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Biomedical subjects

V Mor

Publications and source records attributed to V Mor.

At least 91 records · Page 5Linked to original sources
PubMed1995

Psychotropic use among older residents of board and care facilities.

OBJECTIVE: To describe patterns of psychotropic use as well as clinically relevant and concurrent nonpsychotropic use among older residents of board and care facilities in 10 states. METHODS: Weighted use rates were based on data from a sample of 2054 residents aged 65 and older from 410 facilities in 10 states, drawn via a complex, multistage sampling design. Data, including drug name, use frequency, and PRN use, were collected on all drugs taken by the resident during a 7-day period. During face-to-face interviews with residents and/or proxies, data were also collected on resident characteristics. SUBJECTS: The majority of subjects were female, white, and widowed. Average age was 82 years. Approximately 25% had a current mental or emotional condition, and 8% had been hospitalized for a psychiatric condition during the year before admission. More than half needed help with at least one activity of daily living. Forty percent had moderate or severe cognitive impairment, and 18% had received mental health care during the previous year. ANALYSES: Weighted descriptive analyses were performed with Software for Survey Data Analysis (SUDAAN), which accounts for the complex, multistage sampling design. RESULTS: Approximately 35% of the older residents used at least one psychoactive agent, with 30% of psychotropic users receiving two to four different psychotropic medications. Use rates decline with age, for psychotropics overall and for therapeutic classes. Results revealed potentially problematic polypharmacy in relation to drug duplication within therapeutic classes, use of multiple psychotropics across classes, and concurrent nonpsychotropic use. CONCLUSIONS: Compared with community-dwelling older adults, this study revealed high psychotropic use rates among older board and care facility residents. Overall, our results suggest that serious consideration be given to the apparent need for systematic drug utilization review, a potentially useful program that is mandated in other settings.

Aged↗
PubMed1995

The impact of age on the quality of life in persons with HIV infection.

The authors administered the Medical Outcomes Study (MOS 20) Short Form Health Survey to 369 persons with HIV disease. The MOS survey measures six domains of health: physical function, role function, social function, mental health, health perception, and pain. Additional data included sociodemographics, HIV risk group, time since HIV diagnosis, symptoms (dyspnea, diarrhea, fever, chills, sweats, weight loss, weakness, numbness, memory trouble, seizures), and CD4 lymphocyte count within 3 months of the MOS survey. Bivariate analyses revealed worse MOS scores associated with older age in five health domains: physical function (p less than .01), health perception (p <.10), role function (n.s.), social function (n.s.), and mental health (n.s.). Older subjects reported less pain. When controlling for CD4 count and for sociodemographic and clinical variables, older age was significantly (p less than .05) associated with worse MOS scores in physical function, social function, and health perception, nonsignificantly associated with worse MOS scores in role function and mental health, and nonsignificantly associated with less reporting of pain.

Adolescent↗
PubMed1995

Medicare nursing home residents with a stroke. Characteristics and 90-day outcomes of care.

The objective of this article is to describe the characteristics and outcomes of Medicare patients admitted to nursing homes with a primary diagnosis of stroke. This study used longitudinal clinical information prospectively collected in National Health Corporation (NHC) nursing homes on admission and at discharge or death. In total, 2,345 residents met the following study criteria: age 40 and over, newly admitted from a general hospital to a NHC home under Medicare, and previously living in the community. The outcomes were functional status and discharge disposition within 90 days. By 90-days postadmission, 27.4% remained in the nursing home, 22.4% had gone home, 25.7% had been readmitted to a general hospital, 8.7% had entered another facility, and 15.6% of the patients with stroke had died. Residents who went home showed the greatest improvement in functional status in Barthel Index scores, from 35.2 (SD21.1) to 47 (SD 25.6); 20% were totally dependent and only 34% scored above 60 on the index. Further study is needed to examine the functional outcomes of stroke survivors over the longer term and compare the relative effectiveness of nursing home interventions with other postacute care options.

Activities of Daily Living↗
PubMed1995

Longitudinal patterns of medical service use and costs among people with AIDS.

OBJECTIVE: This study examines the effect of race, HIV transmission group, and decedent status on the use and cost of inpatient and outpatient care among people with AIDS. DATA SOURCES: Data come from 914 people with AIDS who were receiving services in nine cities across the United States in 1990-1991 and who indicated that a hospital clinic was their usual source of care. Review of hospital medical and billing records provided data on use and costs of medical services over an 18-month period. Vital status was determined from hospital records and death certificates. STUDY DESIGN: Data from each respondent were aggregated into three-month intervals, beginning with the last quarter of data and working backward. Regression analyses using random-effect models and generalized estimating equations were conducted to assess temporal patterns of inpatient and outpatient use and costs. PRINCIPAL FINDINGS: Inpatient utilization and costs were higher for decedents than for nondecedents. However, differences between decedents and nondecedents varied as a function of race. Nonwhites had more inpatient use and higher costs than whites, but lower outpatient use, and these differences were greater among decedents. Inpatient nights and costs rose sharply in the six months prior to death. Outpatient use and costs did not display as strong a temporal trend. CONCLUSIONS: Much of the cost of treating HIV infection is concentrated in the period immediately preceding death. The intensity of service use in the terminal period should be considered when developing estimates of annual costs of care and when designing programs to provide community-based treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1994

The psychosocial impact of cancer on older versus younger patients and their families.

Past studies of the psychosocial aspects of cancer have been largely descriptive, with little discussion of differences among cancer patients. Age differences have been noted repeatedly in studies of the effects of various cancer treatments. To determine whether age differences are also present the prevalence of various psychosocial problems often associated with cancer, analyses of data obtained from several different studies of Rhode Island cancer patients' psychosocial conditions were conducted, comparing the responses of older and younger patients. Psychosocial factors examined included multiple measures of functional quality of life, emotional well-being, social consequences, knowledge and use of formal services, and familial reactions. The studies examined included newly diagnosed patients and those undergoing outpatient radiation or chemotherapy for recurrent disease. Except in functional status measures, older persons with cancer manifested fewer and less severe psychosocial problems. The authors contend that older patients have fewer competing demands on their time and resources than do younger patients. This, along with different expectations, may mitigate the negative impact of the specific psychosocial consequences of the disease and its treatment.

Adult↗
PubMed1994

MDS Cognitive Performance Scale.

BACKGROUND: Chronic cognitive impairment is a major problem in U.S. nursing homes, yet traditional assessment systems in most facilities included only limited information on cognitive status. Following the Congressional mandate in the Omnibus Reconciliation Act of 1987 (OBRA '87), U.S. nursing homes now complete the Minimum Data Set (MDS), a standardized, comprehensive assessment of each resident's functional, medical, psychosocial, and cognitive status. We designed a Cognitive Performance Scale (CPS) that uses MDS data to assign residents into easily understood cognitive performance categories. METHODS: Information was drawn from three data sets, including two multistate data sets constructed for the Health Care Financing Administration. The prevalence and reliability of the MDS cognitive performance variables were established when assessed by trained nursing personnel. Five selected MDS items were combined to create the single, functionally meaningful seven-category hierarchical Cognitive Performance Scale. RESULTS: The CPS scale corresponded closely with scores generated by the Mini-Mental State Examination and the Test for Severe Impairment, nursing judgments of disorientation, and neurological diagnoses of Alzheimer's disease and other dementias. CONCLUSIONS: The new CPS provides a functional view of cognitive performance, using readily available MDS data. It should prove useful to clinicians and investigators using the MDS to determine a resident's cognitive assets.

Activities of Daily Living↗
PubMed1994

Nursing home special care units: distribution by type, state, and facility characteristics.

We used the 1991-92 Medicare and Medicaid Automated Certification Survey (MMACS) to document the distribution of nursing home special care units by type, state, and facility characteristics. Of the 16,105 facilities in our sample, 9.5% have at least one of eight types of specialty care units. Overall, special care beds as a percentage of total beds vary from 0.0% in South Carolina to 11.43% in Idaho. More non-profit facilities have special care units than for-profits (12.0% vs 8.5%), and more chain-affiliated facilities than independent facilities. Issues of access, efficacy, and cost are considered.

Certification↗
PubMed1994

An investigation of nonresponse to self-assessment of health by older persons. Associations with mortality.

This study examined the association between mortality and nonresponse to questions about health status (both refusals and "don't know" responses) using a national sample of persons aged 70 and over. Data were drawn from the 1984-1990 Longitudinal Study of Aging. Three time points of vital status were used as the outcome indicators (1984-1986, 1984-1988, 1984-1990). Five self-assessment questions were examined; three of the five questions had bivariate odds ratios that indicated significant associations between a nonresponse and all three mortality indexes. Results of the study suggest that nonresponses by older persons can convey meaningful information. Research on self-assessments of health in later life should not routinely exclude nonresponses as missing data, even if they are an infrequent response.

Aged↗
PubMed1994

Functional transitions among the elderly: patterns, predictors, and related hospital use.

OBJECTIVES: This paper describes 6-year rates and correlates of functional change in the elderly, as well as associated hospital use. METHODS: The Longitudinal Study on Aging (n = 7527) and matched Medicare claims were used to calculate 6-year functional status transition rates and hospital use rates. A hierarchical measure that incorporated activities of daily living, instrumental activities of daily living, and competing risks of institutionalization and death was used to assess functional status. Multinomial logistic regression was used to predict 1990 status. RESULTS: The functional status of 12% of men and women 70 to 79 years of age who were initially impaired in instrumental activities of daily living improved, and about half of the initially independent people in that age group remained so. Multivariate analyses revealed that age, baseline functioning, self-rated health, and comorbidity predicted 1990 status. Both baseline functioning and functional change were related to hospitalization. CONCLUSIONS: This study supports others that have shown some long-term functional improvement, but more commonly decline, in the elderly. Furthermore, it documents the link between functional decline and increased hospital use.

Activities of Daily Living↗
PubMed1994

The outcomes of patients newly admitted to nursing homes after hip fracture.

OBJECTIVES: The outcomes of elderly, hospitalized patients discharged to nursing homes after hip fracture were examined. METHODS: For 2624 hip fracture patients admitted to any of 43 proprietary nursing homes between 1984 and 1988, admission assessments were examined in relation to 1-month outcomes. RESULTS: Mean patient age was 82 +/- 7 y; 85% of the sample were female. Within 1 month after discharge, 24% had returned home, 12% had been rehospitalized, 3% had died, and 61% remained in the nursing home. Characteristics significantly associated with morality included disorientation, functional dependency, neurologic diagnoses, and use of cardiac medications, antidepressants, or narcotics. Rehospitalization was significantly associated with age, gender, living with someone, being ambulatory, and functional dependency. Returning home was associated with younger age, living with someone, being ambulatory, and having no disorientation, functional dependency, or psychiatric or neurologic diagnoses, nor any pressure sores. CONCLUSIONS: Better-functioning persons and those with social support returned home; physically and cognitively impaired persons and those taking narcotics, cardiac medications, or antidepressants were likely to die; and younger men, those with social support, those with functional dependency, and those who were free of disorientation were more likely to be rehospitalized.

Activities of Daily Living↗
PubMed1993

Physician use among patients receiving cancer chemotherapy.

BACKGROUND: Little research has examined the volume and pattern of physician use or the scope of multiple physician use in patients with cancer. METHODS: The authors studied a sample of 259 patients with advanced cancer who received outpatient chemotherapy at two hospital clinics and eight private oncology practices. RESULTS: These patients reported regularly seeing an average of three different physicians an average of 15 times in 3 months. The number of physicians seen was strongly correlated with the number of reported visits (r = 0.65). Demographic and disease characteristics were associated only moderately with visit volume. Patients without a regular physician had a less concentrated pattern of visits to many doctors than did those with a regular doctor. CONCLUSIONS: This pattern of physician use among active treatment patients has not been described before and has implications for continuity of care.

Adult↗
PubMed1993

Perceived needs and unmet needs for formal services among people with HIV disease.

This study presents estimates of the prevalence of perceived needs and unmet needs among people with HIV disease in the United States for six areas of community services: mental health, drug treatment, home care, housing, transportation, and entitlements. The prevalence of service needs and unmet needs within racial, gender, drug use history, and other subgroups was also examined. The study is based on a nonrandom cross-sectional sample of 907 people with HIV disease interviewed between November 1988 and May 1989 in nine major urban areas of the United States. Respondents reported high levels of need and unmet need across a variety of service areas. One third or more of all respondents reported a need for mental health services (57%), housing (39%), entitlements (34%), and transportation (32%). Within each of the six service areas, 40% or more reported unmet need. Women, people of color, and injected drug users were more likely to report unmet service need in a number of areas. Given the limitations of the sampling and the focus on current needs, these estimates may represent a lower bound on the magnitude of service need and unmet need within this population.

Activities of Daily Living↗
PubMed1993

Depressed mood and care preferences in patients with AIDS.

Eight hundred ninety-seven patients with AIDS seen in ambulatory settings were questioned about whether they would accept a nursing home or a respirator if necessary to prolong their lives. Two hundred ninety-one (32.9%) said they would accept a nursing home; 102 (11.5%) said they would accept a respirator. Acceptability of these life-sustaining interventions was significantly lower in those patients who showed evidence of clinical depression on a structural screening instrument (nursing home: 29.4% vs 39.5%, p = 0.002; respirator: 9.4% vs 14.3%, p = 0.032). Depression remained significant in multivariate models of care preferences that controlled for demographics and symptom severity. Based upon follow-up interviews conducted an average of 11 months later, subjects who were initially depressed and found nursing home care unacceptable were significantly more likely to have changed their minds at follow-up if their depression was no longer present (45.7% vs 28.4%; p = 0.0005). Findings for respirator preferences were similar, but did not attain significance. We conclude that assessment for depression is essential when advance directives for care are elicited from patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Measurement of need for assistance with daily activities: quantifying the influence of gender roles.

This research quantified the contribution of traditional gender roles to patient-reported receipt of assistance with personal care activities, housework, cooking, shopping, transportation, and administrative activities among a sample of 629 cancer patients with advanced disease who were undergoing outpatient treatment. Approximately 80 percent of male patients and 30 percent of female patients attributed help received with household tasks to longstanding division of labor. This response was particularly common among married men and did not differ by age or educational status. However, available morbidity indicators suggest that approximately one-third of these patients actually were functionally impaired, despite attribution to gender role expectations. We adjusted estimates of need for assistance to avoid overestimation due to role-related help, and a second time to avoid underestimation due to underreporting of physical inability to perform a task alone. After making these adjustments, male patients' level of need for assistance with traditionally female-associated tasks was reduced by approximately 50 percent.

Activities of Daily Living↗