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R Hammerman-Rozenberg

Publications and source records attributed to R Hammerman-Rozenberg.

17 recordsLinked to original sources
PubMed2006

Moderate renal insufficiency at 70 years predicts mortality.

BACKGROUND: Glomerular filtration rate (GFR) diminishes with age. Kidney function in the elderly is often assessed by serum creatinine alone, although it is insensitive in this age group. Formulae for predicting GFR are not widely used. AIM: To study the effect of low predicted GFR on mortality. DESIGN: Longitudinal cohort study. SETTING: The community-based Jerusalem Seventy Year Olds Longitudinal Study. METHODS: We studied 445 subjects, all aged 70 years, using questionnaires, a medical examination with history-taking, and standard laboratory tests. Moderate renal insufficiency was defined as a predicted GFR of <60 ml/min, based on the Cockcroft-Gault (CG) and the Modification of Diet in Renal Disease (MDRD) equations. RESULTS: Predicted GFR was normally distributed, with a mean +/- SD of 62.4 +/- 15.27 ml/min. Predicted GFR was <60 ml/min in 221 (46%), most of whom had normal serum creatinine. Twelve-year mortality was 38.7% in these 221 vs. 27% in the other 204. The survival advantage was already evident after 3 years. Under Cox proportional hazard analysis using numerous common risk factors as independent variables, lower predicted GFR had a significant mortality risk (hazard ratio 2.108, 95%CI 1.43-3.12, p = 0.0002). DISCUSSION: In community-dwelling elderly people, moderate renal insufficiency as assessed using the CG equation is a strong and independent predictor of mortality. Most of these at-risk patients have 'normal' serum creatinine.

Age Factors↗
PubMed2000

The effects of physical activity on mortality in the Jerusalem 70-Year-Olds Longitudinal Study.

OBJECTIVE: To study the association between physical activity and mortality in older men and women. DESIGN: A community-based cohort study: the Jerusalem 70-Year-Olds Longitudinal Study. PARTICIPANTS: A systematically selected and representative sample of all residents of the western part of Jerusalem born in 1920-1921: 456 subjects, 25% of the total population. MEASUREMENTS: An extensive social and medical profile was developed by extensive interview and physical and ancillary examination. Medical diagnoses were established and subjects reported their level of regular physical activity. RESULTS: Unadjusted mortality at 6-year follow-up was significantly greater for subjects reporting no regular exercise than for those walking as little as 4 hours weekly (23.4% vs 9.9%, odds ratio (OR) = 2.77; 95% confidence interval (CI), 1.64-4.69). The significance of these benefits was demonstrated for males as well as for females (30.28% vs 12.14%, P < .001, 16.19% vs 6.86%, P = .036, respectively). Logistic regression analysis demonstrated the survival advantage to be independent of gender, smoking, subjective economic hardship, or preexisting medical conditions (hypertension; diabetes; coronary artery, cerebrovascular, renal, and respiratory diseases; anemia; and malignancy). Increased regularity of activity correlated with declining mortality. The odds ratios for mortality compared to the sedentary group were 0.73 (CI, 0.33-1.62) for those doing sports activity at least twice weekly, 0.41 (CI, 0.19-0.91) for those walking at least 4 hours weekly, 0.14 (CI, 0.04-0.50) for those exercising daily, and 0.40 (CI, 0.22-0.72) for all levels of physical activity combined. CONCLUSIONS: These results suggest that regular physical activity confers increased survival in the aged. It is proposed that older people be encouraged to engage in regular, moderate physical activity.

Activities of Daily Living↗
PubMed1999

The siesta in the elderly: risk factor for mortality?

BACKGROUND: During the siesta, blood pressure declines like it does during night sleep. Because cardiovascular and cerebrovascular events cluster during the morning hours, when hemodynamic changes from nocturnal baseline are maximal, we hypothesized that an additional sleep period during the day (the siesta) may increase cardiovascular and cerebrovascular events, and thus mortality. METHODS: A prospective population-based cohort study of 455 70-year-old residents of Jerusalem, Israel, using self-reported siesta at baseline and 6 1/2 years of total mortality data. RESULTS: The prevalence of the practice of the siesta was 60.7%. It was more prevalent among men than women (68% vs 51%, P<.001) and in survivors of previous myocardial infarction than in those without previous myocardial infarction (78% vs 58%, P = .009). After 6 1/2 years of follow-up (1990-1996), 75 subjects died. For those who practiced the siesta, total mortality was 20% vs 11% for those who did not (P = .01; risk odds ratio, 2.0; 95% confidence interval, 1.1-3.4). In a multiple logistic regression model that included several lifestyle descriptors, risk factors, and diseases, the siesta remained predictive of mortality (P = .03; risk odds ratio, 2.1; 95% confidence interval, 1.1-3.9).

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PubMed1999

Independence in instrumental activities of daily living and its effect on mortality.

Factors relating to six-year mortality in a representative sample of seventy-year-old Jerusalem residents (N = 605) were investigated using logistic regression techniques. Around 16.3% of the study population died during the six-year post-interview period. Bivariate analysis found elevated mortality related to being male, having more than one IADL dysfunction, more than two ADL dysfunctions, financial problems, no social support in times of emergencies, bad self-rated health status, cognitive impairment, confinement to bed during the fortnight prior to interview, and lack of regular exercise. Logistic regression controlling for gender, various clinical diagnoses, financial state, social support and smoking status showed IADL (ROR = 4.57, 95% CI 1.51, 13.90), cognitive impairment (ROR = 3.99, 95% CI 1.85, 8.59) and having been bed-sick a week or more during the preceding fortnight (ROR = 6.60, 95% CI 1.00, 43.86) to be independent predictors of mortality. All persons who had a cognitive problem and were dysfunctional in more than two IADL categories, and 93.8% of persons who had been bed-sick and had more than one IADL dysfunction died during the study period. Combined measures of these three easily obtainable variables could prove a cheap and efficient method of identifying at-risk elderly persons in order to provide them with specific programs aimed at decreasing functional decline, and hence mortality.

Activities of Daily Living↗
PubMed1998

House calls.

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House Calls↗
PubMed1997

Home hospitalization in the spectrum of community geriatric care.

The Home Hospitalization Programme was initiated in Jerusalem in 1991 to provide intensive medical care at home in order to prevent or shorten hospitalizations. The programme was based upon regular home visits by physicians, and nursing assessment to determine the need for regular nursing care. Primary-care physicians and nurses were renumerated by a global monthly fee, and were on 24-h call in addition to their periodic visits. Patients were recruited by senior geriatric physicians from acute hospital wards, as well as from the community, at the family doctor's request. Ancillary services available to the home hospitalization team included laboratory and electrocardiographic testing, specialty consultations, physical occupational or speech therapy, social work and home help up to 3 h daily. Monthly visits by a senior physician provided oversight and further consultation. Home hospitalization grew out of the continuing care division of the Clalit Sick Fund, a health maintenance organization providing umbrella medical insurance and ambulatory care. The programme grew synergistically with the other facilities of continuing care to encompass a network of comprehensive services to acute, subacute and chronic patients both at home and in institutional settings. In 4 years this network succeeded in establishing the focus of subacute intensive care in the community, achieving high levels of patient and family satisfaction, as well as striking economic advantages. In its first 2 years of operation home hospitalization saved S4 million due to reduced hospital utilization, and preliminary data for the subsequent 2 years indicated that this trend continued. Home hospitalization became the hub of a far-reaching system of supportive, intensive and humane care in the community.

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PubMed1996

Decreased hospital utilization by older adults attributable to a home hospitalization program.

OBJECTIVE: To evaluate the cost effectiveness of a short-term home health care program for older people, Home Hospitalization (HH), compared with the alternative of regular ambulatory care with general or geriatric hospitalization as necessary. SETTING: Our HH was initiated in November 1991 to serve Jerusalem residents. Program staff included physicians, nurses, and paramedical professionals. Other medical/hospital services were provided nonselectively by the general medical personnel of the various hospitals in Jerusalem. STUDY DESIGN: Patients over the age of 65 were either referred to the HH program (study group, n = 36,500) or to routine medical care (control group; n = 9000) depending on their Sick Fund assignment. Hospital utilization rates per enrollee were studied prospectively and compared both between the two groups and with hospitalization rates in the year before the initiation of the program. RESULTS: During the first 26 months of operations, the HH program cared for 741 older persons for a total of 37,290 days' care at an average daily costs of $30.06 (1992) and $23.64 (1993). Annual general hospitalization rates per person declined in the study group from 2.80 days in the 1991 baseline period to 2.65 days in 1992 and to 2.54 days in 1993. Hospitalization rates in the control group increased from 2.62 in 1991 to 2.70 days/member and 2.71 days/member in 1992 and 1993, respectively. Annual geriatric hospitalization rates declined considerably in the study group from the 1991 baseline of 1.49 to 1.34 (1992) to 1.33 (1993). The control group experienced a small decrease from 1.64 (1991) to 1.58 (1992) and then a rise to 1.68 days per member in 1993. For the 26-month duration of the program, estimated savings of 20,773 general hospital days ($5.54 million) and 8486 geriatric hospital days ($0.98 million) exceeded its costs ($0.97 million), providing a cost/benefit ratio of 5.7/1. In addition, patient satisfaction was high. CONCLUSION: The HH program provided a cost effective substitute for care in a geriatric or general hospital for Jerusalem's elderly.

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PubMed1996

Findings from longitudinal cohort studies: Gothenburg and Jerusalem.

The longitudinal study of age-homogeneous cohorts is a powerful tool to elucidate age-related changes and to attempt to distinguish normal aging from the effects of disease. Many influences, such as the effect of changing lifestyle, medical practices and environmental factors with time must be considered when designing and interpreting such studies. Cross-cultural differences manifest in comparing different studies must also be accounted for, but alternately provide a tool to distinguish between endogenous and exogenous factors influencing human aging. The first stage of the longitudinal study of 70 year olds in Gothenburg, Sweden, a cross-sectional survey performed in 1971, is compared to a similar cross-sectional survey performed in Jerusalem in 1991 as part of a projected longitudinal study. The similarities between the two cohorts with regard to living conditions, functional independence and disease prevalence are striking. There are also significant contrasts that reflect the 20 years that elapsed between the execution of the two studies, as well as the cultural and social differences. In particular, the ethnic diversity of the Jerusalem population, hailing from 40 separate countries, is emphasized. The comparison of these two studies highlights many of the principles critical to the role of longitudinal cohort studies in gerontology.

Activities of Daily Living↗
PubMed1996

Laboratory reference values for the 70 year olds.

Reference values for common laboratory tests were determined as part of a cross-sectional survey of 70 year olds in Jerusalem in 1991. Subjects were systematically chosen from electoral lists. They were extensively interviewed regarding demographic, socioeconomic and health characteristics. Subsequently, 456 underwent a thorough medical examination including hematologic, biochemical and endocrinologic testing. Analysis of disease-specific mortality and hospital morbidity at 3 year follow-up proved these subjects to be representative of the overall Jerusalem Jewish population of 70 year olds. Test-specific reference subgroups were determined to exclude effects of known diseases and drug consumption. Reference values in these subgroups differ significantly from reference values currently used for adults without regard to age. The determination of disease for subjects provided the opportunity to identify changes that might reflect normal aging and those that might be affected by subclinical pathology. Interpretation of laboratory testing of older adults must consider the age-related differences in reference values.

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PubMed1996

The Jerusalem 70 year olds longitudinal study: gastrointestinal findings.

The objective of this part of the first cross-section of the longitudinal study of a cohort of 70 year olds in Jerusalem was to survey the gastrointestinal symptoms and signs of this heterogeneous population and thus contribute to the knowledge of the development of gastrointestinal diseases in this age group. A total of 605 persons replied to a home-visit questionnaire gathering data on socioeconomic and migration variables. Later on, 463 of these attended an examination at the Geriatric Research Institute where an in-depth anamnesis and physical examination were conducted. A battery of biochemical and hematologic blood tests were performed as well as urine analysis, ECG, and pulmonary function tests. At 3 year follow-up, the interviewed subjects, subjects examined in the hospital, and the control group consisting of 70 year olds who were not examined, were compared. By the measures of disease-specific mortality and hospital morbidity, the three groups were found to be similar, demonstrating that the sample population does represent the total Jerusalem 70-year-old population. This paper describes the symptoms, signs and laboratory results of the gastrointestinal part of this study. Up to a third of the subjects complained of upper gastrointestinal symptoms, most prominent of which was heartburn. Almost 10% of subjects complained of abdominal pain occurring at least once a week, but less than 1% noted left lower quadrant pain. There was a direct association between upper abdominal pain and symptoms of ischemic heart disease. The second part of this study, which began in 1996, will provide additional information regarding the natural history of these complaints.

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PubMed1996

Determinants of loneliness in Jerusalem's 70-year-old population.

This study aims to find the determinants of feelings of loneliness in 70 year olds living in Jerusalem. Results based on home interviews (n = 605) of a 40% systematic sample of 70 year olds in the electoral register showed that around 46.3% of females and 21.3% of males reported being lonely. Persons of European/North American origin felt less lonely than those of Asian or African origin, probably due to the former's wider social support network, perceiving friends, neighbors or other relatives as being available to back up children in an emergency. The major factors associated with loneliness were: being depressed, having a poor self-assessed health status, not attending synagogue, and being widowed but not remarried. Factors that did not reduce loneliness included having paid employment, watching TV or listening to the radio. No association was found between cognitive status and loneliness. Our systems model suggests a strong reciprocal relationship between loneliness and depression.

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PubMed1995

The Jerusalem seventy-year-old longitudinal study. I: Description of the initial cross-sectional survey.

The main objectives of our first cross-section of a longitudinal study of a cohort of 70 year olds in Jerusalem, are to survey the social and medical conditions of the heterogeneous elderly population and to contribute to the knowledge of aging processes for specific age-groups. Whereas, most previous surveys were conducted on homogeneous and stable population groups, the elderly of Jerusalem provide the basis for ethnographic comparisons and for assessing the impact of profound historical and personal changes. From a representative systematic sample (from a geographically sorted electoral register) of 759 persons, 605 persons replied to our home-visit questionnaire gathering data on migration history, dwelling conditions, health status, health service utilization, employment status, activities of daily living, social support, use of drugs and war experience. Later on, 463 persons attended our geriatric research institute where we gathered information from in-depth anamnesis and physical examination, as well as cognitive and psychological tests. In addition, a battery of biochemical and hematological blood tests were performed as well as urine analysis and culture, ECG and pulmonary function tests. The heterogeneity of our cohort population is demonstrated by the finding that 84% were born in 40 different countries outside of Israel. In contrast, in the seventy-year old population studied in Gothenburg, Sweden, only 3% were not native born. In the years 1996, 2001 and 2006, our initial study cohort will be re-examined and compared to control groups representing states of no-survey intervention until ages 75, 80 and 85 years old. This background paper describes the study design, protocols and procedures. The responders were found to be representative of the 70 year old Jewish population in Jerusalem as a whole, in terms of mortality and hospital utilization rates. The results of the study to be reported in subsequent papers will allow conclusions regarding all 70 year old Jews in Jerusalem to be made.

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PubMed1995

The Jerusalem seventy year olds longitudinal study. II: Background results from the initial home interview.

Basic background information is presented from a representative sample of 605 West Jerusalem Jewish residents aged 70 years in 1990/91. A followup survey of the original cohort is planned for 1996, in addition to a similar sized control group of persons not studied in 1990/91. This paper describes the demographic characteristics, marital status, household composition, migration patterns, language comprehension, education, employment status, religious practices, household conditions, health status, health service utilization, health practices, use of medications, social contacts and activities of daily living of the study population. Only 16% of the study population were born in Israel, the remainder were born in forty different countries in four continents. This article also presents some ethnic comparisons within our cohort. Some significant differences were found between ethnic sub-groups in self-reported chronic diseases. However, many of these differences disappeared when socio-economic covariates were considered. Differences were also found when specific countries were considered. Compared to Polish-born Jews, Moroccan-born Jews had lower economic status, less education, more family contacts and less faith in physicians. Moroccan-born Jews also reported more morbidity for cerebrovascular disorders, emphysema and glaucoma.

Activities of Daily Living↗