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Biomedical subjects

Mark S Lachs

Publications and source records attributed to Mark S Lachs.

15 recordsLinked to original sources
PubMed2006

Design features to enhance external hip protector adherence in the nursing home setting.

OBJECTIVE: To determine the preferences for external hip protector (EHP) design features of both certified nursing assistants (CNAs) and nursing home laundry personnel, and to test the durability of favored model features. DESIGN: Cross-sectional descriptive study of CNAs' and laundry personnels' preferences and a prospective experimental study of EHP fastener durability under institutional laundry conditions. SETTING: Three urban nursing homes and a hospital-based laundry service. PARTICIPANTS: Twenty-seven CNAs, 4 laundry service supervisors. INTERVENTION: Five focus groups with CNAs and a survey of laundry supervisors were conducted to elicit preferences of EHP design features with an emphasis on convenience and durability. A laundry test of 20 EHPs was conducted to compare these design features. RESULTS: There was wide agreement among CNAs and laundry personnel that EHPs with soft pads in garments of light neutral colors, and cotton-blend fabrics were most preferred. CNAs preferred sewn-in pads to removeable ones, but laundry personnel had no consensus on this issue. For dependent residents, wraparound (front opening) garments using Velcro were preferred by CNAs, whereas laundry supervisors preferred snap closures. When EHP underwent repeated washing in the laundry test, Velcro and snaps were functionally comparable at 52 cycles. Garments constructed of heavyweight cotton blends, polyester, or cotton with spandex maintained elasticity at 52 weeks, whereas the lightweight cotton blend stretched significantly. CONCLUSIONS: Based on CNAs' preferences, laundry personnels' input, and a laundry test, EHP design features that could enhance both caregiver efficiency and resident comfort include soft pads sewn into a light-colored (but non-white) heavier weight cotton-blend garment, with the availability of both a pull-up style and a wraparound style using Velcro fasteners. Snaps did not demonstrate superior durability in the laundry test, but further comparison with Velcro under clinical conditions is indicated. Education and inclusion of CNAs in EHP decision making are important ways to improve EHP adherence.

Accidental Falls↗
PubMed2006

Geriatric assessment for oncologists: rationale and future directions.

Sixty percent of all cancer occurrences and seventy percent of cancer mortalities occur in people over the age of 65. As the population ages, there is an emerging need to develop a means for oncologists to characterize the "functional age" of older patients with cancer in order to tailor treatment decisions and stratify outcomes based on factors other than chronological age and to develop interventions to optimize cancer treatment. In this paper, we discuss the formulation of a geriatric assessment for older patients with cancer. The measures included in this assessment were chosen based on their validity, reliability, brevity, adaptability for self-administration, and ability to prognosticate risk for morbidity or mortality in an older patient. The proposed geriatric assessment covers the essential domains of assessment predictive of survival in the geriatric population, is primarily self-administered, and limited personnel time is required. Our eventual goal is to determine if this geriatric assessment measure can identify factors independent of age that predict cancer treatment morbidity and mortality and result in rationale interventions to optimize oncologic care.

Aged↗
PubMed2006

Effect of adjuvant breast cancer chemotherapy on cognitive function from the older patient's perspective.

PURPOSE: This longitudinal prospective study describes the older breast cancer patient's perception of the cognitive impact of adjuvant chemotherapy. METHODS: A total of 50 patients > or =age 65 with stage I to III breast cancer enrolled in this IRB-approved prospective study. Of the 50, 3 refused postchemotherapy testing and 2 had a cerebrovascular accident (CVA) during therapy, leaving 45 evaluable patients. The Squire Memory Self-Rating Questionnaire, given before and 6 months after chemotherapy, measured patients' perceptions of the ability to learn new information, of working memory, and of remote learning capabilities. RESULTS: Mean age was 70 years (range 65-84). Breast cancer stages were: I (33%), II (64%), III (2%). A 51% (23/45) of study participants perceived a decline in memory from before to 6 months after completion of chemotherapy. Patients who perceived a poorer memory than average before chemotherapy were more likely to report further memory deterioration after chemotherapy (19/30, 63%) than patients who perceived that their memory was average or better than average prior to chemotherapy (4/15, 27%). The memory domain most likely to be perceived as affected was the ability to learn new information (22/45, 49%) compared to remote memory (9/45, 20%) or working memory (13/45, 29%) capabilities. CONCLUSION: Approximately half of these older women perceived a decline in cognitive function from before to 6 months after chemotherapy. This perceived decline in cognitive function was most pronounced in patients with preexisting memory complaints. Further prospective study is needed to confirm these observations, correlate perceived memory changes with objective findings, and identify subgroups at special risk.

Aged↗
PubMed2006

Could self-neglect in older adults be a geriatric syndrome?

Self-neglect in older adults is a complex phenomenon characterized by inattention to health and hygiene, typically stemming from an inability or unwillingness to access potentially remediating services. Some aspects of self-neglect clinically resemble geriatric syndromes (e.g., falling, incontinence). The literature on self-neglect was comprehensively reviewed and its quality evaluated in the context of considering its candidacy for a geriatric syndrome. MEDLINE (1966-2004) was searched using self-neglect as a keyword. Using a "snowball" sampling strategy, associated terms (e.g., Diogenes' syndrome) were combined, selecting relevant papers and frequently cited references, assessing each one using specific criteria. Its candidacy for consideration for a geriatric syndrome was assessed based on the quality of data in four domains: multifactorial etiology, shared risk factors with other geriatric syndromes, association with functional decline, and association with increased mortality. The 54 articles reviewed included 24 case series, 13 theoretical articles, 11 observational studies, and six reviews; these were of highly variable methodological quality. The strongest evidence that self-neglect may be a geriatric syndrome includes its often multifactorial etiology, its clear independent association with increased mortality, and the fact that two other geriatric syndromes (cognitive impairment and depression) are risk factors for self-neglect. Self-neglect in older adults is a prevalent problem that appears to have at least some features of a geriatric syndrome. Insofar as the concept of geriatric syndrome has been a useful clinical and research paradigm to create interventions for vulnerable older adults, and no such strategies are available for this vexing and understudied clinical problem, future research is warranted in this area.

Aged↗
PubMed2006

Cognitive function of older patients receiving adjuvant chemotherapy for breast cancer: a pilot prospective longitudinal study.

OBJECTIVES: To report on the longitudinal cognitive functioning of older women receiving adjuvant chemotherapy for breast cancer. DESIGN: Neuropsychological and functional status testing were performed before chemotherapy and 6 months after chemotherapy. SETTING: Cancer center. PARTICIPANTS: Thirty-one patients aged 65 and older with Stage I to III breast cancer. Of the 31 patients enrolled, three refused post-testing, and 28 were evaluable. MEASUREMENTS: The following domains of cognitive function were examined: attention; verbal memory; visual memory; and verbal, spatial, psychomotor, and executive functions. RESULTS: Participants had a mean age of 71 (range 65-84): 39% Stage I, 50% Stage II, and 11% Stage III. The number of scores 2 standard deviations (SDs) below the norm were calculated for each patient before and 6 months after chemotherapy; 14 (50%) had no change, 11 (39%) worsened, and three (11%) improved (P=.05). Seven patients (25%) experienced a decline in cognitive function, defined as a 1-SD decline from pre- to post-testing in two or more neuropsychological domains. Exploratory analyses revealed no significant difference between functional status, comorbidity, and depression scale scores and change in overall quality-of-life scores before and after chemotherapy. CONCLUSION: In this cohort of older women receiving adjuvant chemotherapy, a subset experienced a decline in cognitive function from before chemotherapy to 6 months after chemotherapy. Further prospective study is needed to confirm these observations and to identify the subgroup at special risk.

Age Factors↗
PubMed2006

A prospective, longitudinal study of the functional status and quality of life of older patients with breast cancer receiving adjuvant chemotherapy.

OBJECTIVES: To examine the toxicity experienced by a cohort of older women receiving adjuvant chemotherapy for breast cancer and the longitudinal effect on their functional status and quality of life (QOL). DESIGN: A geriatric assessment measuring functional status, comorbidity, mood, nutritional status, and QOL was performed before chemotherapy, at the end of chemotherapy, and 6 months later. SETTING: This prospective longitudinal study was conducted at Memorial Sloan-Kettering Cancer Center, New York, New York. PARTICIPANTS: Fifty patients aged 65 and older with Stage I to III breast cancer receiving any adjuvant chemotherapy; 49 were evaluable. MEASUREMENTS: The chemotherapy regimen and the toxicity to chemotherapy were recorded. A geriatric assessment was performed before the start of chemotherapy, on completion of chemotherapy, and 6 months after completion of chemotherapy. QOL testing was performed at the same times. RESULTS: Patients (mean age 68, range 65-84) received an anthracycline-based chemotherapy regimen (n=15) or cyclophosphamide 600 mg/m2 intravenously (i.v.), methotrexate 40 mg/m2 i.v., 5-fluorouracil 600 mg/m2 i.v. every 3 weeks for eight cycles (n=34). Grade 3 or 4 toxicity occurred in 53% (n=26), hematological toxicity in 27% (n=13), and nonhematological toxicity in 31% (n=15). Despite toxicity, there was no significant longitudinal change in functional status or QOL. CONCLUSION: Despite toxicity from adjuvant chemotherapy, this cohort of relatively young older patients maintained their functional status and QOL from before chemotherapy to 6 months postchemotherapy. Subtle changes in higher-order functioning would require assessment using different geriatric assessment tools.

Aged↗
PubMed2005

A cost-benefit analysis of external hip protectors in the nursing home setting.

OBJECTIVES: To estimate potential cost savings generated by a program of hip protectors in the nursing home from a Medicare perspective. DESIGN: A state-transition Markov model considering short-term and long-term outcomes of hip protectors for a hypothetical nursing home population, stratified by age, sex, and functional status. Costs, transition probabilities between health states, and estimates of hip protectors' effectiveness were derived from published secondary data. SETTING: Nursing home facilities in the United States. PARTICIPANTS: Hypothetical cohort of permanent nursing home residents aged 65 and older without a previous hip fracture. INTERVENTION: Program of hip protectors reimbursed by Medicare. MEASUREMENTS: Number of fractures, life years, and dollars saved. RESULTS: Three pairs of hip protectors replaced annually would result in a weighted average lifetime absolute risk reduction for hip fracture of 8.5%, with net lifetime savings to Medicare of 223 dollars per resident. When the annual cost of hip protectors is less than 151 dollars per person, relative risk of fracture is less than or equal to 0.65 with hip protectors, or adherence is greater than 42%, hip protectors are cost saving to Medicare over a wide range of assumptions. Extrapolating these results to the estimated population of U.S. nursing home residents without a previous hip fracture, Medicare could save 136 million dollars in the first year of a hip-protector reimbursement program. CONCLUSION: From a Medicare perspective, hip protectors are a cost-saving intervention in the nursing home setting when hip protector effectiveness is less than or equal to 0.65 over the remaining lifetime of subjects.

Aged↗
PubMed2004

Recognition of late-life depression in home care: accuracy of the outcome and assessment information set.

This study evaluated the accuracy of home care nurses' ratings of the Outcome and Assessment Information Set (OASIS) depression items. The accuracy of home care nurses' depression assessments was studied by comparing nurse ratings of OASIS depression items with a research diagnostic assessment based on the Structured Clinical Interview for Axis I Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). The setting for this study was a nonprofit, Medicare-certified, voluntary home healthcare agency. Sixty-four home care nurses assessed 220 patients aged 65 and older with the OASIS upon admission. Of the 220 patients, using standard SCID criteria, 35 cases of major or minor depression were identified. The home care nurses accurately documented the presence of depression in 13 of 35 cases (sensitivity=37.1%; positive predictive value=0.56). Of the 220 patients, 185 had no SCID-identified major or minor depression. The nurses agreed on the absence of depression in 175 of 185 cases (specificity=94.6%; negative predictive value=88.8%). This study indicates that home care nurses often do not accurately rate OASIS depression items for older adult patients.

Aged↗
PubMed2004

Assessment of cognition in primary care: neuropsychological evaluation of the geriatric patient.

Some aspects of memory and other thinking abilities decline as part of the normal aging process. Normal age-related cognitive decline and disease-associated cognitive impairment can be difficult to differentiate in the typical patient-physician interaction, especially in the geriatric primary care setting where patients may present with multiple physical complaints that consume the physician's attention. It is essential that clinician's recognize even modest changes in thinking abilities in the geriatric patient since these changes may be an early warning sign of an impending dementing disorder. At the very least, reduced cognitive functioning can decrease one's quality of life as well as threaten their independence. When cognitive decline is suspected, a neuropsychological evaluation can provide an objective assessment of cognitive functioning that is useful for differential diagnosis, assessing presence and progression of cognitive disorders, and providing information relevant to treatment and planning. This article explores the challenges of cognitive assessment in older adults and provides an overview of the neuropsychological evaluation, its advantages and limitations, as well as common referral questions from primary care physicians.

Aged↗
PubMed2003

Predictive value of nonspecific symptoms for acute illness in nursing home residents.

OBJECTIVES: To examine the predictive value of nonspecific symptoms for acute illness in nursing home residents. DESIGN: Prospective, observational study. SETTING: Academic nursing home located in an urban setting. PARTICIPANTS: Two hundred two newly admitted residents. MEASUREMENTS: Eleven nonspecific symptoms were ascertained by review of observations documented by nursing home staff in the medical record. Research staff independently identified acute illness according to previously established criteria from nurse report and medical record review. Follow-up was divided into 10-day intervals, and concordance between nonspecific symptoms and acute illness within these intervals was determined. Predictive values were calculated according to standard formulae. RESULTS: Nonspecific symptoms and acute illnesses occurred in 21.7% and 12.5% of 10-day intervals, respectively. Positive predictive values (PPVs) were highest for lethargy, weakness, and decreased appetite, each of which correctly predicted the presence of an acute illness one out of two times the symptoms were reported. Agitation and disorientation predicted an acute illness one out of three times, and falls predicted an acute illness one out of four times. Overall, the PPV of the occurrence of any nonspecific symptom was 0.24, and the negative predictive value of the absence of nonspecific symptoms was 0.91. CONCLUSION: Hypoactive nonspecific symptoms are more likely than other nonspecific symptoms to be signs of incipient acute illness. Studies are needed to determine whether an intervention in residents with these nonspecific symptoms can enable earlier detection and treatment of acute illness.

Acute Disease↗
PubMed2002

Adult protective service use and nursing home placement.

PURPOSE: Adult Protective Services (APS) is the official state entity charged with advocacy for older adults who are victims of elder abuse or self-neglect. However, it has been speculated that APS intervention may lead disproportionately to nursing home placement (NHP). These analyses seek to determine if APS use is an independent risk factor for NHP. DESIGN AND METHODS: The sample was 2,812 community-dwelling older adults who were aged 65 years or older in 1982 in the New Haven Established Populations for Epidemiologic Studies in the Elderly cohort, a subset of whom were referred to elder protective services over a 9-year follow-up period from cohort inception. NHP of cohort members over that time period was determined. RESULTS: Rates of subsequent NHP were: 69.2% for self-neglecting subjects, 52.3% for mistreated subjects, and 31.8% for subjects who had no contact with APS (p <.001, both comparisons). In proportional hazard models that included other demographic, medical, functional, and social factors associated with NHP, the strongest risk factors for placement were APS referral for self-neglect (hazard ratio [HR], 5.23; 95% confidence interval [CI], 4.07-6.72), and for elder mistreatment (HR, 4.02; 95% CI, 2.50-6.47). These hazards far exceeded those for other medical, functional, and social factors. IMPLICATIONS: APS use is an independent risk factor for nursing home placement; persons identified by APS as self-neglecting are at the highest risk.

Aged↗
PubMed2002

Elder abuse and neglect: what physicians can and should do.

Although reports of elder abuse to official agencies have been steadily increasing, physicians report only 2% of reported cases. Multiple barriers to reporting exist. This article reviews the terminology, epidemiology, and clinical signs associated with elder abuse in the community and offers practical strategies for intervention.

Aged↗
PubMedDate not supplied

Elder abuse.

Elder abuse has received increasing attention over the past decade as a common problem with serious consequences for the health and wellbeing of old people. Our aim is to assist clinicians by summarising recent international research and clinical findings about elder abuse, and to assess their quality, relevance, and feasibility for health-care providers in clinical practice. This seminar includes issues of definition and frequency of elder abuse and a summary of major known risk factors. The advantages and disadvantages of screening for elder abuse are discussed. We review clinical manifestations and diagnosis of elder abuse, and propose a protocol for medical assessment of a patient with confirmed or suspected abuse. Suggestions for treatment are offered on the basis that elder abuse is multifactorial and needs individual medical and social intervention strategies, preferably in the context of a multidisciplinary team.

Aged↗