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Biomedical subjects

S A Studenski

Publications and source records attributed to S A Studenski.

17 recordsLinked to original sources
PubMed2006

Higher 1,25-dihydroxyvitamin D3 concentrations associated with lower fall rates in older community-dwelling women.

INTRODUCTION: The purpose of this study was to examine the relationships of vitamin D supplementation and serum concentrations of vitamin D metabolites and parathyroid hormone (PTH) with neuromuscular function and falls in older community-dwelling women. METHODS: We examined these relationships using a 4-year prospective multi-center study among 9,526 community-dwelling women enrolled in the Study of Osteoporotic Fractures (median age: 70 years; interquartile range: 67-75) and a subset of 389 women (97%) out of 400 who were randomly selected from the entire cohort for serum measures. Measurements included: vitamin D supplementation, serum 25-hydroxyvitamin D(3) [25(OH)D(3)], serum 1,25-dihydroxyvitamin D(3) [1,25(OH) (2)D(3)], and serum intact parathyroid hormone (iPTH); grip and quadriceps strength, chair-stand time, walking speed, reaction time, and balance-walk time (including changes in grip strength, chair-stand time, walking speed and balance-walk time over approximately 3.7 years); and incident fall rates (number of falls/woman-years). RESULTS: In 9,526 women, vitamin D supplementation was not associated with any measures of neuromuscular function, change in neuromuscular function, or fall rates (p>0.01 for all). In a subgroup of 389 women, there was a trend of higher 25(OH)D(3) concentration with slightly weaker grip strength (p=0.007), and women in the fourth quartile of 1,25(OH)(2)D(3) had a faster chair-stand time (p=0.017) than women in the first quartile; still, in general, concentrations of 25(OH)D(3), 1,25(OH)(2)D(3), and iPTH were not associated with either neuromuscular function or changes in neuromuscular function (p>0.05 for all). However, higher 1,25(OH)(2)D(3) concentration was associated with lower fall rates (p=0.039). CONCLUSIONS: Higher 1,25(OH)(2)D(3) concentration is associated with a lower fall risk in older community-dwelling women, but vitamin D supplementation, and 25(OH)D(3) and iPTH concentrations are not associated with either neuromuscular function or falls.

Accidental Falls↗
PubMed2006

Patient safety culture assessment in the nursing home.

OBJECTIVE: To assess patient safety culture (PSC) in the nursing home setting, to determine whether nursing home professionals differ in their PSC ratings, and to compare PSC scores of nursing homes with those of hospitals. METHODS: The Hospital Survey on Patient Safety Culture was modified for use in nursing homes (PSC-NH) and distributed to 151 professionals in four non-profit nursing homes. Mean scores on each PSC-NH dimension were compared across professions (doctors, pharmacists, advanced practitioners and nurses) and with published benchmark scores from 21 hospitals. RESULTS: Response rates were 68.9% overall and 52-100% for different professions. Most respondents (76%) were women and had worked in nursing homes for an average of 9.8 years, and at their current facility for 5.4 years. Professions agreed on 11 of 12 dimensions of the survey and differed significantly (p<0.05) only in ratings for one PSC dimension (attitudes about staffing issues), where nurses and pharmacists believed that they had enough employees to handle the workload. Nursing homes scored significantly lower (ie, worse) than hospitals (p<0.05) in five PSC dimensions (non-punitive response to error, teamwork within units, communication openness, feedback and communication about error, and organisational learning). CONCLUSIONS: Professionals in nursing homes generally agree about safety characteristics of their facilities, and the PSC in nursing homes is significantly lower than that in hospitals. PSC assessment may be helpful in fostering comparisons across nursing home settings and professions, and identifying targets for interventions to improve patient safety.

Adult↗
PubMed2001

Predicting stroke recovery: three- and six-month rates of patient-centered functional outcomes based on the orpington prognostic scale.

OBJECTIVE: To provide recovery rates after stroke for specific functions using the Orpington Prognostic Scale (OPS). DESIGN: Prospective cohort. SETTING: Hospital and community. PARTICIPANTS: 413 stroke survivors entered the study 3 to 14 days after suffering a stroke. MEASUREMENTS: A cohort of hospitalized stroke survivors were recruited 3 to 14 days after stroke and assessed at 1, 3, and 6 months poststroke for neurological, functional, and health status. Baseline OPS score was used to predict five functional outcomes at 3 and 6 months using development and validation datasets and receiver operating characteristic (ROC) curves. RESULTS: In 413 stroke survivors, functional recovery rates at 3 and 6 months were similar. Baseline OPS predicted significant differences in recovery rates for all five outcomes (P < .0001 for all five outcomes at 3 and 6 months). Personal care dependence was present at 3 months in only 3% of persons with baseline OPS scores of 3.2 or less compared with over 50% with OPS of 4.8 or higher. Independent personal care, meal preparation, and self-administration of medication were achieved by 80% who had baseline OPS scores of 2.4 or lower compared with less than 20% when OPS scores were 4.4 or higher. Independent community mobility was achieved in 50% of those who had OPS scores of 2.4 or lower but only 3% of those with OPS scores of 4.4 or higher. The area under ROC curves assessing OPS scores against each of the five outcomes ranged from 0.805 to 0.863 at 3 months and 0.74 to 0.806 at 6 months. CONCLUSION: OPS scores can predict widely differing rates of functional recovery in five important functional abilities. These estimates can be useful to survivors, families, providers, and healthcare systems who need to plan for the future.

Activities of Daily Living↗
PubMed1999

Spinal-flexibility-plus-aerobic versus aerobic-only training: effect of a randomized clinical trial on function in at-risk older adults.

BACKGROUND: As exercise is associated with favorable health outcomes, impaired older adults may benefit from specialized exercise interventions to achieve gains in function. The purpose of this study was to determine the added benefit of a spinal flexibility-plus-aerobic exercise intervention versus aerobic-only exercise on function among community-dwelling elders. METHODS: We employed a randomized clinical trial consisting of 3 months of supervised exercise followed by 6 months of home-based exercise with telephone follow-up. A total of 210 impaired males and females over age 64 enrolled in this study. Of these, 134 were randomly assigned to either spinal flexibility-plus-aerobic exercise or aerobic-only exercise, with 116 individuals completing the study. Primary outcomes obtained at baseline, after 3 months of supervised exercise, and after 6 months of home-based exercise included: axial rotation, maximal oxygen uptake (VO2max); functional reach, timed-bed-mobility; and the Physical Function Scale (PhysFunction) of the Medical Outcomes Study SF-36. RESULTS: Differences between the two interventions were minimal. Overall change scores for both groups combined indicated significant improvement for: axial rotation (p=.001), VO2max (p=.0001), and PhysFunction (p=.0016). Secondary improvements were noted for overall health (p=.0025) and reduced symptoms (p=.0008). Differences between groups were significant only for VO2max (p=.0014) at 3 months with the aerobic-only group improving twice as much in aerobic capacity as the spinal flexibility-plus-aerobic group. Repeated measures indicated both groups improved during the supervised portion of the intervention but tended to return toward baseline following the home-based portion of the trial. CONCLUSIONS: Gains in physical functioning and perceived overall health are obtained with moderate aerobic exercise. No differential improvements were noted for the spinal flexibility-plus-aerobic intervention.

Aged↗
PubMed1998

Effects of central nervous system polypharmacy on falls liability in community-dwelling elderly.

BACKGROUND: While central nervous system (CNS) active medications such as psychotropics and narcotic analgesics have been implicated in contributing to falls in older adults, the combined effect of multiple CNS-active medications has not been investigated. The purpose of this study was to examine the influence, in community-dwelling elderly, of (1) taking multiple CNS-active medications on fall liability and (2) individual classes of CNS-active medications (using discrete drug classification) on the risk of falls after controlling for important confounders--age, mobility, cognition and depression. METHODS: 305 community-dwelling male veterans (age: 70-104) were screened at study entry for mobility, cognition and depression. CNS-active medications were categorized as benzodiazepines, other sedative-hypnotics, neuroleptics, tricyclic antidepressants, and opioid analgesics. Subjects were prospectively followed for 6 months to monitor falls; at the end of this time period, subjects were classified as fallers (at least one fall) or nonfallers. The relationship between CNS-active drug use and falls was examined using multivariable analyses. RESULTS: The risk of falls was significantly greater in CNS-active medication users as compared with nonusers. Adjusted odds ratio for one CNS-active drug was 1.54 (95% confidence interval 1.07-2.22) and for two or more agents 2.37 (95% confidence interval 1.14-4.94). CONCLUSIONS: In community-dwelling elderly, the use of multiple CNS-active medications is associated with enhanced falls liability, over and above the use of one CNS-active drug alone. This apparent dose-response relationship provides support for causality.

Accidental Falls↗
PubMed1996

The relationship of postural sway to sensorimotor function, functional performance, and disability in the elderly.

OBJECTIVE: To examine the relationship of postural sway to sensorimotor impairment, functional performance, and self-reported disability. DESIGN: Cross-sectional cohort. SETTING: Department of Veterans' Affairs Medical Center. PATIENTS: One hundred community-dwelling elderly unable to climb stairs step over step. MAIN OUTCOME MEASURES: Postural sway (area of ellipse and path length, eyes open and closed), sensorimotor (strength, sensation, range of motion, central processing time), functional performance (functional reach, timed gait, mobility skills, endurance), and disability (MOS-SF36, Falls Efficacy Scale [FES]). RESULTS: Postural sway area measures correlated with sensorimotor measures: (1) During eyes-closed conditions, increased sway occurs in individuals with sensory deficits (p < .05); (2) Sway was positively correlated with tibialis anterior latency (p < .05); (3) Sway area measures increased with increased strength (p < .05). The sway/strength relationship may be explained by week subjects improving their stability by limiting rather than increasing sway. Sway was not significantly correlated with any measures of physical performance. Sway was correlated with some measures of disability: (1) Eyes-closed measures of postural sway were correlated with FES scores (p < .05); (2) Sway was not correlated with the MOS-36 physical functioning question. When controlling for functional measures, eyes-closed measures of sway significantly predicted FES scores (p < .03). CONCLUSIONS: Measures of postural sway are more likely capturing sensorimotor deficits rather than differentiating functional performance abilities, and the relationship between postural sway and self-reported disability is inconsistent.

Activities of Daily Living↗
PubMed1996

Relationships between mobility of axial structures and physical performance.

BACKGROUND AND PURPOSE: Many day-to-day activities require bending and twisting motions of the spine (axial mobility). Because little is known about the relationship between axial mobility and physical performance, this investigation explored these relationships. SUBJECTS: Thirty-one men and 26 women, aged 20 to 91 years (chi=58.4, SD=24.4), participated. METHODS: Subjects were assigned to one of three age groups: 20 to 40 years, 60 to 74 years, or 75 years and older. Five sets of variables were identified and measured: cervical, lumbar, sagittal configuration (ie, kyphosis, lordosis), combined spinal motion, and physical performance. RESULTS: A multivariate analysis of variance revealed age effects for all sets of variables; a post hoc analysis of variance revealed age effects for all variables within the sets. Canonical correlations, controlling for age, demonstrated associations between the cervical and combined spinal motion sets of variables and between the combined spinal motion and physical performance sets of variables. CONCLUSION AND DISCUSSION: This investigation demonstrated an age effect for selected measures of axial mobility, sagittal configuration, and physical performance thought to depend on axial motion. Controlling for age, the results also demonstrated associations between measures of axial mobility and physical performance.

Adult↗
PubMed1995

Postural responses to platform perturbation: kinematics and electromyography.

Dynamic postural control may be studied using feedback paradigms which disturb standing balance. In this study the kinematics and electromyography of the reaction to an unexpected slip were examined simultaneously in 16 young, healthy volunteers to characterize the response to postural perturbation in the context of the perturbation characteristics. Kinematically, results showed ankle plantarflexion, knee flexion, hip extension, and shoulder flexion. Electromyographically, sequences of activation of the postural muscles of the leg were primarily anterior distal. Data is presented that supports a new model of the reaction to perturbation which incorporates the timing and type of muscular activity, the type of motion (active or passive), and the perturbation characteristics. RELEVANCE--:Understanding the interplay of the neurophysiological and biomechanical aspects of dynamic postural control gives insight into balance reactions. Simultaneous consideration of the kinematics, muscle activation, and perturbation characteristics allows a more comprehensive view of recovery of balance.

Journal Article↗
PubMed1995

A clinical tool for measuring functional axial rotation.

BACKGROUND AND PURPOSE: Motion of the neck and back accompany many daily functional activities. Available range of motion is usually measured regionally and within single planes of motion. This report describes a device and measurement technique that can be used to quantify axial motion in a functionally relevant context. Functional axial rotation (FAR) refers to the available motion that persons use to turn toward the posterior, without regard to the plane of motion; FAR-p refers to the physical motion available, and FAR-v refers to the ability to identify objects. SUBJECTS: Nine men and eight women, aged 20 to 74 years, participated. METHODS: Functional axial rotation was determined for each subject. The seated subjects were measured on 2 different days to determine test-retest reliability. Fifteen subjects were measured by two different examiners on the same day to determine interrater reliability. Intraclass correlation coefficients (ICCs) were computed to determine reliability. RESULTS: The FAR-p ranged from 78 to 190 degrees; FAR-v ranged from 135 to 250 degrees. Test-retest reliability of FAR-p and FAR-v was excellent (ICC[1, 1] values of .95 and .90, respectively, to the right and equivalent to the left). Interrater reliability likewise was excellent, with ICC(2, 1) values of .97 to the right and equivalent to the left. CONCLUSIONS AND DISCUSSION: Functional axial rotation provides one means of quantifying a patient's axial motion as it would be used in functional context. The FAR device is easy to construct and portable. Measurement of FAR provides the clinician with reliable information regarding the patient's functional use of available spinal motion, combined with visual ability.

Adult↗
PubMed1993

Does functional reach improve with rehabilitation?

Functional reach (FR, maximal safe standing forward reach) is a precise, reliable, clinically accessible, age-sensitive measure of balance that approximates center of pressure excursion and validly estimates physical frailty. We now test its ability to detect improvement in balance over time. Twenty-eight inpatient male veterans (age 40 to 105, mean, 67.3) undergoing physical rehabilitation and 13 nonrehabilitation controls were evaluated at baseline and every 4 weeks using FR (yardstick method), 10-foot walking time (WT), the Duke hierarchical mobility skills protocol (HMS) and a portion of the Functional Independence Measure (FIM). Their sensitivity to change was determined using the responsiveness index (RI). FR as well as the other physical performance instruments tested were found to be sensitive to change (RI for FR = 0.97, WT = 11.26, HMS = 4.63, FIM = 4.93) and therefore, appropriate measures for use in prospective clinical trials.

Activities of Daily Living↗
PubMed1992

Functional reach: a marker of physical frailty.

OBJECTIVE: To establish the concurrent validity of our new balance instrument, functional reach (FR = maximal safe standing forward reach), as a marker of physical frailty compared with other clinical measures of physical performance. DESIGN, SETTING AND PARTICIPANTS: 45 community-dwelling persons age 66-104 were evaluated at one point in time using (1) FR (yardstick method), (2) Physical and Instrumental Activities of Daily Living (PADL, IADL), (3) Life Space, a 3-point measure of social mobility, (4) 10-item hierarchical mobility skills protocol, (5) 10-foot walking speed, (6) one-footed standing, and (7) tandem walking. Data analysis employed Spearman correlations. Partial r's were also calculated after controlling for age. RESULTS: The FR performance range was broad (4.3-16.5 inches, mean 10.9, SD 3.1). Except for PADL, the association of FR with the other physical performance measures was strong, with r's ranging from 0.64-0.71; the association of FR with PADL was 0.48. After controlling for age in the regression analysis, partial r's ranged from 0.52-0.63. The association of FR with age was -0.50. CONCLUSIONS: Based on cross-sectional data, FR is a practical instrument that correlates with physical frailty even more than with age.

Activities of Daily Living↗
PubMed1990

Balance performance on the postural stress test: comparison of young adults, healthy elderly, and fallers.

The purpose of this study was to compare the postural responses of three groups of individuals--healthy young adults (n = 42; age, 20-40 years); healthy, community-dwelling, elderly individuals (n = 66; age, 60-102 years), and elderly individuals with a history of frequent falls (n = 10; age, 66-95 years)--using the postural stress test (PST). The PST is a simple, clinically applicable, quantitative measure of an individual's ability to withstand a series of graded destabilizing forces applied at the level of the subject's waist. Elderly fallers tend to score lower on the PST than elderly nonfallers, but age-related differences in postural responses during the PST have not been established. Each subject underwent the PST using a method and scoring procedure described previously. Results of this study confirm previous findings that elderly fallers score significantly lower on the PST than either young adult or nonfalling elderly individuals. This study also showed that there was no difference in balance strategy scores between the young adults and the healthy elderly subjects. Therefore, it appears that poor performance on the PST cannot be attributed to age alone, but may be predictive of pathological processes that predispose an individual to frequent falls.

Accidental Falls↗
PubMed1990

Cardiopulmonary resuscitation policies and practices. A statewide nursing home study.

We determined the prevalence of written cardiopulmonary resuscitation policies in North Carolina nursing homes and evaluated their content according to predetermined criteria. Questionnaires were mailed to 236 state-registered facilities. Two hundred nine nursing homes (88.5%) responded to the questionnaire; 83% reported having a written policy, and half (86 nursing homes) provided copies. Nine of ten nursing homes reported that cardiopulmonary resuscitation was performed at their institution, and a similar number (92%) permitted physician orders restricting cardiopulmonary resuscitation. Written policies were systematically compared with 10 model criteria. Policy content varied substantially. More than half of the policies contained provisions for authorization, informed consent, documentation, competency, review, and applicability of do not resuscitate orders. Less than half contained criteria for autonomy, treatment alternatives, dignity and quality of care, and patient identification. Nursing homes that had written policies were newer, larger, and for-profit; had a greater proportion of skilled nursing care beds; and were more likely to have both Medicare and Medicaid certification. The variations in these policies place nursing home residents at risk for having important personal rights limited or ignored. Inclusion of these 10 policy criteria in a comprehensive cardiopulmonary resuscitation policy would represent an important step toward enhancing the quality of decision making by nursing home residents.

Aged↗
PubMed1986

Polymyalgia rheumatica and temporal arteritis.

Polymyalgia rheumatica and temporal arteritis are a clinical syndrome and clinicopathologic entity, respectively. Polymyalgia rheumatica occurs more commonly than temporal arteritis, with approximately half of all patients with temporal arteritis having the polymyalgia rheumatica syndrome. Both conditions are found in the population over 50 years of age and are associated with an elevated ESR. The etiology of both is unclear, although genetic, and potentially, environmental factors may play significant roles. Both conditions respond to corticosteroid therapy, but patients with temporal arteritis require significantly higher doses to control symptoms and to prevent blindness.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Factors associated with suboptimal analgesic use in community-dwelling elderly.

OBJECTIVE: To examine patterns and factors associated with overall and suboptimal analgesic use among community-dwelling elderly. DESIGN: Cross-sectional survey. SETTING: Five-county urban and rural region in Piedmont, NC. PARTICIPANTS: A stratified random sample from the Duke Established Populations for Epidemiologic Studies of the Elderly of 3973 participants aged 65 years or older. MAIN OUTCOME MEASURES: Use of any analgesic medication, suboptimal analgesic use (taking 2 or more analgesics from the same class, using 3 or more analgesics concurrently, or use of an analgesic that has a major interaction with another drug). RESULTS: Analgesics were used by 60.4% of the participants. Use was more likely for those who had physical functional impairment, a history of cardiovascular disease, one or more health visits in the previous year, or were female. Use was less likely for older participants and for African-Americans with adequate financial status. Suboptimal use occurred in 9.2% of analgesic users. Therapeutic duplication was more likely in those who were depressed, needed help with basic activities of daily living, or used alcohol, and was less likely in those with adequate financial status. Multiple analgesic use was more likely in those who were depressed, had impaired physical functional status, had one or more health visits in the previous year, were African-American (of either sex), or were white women. Only two persons had a potential major analgesic-drug interaction. CONCLUSIONS: Suboptimal analgesic use is common in community-dwelling elderly, and its risk in consistently increased in those who are depressed or have impaired physical functional status.

Aged↗