172 adult children caring for functionally impaired parents. Logistic regression was employed to determine the probability that an older parent establishes co-residency with the adult child following hospitalization instead of remaining in a separate household. Results indicate that the overall level of caregiver involvement in activities of daily living (ADL) and instrumental activities of daily living (IADL) were strong predictors of parent and adult children forming a joint household. Increased household income of caregivers was inversely related to co-residency. Decisions about co-residency following hospitalization appear to hinge both on parental need and the resources of the adult child, suggesting that the decision to move together is largely one of need and not preference.

Activities of Daily Living↗
PubMed1994

The impact of age, treatment, and symptoms on the physical and mental health of cancer patients. A longitudinal perspective.

BACKGROUND: To describe continuing care and rehabilitation needs of cancer patients, a longitudinal design (6 months) was performed among patients 50 years of age and older with solid tumors. The study examined how age, type of treatment, site of cancer, and symptom experience affect physical functioning and their mental health; age, site of cancer and the interval of time out of treatment influence changes in their symptom experience; and age, site of cancer, the interval of time out of treatment, and changes in symptom experience influence changes in physical and mental health. METHODS: Patients (n = 111) who completed an intake and a 6-month self-administered questionnaire were included. Treatment included chemotherapy, radiation, or hormonal treatment at intake and for 6 months. Scales of nine symptoms and physical health using activities of daily living and measures of vigorous function were composed. Mental health was measured by the Center for Epidemiological Studies--Depression Scale. RESULTS: The analyses yielded the following findings: (1) Primary site may have had an impact on symptom experience, limitations in functioning, and mental health if more patients with lung cancer had survived to 6 months. (2) Age, gender, treatment, or change in treatment had no impact on symptoms, functioning, or mental health at intake or changes in these variables. (3) Symptom experience at intake and the changes in symptoms predicted physical functioning and mental health at intake and the changes in these variables over time. (4) Gender differences were important in predicting mental health. CONCLUSIONS: Strategies for continuing care and rehabilitation need to focus on symptom management, and strategies need to be different for male and female patients.

Activities of Daily Living↗
PubMed1994

The costs of family contributions to the care of persons with dementia.

This study focuses on the costs of dementia care incurred by families. Cost components operationalized include: costs of unpaid caregiver labor services, paid and unpaid family labor, paid and unpaid services of nonfamily persons, and cash outlays for equipment and services. Among 182 families of dementia patients, average care costs for a 3-month period amount to $4,564. Cash expenditures average only 29% of total care costs, with unpaid labor accounting for 71% of the family care costs. Total care costs rise by $1,158 for each additional dependency in an activity of daily living (ADL), while reliance on paid services is 5% higher for each additional $10,000 household income and drops by 25% if the patient lives in the caregiver's household.

Activities of Daily Living↗
PubMed1994

Predictors of use of secondary carers used by the elderly following hospital discharge.

This research examines how caregiver-patient relationship (female spouses, and adult daughters and daughters-in-law) when cross classified with patient coresidence patterns explains the level of secondary carers' involvement among patients with newly added needs for assistance at home following hospital discharge. Among 196 primary caregivers (104 spouses, 92 daughters and daughters-in-law), patient needs were divided into ADL and mobility limitations, and medical tasks. Secondary carer involvement was categorized into levels differing at two observations: one following discharge and a second 3 months later. Analyses focused on explaining the levels of involvement of secondary carers following hospital discharge and the changes in secondary carers' involvement between the two observations. The baseline and change analyses revealed that caregiver-patient relationship was more important than coresidence patterns or patients' demands in explaining assistance from secondary carers. The implications of these findings on caregivers' reactions and policies regarding home care are explored.

Aged↗
PubMed1993

The cost of cancer home care to families.

BACKGROUND: For the most part, previous research on costs of cancer care has focused on the formal medical care costs. Research on home care for patients with cancer has emphasized direct care costs (expenditures). Among indirect costs, only loss of income to family members has been studied. However, a major component of indirect costs, the family labor expended to care for the patient with cancer, needs to be included for a more realistic appreciation of home care costs. METHODS: The costs of family labor are estimated by imputing monetary values for the time spent caring for the patient with cancer. The assigned monetary cost either is equated with income losses of the helper in question or is based on a putative market value of the expended labor time. In addition, out-of-pocket expenditures examined in this study cover all cancer care-related expenses for which the patient was not reimbursed by third parties. Data were obtained from a convenience sample of 192 patients with cancer and their families in lower Michigan. RESULTS: When family labor is included in the cost calculations, average cancer home care costs for a 3-month period ($4563) are not much lower than the costs of nursing home care. The substantial variation in home care costs (standard deviation [SD] = $4313) appears to be unrelated to the type of cancer diagnosis, type of treatment, or time since diagnosis but seems to be driven by the functional status of the patient and the family living arrangements. CONCLUSIONS: Outpatient care for patients with cancer coupled with greater reliance on home care appear to be economically attractive because costs to families usually are underestimated.

Adult↗