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Biomedical subjects

L G Branch

Publications and source records attributed to L G Branch.

At least 73 records · Page 4Linked to original sources
PubMed1990

CCRC statutes: the oversight of long-term care service delivery.

A 1987 national survey revealed 27 states with continuing care or life care legislation. State oversight staff in 22 states responded to questions concerning characteristics of the regulated continuing care retirement community (CCRC) industry, the regulation of health and human service delivery within CCRCs, and interdepartmental working relationships between oversight agencies and other state units. Discussion focuses on the regulation of long-term care service provision in the CCRC industry.

Aged↗
PubMed1990

The Framingham Disability Study: relationship of various coronary heart disease manifestations to disability in older persons living in the community.

The relation between coronary heart disease and disability was examined in 2,576 community-dwelling women and men ages 55-88 years. These Framingham Study participants were originally recruited in 1948-51 for an examination of cardiovascular disease. Twenty-seven years later, remaining members of the cohort were interviewed to ascertain physical abilities, and a score on a disability scale was assigned. Multivariate logistic analyses examined disability in relation to uncomplicated angina pectoris (AP), complicated AP, and coronary heart disease other than AP, controlling for possible confounders. In younger and older women and men, uncomplicated and complicated AP were associated with disability. Coronary heart disease other than AP was associated with disability only in the younger men. Congestive heart failure predicted disability only in the women. These results suggest that onset of AP should be recognized as a critical point in the development of disability and that AP is a better predictor of disability than is myocardial infarction or coronary insufficiency.

Aged↗
PubMed1989

Predictors of medical care utilization by independently living adults with spinal cord injuries.

A prospective study of 87 independently living adults with spinal cord injury (SCI) as a major disabling condition showed the following average annual health care utilization rates: 1.3 hospital admissions, 16.8 days hospitalized, 1.7 emergency room (ER) visits, and 22.4 outpatient contacts (in person or by telephone). Those hospitalized (n = 66) experienced a mean of 22.2 days hospitalized per person per year. Mean length of stay (LOS) was 11.1 days per admission. Stepwise regression analysis indicated no statistically significant (p less than or equal to .05) predictors of hospital admissions. There were three independent predictors of days hospitalized (greater age, fewer years of education, and more days hospitalized during the previous year), three predictors of days hospitalized for those hospitalized only (greater age, fewer years of education, and longer hospital LOS during the previous year), one predictor of LOS (self-assessment of health), three of emergency room (ER) visits (more unmet instrumental activities of daily living needs, lack of organizational memberships, and more ER visits during the previous year), and five predictors of outpatient contacts (greater age, less satisfaction with health care providers' expressions of concern for their health, lower frequency of leaving apartments, lower levels of life satisfaction, and nonparticipation in a managed medical care demonstration project). Many predictors of health services utilization are immutable. However, changes which facilitate social interaction and changes in the organization of health services may reduce certain types of medical care utilization by people with SCI.

Activities of Daily Living↗
PubMed1989

Predictors of physical disability in elderly blacks and whites of the Charleston Heart Study.

During the 1984/85 recall of the Charleston Heart Study Cohort, physical function data were obtained for 247 white males, 376 white females, 123 black males, 247 black females and 71 high socioeconomic status (SES) black males over 60 years of age. Black females had the highest prevalence of physical disability (55.8%), followed by white females (43.2%), black males (39.0%) and white males (25.8%) and high SES black males (22.3%). Physical disability was 1.5-2.5 times as prevalent among individuals with a history of cardiovascular disease (CVD) than those without such a history. Among individuals without a current history of CVD univariate analyses showed the following as significant (lower 95% CI greater than 1.0) predictors of physical disability: elevated systolic blood pressure in white females, black males, and black females; elevated cholesterol in black females; obesity in black females; and low educational level in white females. Regression analyses indicated that obesity in 1960 accounted for 10.9 and 2.9% respectively of the variability in physical disability scores in 1985 for black females and white females.

Activities of Daily Living↗
PubMed1989

Physical performance measures in aging research.

Evaluation of physical functioning plays a valuable role in clinical geriatrics as well as in aging research. Physical functioning has generally been assessed through self- or proxy-report. An important addition to this form of assessment is the use of performance measures of physical function, in which individuals are asked to actually perform specific tasks and are evaluated using standardized criteria. Although there has been limited methodological work on physical performance instruments, this approach offers a number of potential advantages. Several performance assessments have been developed that correlate highly with other measures of health status and predict need for long-term care and mortality. It is suggested that more widespread use be made of physical performance assessments and that they be evaluated as measures of functioning in cross-national studies, as indicators of change in functioning over time, as endpoints in intervention studies, as tools for identifying persons functioning at high levels, and as sources of relevant information for the clinician.

Activities of Daily Living↗
PubMed1989

Patterns of nursing home use in a prepaid managed care system: the continuing care retirement community.

The use of nursing home services among 3,316 residents of six continuing care retirement communities (CCRCs) was compared with that of the general elderly population. CCRC residents have a greater lifetime risk of nursing home entry and repeat entries. CCRC resident's length of stay per admission, however, is shorter. Findings from this comparative analysis provided insight into nursing home use in an insured and managed long term care program for a closed population.

Aged↗
PubMed1989

The implications for everyday life of incident self-reported visual decline among people over age 65 living in the community.

We examined the consequences of incident self-reported vision loss among a cohort of community-living people aged 66 years and older. Those with visual decline were older than those reporting constant excellent or good vision, but not different in any other demographic characteristic, the use of formal support services, the use of health services, or ADL (activities of daily living) functioning. Controlling for age and sex, vision loss was associated with unmet instrumental ADL needs such as housekeeping, grocery shopping, and food preparation, and with physical and emotional disabilities. We discuss the implications of these disabilities in terms of the challenges to the aging and blindness service delivery systems.

Activities of Daily Living↗
PubMed1989

Peak expiratory flow rate in an elderly population.

A population survey was conducted in 1982-1983 among 3,812 persons aged 65 years and older residing in East Boston, Massachusetts, a geographically defined urban community. Three measurements of peak expiratory flow rate were obtained by using calibrated mini-Wright meters. Peak expiratory flow rate was strongly related to age, sex, smoking, and years smoked. After adjustment for these factors, low peak expiratory flow rate was associated with chronic respiratory symptoms (cough, wheeze, shortness of breath, exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea; p less than 0.0001) and with certain cardiovascular variables (history of stroke, p = 0.0014; angina, p = 0.05; and high pulse rate, p = 0.004). No significant associations were found with history of myocardial infarction or systolic and diastolic blood pressures. Peak expiratory flow rate was positively related to education (p less than 0.0001) and income (p less than 0.0001). Peak expiratory flow rate also was strongly related (p less than 0.0001) to measures of functional ability and physical activity, self-assessment of health, and simple measures of cognitive function. The correlations of peak expiratory flow rate with pulmonary symptoms and other indices of chronic disease raise the possibility that peak expiratory flow rate will predict mortality in an elderly population.

Age Factors↗
PubMed1989

Influence of attitude and expectation on moods and symptoms during cold weather military training.

The present study examined the influence of the following: 1) air temperature, 2) day into training, 3) self rating of life stress, 4) rating of relative warmth in cold weather, and 5) expectation for liking cold weather training, on 59 soldiers' self-reports of illness and mood during 3 days of training in the cold (-18 degrees to 0 degree C range). Mood was assessed on six domains of the Profile of Mood States rating scale, and symptoms of illness were assessed on 5 domains of the Environmental Symptoms Questionnaire. Multiple regression analyses showed that: 1) the more soldiers expected to dislike the cold weather training, the more tense, depressed, angry, fatigued, and physically uncomfortable they were during training; 2) the more stress they perceived in their everyday lives, the more fatigued, confused, and physically uncomfortable they were during training; 3) as days into training increased the more fatigued and physically uncomfortable they became; and 4) due to appropriate clothing and training, ambient temperature was found to have no significant influence on the soldiers' moods and symptoms.

Adult↗
PubMed1988

The epidemiology of medical care utilization by severely-disabled independently-living adults.

A prospective study of the medical care utilization experience of 205 severely-disabled independently-living adults in Eastern Massachusetts shows that there was a mean of 0.83 +/- 1.26 hospital admissions, 9.9 +/- 22.7 hospital days, 1.5 +/- 2.31 emergency room (ER) visits, and 26.88 +/- 44.4 outpatient contacts per person per year. Among those hospitalized, the mean experience was 16.2 +/- 27.1 days per person per year; mean length-of-stay was 9.3 +/- 14.7 days per admission. Regression analysis indicates that those with spinal cord injuries as major disabling conditions were significantly more likely to be hospitalized. So were those with lower self-assessments of health, higher levels of depressions, and more baseline ER visits. Self-assessment of health is a significant predictor of hospital days for the total cohort (including those with no admissions); so are age at onset of disability (greater age; higher risk), and bed disability days in the month before the baseline survey (more disability days; higher risk). Among those hospitalized, the total number of days hospitalized is significantly related to both age at onset of disability (later onset; more days) and baseline days hospitalized (greater number; more days). Lengths-of-stay are significantly related to two factors; age and age at onset of disability (in both cases, greater age associated with longer stays). Prior ER visits are a significant predictor of subsequent ER visits (more baseline; more subsequent); so are respondents' reported satisfaction with their participation in their medical care (lower reported satisfaction; more ER visits), organizational affiliations, and frequencies of contacts with friends or relatives. Higher levels of social interaction (i.e. organizational affiliation and more frequent social contacts) were associated with more ER visits. Prior contacts with physicians, nurse-practitioners, or physician-assistants was the most powerful predictor of subsequent outpatient contacts (more baseline; more subsequent). There were also significant relationships between subsequent contacts and respondents' assessments of their health relative to others with similar disabilities (relatively worse health; more contacts), age (greater age; more contacts), and baseline ER visits (more visits; more contacts).

Activities of Daily Living↗
PubMed1988

The Framingham Disability Study: physical disability among community-dwelling survivors of stroke.

The relationship between stroke and physical disability was examined in a cohort of adult, Framingham, Massachusetts, residents who, between 1948 and 1951, were assembled for a longitudinal examination of cardiovascular disease. Multivariate analyses examined the amount of residual disability attributable to stroke among 2540 community-dwelling survivors, 27 years after their initial examination, after controlling for age, cardiovascular risk factors, other cardiovascular diseases, and eight general health conditions related to physical disability. Among men living in the community, a history of stroke explained 12% of the variance in physical disability. Suffering a stroke, however, was not as strongly related to physical disability among women living in the community, accounting for only 3% of the variance. Results suggest that although older men and women die from the same major causes, they may not be disabled by the same conditions.

Activities of Daily Living↗
PubMed1988

Correlates of cognitive function in an elderly community population.

In 1982 and 1983, brief, structured performance tests of selected areas of cognitive function were administered to 3,682 (82.1 per cent) of the residents aged 65 years and older of the geographically defined community of East Boston, Massachusetts, a center of the Established Populations for Epidemiologic Studies of the Elderly program. There was a strong inverse relation between age and performance on all four cognitive tests in analyses adjusted for sex only as well as in those adjusted for the effects of other variables. Similarly, fewer years of formal education, increasing level of disability on the modified Katz Activities of Daily Living Scale, and less prestigious occupations, as measured by the modified Duncan Socioeconomic Index, were each independently related to lower performance on all four tests.

Activities of Daily Living↗