Federal resources for training nursing personnel in the geriatric field.
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Biomedical subjects
M D Grant
Publications and source records attributed to M D Grant.
Cohort effects in a genetically determined trait: eye colour among US whites.
BACKGROUND: While the inheritance of eye colour is likely polygenic, blue eye colour is thought to follow an inheritance pattern similar to that of a recessive trait. Consequently, age-related differences in the prevalence of blue eye colour would be unanticipated. AIM: This study explores the finding and explanation for birth cohort differences in the prevalence of blue eye colour in the US white population. SUBJECTS AND METHODS: Data from the first (1971-1975) and third (1988-1994) US National Health and Nutrition Examination Surveys (NHANES-I and NHANES-III), nationally representative surveys of the US population, were analysed. Trends in eye colour prevalence by birth cohort were analysed together with mortality rates according to eye colour. US census data (1980) were examined to explore cohort differences in ancestry and assortative mating by ancestry. RESULTS: The prevalence of blue eye colour among non-Hispanic whites in NHANES-III was 57.4% (95% CI: 50.1-64.7) for individuals born between 1899 and 1905 compared to 33.8% (95% CI: 31.3-36.5) for those born between 1936 and 1951. No association was found between survival and eye colour, nor was a cohort effect evident for primary ancestry. However, proportions reporting only one ancestry in census data declined with successive birth cohorts. CONCLUSIONS: A cohort effect in blue eye colour prevalence was found for the US white population. A secular trend of decreasing assortative mating by ancestry is the likely explanation.
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Case report: splenectomy in patients with Hodgkin's disease and marrow hypoplasia.
Two patients with Hodgkin's disease and hypoplastic bone marrow underwent splenectomy in an attempt to reverse pancytopenia and to improve chemotherapeutic tolerance. Although the peripheral blood counts were improved, the clinical course was not significantly affected. Infectious complications occurred. This suggests that the peripheral hematologic improvement following splenectomy may not reflect a true improvement in marrow tolerance.
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Effectiveness of feeding tubes in nursing home residents with swallowing disorders.
BACKGROUND: Among nursing home residents who stop eating, a common decision for residents, caregivers, and families is the decision to begin tube feeding. This study examines the effectiveness of feeding tubes at reducing mortality among nursing home residents with swallowing disorders and feeding disabilities. METHODS: Data from a version of the Minimum Data Set+ (MDS +) encompassing three different states from calendar years 1993 and 1994 were analyzed. Residents were included in the study if they were not totally dependent on staff for eating upon their first assessment but became totally dependent on staff for eating and had a swallowing disorder at some point during their nursing home stay. We used a proportional hazard regression to examine the relationship of feeding tubes with mortality after total eating dependence occurred. RESULTS: Unadjusted Kaplan-Meier curves found that those with feeding tubes were less likely to die than comparable residents without feeding tubes (p < .001). Estimated survival at 1 year was 39% for those without feeding tubes and 50% for those with feeding tubes. The multivariate results indicated that feeding tubes were associated with a reduced risk of death (risk ratio, 0.71; 95% confidence interval, 0.59, 0.86). CONCLUSIONS: This study provides evidence that tube feeding can be life-prolonging, even if the gain in life is not substantial. Such information can be useful to nursing home staff, residents, and families when trying to decide whether to place a feeding tube in a resident with swallowing disorders and eating disabilities.
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Gastrostomies in older patients: the 1990 National Hospital Discharge Survey.
BACKGROUND: Although many published case series have described patients' experiences after gastrostomy placement, generalizing from the results of case series can present problems. The purpose of this study was to examine gastrostomy placement among hospitalized older patients in a nationally representative sample. METHODS: Using the 1990 National Hospital Discharge Survey, age, sex, race, primary and secondary diagnoses, and mortality were described for hospitalized patients aged 65 years and older having gastrostomies. Age-specific placement rates were calculated using mid-1990 Census Bureau population estimates. RESULTS: In 1990 an estimated 85,400 patients aged 65 years and older were discharged from hospitals with gastrostomies. Frequent primary diagnoses included cerebrovascular disease (19 percent), pneumonia with or without aspiration (12 percent), neoplasm (11 percent), and fluid and electrolyte disorders (9 percent). The in-hospital mortality rate was 16 percent. Age-specific rates for gastrostomy increased from 1.2 per 1000 for those aged 65 to 74 years to 10.8 per 1000 for those aged 85 years and older. CONCLUSIONS: In 1990 older hospitalized patients had gastrostomies with surprising frequency, and their in-hospital mortality rate was substantial. An estimated 1 percent of the US population aged 85 years and older was discharged from a hospital in 1990 with a gastrostomy.
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