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Biomedical subjects

R G Cumming

Publications and source records attributed to R G Cumming.

At least 91 records · Page 5Linked to original sources
PubMed1996

Nursing home residence and risk of hip fracture.

This population-based case-control study was performed to determine whether the high incidence of hip fractures in people living in nursing homes is explained by the generally poor physical and mental health status of institutionalized older people. The study, which was conducted between 1990 and 1991, involved 209 hip fracture cases and 207 controls randomly selected from the same population in Sydney, Australia. Data on potential confounders were collected by using an interviewer-administered questionnaire. The age- and sex-adjusted odds ratio for the association between nursing home residence and risk of hip fracture was 2.4 (95% confidence interval 1.4-4.3). However, after adjustment for multiple confounders, the odds ratio was 0.6 (95% confidence interval 0.2-1.6). It appears that living in a nursing home is not an independent risk factor for hip fracture.

Aged↗
PubMed1996

Case-control study of hazards in the home and risk of falls and hip fractures.

The importance of environmental hazards in the home as risk factors for falls and fractures is uncertain. A case-control study was conducted, involving people aged 65 years and over referred to an occupational therapy department for home assessment. There were 52 subjects with a recent hip fracture, 43 fallers (subjects with two or more falls in the past year but no hip fracture), and 157 non-fallers (subjects without hip fracture and with fewer than two falls in the past year). Subjects' homes were assessed for environmental hazards by occupational therapists using a structured home assessment form comprising 35 potential hazards. Overall, the homes of fallers were no more hazardous than the homes of non-fallers. However, fallers with cognitive impairment had significantly more hazards in their homes than non-fallers with cognitive impairment. A wide range of environmental hazards was associated with hip fractures. Many of the findings of this study could be due to bias inherent in the case-control design. To overcome the inadequacies of observational studies for the investigation of home hazards and falls, randomized trials are recommended to determine if removing hazards reduces the risk of falls and fractures.

Accidental Falls↗
PubMed1996

Cohort study of risk of institutionalisation after hip fracture.

The purpose of this study was to describe the rate of permanent placement in aged care institutions (nursing homes and hostels) after hip fracture and to assess whether or not hip fracture is an independent risk factor for institutionalisation. It was a cohort study with median follow-up time of 14 months. Subjects were 291 people living in the community in western Sydney: 13] with hip fractures and 160 controls. Permanent admission to an aged care institution and/or death during follow-up was assessed by telephone interview with study subjects of carers. Data on potential confounders were collected with an interviewer-administered questionnaire at the time of recruitment into the study. During follow-up, 27 per cent of hip fracture cases and 5 per cent of controls were admitted to an aged care institution. The age- and sex-adjusted hazard ratio for hip fracture and institutionalisation was 5.1 (95 per cent confidence interval (CI) 2.2 to 11.9). Adjusting for multiple health-related factors reduced the strength of association but the hazard ratio remained high at 4.0 (CI 1.7 to 9.5). The risk of institutionalisation after hip fracture is high; this is only partly explained by the poor pre-fracture health status of many people who fracture their hips.

Aged↗
PubMed1996

Health status before and mortality after hip fracture.

A cohort study was done to determine the direct impact of hip fracture on mortality in older people. Survival was compared between 211 hip fracture patients from a defined area and 201 non-hip fracture control subjects randomly selected from the same area. The mortality rate 1 year after hip fracture was 21.7%; 1-year mortality in the comparison group was 4.7%. The crude hazard ratio for hip fracture and mortality was 4.0 (95% confidence interval [CI] = 2.2, 7.4); adjusting for multiple health-related variables reduced it to 3.3 (95% CI = 1.7, 6.5). This finding suggests that the observed excess mortality after hip fracture is not explained by poor prefracture health status.

Age Distribution↗
PubMed1994

Case-control study of risk factors for hip fractures in the elderly.

The objective of this population-based case-control study was to identify risk factors for hip fracture among elderly women and men, particularly factors during young and middle adult life. The study base comprised people aged 65 years and over living in a defined region in Sydney, Australia, during 1990-1991. Cases were recruited from 12 hospitals, and controls were selected using an area probability sampling method, with additional sampling from nursing homes. There were 416 subjects (209 cases and 207 controls); proxy respondents were needed for 27 percent of the subjects. Smoking, underweight in old age, overweight at age 20 years, and weight loss were associated with an increased risk of hip fracture. Consumption of dairy products, particularly at age 20 years, was associated with an increased risk of hip fracture in old age. Multivariate-adjusted odds ratios for quintiles of dairy product consumption at age 20 years were 1.0 (lowest quintile), 0.8, 1.8, 3.4, 2.9 (highest quintile). Caffeine and alcohol intake were not associated with hip fracture risk. Some of the results of this study were unanticipated and may be due to chance or bias. If confirmed by other studies, these results would challenge some current approaches to hip fracture prevention.

Aged↗
PubMed1994

The association between medications and falls in Australian nursing-home residents.

OBJECTIVE: To determine whether commonly used medications increase the risk of falling in elderly Australians living in nursing homes. DESIGN: Case-control study. SETTING: A 104-bed nursing home in western Sydney during 1990-1991. SUBJECTS: The cases comprised 71 people who had at least one fall during the 12-month study period; 55 people with no falls over the same period served as the control group. The mean age of subjects was 82 years. MEASURES: Data included medication use in the 24 hours prior to a fall, and assessments of ambulatory status, and gait and balance problems. All data were abstracted from medical records. RESULTS: After adjusting for potential confounders (age, sex, health status, depression, dementia, incontinence, ambulatory status, gait and balance problems, length of stay and use of other medications), the use of antipsychotics was found to be an important risk factor for falls (odds ratio 4.4, 95% confidence interval 1.2-16.5). CONCLUSIONS: Our results support the conclusion that antipsychotic medications increase the risk of falls among elderly Australians living in nursing homes. Health professionals should minimise the use of these medications.

Accidental Falls↗
PubMed1994

Aluminium in antacids and cooking pots and the risk of hip fractures in elderly people.

The relationship between hip fractures and aluminium in antacids and cooking pots was examined in an epidemiological study in Sydney, Australia. A population-based case-control study was conducted and 416 men and women aged 65 years and over were recruited (209 cases and 207 controls). There was a significantly (p < 0.05) increased risk of hip fracture associated with use of aluminium cooking pots at age 20 years: the age- and sex-adjusted odds ratio was 1.9 [95% confidence interval (CI) 1.1-3.2]. No association was detected between risk of hip fracture and current use of aluminium cooking pots or use at age 50. There was some suggestion that long-term use of aluminium-containing antacids might increase the risk of hip fracture: the adjusted odds ratio comparing those who had used aluminium-containing antacids for more than 10 years with those who had never used them was 1.8 (95% CI 0.8-4.1). The findings of this study support the need for further research on the association between oral ingestion of aluminium and risk of hip fracture.

Aged↗
PubMed1994

A study of the reproducibility of long-term recall in the elderly.

We assessed reproducibility of long-term recall (over periods of up to 82 years) by repeat interviews 1-3 months apart in 63 people age 65-95 years. We assessed weight, height, physical activity, smoking, reproductive factors, and consumption of alcohol, coffee, tea, milk, cheese, and fruit. Reproducibility was acceptable for most variables. Spearman rank correlation coefficients ranged from 0.95 to 0.36; kappas ranged from 0.97 to 0.35. Past physical activity was the least reproducible variable. Older age, cognitive impairment, and male gender were associated with reduced reproducibility.

Age Factors↗
PubMed1994

Fall frequency and characteristics and the risk of hip fractures.

OBJECTIVES: The 2 objectives of this study were to investigate the association between history of falls and risk of hip fracture and to identify characteristics of falls that determine whether or not a hip fracture will occur. DESIGN: Population-based case-control study. SETTING: Subjects were selected from the community and from nursing homes in Sydney, Australia. PATIENTS: There were 412 subjects (205 cases, 207 controls) in the part of the study concerned with falls frequency and risk of hip fracture (age range 65-100 years). Differences between hip fracture-related falls and other falls were studied in 209 cognitively intact subjects: 84 controls who had fallen at least once in the previous 3 years and 125 cases. MEASUREMENTS: Data were collected with an interviewer-administered questionnaire. MAIN RESULTS: There was a strong relationship between reported number of falls in the past year and risk of hip fracture. This relationship was stronger among men than among women. There was only 1 statistically significant fall characteristic associated with risk of hip fracture; falling while turning was much more likely to lead to a hip fracture than falling when walking in one direction (age- and sex-adjusted odds ratio: 7.9, 95% confidence interval: 1.4-43.0). CONCLUSIONS: (1) Taking a simple falls history is a useful way of identifying elderly people, particularly men, at increased risk of hip fracture; (2) The direction of a fall is an important determinant of hip fracture occurrence.

Accidental Falls↗
PubMed1993

Psychotropics, thiazide diuretics and hip fractures in the elderly.

OBJECTIVE: To determine whether psychotropic medications increase, and thiazide diuretics decrease, the risk of hip fractures in elderly Australians. DESIGN: Population-based case-control study. SUBJECTS AND SETTING: The population aged 65 years and over living in a defined area in western Sydney, Australia, during 1990-1991. Cases (n = 209) were recruited from hospitals and controls (n = 207) were selected by an area probability sampling method, with additional sampling from nursing homes. Response rates were 96% for cases and 84% for controls. MEASURES: Data were collected directly from subjects by questionnaire; a proxy respondent was required for 27% of subjects. In addition to medication use, information was also collected on potential confounders: alcohol consumption, body mass index, cognitive status, dairy product consumption, health status, physical activity, smoking history and type of residence. RESULTS: The use of temazepam, a short-acting benzodiazepine, was associated with an increase in the risk of hip fracture--odds ratio, adjusted for age, gender and residence is 3.78; 95% confidence interval (CI), 1.60-8.92. After adjusting for multiple potential confounders by logistic regression, the odds ratio for temazepam use was 3.52. There was a non-significant (P > 0.05) increase in hip fracture risk associated with the use of antidepressants and antipsychotics. Thiazide diuretics were not associated with a risk of hip fracture--the multivariate-adjusted odds ratio was 0.98 (95% CI, 0.49-1.99). CONCLUSIONS: Temazepam may increase the risk of hip fracture in elderly people. The effect of thiazide diuretics on fracture risk should be assessed in a large randomised trial.

Aged↗
PubMed1993

Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women.

The objective of this population-based case-control study was to clarify the relationships between parity, breastfeeding and ages at menarche and menopause and the risk of hip fracture among elderly women. The study base comprised women aged 65 years and over living in a defined region in Sydney, Australia, during 1990-1991. Cases (n = 174) were recruited from 12 hospitals and controls (n = 137) were selected using an area probability sampling method, with additional sampling from nursing homes. The age- and proxy-adjusted odds ratio (OR) comparing parous women who had never breastfed with nulliparous women was 2.11 (95% confidence interval (CI): 0.85-5.25). Among parous women, the age- and proxy-adjusted OR for ever versus never breastfeeding was 0.47 (95% CI: 0.22-0.99). There was a dose-response relationship between average duration of breastfeeding per child and risk of hip fracture (test for trend: P < 0.01). Age at menopause and age at menarche were only weakly associated with hip fracture risk. This study suggests that breastfeeding may protect parous women against hip fracture in old age.

Age Factors↗
PubMed1993

Epidemiological study of the relation between arthritis of the hip and hip fractures.

OBJECTIVES: To clarify the nature of the relation between hip fractures and osteoarthritis. METHODS: The study was a population based case-control study conducted in Sydney, Australia. Four hundred and sixteen men and women aged 65 years and over were recruited (209 cases, 207 controls). The presence of osteoarthritis was based on self reported pain, swelling, or stiffness of joints in the past year. RESULTS: Among 189 subjects aged 65 to 79 years, but not in older subjects, there was an inverse relation between self reported arthritis in any joint(s) and risk of hip fracture: the age and gender adjusted odds ratio was 0.52 (95% confidence interval 0.27 to 0.98). The prevalence of self reported arthritis of the hip was much lower in patients with hip fracture (4%) than in controls randomly selected from the community (13%); the age and gender adjusted odds ratio was 0.33 (95% confidence interval 0.15 to 0.74). There was also an inverse association between the number of joints reported to be affected by arthritis and risk of hip fracture. These associations were not explained by differences between cases and controls in body mass index or physical activity. CONCLUSIONS: The findings of this study support the hypothesis that there is a causal association between osteoarthritis and osteoporosis of the hip.

Aged↗
PubMed1991

Medications and multiple falls in elderly people: the St Louis OASIS study.

The purpose of this study was to identify associations between the use of commonly taken medications and groups of medications and the risk of falls in elderly people living in the community. A stratified random sample of 1358 persons aged 65 years and over was selected from the 15,000 members of an educational organization for functionally independent, community-dwelling elderly people in St Louis, Missouri. Twenty-seven per cent of subjects reported at least one fall in the past year and 8% reported two or more falls. After adjusting for potential confounders (including age, sex, relevant medical conditions, health status, cognitive impairment, use of alcohol, depression and use of other medications), the following medications were found to be important risk factors for multiple falls: diazepam [odds ratio (OR): 3.7, 95% confidence interval (CI): 1.5-9.3], diltiazem (OR: 1.8, 95% CI: 0.8-4.1), diuretics (OR: 1.8, 95% CI: 1.2-2.8) and laxatives (OR: 2.1, 95% CI: 1.0-4.5). We conclude that caution is needed before prescribing diuretics and psychotropics, especially diazepam, for elderly people. The safety of diltiazem in this age group should be assessed further.

Accidental Falls↗
PubMed1990

Calcium intake and bone mass: a quantitative review of the evidence.

The relationship between calcium intake and bone mass remains controversial. In this paper, the published research on this association is reviewed using the quantitative technique of meta-analysis. Selection of studies was based on defined eligibility criteria, and information relating to study design was recorded. Study results were converted, where necessary, to similar outcome measures so that direct comparison among studies was possible. A total of 37 eligible papers, representing 49 separate studies or parts of studies, were identified in the literature. Calcium had a consistent prevention effect on the rate of bone loss in the 12 studies of calcium supplements in postmenopausal women. This effect was greatest in studies in which the baseline calcium was low, supporting the idea of a threshold beyond which the effect of calcium is reduced. Cross-sectional studies showed a small but consistent positive correlation between calcium intake and bone mass. This association was greater in studies of premenopausal women. Some caution is needed in interpreting the results of this meta-analysis because of the poor quality of many of the studies reviewed. Nevertheless, the consistency of findings suggests that women in their early postmenopausal years will benefit from a high calcium intake.

Adult↗
PubMed1990

Methodologic issues in the study of frequent and recurrent health problems. Falls in the elderly.

In this paper the example of falls in the elderly is used to demonstrate methodologic difficulties that arise in the epidemiologic study of frequent and recurrent health problems. Issues discussed include whether the relevant outcome is the state of being a faller or the rate at which falls occur, misclassification of self-reported outcome data, the inadequacies of current terminology for describing certain study types and measures of frequency and effect from studies of recurrent events, the potential for outcome to influence exposure status in cohort studies of recurrent health problems, and the question of controlling for falls occurring prior to the study period. It is concluded that epidemiology needs to develop a framework for studying frequent and recurrent health problems.

Accidental Falls↗
PubMed1990

Is probability sampling always better? A comparison of results from a quota and a probability sample survey.

Two surveys in the same defined population in Sydney's western suburbs in 1986 and 1987 provided the opportunity to compare results obtained from a quota and a probability sample survey. These surveys were designed to provide information for the planning of local health promotion programs. The quota sample survey was conducted in shopping centres and used quota sampling to select 1727 respondents. In the second survey, area probability sampling was used to select 484 respondents. This survey had a response rate of 65 per cent. There were 15 questions common to both surveys; results of only three differed significantly (p less than 0.05) between surveys. None of these differences was important from a public health perspective. The agreement between the results of these two surveys probably reflects the fact that the same selection bias has operated in both. Unless a very high response rate can be achieved, quota sample surveys with age and sex quota controls may be an acceptable alternative to probability sample surveys for gathering local data relevant to the development of health programs.

Adult↗