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Biomedical subjects

N G Kutner

Publications and source records attributed to N G Kutner.

At least 37 records · Page 2Linked to original sources
PubMed1994

Psychosocial issues in end-stage renal disease: aging.

Older end-stage renal disease (ESRD) patients presumably encounter multiple stressors: the need to undergo treatment for a chronic, life-threatening illness, age-related physical frailty and comorbidities, and exposure to psychosocial losses related to aging. However, most studies comparing older patients (typically patients aged 60 and older) with younger patients undergoing ESRD therapy indicate that the psychosocial well-being reported by older patients is at least as good as, and perhaps better than, the well-being reported by younger patients. These data reflect a health optimism generally characteristic of older persons, and ESRD patients' tendency to evaluate their functional status and their psychosocial well-being as largely independent domains. At the same time, availability of support from dialysis caregivers and from family members is acknowledged as a crucial variable affecting older patients' ability to successfully comply with treatment regimens and adjust to various ESRD therapies. Differential psychosocial outcomes related to older patients' sociodemographic characteristics are not well studied, but data from the United States show better perceived physical status and psychosocial well-being among older African-American patients than among older white patients on chronic dialysis. Suggestions are offered for methodological and conceptual refinements of research investigating the relation of age to psychosocial outcomes in ESRD.

Aged↗
PubMed1994

Older adults' perceptions of their health and functioning in relation to sleep disturbance, falling, and urinary incontinence.FICSIT Group.

OBJECTIVE: To investigate variation in older adults' perceived health and functioning that is associated with self-reported sleep disturbance, falling, and urinary incontinence, controlling for self-reported depression, ambulation difficulty, number of chronic conditions, and subjects' sociodemographic characteristics. DESIGN: Multicenter prospective study (FICSIT). SETTING: Persons age 70 and older living in the community evaluated at baseline. PARTICIPANTS: 239 women, 113 men; mean age = 77. MEASUREMENTS: Sleep disturbance score based on EPESE questions, recent falls history (Y/N), incontinent episodes (Y/N), CES-D score, SIP Ambulation score, and 4 MOS SF-36 scale scores. RESULTS: Women were significantly more likely than men to report multiple conditions (sleep disturbance, falling, incontinence) and to report lower levels of functioning as measured by 3 of 4 SF-36 scales. In regression analyses, sleep disturbance and urinary incontinence were significant predictors of perceived limitations in usual role activities because of physical health problems. Depression and ambulation measures significantly predicted scores on all 4 SF-36 scales. CONCLUSIONS: Our analysis suggests that it is important to address depressive symptomatology and ambulation difficulty--which in turn are related to sleep disturbance, falling, and urinary incontinence--in efforts to enhance older adults' perceived health and functioning.

Accidental Falls↗
PubMed1993

Development of the common data base for the FICSIT trials.

The eight FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) sites test different intervention strategies in selected target groups of older adults. To compare the relative potential of these interventions to reduce frailty and fall-related injuries, all sites share certain descriptive (risk-adjustment) measures and outcome measures. This article describes the shared measures, which are referred to as the FICSIT Common Data Base (CDB). The description is divided into four sections according to the four FICSIT committees responsible for the CDB: (1) psychosocial health and demographic measures; (2) physical health measures; (3) fall-related measures; and (4) cost and cost-effectiveness measures. Because the structure of the FICSIT trial is unusual, the CDB should expedite secondary analyses of various research questions dealing with frailty and falls.

Accidental Falls↗
PubMed1993

The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders.

This study examines the effect of two different exercise approaches on balance and frailty measures among more than 200 community-dwelling individuals greater than 70 years of age. Exercises are provided for 15 weekly sessions on an individual basis for participants randomly assigned to a Balance Training group. Training consists of center-of-mass feedback displayed on a motor under static conditions, or, in later sessions, as the floor surface is moved, with eyes open or closed. This high technology interface provides instantaneous information about displacement of body weight in space so that balance can be enhanced. An alternative procedure is comparatively simple and requires little expense or space. Tai Chi Quan was originally developed as a martial arts form but has been used for centuries in China as an exercise among elderly citizens. Participants randomly assigned to this intervention meet twice weekly for 15 weeks to learn a condensation of 108 Tai Chi forms into 10 that emphasize movement components often restricted or absent with aging. A third group serves as a control for exercise interventions by meeting weekly for 15 sessions to discuss topics of interest such as memory loss, drug management, and nutrition. All subjects are screened prior to assignment, and a host of physical, behavioral, and functional measures are assessed before and after the intervention as well as 4 months later. Measurements unique to the Atlanta site include: balance with eyes closed, programmed force-distribution changes when stance is perturbed, cardiovascular assessments, WAIS, Affects Balance Scale, and a survey of home environment.

Aged↗
PubMed1992

Assisted survival, aging, and rehabilitation needs: comparison of older dialysis patients and age-matched peers.

In Western societies a growing number of older persons have their lives extended by medical or surgical intervention. Older persons who suffer kidney failure and are maintained by chronic dialysis therapy are a good example. We compared 349 persons aged 60 years or older, who were on chronic dialysis, with 354 persons similar in age, race, gender, and geographic residence who were not undergoing dialysis. Recent health problems and demographic characteristics were included as control variables in all analyses. Older persons on dialysis reported more functional disability (as measured by ADL-mobility difficulty), less frequent walking for exercise, decreased ability to do the things they would like to do, and lower levels of perceived mastery over their lives. They were also more likely to report a need for health-related aids or services. The residual impairments of disabled elderly persons challenge rehabilitation professionals to address quality of life issues.

Activities of Daily Living↗
PubMed1992

Survival differences among older dialysis patients in the southeast.

Older end-stage renal disease (ESRD) patients treated by chronic dialysis have higher mortality in the United States than in many other countries. While increasing age, white race, male sex, and/or diabetes are considered risk factors for survival, few studies of older dialysis patients have simultaneously considered multiple predictor variables and their interactions. Using information contained in the 1982 to 1986 ESRD Network 20 database for Georgia and South Carolina, we studied hospitalizations and survival of 1,354 blacks and 965 whites who were age 60 years or older when they began dialysis therapy. Survival time was modeled using the Cox life-table regression method. Older blacks' median age at dialysis initiation was 67.4, compared with 68.7 for older whites (P = 0.001). Blacks were more likely than whites (P < 0.001) to have hypertension-related or diabetes-related ESRD. White patients experienced approximately 25% more hospitalization when adjustment was made for patient-days at risk. Separate multivariate survival models were required for patients with diabetes-related versus non-diabetes-related ESRD. Among diabetics, mortality was higher among whites and among patients who were older when they began dialysis. Among patients with non-diabetes-related ESRD, mortality was higher among patients who were older when they began dialysis, but the age effect was much stronger for white males. Our hospitalization and mortality data support the view that unmeasured severity (or frailty) differences characterize white as compared with black dialysis patients. Among non-diabetes-related ESRD patients, the age effect on survival was more severe in white males than in blacks or in white females. The high mortality we observed among older dialysis patients in Georgia and South Carolina warrants further study; the data may in part reflect patients' lower socioeconomic status compared with age, race, and sex-matched controls.

Aged↗
PubMed1992

Rehabilitation, aging and chronic renal disease.

Restorative management of the disabled elderly requires knowledge about realistic functional expectations, in addition to knowledge about a patient's particular disease. Health outlook, especially sense of control, should also be assessed because rehabilitation depends on the patient's active participation. A comparison of 349 older end-stage renal disease (ESRD) patients on chronic dialysis and 354 similar-age persons selected as a control group showed that significantly compromised physical function and health outlook were reported by the dialysis patients compared with the control group. Increasing exercise capacity and participation in dialysis self-care activity are recommended ways to improve physical functioning and health outlook among ESRD patients. Individuals who cannot perform strenuous activity can improve in level of fitness; improvements in anemia and muscle strength are key variables. Clinical application of therapeutic and rehabilitative strategies to improve physical function and health outlook in the geriatric renal patient is greatly needed.

Activities of Daily Living↗
PubMed1991

Employment status and ability to work among working-age chronic dialysis patients.

283 patients, age 18-59 years on chronic dialysis were interviewed about their current work status and their ability to work if currently not employed. Only 11% of the total sample was currently employed. However, one third of the nonemployed patients said they were able to work, and most of these patients had made an effort to be employed. Age, race, educational level, health status, and physical ability to perform job tasks, recent work experience, and interest in working were related to the reported ability to work. Patients who said they were able to work were also likely to be rated able to work by the medical director of their dialysis facility. The data indicate the importance of helping work-interested patients maintain their jobs when they start chronic dialysis treatment.

Adult↗
PubMed1990

Gender roles, medical practice roles, and ob-gyn career choice: a longitudinal study.

This paper discusses follow-up data from physicians who were studied ten years earlier when they were medical students. Seventeen physicians were practicing ob-gyn, and 57 of the physicians studied had been interested in an ob-gyn career when they were medical students. At Time 1, women were more likely than men to be strongly interested in ob-gyn, but they were no more likely than men to be ob-gyn physicians at Time 2. The desire to have a surgical specialty was much more important to men than to women practitioners. Men ob-gyn practitioners were significantly more traditional in their sex-role outlook as medical students than were either women practitioners or women who had been strongly interested in the field but did not enter it. The data suggest that women ob-gyn physicians are more likely than their male peers to be egalitarian in their relationships with female patients.

Career Choice↗
PubMed1990

Expectations and psychological needs of elderly dialysis patients.

Half of the patients currently beginning chronic kidney dialysis therapy each year in the United States are sixty years of age or older. This is expensive therapy, and patients must cope with limitations stemming from physical debilitation, disruption of normal living routines, and dialysis dependency. It is important, therefore, to investigate patients' views of the quality of their lives. As limitations associated with receipt of chronic dialysis are lessened, patients' overall psychological outlook tends to be increasingly positive. Adjustment problems may persist, however, for those who were especially active before their kidney failure and for those who are coping not only with their own physical adjustment to dialysis but also with family relationship problems. The social context of dialysis treatment can potentially compensate for several losses that often accompany aging, especially if dialysis staff have sufficient time and patience to address issues impacting the psychological well-being of their elderly patients.

Aged↗
PubMed1987

Social ties, social support, and perceived health status among chronically disabled people.

Social ties can be particularly useful to disabled people, but little is known about the nature of social support in this population. This study investigated social ties, perceived support, received support, and perceived health status in a sample of 332 disabled persons living in a southeastern metropolitan area of the U.S. Major disability groups represented were musculoskeletal, neuromuscular, cardiac, and end-stage renal disease. Size of kin networks was inversely related to respondents' socioeconomic status. Disabled women were less likely than disabled men to be married, more likely to be single-parent heads of household, and more likely to be socioeconomically disadvantaged. Perceived support from family was high for all respondents. Perceived health status did not vary with amount of perceived support, but within disability groups, perceived health status tended to vary with amount of received help.

Adolescent↗
PubMed1986

End-stage renal disease treatment modality and patients' quality of life. Longitudinal assessment.

Quality of life assessments were obtained at two 18-month follow-up intervals from 97 end-stage renal disease patients. Data were compared for three stable treatment groups (transplant, home hemodialysis, in-center hemodialysis) and for two transfer treatment groups (hemodialysis to transplant, hemodialysis to continuous ambulatory peritoneal dialysis). Home hemodialysis patients demonstrated the highest quality of life and lowest hospitalization rates over time. Transplant patients had higher employment and perceived health status but not necessarily higher subjective quality of life as compared to in-center hemodialysis patients, and transplant patients experienced more hospitalization. At follow-up, hemodialysis patients who obtained transplants assessed their quality of life as higher than did hemodialysis patients who went on continuous ambulatory peritoneal dialysis.

Adolescent↗