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Biomedical subjects

S L Tennstedt

Publications and source records attributed to S L Tennstedt.

At least 19 recordsLinked to original sources
PubMed2001

ACTIVE: a cognitive intervention trial to promote independence in older adults.

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial is a randomized, controlled, single-masked trial designed to determine whether cognitive training interventions (memory, reasoning, and speed of information processing), which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions, can affect cognitively based measures of daily functioning. Enrollment began during 1998; 2-year follow-up will be completed by January 2002. Primary outcomes focus on measures of cognitively demanding everyday functioning, including financial management, food preparation, medication use, and driving. Secondary outcomes include health-related quality of life, mobility, and health-service utilization. Trial participants (n = 2832) are aged 65 and over, and at entry into the trial, did not have significant cognitive, physical, or functional decline. Because of its size and the carefully developed rigor, ACTIVE may serve as a guide for future behavioral medicine trials of this nature.

Activities of Daily Living↗
PubMed2000

Empowering older patients to communicate more effectively in the medical encounter.

Active involvement of patients in medical encounters has been associated with several desirable outcomes, including greater satisfaction, increased adherence to treatment, and positive treatment outcomes. Older patients, particularly the very old and less well educated, are more likely to place physicians in a dominant role and themselves in a submissive role. Intervention trials to increase patient involvement have shown positive results. Activation interventions with older patients to increase a sense of control and self-efficacy are promising. Most of the attention to improving doctor-patient interaction has been directed toward physicians. The results of these few intervention trials support increased attention to patient behaviors.

Aged↗
PubMed1998

Quality of the caregiver--care recipient relationship: does it offset negative consequences of caregiving for family caregivers?

This study examined whether relationship quality mediates, moderates, or both mediates and moderates the associations between caregiving stressors (e.g., disability and behavioral problems) and negative consequences associated with caregiver well-being (overload, role captivity, and depression). Data on family (spouses and children) caregivers (n = 118) came from a longitudinal study of a representative sample of disabled older people and their primary caregivers. Relationship quality mediated the linkages between the presence of problem behaviors and the outcomes of role captivity and depression. That is, when problem behaviors were present, they related to higher levels of captivity and depression because quality of the relationship suffered. Relationship quality moderated the linkage between disability and overload. Specifically, for those with a higher quality of relationship, increased disability was related to higher levels of perceived overload.

Adult↗
PubMed1998

The role of religion/spirituality in coping with caregiving for disabled elders.

This study examined how religious/spiritual coping was related to specific conditions of caregiving and psychological distress among 127 informal caregivers to community-residing disabled elders. Support was found for the hypothesis that religious/spiritual coping influences caregiver distress indirectly through the quality of the relationship between caregiver and care recipient. Caregivers who used religious or spiritual beliefs to cope with caregiving had a better relationship with care recipients, which was associated with lower levels of depression and role submersion.

Adaptation, Psychological↗
PubMed1998

Intensity and correlates of fear of falling and hurting oneself in the next year: baseline findings from a Roybal Center fear of falling intervention.

Fear of falling is highly prevalent and associated with restricted activity. To help inform design of interventions, the authors examined the correlates of this fear. Data came from baseline information on subjects in a community-based falls intervention study (N = 392). In a multivariate model, lower levels of fear of falling and hurting oneself in the next year were related to being younger, having higher levels of dysfunction, and having lower levels of perceived ability to manage falls, with the last two remaining significant even after controlling for generalized fearfulness. When analyzing specific domains of dysfunction, higher levels of fear of falling and hurting oneself in the next year were associated with higher levels of physical dysfunction. The findings lend support to the expanding awareness that fear of falling may imperil quality of life and suggest the importance of interventions aimed at enhancing ability to manage falls.

Accidental Falls↗
PubMed1997

Subject-caregiver response comparability on global health and functional status measures for African American, Puerto Rican, and Caucasian elders and their primary caregivers.

Ethnic differences in response comparability and bias were evaluated for elderly African American, Puerto Rican, and non-Hispanic Caucasian elderly subjects with some degree of disability and their caregivers. Responses were compared for items assessing basic and instrumental activities of daily living, memory problems, confusion, and global health status. In general, for all ethnic groups, response comparability, based on kappa, was only poor to fair, with the lowest agreement found for items assessing memory problems and confusion. When disagreements occurred, caregivers tended to overestimate impairment relative to the elderly subjects, regardless of ethnicity. However, there were very few significant differences between the response patterns of the caregivers of these different ethnic groups. Thus, although three may be bias in the responses of caregivers relative to elderly persons, in general further bias is not introduced by ethnic differences in comparability of caregiver responses for elders with some degree of disability.

Activities of Daily Living↗
PubMed1997

Meaning in caregiving and its contribution to caregiver well-being.

This multivariate study examined the relationship between meaning in caregiving--positive beliefs about the caregiving situation and the self as caregiver--and the psychological well-being of 131 informal caregivers to community-residing frail elders. Measures of well-being included depression, self-esteem, mastery, role captivity, and loss of self. Meaning in caregiving explained a significant portion of the differences in depression and self-esteem scores even after demographic and stressor variables had been controlled. Meaning was not related to mastery, role captivity, or loss of self. The conceptual parameters of meaning in caregiving are discussed, as are directions for future research.

Adult↗
PubMed1995

A comparison of anlaytic methods for non-random missingness of outcome data.

Missing outcome values occur frequently in survey data and are rarely missing randomly. Depending on the pattern of missingness, the choice of analytic method has implications for accuracy of the estimated outcome distribution as well as multivariate models. Data from a study of patterns of care in disabled elders were used to evaluate several common methods when missingness of the outcome was nonrandom. Results from single and multiple model-based imputation were compared with results from complete-case analysis and mean imputation. By ignoring nonrespondents' covariate information, the latter two methods yielded biased estimates of population means. Mean imputation and single model-based imputation underestimated standard errors by treating imputed values as if they were observed. Mean imputation also distorted the relationship between the outcome and predictors. Multiple model-based imputation provided an easily implemented method of adjustment for non-random non-response in both univariate and multivariate analyses.

Activities of Daily Living↗
PubMed1995

How costly is it to care for disabled elders in a community setting?

This article describes the total cost of care, including both informal caregiving and formal services for a cohort of disabled elderly living in the community. The cost of informal caregiving hours was calculated using a market value approach. The total annual cost of caring was estimated to be $9,600. Increased disability was associated with increased costs. High-cost elders were more likely to be severely disabled, live with their caregiver, and become institutionalized. For most elders, even the cost of a complete substitution of informal care for formal services, plus living expenses, was less costly than nursing home care.

Aged↗
PubMed1995

The everyday impacts of providing informal care to dependent elders and their consequences for the care recipients.

Longitudinal data were used to identify the relationship between different areas of negative impact and elder and caregiver characteristics. The extent and predictors of persistence and development of negative impact in different areas and the relationship between caregiving impact and subsequent caregiving patterns, including termination of care and institutionalization of the elder, were also examined. Caregiving exerted the greatest toll on a caregiver's personal life reported by 61%, in comparison to family life (18%), or employment (15%-20%). Those at particular risk of negative impact included offspring and other-relative caregivers who resided with the elder. All areas of negative impact persisted over time but did not result in any major disruption in care for the elder. However, those elders whose caregivers experienced personal impact were twice as likely to be institutionalized.

Aged↗
PubMed1994

Understanding dental service use by older adults: sociobehavioral factors vs need.

OBJECTIVES: This study investigated correlates of dental care use in a representative sample of adults aged 70 and older throughout New England. METHODS: Data were collected in in-home interviews and dental examinations. Following Andersen's behavioral model of health services utilization, varied measures of sociodemographic characteristics, dental health attitudes and practices, perceived need for care, and need objectively determined by clinical examination were included as potential correlates. RESULTS: Recency of last visit was associated with positive attitudes toward dental care, regular dental hygiene, and having a usual source of care. Among dentulous subjects, recency of last visit also was related to sex and living arrangements. Frequency of visits for dentulous subjects was associated with the same variables, as well as with age and social class or education, in addition to need for care. For edentulous subjects, only a usual source of care and higher social class were associated with more frequent visits. CONCLUSIONS: Perceived need and attitudes toward dental care are important influences on use of care. Older persons must be convinced of the importance of regular dental care.

Activities of Daily Living↗
PubMed1994

Do characteristics of informal caregivers affect the length of hospital stay for frail elders?

Studies examining the length of hospital stay for the very old rarely include characteristics of the informal caregiver as potentially explanatory variables. This study expanded a frequently used conceptual model of health services use to include caregiving factors as enabling variables. Data were collected from a representative sample of frail elders who had been hospitalized in the previous 18 months (n = 181) and their primary informal caregivers. The findings indicate that elders whose primary caregiver was a coresiding offspring had shorter hospitalization than elders whose offspring caregiver lived in different households. These data indicate that the amount of variance explained by this conceptual model is increased when social factors are included as explanatory variables.

Adult↗
PubMed1993

Oral health status of the elderly in New England.

The New England Elders Dental Study (NEEDS) reports the prevalence, extent and severity of oral diseases and conditions among a representative sample of community-dwelling elders age 70 and older residing throughout the six New England states. In-home, full-mouth examinations were conducted by four calibrated dentists who used National Institute of Dental Research (NIDR) standardized disease measures plus additional diagnostic codes on all tooth surfaces. Only 37.6% of elders age 70 and older were edentulous, while dentate elders had a mean number of teeth per person ranging from 21.5 to 17.9 across age and gender cohorts. The prevalence of untreated coronal decay in elders with teeth was 28% in female elders and 34% in male elders. More than 90% of all elders with teeth had coronal fillings and 22% exhibited untreated root caries. Periodontal destruction was substantial, with 66% of dentate elders exhibiting moderate periodontal pockets (4-6 mm) while 21% exhibited severe periodontal pocketing (> 6 mm). Comparisons with national surveys suggest that periodontal disease prevalence and severity appear to have been underestimated in previous national studies of the elderly. Because of aging and tooth retention trends, the periodontal disease problem of the elderly may be increasing in the face of dentists' tendency to underdiagnose the periodontal diseases, legal constraints on dental hygienists to independently treat them, and inadequate funding for conservative nonsurgical therapies.

Aged↗
PubMed1993

Determining the pattern of community care: is coresidence more important than caregiver relationship?

Researchers have previously emphasized the importance of kinship tie to explaining the pattern of care received by a disabled elder. For example, it has been argued that spouses are a distinct group of caregivers, i.e., they provide more care with less help from others and experience more stress. However, based on the theory of primary group structures and functions, this study hypothesized that coresidence rather than the kinship tie is more important in determining the pattern of caregiving. When spouses are compared to other coresiding caregivers, patterns of informal care and use of formal services are similar. Variance in amounts of informal care is explained by elder gender and frailty level rather than by caregiver relationship. Similarly, level of frailty was the only important predictor of use of formal services.

Activities of Daily Living↗
PubMed1993

Beneath the surface of coronal caries: primary decay, recurrent decay, and failed restorations in a population-based survey of New England elders.

A cross-sectional study was conducted of the oral health status of a random sample of community dwelling elders, aged 70 and older, living within the six New England states. Four examining teams, each composed of a trained and calibrated dentist and a field technician, collected data during an in-home oral examination. The prevalence of carious, filled, recurrent decayed, and non-carious but failed restored coronal surfaces was recorded. For the 1,151 respondents, the mean DFT was 6.16 (SD = 6.96) and the mean DFS was 18.83 (SD = 23.37), with 37.6 percent of the sample edentulous. Eleven percent of the population had 70 percent of the coronal decay. Males (OR = 2.2, CI = 1.3-3.8) and elders with less education (OR = 1.8, CI = 1.0-3.0) were at higher risk for three or more surfaces of coronal decay. Recurrent decay was present in 16 percent of the dentate population. However, more noncarious but failed restored coronal surfaces (332) were recorded in the population of New England elders than were surfaces of recurrent decay (234). The New England elders have higher rates of decay than New England children, although the rates matched those of previous national studies. The findings signal a need to develop targeted preventive regimens for older adults and greater understanding of dental treatment needs of elders.

Aged↗
PubMed1993

Tobacco use: a modifiable risk factor for dental disease among the elderly.

OBJECTIVES: Because the public health literature contains few analytic studies of modifiable behavioral risk factors for dental disease among older community-dwelling populations, the New England Elders Dental Study was undertaken as an epidemiologic study of the oral health status of a representative sample of older adults living within the six New England states. METHODS: Five dentists conducted comprehensive in-home oral health examinations on 1156 community-dwelling adults aged 70 and older to determine whether lifetime use of tobacco products was a significant risk factor for tooth loss, caries, and periodontal disease. RESULTS: Among New England elders, tobacco use was more common among men (18.1%) than women (7.9%), with a combined rate of 12.3%. Further, 64.7% of men and 36.6% of women were previous tobacco users. Years of exposure to tobacco products was a statistically significant risk factor for tooth loss, coronal and root caries, and periodontal disease, regardless of other social and behavioral factors. CONCLUSIONS: Lifelong tobacco use is a modifiable risk factor for poor dental health among older adults. Dental practitioners need to intervene with all their adult patients to discourage use of tobacco products for oral as well as general preventive health care.

Aged↗