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R G Cumming

Publications and source records attributed to R G Cumming.

At least 19 recordsLinked to original sources
PubMed2007

Influence of fall related factors and bone strength on fracture risk in the frail elderly.

INTRODUCTION: When subjects are selected on the basis of fall risk alone, therapies for osteoporosis have not been effective. In a prospective study of elderly subjects at high risk of falls, we investigated the influence of bone strength and fall risk on fracture. METHODS: At baseline we assessed calcaneal bone ultrasound attenuation (BUA) as well as quantitative measures of fall risk in 2005 subjects in residential care. Incident falls and fractures were recorded (median follow-up 705 days). RESULTS: A total of 6646 fall events and 375 low trauma fracture events occurred. The fall rate was 214 per 100 person years and the fracture rate 12.1 per 100 person years. 82% of the fractures could be attributed to falls. Although fracture rates increased with decreasing BUA (incidence rate ratio 1.94 for lowest vs. highest BUA tertile, p<0.002), incident falls also affected fracture incidence. Subjects who fell frequently (>3.15 falls/per person year) were 3.35 times more likely to suffer a fracture than those who did not fall. Some fall risk factors such as balance were associated with the lowest fracture risk lowest in the worst performing group. Multivariate analysis revealed higher fall rate, history of previous fracture, lower BUA, lower body weight, cognitive impairment and better balance as significant independent risk factors for fracture. CONCLUSIONS: In the frail elderly, both skeletal fragility and fall risk including the frequency of exposure to falls are important determinants of fracture risk.

Accidental Falls↗
PubMed2006

Calcaneal ultrasound but not bone turnover predicts fractures in vitamin D deficient frail elderly at high risk of falls.

BACKGROUND: Biochemical markers of bone turnover have been reported to predict fracture risk independent of bone mass in postmenopausal women. We investigated their use in predicting fractures in the frail elderly. METHODS: Cases were 151 low trauma fractures. For each case, a control was selected marched for sex, age, institution type and follow-up period. We measured two bone resorption markers (serum ICTP and serum CTX-I) and two bone formation markers (serum PINP and serum BAP). Quantitative Ultrasound (QUS) was measured in the calcaneus. Fractures were ascertained by x-ray reports. RESULTS: The mean age of subjects was 86.8 years (+/- 5.8 SD) and 86% were female. 76% had hypovitaminosis D (a serum 25 hydroxy vitamin D (25OHD) level < 39 nmol/L) and 81% had BUA < 67.4 dB/MHz (corresponding to a BMD T-score < -2.5). No significant differences in bone turnover markers were detected between fracture cases and their matched controls. In contrast, there was a significant difference between cases and controls for both broadband ultrasound attenuation (BUA) and velocity of sound (VOS) (both P < 0.05). These results remained the same after adjusting for weight, lower leg length and walking aids as well as the higher falls incidence in cases than controls (average 2.7 vs 0.9 falls respectively; P < 0.001) during the follow-up period. CONCLUSION: In the frail elderly with vitamin D deficiency and high falls risk, calcaneal ultrasound but not markers of bone turnover were associated with fractures.

Accidental Falls↗
PubMed2005

A multivariate regression model predicted falls in residents living in intermediate hostel care.

BACKGROUND AND OBJECTIVE: To evaluate whether individual falls risk could be predicted in a frail elderly population. STUDY DESIGN AND SETTING: We developed and tested an assessment tool and falls risk score for predicting falls based on a multivariate regression model in a prospective cohort study of intermediate care residents. RESULTS: During the follow-up period, 1,736 falls by 1,107 subjects were recorded with an average of 170 falls per 100 person-years. Fifty percent of the study population had at least one fall within a year. Significant independent risk factors were poor balance, cognitive impairment, incontinence, higher illness severity rating, and older age. Twenty-two percent of participants with a falls risk score > or =7 accounted for 42% of the total falls, with a falls rate of 317 per 100 person-years. This rate was a sixfold increase from the falls rate of 52 per 100 person-years observed in participants with a score < 3. A high score (> or =7) indicated almost a 2 in 3 chance of falling, while a low score (<3) indicated approximately a 1 in 7 chance of falling within 6 months. CONCLUSION: The assessment tool and falls risk score could identify individuals in this frail elderly population at high risk of falls.

Accidental Falls↗
PubMed2005

Determinants of health-related quality of life in institutionalised older persons in northern Sydney.

It is recognised that the focus of health-care interventions for frail older persons should not be restricted to increasing longevity, but should encompass measures aimed at improving or maintaining the health-related quality of life (HRQoL) of these individuals. We studied the HRQoL profile of 612 frail older persons residing in nursing homes and hostels in northern Sydney, Australia, and sought to ascertain some of the factors that affect their perceived quality of life. Our findings suggest that common health states that may cause loss of independence and dignity (e.g. presence of osteoarthritis, presence of urinary incontinence, previous fracture, Parkinson's Disease and increasing frailty as reflected by residence in nursing homes) are strongly, and independently, associated with the HRQoL of institutionalised older persons. Some of these conditions may be amenable to intervention.

Aged↗
PubMed2004

Effects of cataract type and location on visual function: the Blue Mountains Eye Study.

PURPOSE: To measure the effect of cataract type, severity and location on presenting, and best-corrected visual acuity, contrast sensitivity, and glare disability. METHODS: In all, 3654 (82.4% participation rate) eligible noninstitutionalised residents aged 49 years or older, living in two postcode areas of the Blue Mountains, Australia, received detailed eye examinations including visual acuity, contrast sensitivity, and glare disability testing. Data from right eyes were analysed using multiple regression modelling. RESULTS: The effect of age on visual acuity and contrast sensitivity only became evident in persons aged at least 60 years. Cataract severity was inversely related to visual acuity and contrast sensitivity. Late posterior subcapsular cataract caused the greatest reduction in visual acuity. Early grade cataract caused significant reduction in contrast sensitivity at intermediate and high spatial frequencies, but late grade cataract reduced contrast sensitivity across all spatial frequencies. There was insufficient study power to detect consistent significant effect of cataract on glare disability tests or cortical cataract location on visual function. CONCLUSIONS: Age at least 60 years, cataract type, and cataract severity were principal determinants of visual acuity and contrast sensitivity in this study. Axial and superotemporally located cortical cataract had the greatest effect on visual function tests.

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PubMed2004

Serum parathyroid hormone predicts time to fall independent of vitamin D status in a frail elderly population.

Very frail older people constitute an increasing proportion of ageing populations and often have vitamin D deficiency. Falls are frequent in this population and have usually been associated with vitamin D deficiency. In this prospective study we measured serum 25-hydroxyvitamin D (25OHD), serum PTH, and falls in 637 ambulatory subjects living in institutional aged care facilities (intermediate-care hostels or nursing homes). The study sample comprised 121 men (mean age, 82.1 yr) and 516 women (mean age, 86.7 yr). Two hundred and seventy-four subjects fell one or more times over a mean duration of follow-up of 10.2 months. Vitamin D deficiency, defined as a serum 25OHD level below 39 nmol/liter was present in 73.6%. Baseline serum 25OHD and PTH were significantly associated with falls in univariate analyses. In multivariate analyses that also corrected for balance and health status, PTH remained a significant predictor of falls independent of 25OHD. Serum PTH is a predictor of time to first fall in the frail elderly independent of vitamin D status and measures of general health.

Accidental Falls↗
PubMed2004

Serum parathyroid hormone is associated with increased mortality independent of 25-hydroxy vitamin d status, bone mass, and renal function in the frail and very old: a cohort study.

Very frail older people constitute an increasing proportion of the aging population and often have vitamin D deficiency and impaired renal function. Primary hyperparathyroidism has been associated with increased mortality, but it is unclear whether secondary hyperparathyroidism is associated with increased mortality independent of renal function and vitamin D status. This study aimed to examine the effect of vitamin D deficiency and secondary hyperparathyroidism on mortality in frail older people after accounting for renal function and general measures of health. We evaluated 842 subjects (182 men with a mean age of 81.9 yr and 660 women with a mean age of 86.2 yr) living in residential aged care facilities in Sydney, Australia in a prospective, cohort study. Over a mean duration of follow-up of 31 months, 345 subjects died. Baseline serum 25-hydroxy vitamin D, serum PTH, and bone ultrasound attenuation were significantly associated with mortality in univariate and multivariate analyses (for PTH, a hazard ratio of 1.39 for time to death) after correcting for age and gender. In multivariate analyses that corrected for health status, nutritional status, and renal function, PTH remained a significant predictor of mortality but not 25-hydroxy vitamin D or bone ultrasound attenuation. Serum PTH appears to be associated with increased mortality in the frail elderly independent of vitamin D status, renal function, bone mass, and measures of general health. The mechanism of this effect requires further investigation.

Aged↗
PubMed2003

Adherence with hip protectors: a proposal for standardised definitions.

Definitions of adherence, also termed compliance, with use of hip protectors have varied in published studies, making interpretation of results difficult. This paper proposes standard definitions of adherence with the use of hip protectors. Adherence is the wearing of hip protectors in accordance with the recommendations of the study protocol, and is measured as the amount of time hip protectors are worn. When reporting use of hip protectors in clinical trials investigators should indicate the specific definition of adherence used, explicitly state the recommendation that was made for use of hip protectors during the study, and describe the methods of recording adherence.

Activities of Daily Living↗
PubMed2003

Five year incidence of cataract surgery: the Blue Mountains Eye Study.

AIMS: To assess the 5 year incidence of cataract surgery in an older population based prospective cohort. METHODS: 5 Year prospective follow up of the population based Blue Mountains Eye Study (BMES) performed in 1992. The follow up study examined 2335 survivors (75.1%) of the 3654 baseline participants. Baseline and 5 year slit lamp and retroillumination lens photographs were graded for presence of cortical, nuclear, or posterior subcapsular cataract using the Wisconsin cataract grading method and cataract surgery was documented from the history and the clinical examination. RESULTS: An overall cataract surgery rate of 5.7% in first or both eyes was documented. The incidence was 0.3% in people aged 49-54 years at baseline, 1.7% for ages 55-64 years, 7.9% for ages 65 to 74 years, and 17.4% in people aged 75 years or older. The rate of surgery in first or both eyes was 6.0% in women and 5.2% in men, age adjusted p = 0.66. Bilateral cataract surgery was performed during follow up on 2.7% of participants, while 43.1% of unilateral phakic cases had second eye surgery. Presence of any posterior subcapsular (PSC) cataract, either alone or in combination with other cataract types, was the most likely type of cataract at baseline to be associated with incident cataract surgery. Baseline age was the most important non-ocular variable predicting incident cataract surgery. CONCLUSIONS: This study has documented age specific rates for 5 year incident cataract surgery in an older community. The finding of relatively similar incidence rates and ocular predictors of cataract surgery to those reported by the Beaver Dam Eye Study, Wisconsin, United States, is of interest, given previous documented similarities between these two populations.

Age Distribution↗
PubMed2003

A randomised trial of hip protector use by frail older women living in their own homes.

OBJECTIVES: To investigate the efficacy and effectiveness of hip protectors in frail community living older women. DESIGN: Randomised controlled trial. SETTING: Aged care health services in New South Wales, Australia. PATIENTS: 600 women 74 years of age or more (mean age 83 years), who had two or more falls or one fall requiring hospital admission in the previous year, and who lived in their own homes. INTERVENTION: Use of hip protectors. MAIN OUTCOME MEASURES: Adherence with use of hip protectors, falls, incidence of hip fracture, and adverse effects of use of hip protectors. RESULTS: Adherence was approximately 53% over the duration of the study and hip protectors were worn at the time of 51% of falls in the intervention group. The risk of hip fracture when falling while wearing hip protectors, compared with a fall with no hip protectors in place, was significantly reduced (relative risk (RR) 0.23, 95% confidence interval (CI) 0.08 to 0.67). On an intention to treat analysis, 21 and 22 hip fractures occurred in the intervention and control groups respectively (adjusted RR 0.92, 95% CI 0.51 to 1.68). Three users of hip protectors sustained a hip fracture while wearing properly applied protectors, while 16 hip protector users (5%) developed minor local complications. CONCLUSIONS: Hip protectors prevent hip fractures in community dwelling older women if worn at the time of a fall. The overall effectiveness of hip protectors was not established in this study, because of incomplete adherence with use of the protectors, and limited statistical power.

Accidental Falls↗
PubMed2002

Risk factors for fractures of the wrist, shoulder and ankle: the Blue Mountains Eye Study.

Few studies have examined risk factors for fractures of the wrist, shoulder or ankle. The Blue Mountains Eye Study is a population-based longitudinal study in 3654 people aged 49 years or older resident in an area west of Sydney, Australia. Detailed eye examinations and interviews were carried out at baseline (1992-3) and after 5 years (1997-9). Information about fractures sustained during follow-up were collected by a combination of self-report and a search of hospital radiology records. After 4.7 years follow-up subjects had sustained 53 fractures of the distal forearm, 20 fractures of the proximal humerus and 33 ankle fractures. In multivariate models factors independently associated with wrist fractures in women were no vigorous exercise in the past 2 weeks (relative risk RR 0.4, 95% CI 0.2-0.9) and ever use of HRT (RR 0.4, 95% CI 0.1-1.0). Factors independently associated with ankle fractures were male sex (RR 0.3, 95% CI 0.1-0.8) and visual field loss (RR 2.8, 95% CI 1.2-6.6). These findings are in keeping with other studies, and suggest that different types of osteoporotic fracture have different, if overlapping, sets of risk factors.

Aged↗
PubMed2002

Quantitative ultrasound of the calcaneus and falls risk in the institutionalized elderly: sex differences and relationship to vitamin D status.

Very frail older people constitute an increasing proportion of aging populations and are likely to contribute substantially to costs due to osteoporosis. Quantitative ultrasound (QUS) of the calcaneus is potentially a simple method for assessing fracture risk in frail elderly, but there have been few studies of male/female differences in QUS or its relationship to falls risk or vitamin D status, which is often subnormal in this population. We studied QUS, falls risk and serum 25(OH)-vitamin D in subjects living in institutional aged care facilities (hostels or nursing homes). The study sample comprised 294 men (mean age 81.2 years, range 65-102 years) and 899 women (mean age 86.7 years, range 65-104 years). Broadband ultrasound attenuation (BUA) and velocity of sound (VOS) were higher in men than women by approximately 30% and 2% respectively ( p<0.0001) and this difference was maintained at all ages. Serum 25(OH)D levels were higher in men than women ( p<0.001) but vitamin D deficiency was very common in both sexes and serum 25(OH)D was not associated with QUS in either sex. There was no significant decline in BUA or VOS with age in men; however, for women BUA declined by 2.8-4.7% per decade and VOS by 1% per decade (both p<0.001). Mean BUA T-scores were -1.55 and -2.48 at age 90 years in men and women. Quadriceps strength and weight but not serum 25(OH)D were significantly associated with BUA. These data suggest only minor loss occurs at the calcaneal site in BUA and VOS with very old age in either sex.

Accidental Falls↗
PubMed2002

Factors associated with undercorrected refractive errors in an older population: the Blue Mountains Eye Study.

AIMS: To identify characteristics of people with clinically relevant undercorrected refractive errors. METHODS: The Blue Mountains Eye Study was a population based survey of 3654 Australians aged 49-97 years. Examinations included a standardised refraction and measurement of presenting and best corrected visual acuity. Clinically relevant undercorrected refractive error was defined as improvement of >/=10 letters (2+ lines on the logMAR chart) in subjects with presenting acuity 6/9 or worse. Associations with a range of demographic and ocular variables were explored, adjusting for age and sex, presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Undercorrected refractive error was present in 814/3654 subjects (10.2%). Older age (p <0.001), hyperopia (OR 1.45, CI 1.15 to 1.83), longer interval from last eye examination (p <0.001), past occupation as tradesperson (OR 1.64, 1.13 to 3.29) or labourer (OR 2.00, CI 1.39 to 2.89), receipt of government pension (OR 1.47, CI 1.12 to 1.94), and living alone (OR 1.34, CI 1.05 to 1.72) were all associated with undercorrected refractive error. Past or current use of distance glasses (OR 0.25, CI 0.20 to 0.32) and driving (OR 0.67, CI 0.52 to 0.86) were associated with a lower prevalence. CONCLUSIONS: Increasing age and measures of socioeconomic disadvantage and isolation were found to predict undercorrected refractive error. Given the documented impacts from correctable visual impairment, these findings suggest a need to target education and eye care services.

Age Factors↗
PubMed2002

Congenital abnormalities of the urogenital tract in association with congenital vertebral malformations.

There is a close link between the embryological development of the musculoskeletal system and all other main organ systems. We report a prospective series of 202 patients with congenital vertebral abnormalities and document the associated abnormalities in other systems. There were 100 boys and 102 girls. In 153 there were 460 associated abnormalities, a mean of 2.27 abnormalities for each patient. Intravenous pyelography was carried out on 173 patients (85.6%) and ultrasonography on the remaining 29 (14.4%). Patients with genitourinary anomalies were more likely to have musculoskeletal (p = 0.002), gastrointestinal (p = 0.02) and cardiac abnormalities (p = 0.008) than those without genitourinary involvement. A total of 54 (26.7%) had at least one genitourinary abnormality, the most frequent being unilateral renal agenesis. There was urinary obstruction in six (3%). There was no association between genitourinary abnormality and the place of birth, parental age, birth order, level of spinal curvature, or the number, type and side of spinal anomaly. There was, however, a statistically significant association (p = 0.04) between costal and genitourinary abnormalities. The incidence of genitourinary abnormalities (26.7%) was similar to that of previously reported series. The diagnosis of a congenital vertebral abnormality should alert the clinician to a wide spectrum of possible associated anomalies most of which are of clinical importance.

Abnormalities, Multiple↗
PubMed2001

Incidence of nursing home placement in a defined community.

OBJECTIVE: To assess cumulative incidence and non-cognitive factors predicting nursing home placement in a defined older population. DESIGN AND SETTING: Six-year follow-up of a population-based cohort living west of Sydney. PARTICIPANTS: 3654 non-institutionalised residents aged 49 years or older (82.4% of those eligible) participated in baseline examinations during 1992 to 1994. MAIN OUTCOME MEASURES: Permanent nursing home admission for long-term institutionalised aged care in New South Wales, confirmed by records of approvals by the regional Aged Care Assessment Team and subsidy payments by government. RESULTS: After excluding 384 participants who moved from the area or were lost to follow-up, 162 participants (5.0%) had been admitted to nursing homes on a permanent basis by October 1999. Of participants who died since baseline, 20% had been admitted to a nursing home before death. Of those alive, 1.6% were current nursing home residents. Six-year cumulative incidence rates for nursing home placement were 0.7%, 1.1%, 2.4%, 3.9%, 9.0%, 18.3% and 34.9% for people aged 55-59, 60-64, 65-69, 70-74, 75-79, 80-84 and 85 years or older, respectively. Non-cognitive factors at baseline predicting subsequent nursing home admission included each additional year of age (risk ratio [RR], 1.14), fair or poor compared with excellent self-rated health (RR, 2.9, 3.6), walking difficulty (RR, 3.6) and current smoking (RR, 1.9). People owning their homes had a decreased likelihood of nursing home placement (RR, 0.6). CONCLUSIONS: Incidence rates of institutional aged care doubled for each five-year interval from the age of 60 years. A range of non-cognitive factors predict nursing home placement.

Aged↗
PubMed2001

Visual impairment, age-related cataract, and mortality.

OBJECTIVE: To explore associations between visual impairment, cataract, and mortality in older persons after adjusting for other factors associated with mortality. METHODS: A population cohort of 3654 persons aged 49 years or older (82.4% of eligible residents in the Blue Mountains region, west of Sydney, Australia), were examined at the Blue Mountains Eye Study baseline period (1992-1994) and followed up 5 years later (1997-1999). Australian National Death Index data were used to confirm persons who had died since baseline. Associations between mortality and presence of visual impairment and cataract at baseline were assessed using the Cox proportional hazards regression model, controlling for age, sex, demographic and socioeconomic status, medical history, and health risk behaviors. RESULTS: By June 30, 1999, 604 participants (16.5%) had died. The age- and sex-standardized 7-year cumulative mortality rate was 26% among persons with any visual impairment and 16% in persons without visual impairment. After adjusting for factors found significantly associated with mortality, including age, male sex, low self-rated health, low socioeconomic status, systemic medical conditions, and negative health risk behaviors, the presence at baseline of any visual impairment was independently associated with increased mortality risk (risk ratio [RR], 1.7; 95% confidence interval, 1.2-2.3). The presence of age-related cataract, either nuclear (RR, 1.5), cortical (RR, 1.3), or posterior subcapsular cataract (RR, 1.5), was also significantly associated with increased mortality risk. These associations remained statistically significant when visual impairment and each type of cataract were included simultaneously in the multivariate Cox model. CONCLUSION: Visual impairment and age-related cataract may be independent risk factors for increased mortality in older persons.

Aged↗