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L F Berkman

Publications and source records attributed to L F Berkman.

At least 73 records · Page 4Linked to original sources
PubMed1994

Predictors of mortality and institutionalization after hip fracture: the New Haven EPESE cohort. Established Populations for Epidemiologic Studies of the Elderly.

OBJECTIVES: Hip fractures can have devastating effects on the lives of older individuals. We determined the frequency of occurrence of hip fracture and the baseline factors predicting death and institutionalization at 6 months after hip fracture. METHODS: A representative cohort of 2812 individuals aged 65 years and older was followed prospectively for 6 years. Hip fractures were identified, and the occurrence of death and institutionalization within 6 months of the fracture was determined. Prefracture information on physical and mental function, social support, and demographic features and in-hospital data on comorbid diagnoses, fracture site, and complications were analyzed to determine predictors of death and institutionalization after hip fracture. RESULTS: Of 120 individuals suffering a hip fracture, 22 (18%) died within 6 months and 35 (29%) were institutionalized at 6 months. The predictors of death in multiple logistic regression included fracture site, a high number of comorbid conditions, a high number of complications, and poor baseline mental status. The primary predictor of institutionalization was poor baseline mental status. CONCLUSIONS: The frequency of death, institutionalization, and loss of function after hip fracture should prompt a reevaluation of the current approach to this problem.

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PubMed1994

Family networks: predictors of nursing home entry.

Despite the importance of kin in caring for older relatives, few studies have examined the relationship between the family network and the risk of nursing home placement. Data from a cohort of noninstitutionalized elderly persons living in New Haven in 1982 were used to predict nursing home admission through 1985. Logistic regression analyses show that older persons who have regular contact with kin have a lower risk of institutionalization. For men, the spouse is most important in reducing the risk of entry; for women, having regular contact with at least one family member--of any relation--reduces the risk of entry.

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PubMed1993

Maintaining mobility in late life. I. Demographic characteristics and chronic conditions.

To assess the role of demographic factors and chronic conditions in maintaining mobility in older persons, this study utilized longitudinal data collected as part of the Established Populations for Epidemiologic Studies of the Elderly between 1981 and 1987 on 6,981 men and women aged 65 years and older in East Boston, Massachusetts; Iowa and Washington counties, Iowa; and New Haven, Connecticut. Results are presented for those who at baseline reported intact mobility, defined as the ability to climb stairs and walk a half mile without help, and who were followed annually for up to 4 years for changes in mobility status. Age, income, education, and chronic conditions present at baseline and occurring during follow-up were evaluated for their association with loss of mobility. Over the follow-up period, 55.1% of subjects maintained mobility, 36.2% lost mobility, and 8.7% died without evidence of mobility loss prior to death. In both men and women, increasing age and lower income levels were associated with increased risk of losing mobility, even after controlling for the presence of chronic conditions at baseline. After adjustment for age, income, and chronic conditions, lower education levels were a significant risk factor for mobility loss in men, but not in women. Baseline reports of previous heart attack, stroke, high blood pressure, diabetes, dyspnea, and exertional leg pain were associated with small but significant risks for mobility loss. There was a stepwise increase in the risk of mobility loss according to the number of chronic conditions present at baseline that was very consistent between men and women. The occurrence during the study of a new heart attack, stroke, cancer, or hip fracture was associated with a substantially greater risk of mobility loss than was associated with the presence of these conditions at baseline.

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PubMed1993

Maintaining mobility in late life. II. Smoking, alcohol consumption, physical activity, and body mass index.

While positive health behaviors have been shown to extend life, their association with extending active life has not been well investigated. In this report, several health behaviors were investigated in relation to maintaining mobility during 4 years of follow-up among 6,981 men and women aged 65 years and older with intact mobility at baseline between 1981 and 1983 who lived in one of three communities: East Boston, Massachusetts; Iowa and Washington counties, Iowa; and New Haven, Connecticut. Intact mobility, defined as the ability to climb up and down stairs and walk a half mile, was determined annually by interview, and study subjects were classified into one of three categories at the end of 4 years of follow-up: 1) maintained mobility (55.1%); 2) lost mobility (36.2%); or 3) died without evidence of having lost mobility prior to death (8.7%). After adjustment for age and all of the health behaviors, risk of losing mobility was significantly associated with current smoking, not consuming alcohol compared with small-to-moderate amounts of alcohol consumption, high (> 80th percentile) compared with moderate (21-80th percentiles) body mass index, and low physical activity levels in both men and women. These findings suggest that positive health behaviors can not only extend longevity but also reduce the risk of losing mobility and independence in later life.

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PubMed1993

Established populations for epidemiologic studies of the elderly: study design and methodology.

A project initiated by the intramural Epidemiology, Demography and Biometry Program of the National Institute on Aging, entitled "Established Populations for Epidemiologic Studies of the Elderly" (EPESE), has developed information on death, chronic conditions, disabilities, and institutionalization for representative samples of elderly people living in communities. The EPESE consists of prospective epidemiologic studies of approximately 14,000 persons 65 years of age and older in four different communities: East Boston, Massachusetts; two rural counties in Iowa; New Haven, Connecticut; and segments of five counties in the north-central Piedmont area of North Carolina. The study design includes an initial baseline household interview followed by continued surveillance of morbidity and mortality. Participants are re-contacted annually in conjunction with the collection of data on cause of death and factors related to hospitalization and nursing home admissions. Concurrently, the investigators developed substudies focused on specific problems of the elderly. The value of this research lies in the longitudinal design which allows for analyses aimed at identifying risk factors of diseases, disabilities, hospitalizations, institutionalization, and mortality.

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PubMed1993

High, usual and impaired functioning in community-dwelling older men and women: findings from the MacArthur Foundation Research Network on Successful Aging.

The objective of this study is to determine the range of complex physical and cognitive abilities of older men and women functioning at high, medium and impaired ranges and to determine the psychosocial and physiological conditions that discriminate those in the high functioning group from those functioning at middle or impaired ranges. The subjects for this study were drawn from men and women aged 70-79 from 3 Established Populations for the Epidemiologic Study of the Elderly (EPESE) programs in East Boston MA, New Haven CT, and Durham County NC screened on the basis of criteria of physical and cognitive function. In 1988, 4030 men and women were screened as part of their annual EPESE interview. 1192 men and women met criteria for "high functioning". Age and sex-matched subjects were selected to represent the medium (n = 80) and low (n = 82) functioning groups. Physical and cognitive functioning was assessed from performance-based examinations and self-reported abilities. Physical function measures focused on balance, gait, and upper body strength. Cognitive exams assessed memory, language, abstraction, and praxis. Significant differences for every performance-based examination of physical and cognitive function were observed across functioning groups. Low functioning subjects were almost 3 times as likely to have an income of < or = $5000 compared to the high functioning group. They were less likely to have completed high school. High functioning subjects smoked cigarettes less and exercised more than others. They had higher levels of DHEA-S and peak expiratory flow rate. High functioning elders were more likely to engage in volunteer activities and score higher on scales of self-efficacy, mastery and report fewer psychiatric symptoms.

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PubMed1993

Intercommunity variations in the association between social ties and mortality in the elderly. A comparative analysis of three communities.

Identical measures of social ties obtained from three community-based cohorts aged 65 and over from East Boston, MA; New Haven, CT; and two rural counties in Iowa permit the first direct cross-community comparison of the hypothesis that social isolation increases 5-year mortality risks (1982 to 1987) for older men and women. In sex-specific proportional hazards analyses, social ties were significantly and inversely related to mortality independently of age in all three cohorts (e.g., relative hazard (RH) = 1.97 to 3.06 for men and women, comparing those with no ties to those with four types of ties). After controlling for age, pack-years of smoking, body mass, chronic conditions, angina, and physical and cognitive disability, social ties remain significant predictors of mortality risk for the men and women in New Haven (RH = 2.4 and 1.8) and for women in Iowa (RH = 1.9). For the men in Iowa (RH = 1.4) and the men and women in East Boston (RH = 1.0 and 1.3), the associations are weaker and nonsignificant.

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PubMed1993

Cognitive performance in a high-functioning community-dwelling elderly population.

BACKGROUND: The purpose of this study was to examine the role of demographic factors as predictors of cognitive performance in a high-functioning, community-dwelling elderly population. METHODS: The study cohort consisted of 1,192 community-dwelling subjects, who were selected to represent the highest third of an elderly population with respect to physical and cognitive functioning. A neuropsychological battery, including 5 cognitive performance subtests (confrontation naming, delayed recognition span, similarities, figure-copying, and incidental delayed recall) was administered to the subjects in their homes. RESULTS: A summary measure of the 5 neuropsychological subtest scores, the total cognitive score, arrayed the study group across a broad range of difficulty, creating a near-normal distribution. Education, income, and race had statistically significant associations with the total score and the individual subtests. The effect of education was the most striking finding, explaining 30% of the variance in the total score. Education was most strongly related to the abstraction (partial R2 = .11) subtest, and least related to the memory subtests, delayed recognition (R2 = .02) and delayed recall (R2 = .01). CONCLUSIONS: Demographic factors are important predictors of cognitive performance in this high-functioning cohort. Education had the strongest influence on overall cognitive performance, and particularly notable associations with subtests that depended upon the use of previously learned materials. Longitudinal follow-up, now underway, will help to determine whether high levels of education help to maintain cognitive performance with age.

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PubMed1993

Psychosocial predictors of stroke outcomes in an elderly population.

The influence of premorbid psychosocial factors on physical function and institutionalization 6 weeks after hospital discharge was studied in elderly stroke patients. The predictor variables of interest were social networks, availability of social support, pre-stroke depression (CES-D), and religiousness. The data were obtained from a prospective longitudinal study based on 2,812 noninstitutionalized individuals aged 65 years and older living in New Haven, Connecticut. Incident stroke cases from this study were followed for post-stroke outcomes. Results from 87 survivors indicated that larger social networks were associated with fewer limitations in physical function, controlling for relevant health and sociodemographic conditions. Larger networks were also associated with a lower risk of institutionalization (p < .05). None of the other psychosocial factors assessed appeared to be related to these outcomes.

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PubMed1993

Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index.

Brief measurement devices can alleviate respondent burden and lower refusal rates in surveys. This article reports on a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index in a multisite survey of persons 65 and older. Factor analyses demonstrate that the briefer forms tap the same symptoms dimensions as does the original CES-D, and reliability statistics indicate that they sacrifice little precision. Simple transformations are presented to how scores from the briefer forms can be compared to those of the original.

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PubMed1992

Emotional support and survival after myocardial infarction. A prospective, population-based study of the elderly.

OBJECTIVE: To compare the survival of elderly patients hospitalized for acute myocardial infarction who have emotional support with that of patients who lack such support, while controlling for severity of disease, comorbidity, and functional status. DESIGN: A prospective, community-based cohort study. SETTING: Two hospitals in New Haven, Connecticut. PATIENTS: Men (n = 100) and women (n = 94) 65 years of age or more hospitalized for acute myocardial infarction between 1982 and 1988. MEASUREMENTS: Social support, age, gender, race, education, marital status, living arrangements, presence of depression, smoking history, weight, and physical function were assessed prospectively using questionnaires. The presence of congestive heart failure, pulmonary edema, and cardiogenic shock; the position of infarction; in-hospital complications; and history of myocardial infarction were assessed using medical records. Comorbidity was defined using an index based on the presence of eight conditions. RESULTS: Of 194 patients, 76 (39%) died in the first 6 months after myocardial infarction. In multiple logistic regression analyses, lack of emotional support was significantly associated with 6-month mortality (odds ratio, 2.9; 95% CI, 1.2 to 6.9) after controlling for severity of myocardial infarction, comorbidity, risk factors such as smoking and hypertension, and sociodemographic factors. CONCLUSIONS: When emotional support was assessed before myocardial infarction, it was independently related to risk for death in the subsequent 6 months.

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PubMed1992

Social support and depressive symptoms in the elderly.

The purpose of this study was to examine the effect of characteristics of social networks and support on depressive symptoms in the elderly. The subjects were 1,962 noninstitutionalized persons 65 years and older from the New Haven Establishment of Populations for Epidemiologic Study of the Elderly in 1982, who were available to give a complete follow-up interview in 1985. Baseline depression, functional disability in 1982, and any change in disability by 1985 were considered as additional influences on 1985 depression, requiring adjustment along with sociodemographic variables. Multiple regression procedures were used to simultaneously examine the variables. Baseline depression, functional disability, and change in functional disability made the largest contribution to explaining the variance in depression. Among the social support and network characteristics, loss of a spouse, adequacy of emotional support, and its change during 1982-1985 made the largest contributions. Other significant characteristics in relative order of magnitude of effect, based on contrast tests, included tangible support adequacy and its change, loss of a confidant between 1982 and 1985, number of children making weekly visits and change in this number by 1985, and the absence of a confidant in both 1982 and 1985. For mental health outcomes, these findings emphasize the need to consider specific dimensions of social support and networks rather than global measures.

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PubMed1992

Decline in physical function following hip fracture.

OBJECTIVE: The main objective of the study was to determine the change in physical function following hip fractures in a community-living elderly population. A secondary objective was the determination of baseline factors predictive of altered function following hip fracture. DESIGN: Prospective, cohort study. SETTING: Urban, community-living elders. PARTICIPANTS: 120 members of a cohort of 2806 individuals age 65 and older in New Haven, CT who sustained a hip fracture from 1982 to 1988 and were treated in the two New Haven hospitals. OUTCOME MEASURE: Self-reported performance of dressing, transferring, walking across a room, climbing stairs, and walking one-half mile before the fracture occurred and 6 weeks and 6 months post-fracture. Baseline factors were assessed before the hip fracture occurred. RESULTS: Of the 120 cohort members who sustained a hip fracture in the 6-year study period, 22 died within 6 months of the fracture. Among survivors there was a sustained decline in function at 6 weeks after the fracture with little improvement by 6 months. At baseline, 86% could dress independently versus 49% at 6 months; 90% could transfer independently versus 32% at 6 months; 75% could walk across a room independently versus 15% at 6 months; 63% could climb a flight of stairs versus 8% at 6 months; and 41% could walk one-half mile versus 6% at 6 months. Physical function and mental status were the only baseline factors significantly associated with physical function at 6 months after the fracture in bivariate analysis, while physical function and depression were associated in multivariate analysis. CONCLUSION: We found a substantial decline in physical function following hip fracture in a prospectively followed community-living elderly population. Only pre-morbid physical and mental function predicted this decline.

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PubMed1990

Assessment of social relationships in elderly patients.

This article provides an overview of measures for assessing the importance of social relationships to the outcome of illness in the elderly. Review of the evidence associating social relationships with the variability in health outcome emphasizes the need for separating social relationships into three components: Social network structure and composition; Type and amount of social support provided through the network; and, perceived adequacy of the social support. Because of physical and social changes during the life cycle, care must be exercised in selecting and interpreting social relationship measures for use with the elderly. Available measures relevant for assessing the three components of social relationships in the elderly are described.

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PubMed1989

The health impact of living with a cognitively impaired elderly spouse: depressive symptoms and social functioning.

The purpose of this study was to identify the social and psychological consequences of living with a cognitively impaired spouse among community-dwelling elderly individuals. The study sample consisted of 318 spouse pairs drawn from a representative sample of noninstitutionalized elderly individuals. Our principal findings were that: (a) Cognitive impairment in wives is significantly (p less than .05) associated with depressive symptomatology in husbands, whereas cognitive impairment in husbands is only weakly (p greater than .20) associated with depressive symptomatology in wives; (b) Decreased participation in social/leisure activities is selectively related to spouses' level of cognitive functioning among both men and women; (c) The relationship between wives' cognitive impairment and husbands' depressive symptoms is influenced by perceived availability of financial support from friends and relatives, but not by ADL limitations in wives, lack of emotional or instrumental support from wives, household responsibilities among husbands, or lack of participation in social/leisure activities in husbands.

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PubMed1988

Structural characteristics of social networks and their relationship with social support in the elderly: who provides support.

The analyses presented here examine relationships between structural characteristics of social networks and two types of support (instrumental and emotional support) in a sample of community-dwelling individuals aged 65 and older. For each type of support, two dimensions are examined (1) the availability of such support and (2) the perceived adequacy of that support. Regression models, adjusting for age, sex, race and income show that structural characteristics such as total network size, number of face-to-face contacts and number of proximal ties are associated with greater availability of both instrumental and emotional support. The perceived adequacy of both types of support is most strongly related to the number of monthly face-to-face contacts. Comparisons of specific types of ties show that neither ones' spouse nor ones' children are primary sources of support. Rather the presence of a confidant is strongly associated with both dimensions of instrumental and emotional support; the presence of a spouse is not. And, while ties with children are most strongly related to aspects of instrumental support, ties with close friends and relatives are more strongly related to aspects of emotional support. Analyses of possible interactions show that for those without a spouse, confidants assume greater importance in providing emotional support. For those without children, ties with close friends and relatives assume a larger role relative to the perceived adequacy of both emotional and instrumental support.

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PubMed1988

Factors affecting pediatric preventive care utilization in a prepaid group practice.

Previous research on the utilization of pediatric preventive care has shown that certain sociodemographic factors, such as age, birth order, family size and race, as well as health attitudes and beliefs are related to the use of well-child services. To examine the simultaneous effects of sociodemographic, psychosocial and behavioral factors, we conducted a 16-month prospective investigation of 532 children belonging to a university-affiliated prepaired group practice. The children were under 5 years of age upon enrollment and came predominantly from white, middle-class families with well-educated parents. Our bivariable results showed that 13 factors were related to preventive care utilization (p less than 0.05) and, in effect, confirmed findings from previous investigations. However, using model-fitting procedures, we found that only two variables, child's age and birth order, significantly predicted the rate of preventive care visits; a high utilization rate was observed for younger children and for first-born children. Since the observed age-specific rates of preventive care utilization were nearly identical to the schedule recommended by the pediatricians in this practice, we believe that most of the variability in well-child care in our population was due to provider-induced demand. Furthermore, none of the other demographic or psychosocial factors that significantly predicted acute care utilization in this population had any effect on preventive care once age and birth order were accounted for.

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