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Biomedical subjects

C I Cohen

Publications and source records attributed to C I Cohen.

At least 19 recordsLinked to original sources
PubMed2001

Ethnic differences in self-reported sleep problems in older adults.

STUDY OBJECTIVES: To date, conflicting observations have been made regarding ethnic differences in sleep patterns. Plausibly, differing sampling strategies and disparity in the cohorts investigated might help explain discrepant findings. To our knowledge population-based studies investigating ethnic differences in sleep complaints have not addressed within-group ethnic heterogeneity, although within-group health disparities have been documented. DESIGN: Volunteers (n =1118) in this study were community-residing older European Americans and African Americans residing in Brooklyn, New York, which were recruited by a stratified, cluster sampling technique. Trained interviewers of the same race as the respondents gathered data during face-to-face interviews conducted either in the respondent's home or another location of their choice. Data included demographic and health risk factors, physical health, social support, and emotional experience. Relationships of demographic and health risk factors to sleep disturbances were examined in multiple linear regression analyses. Within-group differences in sleep complaints were also explored. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Of the factors showing significant associations with sleep disturbance, European American ethnicity was the most significant predictor (r2 = 0.20). Worse sleep and greater reliance on sleep medicine were observed among European Americans. Caribbean Americans reported less sleep complaints than did U.S.-born African Americans, and immigrant European Americans reported greater complaints than did US-born European Americans. CONCLUSIONS: As expected several health risk factors were predictive of sleep disturbance among urban community-dwelling older adults, but ethnicity was the most significant predictor. The present data suggest both between-group and within-group ethnic differences in sleep complaints. Understanding of demographic and cultural differences between African Americans and European Americans may be critical in interpreting subjective health-related data.

Affect↗
PubMed2000

Schizophrenia and older adults. An overview: directions for research and policy.

The Group for the Advancement of Psychiatry, Committee on Aging, believes that a crisis has emerged with respect to the understanding of the nature and treatment of schizophrenia in older persons. Moreover, critical gaps exist in clinical services for this population. In this article, we examine the epidemiology of aging and schizophrenia; life-course changes in psychopathology, cognitive function, social functioning, and physical health; and various concerns regarding treatment, services, and financing. Finally, we propose six research and policy recommendations and suggest methods for addressing the research questions that we have posed.

Aged↗
PubMed2000

A controlled clinical trial of sertraline in the treatment of depression in nursing home patients with late-stage Alzheimer's disease.

A sample of 31 female nursing home patients with late-stage Alzheimer's disease participated in a double-blind clinical trial of the antidepressant medication sertraline. Measures of depression included various objective scales and two measures of facial expressions of emotion coded during a semistructured interview using a facial affect coding system. Repeated-measures ANOVAs at baseline and at the 8-week endpoint indicated that on all measures, both the treatment and placebo groups improved over time, with three of six measures showing a significant time effect. The "knit-brow" facial measure approached significance for a Treatment x Time effect. Thus, sertraline had no significant benefits over placebo. However, if, as we hypothesize, the knit-brow response is more sensitive to signs of depression in advanced dementia, our study justifies the further investigation of the use of sertraline in this population.

Aged↗
PubMed2000

Potential cost savings from pill splitting of newer psychotropic medications.

Many of the newer psychotropic medications have a pricing structure in which there are only small cost differences between pills of different strengths, affording an opportunity for cost saving by splitting pills. Twelve newer psychotropic medications were examined. Although savings varied for each drug, aggregate data indicated that splitting pills can produce an annual savings of up to $1.45 billion, which represents about 10 percent of the retail sales of these drugs. Such savings can benefit individuals, state Medicaid programs, community mental health centers, and managed care companies. The authors propose several strategies for encouraging the use of pill splitting.

Cost Control↗
PubMed2000

Overcoming social amnesia: the role for a social perspective in psychiatric research and practice.

Psychiatry's reliance on biological models has resulted increasingly in the social realm's being dismissed or trivialized. The author examines the adverse consequences of this situation for psychiatric research and practice and suggests methods for addressing the problem. He describes how the social perspective has been extruded from discussions about the definition, future, and accomplishments of psychiatry, and he reviews four areas in which the biological model has produced unvalidated assumptions about the etiology, course, and prevention of mental disorders. The author shows how the social realm is intrinsic to concepts of mind and mental illness, and he describes seven ways in which a social perspective can provide a complement or a corrective to the prevailing assumptions of biological models, indicate new points of departure, and suggest methods for psychiatry's expansion.

Attitude to Health↗
PubMed2000

Functional impairment in older schizophrenic persons. Toward a conceptual model.

The authors examined the determinants and consequences of impaired functioning in older schizophrenic persons by adapting a model of impairment developed by Berkman and Gurland. The sample consisted of 117 persons age 55 or older with a DSM-III-R diagnosis of schizophrenia. In logistic-regression analysis, the overall model attained significance in predicting functional impairment, and three predictor variables-abnormal movements, use of antiparkinsonian agents, and negative symptoms-attained independent significance. Functional impairment had a direct effect on two of the seven resultant variables, community activities and self-health, and an indirect effect on two other resultant variables, depression and life satisfaction. Thus, the Berkman-Gurland Model has potential usefulness for exploring functioning impairment among older schizophrenic persons. Moreover, the variables that have the greatest impact on functional impairment are potentially remediable.

Aged↗
PubMed1999

A comparison of consumer and provider preferences for research on homeless veterans.

Despite the dramatic growth of homelessness research, there have been no systematic assessments of consumer and provider preferences regarding the content of this research. Therefore, 87 clients and 28 staff of a homeless veterans program were administered a 15-item questionnaire requesting identification of the 5 "most" and 5 "least" important research topics. Staff and clients differed significantly on 6 items considered most important and 4 items considered least important. Clients wanted more research that focused on material needs, whereas staff preferences were more broadly distributed. The fact that appreciable data exist for many of the research topics that respondents identified as important raises concerns about the accessibility of homelessness research.

Attitude↗
PubMed1999

Aging and homelessness.

Aging homeless persons have been largely neglected in the gerontological and homeless literature. This article presents an overview of homelessness and aging within the context of a testable, provisional model for explaining homelessness in this population. The author proposes 16 individual and 5 structural and programmatic variables that contribute to the etiology and sustenance of homelessness among aging persons.

Aged↗
PubMed1999

An evaluation of the use of the natural helping network model to enhance the well-being of nursing home residents.

This article describes and evaluates the Buddy Program, which uses a natural helping network model to enhance the well-being of persons in nursing homes. Thirty-six nondemented patients ("buddies") and 33 persons with dementia completed the 6-month study that involved an educational program for the buddies and regular meetings between buddy-dementia patient pairs. Over the 6 months, compared to a matched control group, the dementia patients showed no advantage on any of the seven outcome measures and actually had significantly more depressive symptoms and greater nursing home dissatisfaction. The nondementia buddies showed no differences from the controls on any of the outcome measures. The results suggest that natural helping network models may not be easily imported into nursing home settings.

Aged↗
PubMed1999

Racial differences in neuropsychiatric symptoms among dementia outpatients.

This study, based on evaluations of 240 outpatients with Alzheimer's disease or multi-infarct dementia, examines whether race has any independent effects on the prevalence and levels of related neuropsychiatric symptoms. After the authors controlled for 14 potentially confounding variables, race had a significant independent effect on the levels of psychotic and depressive symptoms, the former being greater among blacks and the latter among whites. There were no differences in symptoms between U.S.-born African Americans and African Caribbeans. Although it is likely that racial differences reflect variations in symptoms brought in for evaluation, the absence of intraracial differences suggests the possibility of an underlying biological process.

Black or African American↗
PubMed1998

Attachment style and emotion regulation in dementia patients and their relation to caregiver burden.

One hundred and sixty-eight patients with mid- to late-stage dementia and their caregivers participated in a study of the relation between patient emotional characteristics, dementia symptomatology, and caregiver burden. Measures included premorbid attachment style, premorbid emotion regulation style, and behavioral symptoms of dementia. The attachment patterns (secure, avoidant, ambivalent) of these elderly patients resembled those obtained in samples of younger individuals in terms of emotion regulation characteristics; however, the distribution of attachment styles was significantly different, with a lower proportion of ambivalently attached individuals in the present sample. In terms of the behavioral symptoms of dementia, ambivalent patients had more depression and anxiety than secure and avoidant patients; the latter patients experienced more activity disturbance than ambivalently attached individuals and were higher on paranoid symptomatology than securely attached persons. Caregivers of securely attached individuals experienced less total burden than did caregivers of both insecure groups. In regression analysis, attachment style accounted for the largest proportion of unique variance in the prediction of caregiver burden (8%); only 1 of 7 patient symptoms contributed a significant independent effect, namely depressed affect, which accounted for 4% of the variance.

Adult↗
PubMed1998

Interracial and intraracial differences in neuropsychiatric symptoms, sociodemography, and treatment among nursing home patients with dementia.

Using an adaptation of George's (1989) social antecedent model of psychopathology, this article examines interracial and intraracial differences in neuropsychiatric symptoms, sociodemography, and treatment among nursing home patients with dementia. The final sample consisted of 164 U.S.-born African Americans, 54 African Caribbeans, and 68 Caucasians. Although there were appreciable interracial differences in sociodemographics, there were minimal clinical differences. This finding may reflect both racial differences in pathways to institutionalization and the homogenization of clinical characteristics created by new governmental standards for nursing homes. There were no substantial differences between African Americans and African Caribbeans. Use of medication to treat neuropsychiatric symptoms was low, and may have reflected difficulties in diagnosis and concerns about the abuse of medications.

Black or African American↗