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Biomedical subjects

S Studenski

Publications and source records attributed to S Studenski.

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

Predicting falls: the role of mobility and nonphysical factors.

OBJECTIVE: Our purpose was to test a four-domain predictive model of recurrent falls developed for this study. In this model, limited mobility is considered a necessary but not sufficient element in risk of recurrent falls. Three other domains, attitudinal, social, and environmental, are proposed to influence fall risk only in persons with impaired mobility. DESIGN: Prospective cohort study. SETTING: Veterans Affairs Ambulatory Care Service serving rural and urban central North Carolina. SUBJECTS: Male Veterans aged 70 or older (n = 306) were monitored prospectively for falls. At baseline, 159 screened as high-risk mobility status and 147 as low-risk mobility status. MEASUREMENTS: The primary outcome was recurrent falls. The mobility screen used for risk assignment defined immobile as unable to sit without support for 60 seconds, mobile and stable as meeting criteria for normal ambulation and stair climbing, and mobile but unstable as those who met neither of the above criteria. The high-risk subjects were further assessed in their homes for mobility in more detail, attitude toward risk, social supports, and environmental status. Other data included demographics, functional status, diagnoses, and medications. RESULTS: Recurrent falls occurred in 37 (23.3%) high-risk subjects and seven (4.8%) low-risk subjects (relative risk = 4.8, confidence interval 2.5 to 9.6, P < 0.001). Within the high-risk group, the probability of recurrent falls was significantly affected by degree of impaired mobility (P < 0.001), attitude toward risk (P = 0.005), and environment score (P = 0.03). CONCLUSIONS: A simple mobility screen can identify elders at increased risk for recurrent falls. Risk within this group is further modified by risk-taking behavior and environment.

Accidental Falls↗
PubMed1993

How do physiological components of balance affect mobility in elderly men?

The purpose of this study was to assess the relationship between physiological components of balance and mobility in elderly men without significant disease. Our a priori hypothesis was that physical function is influenced more by accumulated modest impairments than by a single deficit. We examined 39 ambulatory men (> 69 years). Subjects were classified functionally as high, intermediate, or low. Assessment included mobility functions (6-minute walk, mobility skills, reach, 10ft walk time) and physiological components of balance: sensory (vibration, proprioception, vision, vestibular), effector (ankle, knee, hip strength, range of motion), and central processing (response time to perturbations). All mobility functions were significantly (p < .05) different between groups. Impairments in components of postural control were rarely different between groups: the major differences were in ankle strength and visual fields. The number of impaired domains differed across the three groups. Nineteen percent of the low group had at least three domains impaired; none of the intermediate or high groups were impaired in three domains. Fifty-six percent of the low, 20% of the intermediate, and 7% of the high were impaired in two or more domains. Variability in specific mobility measures was also predicted by the number of impaired domains. The decline in physical function may be better explained by the accumulation of deficits across multiple domains than by any single specific impairment.

Accidental Falls↗
PubMed1993

When older adults face the chair-rise challenge. A study of chair height availability and height-modified chair-rise performance in the elderly.

OBJECTIVE: Define the range of community seating heights available for use by older adults; test whether raising chair height by small increments facilitates chair-rise performance; and heighten physician and furniture industry awareness of discrepancies that may exist between actual and acceptable chair heights for older adults. DESIGN: Phase 1: Survey of commercially available chair heights. Phase 2: Cross-sectional descriptive study of chair-rise ability. SETTING: Phase 1: Local furniture stores, physician offices, hospital waiting areas, and nursing homes. Phase 2: Postural Control Lab. PARTICIPANTS: Twenty-two volunteers (nursing home residents and community dwellers). EXCLUSION CRITERIA: inability to stand independently and inability to bear full weight on the lower extremities in the standing position. MEASUREMENTS: Chair rise success at six heights (17-22 inches), self-reported difficulty (visual analogue scale), change in minimum hip angle and maximum shoulder angle during rise, using motion analysis. RESULTS: Phase 1: Community chair heights ranged from 12 to 18 inches, with a mean of 16.3 in physician offices, 16.6 in nursing homes, 16.4 in hospitals, 17.3 in "kitchens" and 15 in "living rooms." Phase 2: As chair height increased from 17 to 22 inches, chair rise effort decreased, as shown by near doubling of percent successful rises, decline in mean self-reported difficulty score, increase in mean minimum hip angle, and decrease in mean maximum shoulder angle. CONCLUSIONS: Seating height may need to be more closely scrutinized in areas frequented by frail elders. Augmentation of seat height by small increments facilitates chair rise performance.

Activities of Daily Living↗
PubMed1993

Measuring rehabilitation outcomes.

The best way to measure the outcomes of rehabilitation in the older person depend on the health problem, the setting, and the way the data will be used. The process of selecting rehabilitation outcome measures can be based on purpose, clinical relevance, test characteristics, and practical considerations. There is no one best measure for all uses. A small set of measures that complement each other may be the most useful choice for the clinician wishing to measure the effect of treatment.

Activities of Daily Living↗
PubMed1992

Functional reach: predictive validity in a sample of elderly male veterans.

A new measure of balance, functional reach, has been recently developed. Functional reach is the maximal distance one can reach forward beyond arm's length while maintaining a fixed base of support in the standing position. Reliability, criterion, and concurrent construct validity of functional reach have been established. The purpose of this study was to assess the predictive validity of functional reach in identifying elderly subjects at risk for recurrent falls. Two hundred and seventeen elderly, community-dwelling male veterans (aged 70-104) underwent baseline screening and were followed for 6 months to monitor falls. Subjects with two or more falls during the 6-month follow-up were classified as recurrent fallers. Logistic regression reveals that if individuals were unable to reach, the adjusted odds ratio (OR) of having two falls was 8.07 (2.8-23.71); if their reach was less than or equal to 6 inches the OR was 4.02 (1.84-8.77); and if reach was greater than 6 inches but less than 10 inches the OR was 2.00 (1.35-2.98). The association between functional reach and recurrent falls was not confounded by age, depression, or cognition. We conclude that functional reach is a simple and easy-to-use clinical measure that has predictive validity in identifying recurrent falls.

Accidental Falls↗
PubMed1992

Clinical prognostic factors in lupus nephritis. The importance of hypertension and smoking.

BACKGROUND: Many previous studies of the influence of sociodemographic and clinical factors on the development of renal failure in patients with lupus nephritis have been based on selected subgroups of patients and have yielded conflicting results. We sought to determine the prognostic importance of patient demographic characteristics (age, gender, race, and socioeconomic status), smoking status, and hypertension in the development of end-stage renal disease (ESRD) among patients with lupus nephritis. METHODS: This retrospective cohort study followed an inception cohort of 160 adults with lupus nephritis. The outcome measure was the development of ESRD, defined as the institution of maintenance dialysis or measurement of a creatinine clearance of 10 mL/min or less. Life-table analysis was used to determine differences between patient subgroups in the time to development of ESRD. RESULTS: End-stage renal disease developed in 41 (26%) of 160 patients followed up for a median of 6.4 years. Hypertension and smoking status at the onset of nephritis were strongly associated with differences in the time to development of ESRD. The median time to ESRD among patients with moderate to severe hypertension (diastolic blood pressure, greater than or equal to 105 mm Hg) was 7 months, among patients with mild hypertension (diastolic blood pressure, 90 to 104 mm Hg) it was 146 months, and among normotensive patients it was greater than 273 months. The median time to ESRD among smokers was 145 months and among nonsmokers it was greater than 273 months. These effects persisted in multivariable analyses adjusting for differences among patients in age, gender, socioeconomic status, renal histology, and immunosuppressive treatment. The independent effects of hypertension and smoking resulted in shorter times to renal failure among patients who were both hypertensive and smoking, compared with nonsmoking hypertensive patients. The development of ESRD did not differ among patient demographic subgroups. CONCLUSION: Patient demographic characteristics had no detectable impact on the rate of progression to ESRD in this cohort. Hypertension and smoking appear to be important, potentially modifiable, factors influencing the prognosis of patients with lupus nephritis.

Adult↗
PubMed1991

Postural responses and effector factors in persons with unexplained falls: results and methodologic issues.

Automatic postural responses and effector factors were examined in 10 persons with unexplained falls after clinical examination and 24 older controls. Fallers were more unstable than controls on clinical tests of balance (20% of fallers vs 79.2% of controls were able to stand on one foot (P less than .005), 40% of fallers and 100% of controls were stable while turning in place (P less than .001), postural stress test median score was 12 for fallers and 20 for controls (P less than 0.001). We found prolonged tibialis anterior latency (fallers 158.8 +/- 23.7, controls 143.2 +/- 15.7 milliseconds, P = 0.03), marked losses in ankle strength (dorsiflexion: faller 3.2 +/- 2.9, controls 8.9 +/- 4.2 foot-pounds, P less than 0.001; plantarflexion: fallers 7.9 +/- 5.3, controls 21.4 +/- 11.1 foot-pounds, P less than 0.001), and decreases in range of motion (ankle plantarflexion: fallers 29.2 +/- 7.0, controls 37.8 +/- 12.4 degrees, P = 0.02). Gastrocnemius latency and electromyographic (EMG) measures of sequence showed no differences between fallers and controls. Sequence measures were not symmetric between the lower extremities in either fallers or controls. In this population of persons with unexplained falls who demonstrated substantial impairments in functional balance, effector factors appear more impaired than automatic postural responses. Alternatively, contemporary analysis of automatic postural responses may require further development before it can be useful to study balance problems in older persons.

Accidental Falls↗
PubMed1991

The time course of acute psychiatric episodes in systemic lupus erythematosus.

Acute psychotic manifestations in systemic lupus erythematosus (SLE) have been considered usually to occur early in the course of illness, although these findings are primarily based on studies with few patients and limited lengths of observation. To further investigate the chronology of acute psychiatric disturbances in SLE, the time course of these episodes was examined in 36 patients over a median duration of observation of 72 months. Twenty-two of 36 (61.1%) initial psychiatric episodes occurred within the first year of diagnosis of SLE, although several patients experienced the initial onset of psychiatric manifestations several years after the onset of SLE. Recurrent episodes occurred in 10 of 36 patients at a median of 8 months after the initial episode. Although tending to occur early in SLE, primary acute psychiatric events may first occur in patients with long durations of illness, and the time of onset of these episodes does not appear helpful in their differential diagnosis.

Acute Disease↗
PubMed1990

Functional reach: a new clinical measure of balance.

A new clinically accessible measure of balance, functional reach (FR), is the difference between arm's length and maximal forward reach, using a fixed base of support. The purposes of this study were to (a) establish FR as a measure of the margin of stability versus the laboratory measure, center of pressure excursion (COPE); (b) test reliability and precision, and (c) determine factors that influence FR, including age and anthropometrics. We evaluated FR in 128 volunteers (age 21-87 years). FR was determined with a precise electronic device and a simple clinical apparatus (yardstick). FR correlates with COPE (Pearson r = .71) and is precise (coefficient of variation = 2.5%) and stable (intraclass correlation coefficient across days = .81). Age and height influence FR. FR is portable, inexpensive, reliable, precise, and a reasonable clinical approximator of the margin of stability. FR may be useful for detecting balance impairment, change in balance performance over time, and in the design of modified environments for impaired older persons.

Adult↗
PubMed1990

Electromyographic analysis of postural adjustments in two methods of balance testing.

The primary purpose of this study was to compare postural responses during two methods of balance testing: 1) a platform perturbation test (PP), with destabilizing forces of uniform magnitude given at the base of support, and 2) a postural stress test (PST), with destabilizing forces of increasing magnitude given at the waist. A secondary purpose was to examine the relationship between balance strategy scores and the patterns of muscle responses as determined by electromyographic analysis on the PST. Postural responses to backward sway of 17 healthy subjects, aged 60 to 79 years (means = 69.0, s = 5.3), were characterized bilaterally by EMG recording of the tibialis anterior, quadriceps femoris, gastrocnemius, and hamstring muscles. We examined three measures of bilateral postural responses: 1) latency to first muscle response (FR) among the four lower extremity muscle groups, 2) tibialis anterior muscle latency (TA), and 3) patterns of muscle responses. Our results demonstrated significantly shorter (p less than .001) TAs and FRs (in milliseconds) on the PST than on the PP (PST TA: = means = 80.3, s = 12.4; PP TA: = means = 142.6, s = 13.4; PST FR: means = 75.9, s = 10.4; PP FR: = means = 140.4, s = 13.6). The ankle strategy was the most frequently used pattern of muscle response during both the PP and the PST, but it occurred less frequently on the PST than on the PP (PP = 72.5%, PST = 50.9%) (p less than .05). No consistent relationship was observed between the balance strategy scores as determined by videotape analysis of the PST and the patterns of muscle responses as determined by EMG analysis.

Aged↗
PubMed1990

Are stressful life events risk factors for herpes zoster?

To determine if psychologically stressful life events are risk factors for herpes zoster, we conducted a case-control study of zoster and self-reported recent negative life events and major changes in spousal relationships. The subjects were 101 healthy community-dwelling cases of zoster and 101 healthy controls matched for age, sex, and race and generated by random digit dialing. The Geriatric Scale of Recent Life Events was administered to case and control subjects, and additional questions were asked regarding the perception of the life event. The results showed that case subjects experienced negative life events significantly more often than subjects in the control groups in the 2 months before zoster onset by analysis of discordant pairs (26 versus 10, odds ratio 2.60, 95% confidence interval [CI] 1.13, 6.27, P = .012), 3 months before (29 versus 11, odds ratio 2.64, 95% CI 1.20, 6.04, P = .007), or 6 months before (35 versus 16, odds ratio 2.00, 95% CI 1.04, 3.93, P = .012). The mean number of total life events was significantly higher in cases at 6 months before zoster (case means = 2.64, control means = 1.82, P = .008), but there were no significant differences at 2, 3, or 12 months before. There were no significant differences between case subjects and control subjects for spousal events, or any given single life event. In conclusion, we found that whereas patients with herpes zoster experienced the same kinds of life events in the year preceding the illness as did control subjects, recent events perceived as stressful were significantly more common among patients with zoster.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Systemic lupus erythematosus in men: a multivariate analysis of gender differences in clinical manifestations.

The marked gender influence on the occurrence of systemic lupus erythematosus (SLE) indicates that genetic and hormonal factors may be important in the etiology of this illness. However, few differences in clinical manifestations between males and females have been reported. To further investigate gender differences in SLE, the prevalence of 23 clinical manifestations of SLE were compared in a cohort of 62 men and 299 women. After adjusting for differences in age, race, and duration of followup, men were found to more commonly have seizures (odds ratio = 1.65; 95% confidence interval = 1.09, 2.49), and showed a trend to progress to renal failure more often (odds ratio = 1.40; 95% confidence interval = 0.96, 2.03) than women. Gender differences were not evident for the remaining 21 clinical features. The clinical similarity between men and women with SLE represents a circumstance in which the use of clinically defined patient subsets does not appear to facilitate the investigation of potential pathogenetic or etiologic factors.

Adult↗
PubMed1990

Clinical manifestations of systemic lupus erythematosus. Identification of racial and socioeconomic influences.

The identification of differences in the clinical manifestations of systemic lupus erythematosus (SLE) due to racial and socioeconomic factors has been hampered in previous studies by limitations in the numbers of black patients examined. We sought to define racial differences in the cumulative clinical manifestations of SLE in a large, racially balanced cohort (184 black patients and 174 white patients). Differences in the cumulative disease manifestations of SLE between black and white patients were evaluated by multivariate regression techniques, controlling for socioeconomic status and the potential confounding factors of age, gender, duration of follow-up, and treatments. Race was found to be an important factor influencing the prevalence of 9 of 24 clinical features of SLE. As a group, blacks more commonly manifested anti-Sm and anti-RNP antibodies, discoid skin lesions, and proteinuria, and less commonly manifested photosensitivity, than whites. Among specific age, gender, and socioeconomic subgroups, blacks were more likely than whites to have had psychosis, serositis, and urinary cellular casts, and less likely to have had sicca syndrome. Racial differences in the prevalence of renal failure were due to socioeconomic effects. These results suggest that race is under-recognized as a factor influencing the clinical heterogeneity of SLE.

Adult↗
PubMed1990

Age associated clinical manifestations of systemic lupus erythematosus: a multivariate regression analysis.

The influence of age on the prevalence of individual clinical manifestations of systemic lupus erythematosus (SLE) has not been adequately distinguished from racial or gender influences. Therefore, we examined variations in the clinical manifestations of SLE with age in a group of 361 patients. Multivariate regression techniques, including logistic regression and analysis of covariance, were used to identify clinical features associated with age, while controlling for important confounding factors, including race, gender, duration of followup, and treatment effects. Lymphopenia was found more frequently with increasing age, while malar rash, seizures, false-positive VDRL, thrombocytopenia (in whites), proteinuria (0.5-3.5 g/day), elevated antidouble stranded DNA antibodies, and hypocomplementemia were found less frequently. No age relationship was found for the prevalence of 16 of 24 clinical features examined, including the important disease manifestations of arthritis, serositis, psychosis, nephrotic-range proteinuria, renal failure, autoimmune hemolytic anemia, and leukopenia. The use of regression analysis allows the recognition of similarities and differences in cumulative clinical features of SLE due to age in isolation from the effects of other demographic factors.

Adult↗
PubMed1987

Survival in systemic lupus erythematosus. A multivariate analysis of demographic factors.

We analyzed survival rate and important clinical outcomes in 411 patients with systemic lupus erythematosus who were seen at our center between 1969 and 1984. All eligible subjects met 4 of the revised American Rheumatism Association criteria for systemic lupus erythematosus and all were seen within 2 years of diagnosis. Mean followup was 75.6 months. Multivariate analysis suggested significant independent effects of race (P = 0.0139) and socioeconomic status (P = 0.0326) on survival. No evidence of diminished lupus-related mortality with age was documented. Previously reported findings of improved survival rate with age may have been confounded by differences in race distribution between the younger- and older-onset groups.

Adult↗
PubMed1987

What is the clinical significance of bone loss in primary hyperparathyroidism?

To help determine the clinical significance of the bone loss associated with primary hyperparathyroidism, we studied the prevalence of vertebral fractures in a group of patients with this disorder. From a registry of parathyroidectomies, 206 cases were reviewed, and lateral chest roentgenograms were studied for the presence of fractures. All roentgenograms were interpreted by two of the investigators who were "blinded" to diagnoses. Comparisons of readings were made that assured interrater agreement. A group of patients who underwent cholecystectomy served as controls. Studied in a logistic regression analysis model, controlling for the effects of age, sex, and race, primary hyperparathyroidism was found to be significantly associated with vertebral fractures. Subgroup analyses performed on the patients with hyperparathyroidism failed to identify specific biochemical or clinical markers associated with fractures. Our results suggest that the bone loss of primary hyperparathyroidism is clinically significant, leading not only to decreased bone densities but also to an increased prevalence of fractures.

Adult↗