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Biomedical subjects

V Mor

Publications and source records attributed to V Mor.

At least 145 records · Page 8Linked to original sources
PubMed1990

The Senior Care Study. A controlled trial of a consultative/unit-based geriatric assessment program in acute care.

Successful models of inpatient geriatric assessment have often involved long hospital stays, specialized interdisciplinary care, and prolonged follow-up, which are difficult to achieve within a prospective payment system. A randomized clinical trial was undertaken to evaluate the efficacy (maintenance or improvement in mental, emotional, and physical function) of using a geriatric assessment process in acute hospital care without increasing hospital charges or lengths of stay. Four hundred thirty-six patients greater than or equal to 75 years of age were randomly allocated to treatment (n = 221) or control (n = 215) conditions. Patients in the treatment group were admitted to a special unit and evaluated on admission by an interdisciplinary team, which developed a care plan. Although primary care was provided by the patient's own physician, the team followed the patients as consultants on the unit in the hospital, and by telephone for 2 months after discharge. The control group was placed on other units and received usual hospital care. The treatment and control groups were similar at study entry. At follow-up, there were no significant differences between the groups with respect to lengths of stay, hospital charges, mortality, change in physical function, or change in mental function. The treatment group changed more often in measured emotional function (chi 2 = 6.213, P = .045). This study indicates that it is feasible to implement consultative interdisciplinary team care in the acute-care hospital, but that its efficacy may be limited when applied to an unselected group of older patients.

Activities of Daily Living↗
PubMed1990

Multiple stumbles: a risk factor for falls in community-dwelling elderly. A prospective study.

To better understand risk factors for falls among community-dwelling elderly, we analyzed data from a sample of elderly Medicare beneficiaries interviewed in 1987 and a year later. Demographic, social, medical, and functional information were obtained by telephone interviews with 736 subjects (68% women) whose average age was 76.5 (range, 65-99). At baseline, 63 subjects reported a fall and 67 reported two or more stumbles without a fall in the past month. At the second interview follow-up information on falls in the past year was obtained on 586 subjects. One hundred twenty-seven (22%) subjects reported one or more falls. Baseline risk factors that were independent predictors of a fall at the second interview included two or more stumbles (adjusted odds ratio [AOR] 2.3, 95% confidence interval [CI], 1.2-4.5), one or more falls (AOR 5.9, 95% CI 2.9-12.2), having spent 4 or more days in bed in the past month (AOR 7.7, 95% CI 1.9-31.0), and self-reported declining health status (AOR 2.0, 95% CI 1.1-3.5). Falls and stumbles are prevalent among community-dwelling elderly. After controlling for covariates, we found subjects who reported two or more stumbles in the past month are at increased risk for a fall in the following year.

Accidental Falls↗
PubMed1990

A hierarchical exercise scale to measure function at the Advanced Activities of Daily Living (AADL) level.

Standard functional assessment instruments often fail to capture subtle impairment in community-dwelling older persons. To create a scale to measure function at the Advanced Activities of Daily Living (AADL) level, we chose three questions to separate a community sample into four levels: frequent vigorous exercisers (8.0%), frequent long walkers (10.8%), frequent short walkers (23.7%), and nonexercisers (57.5%). These levels of exercise formed a hierarchical scale that correlated positively in a graduated manner with progressively advanced social activities of daily living, current health status, and mental health. At 1-year follow-up, 20% of persons declined in exercise level, 63% showed no change in exercise level, and 17% improved their exercise level. Changes in exercise level in both directions were associated with changes in mental health status. The Advanced Activities of Daily Living scale may be a sensitive measure of earlier functional decline, but longer follow-up will be necessary to determine its clinical usefulness.

Activities of Daily Living↗
PubMed1990

A comparison of hospice vs conventional care of the terminally ill cancer patient.

Hospice is an alternative system of end-stage oncological care emphasizing palliative care, the patient and family as the unit of care, and the administration of care by an interdisciplinary team. Since its inception in the US in the early 1970s, hospice has evolved from a grass-roots social movement to a legitimate component of the health-care system, primarily serving a white, "young-old" cancer patient population under a variety of organizational arrangements. Data from the National Hospice Study compares medical and social service receipt by patients served in hospice and non-hospice settings during their last two weeks of life. Results indicate that patients served by conventional oncological care were more likely to receive diagnostic tests, chemotherapy, radiation therapy (for non-palliative purposes), surgery, and respiratory therapy than hospice patients. Social service interventions were more likely to be reported by hospice than non-hospice patients.

Analgesics↗
PubMed1990

The influence of patient age on the diagnosis and treatment of lung and colorectal cancer.

We examined the relationship between patient age and medical care received by patients diagnosed with the following two common cancers: non-small-cell lung cancer and colorectal cancer. Controlling for the influence of sex, marital status, presence of comorbid disease, and socioeconomic status, we found that age was not related to the diagnostic tests ordered for either cancer type. However, lung cancer patients with local disease who were older than age 74 years underwent definitive surgical treatment less often than did younger patients. Few patients at any age (less than 9%) with colorectal cancer did not undergo definitive surgical treatment. Patients with regional colorectal disease who were older than 74 years of age underwent radiation therapy to the abdomen less often than did younger patients. These results add to the growing body of literature suggesting that older cancer patients are less likely to undergo the same type of care received by younger patients.

Age Factors↗
PubMed1989

Risk of functional decline among well elders.

Active lifestyles may delay the onset of the functional consequences of chronic disease, potentially increasing active life expectancy. We analyzed the Longitudinal Study of Aging (LSOA) to test the hypothesis that elders participation in an active lifestyle prevents loss of function. Focusing on the cohort aged 70-74 who reported being able to carry 25 lb, walk 1/4 mile, climb 10 steps and do heavy housework without help and without difficulty at baseline, decline was defined as no longer being able to perform these tasks independently and without difficulty 2 years later. Using multivariate logistic regression, results reveal that those who did not report regularly exercising or walking a mile were 1.5 times more likely to decline than those who did, controlling for reported medical conditions and demographic factors. Similar findings (with different models) were observed for both men and women. Findings suggest the potential value of programs oriented toward the primary prevention of functional decline.

Aged↗
PubMed1989

Age as a predictor of diagnostic and initial treatment intensity in newly diagnosed breast cancer patients.

Newly diagnosed breast cancer patients (N = 494) aged 45-90 years were studied to determine if age was associated with appropriate diagnostic and prognostic evaluations, and initial definitive therapy. Women 75 years of age and older were less likely to receive an appropriate diagnostic evaluation than were younger women, but age was not associated with an appropriate prognostic evaluation. Older patients with local disease who were undergoing lumpectomy were less likely to receive follow-up radiation; older patients with regional disease undergoing mastectomy were less likely to receive adjuvant chemotherapy (including hormonal therapy). Physicians' attitudes about appropriateness of therapy appear to be the major determinant of what treatment is received.

Age Factors↗
PubMed1989

Negotiating concrete needs: short-term training for high-risk cancer patients.

Advances in the diagnosis and treatment of cancer and revisions in health care financing and reimbursement have changed the experience of living with cancer. The disease now is diagnosed earlier and patients are likely to live longer with the disease. Patients and their families, thus, will require more concrete service needs. The authors review the psychosocial oncology literature and the literature on case management theories. They present their findings of a survey of the concrete needs of 413 cancer patients who were undergoing chemotherapy. Based on this survey, they developed a short-term case management intervention model to improve patient problem-solving skills. The intervention is designed to increase patient and family autonomy and mastery, reduce unmet needs, and counteract common feelings of helplessness associated with serious illness.

Adult↗
PubMed1988

Malignant disease and the elderly.

Most cancers are diseases of the ageing. Approximately 50% of all cancers occur among those over 65 and nearly 60% of all cancer deaths occur among the elderly. The cumulative risk of acquiring cancer among those aged 65-85 is 17% in females and 23% in males. Cancer incidence increases steadily as a function of age, reaching 23 per 1000 population among those aged 85 and older. Recent estimates of age-specific cancer prevalence rates for women over 70 were 106 per 1000 population and were 118 per 1000 population among men over 70. The rapidly shifting age distribution in most industrialized nations, including the growth of the 'old-old', means that the actual number of older people with cancer will increase at least in proportion to the ageing of the population. This trend will have an impact on the health-care system and may affect social norms regarding the treatment of elderly cancer patients. This paper reviews these trends and presents data from a series of research projects and the related literature to examine how older people respond to cancer symptoms and treatment and whether the treatment received by aged cancer patients differs from that given to younger patients. The relationship between age and stage of disease at presentation is explored, together with the manner in which older cancer patients' disease is identified, the 'aggressiveness' of treatment pursued, and patients' responses to those treatments.

Age Factors↗
PubMed1988

Day hospital as an alternative to inpatient care for cancer patients: a random assignment trial.

A stratified, random-assignment trial of 442 cancer patients was conducted to evaluate medical, psychosocial, and financial outcomes of day hospital treatment as an alternative to inpatient care for certain cancer patients. Eligible patients required: a 4- to 8-hour treatment plan, including chemotherapy and other long-term intravenous (i.v.) treatment; a stable cardiovascular status; mental competence; no skilled overnight nursing; and a helper to assist with home care. Patients were ineligible if standard outpatient treatment was possible. No statistically significant (p less than 0.05) differences were found between the Adult Day Hospital (ADH) and Inpatient care in medical or psychosocial outcomes over the 60-day study period. The major difference was in medical costs--approximately one-third lower for ADH patients (p less than 0.001) than for the Inpatient group. The study demonstrates that day hospital care of medical oncology patients is clinically equivalent to Inpatient care, causes no negative psychosocial effects, and costs less than Inpatient care. Findings support the trend toward dehospitalization of medical treatment.

Adult↗
PubMed1988

Predictors of bereavement depression and its health services consequences.

As a crisis event and major life transition, bereavement is believed to precipitate or exacerbate physical and psychologic dysfunction. Yet, despite an ever-growing body of research, the causal relationship between bereavement and subsequent morbidity remains unsettled. Using a large sample, prospective measurements, and multivariate analyses, a literature-based model of the determinants of clinical depression after bereavement was tested. Results show that consanguinity, patient age, poor prior physical and mental health, family tension, and survivor dissatisfaction with their caretaking abilities during the terminal phase were the most important determinants of risk of depression after bereavement. Among spouses, bereavement depression was significantly associated with poor prior physical and mental health and dissatisfaction with caretaking abilities. Analyses of the consequences of bereavement in terms of health-care utilization found strong effects of depression on physician utilization. In light of the aging of the United States population, and thus the growth of the bereaved population, the results suggest the importance of preventive medicine to avert the costs to the health-care system of depression-related somatization following bereavement.

Age Factors↗
PubMed1988

Lung, breast, and colorectal cancer: the relationship between extent of disease and age at diagnosis.

We examined the relationship between age and extent of disease at initial diagnosis as part of a population-based, prospective study documenting the patterns of care received by over 1500 newly diagnosed lung, breast, and colorectal cancer patients identified in nine Rhode Island hospitals. For each cancer site examined, no age by extent of disease relationship was observed; however, analysis by sex among lung cancer patients indicated an inverse age relationship for men. The absence of an age effect for breast cancer patients is in contrast to earlier research findings that identify a positive association between extent of disease and age at diagnosis. Past results may reflect age-related differences in patient and physician screening behavior characteristic of earlier time periods.

Age Factors↗