Geriatrics and Palliative Care

Medicine Lodge, United States

Geriatrics and Palliative Care

Medicine Lodge, United States
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Yang Y.,University of Alabama at Birmingham | Brown C.J.,Birmingham Atlanta Veterans Affairs Geriatric Research | Burgio K.L.,Birmingham Atlanta Veterans Affairs Geriatric Research | Kilgore M.L.,Geriatrics and Palliative Care | And 4 more authors.
Journal of the American Medical Directors Association | Year: 2011

Objective: Older adults receiving Medicare home health services who experience undernutrition may be at increased risk of experiencing adverse outcomes. We sought to identify the association between baseline nutritional status and subsequent health service utilization and mortality over a 1-year period in older adults receiving Medicare home health services. Design: This was a longitudinal study using questionnaires and anthropometric measures designed to assess nutritional status (Mini-Nutritional Assessment) at baseline and health services utilization and mortality status at 6-month and 1-year follow-ups. Setting: Participants were evaluated in their homes. Participants: A total of 198 older adults who were receiving Medicare home health services. Results: Based on Mini-Nutritional Assessment, 12.0% of patients were malnourished, 51.0% were at risk for malnourishment, and 36.9% had normal nutritional status. Based on body mass index, 8.1% of participants were underweight, 37.9% were normal weight, 25.3% were overweight, and 28.8% were obese. Using multivariate binary logistic regression analyses, participants who were malnourished or at risk for malnourishment were more likely to experience subsequent hospitalization, emergency room visit, home health aide use, and mortality for the entire sample and hospitalization and nursing home stay for overweight and obese participants. Conclusions: Experiencing undernutrition at the time of receipt of Medicare home health services was associated with increased health services utilization and mortality for the entire sample, and with increased health services utilization only for the overweight and obese subsample. Opportunities exist to address risk of undernutrition in patients receiving home health services, including those who are overweight or obese, to prevent subsequent adverse health outcomes. © 2011 American Medical Directors Association.

Buys D.R.,Geriatrics and Palliative Care | Buys D.R.,Comprehensive Center for Healthy Aging | Buys D.R.,University of Alabama at Birmingham | Roth D.L.,Johns Hopkins University | And 9 more authors.
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2014

Background. Nutritional risk and low BMI are common among community-dwelling older adults, but it is unclear what associations these factors have with health services utilization and mortality over long-term follow-up. The aim of this study was to assess prospective associations of nutritional risk and BMI with all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality over 8.5 years. Methods. Data are from 1,000 participants in the University of Alabama at Birmingham Study of Aging, a longitudinal, observational study of older black and white residents of Alabama aged 65 and older. Nutritional risk was assessed using questions associated with the DETERMINE checklist. BMI was categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), class I obese (30.0-34.9), and classes II and III obese (≥35.0). Cox proportional hazards models were fit to assess risk of all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality. Covariates included social support, social isolation, comorbidities, and demographic measures. Results. In adjusted models, persons with high nutritional risk had 51% greater risk of all-cause hospitalization (95% confidence interval: 1.14-2.00) and 50% greater risk of nonsurgical hospitalizations (95% confidence interval: 1.11-2.01; referent: low nutritional risk). Persons with moderate nutritional risk had 54% greater risk of death (95% confidence interval: 1.19-1.99). BMI was not associated with any outcomes in adjusted models. Conclusions. Nutritional risk was associated with all-cause hospitalizations, nonsurgical hospitalizations, and mortality. Nutritional risk may affect the disablement process that leads to health services utilization and death. These findings point to the need for more attention on nutritional assessment, interventions, and services for community-dwelling older adults. © The Author 2014.

Judd S.E.,University of Alabama at Birmingham | Newby P.K.,University of Alabama at Birmingham | Howard G.,University of Alabama at Birmingham | Locher J.L.,Geriatrics and Palliative Care | Kissela B.M.,University of Cincinnati
Stroke | Year: 2013

BACKGROUND AND PURPOSE - Black Americans and residents of the Southeastern United States are at increased risk of stroke. Diet is one of many potential factors proposed that might explain these racial and regional disparities. METHODS - Between 2003 and 2007, the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study enrolled 30 239 black and white Americans aged ≥45 years. Dietary patterns were derived using factor analysis and foods from food frequency data. Incident strokes were adjudicated using medical records by a team of physicians. Cox-proportional hazards models were used to examine risk of stroke. RESULTS - During 5.7 years, 490 incident strokes were observed. In a multivariable-adjusted analysis, greater adherence to the plant-based pattern was associated with lower stroke risk (hazard ratio, 0.71; 95% confidence interval, 0.56-0.91; Ptrend=0.005). This association was attenuated after addition of income, education, total energy intake, smoking, and sedentary behavior. Participants with a higher adherence to the Southern pattern experienced a 39% increased risk of stroke (hazard ratio, 1.39; 95% confidence interval, 1.05, 1.84), with a significant (P=0.009) trend across quartiles. Including Southern pattern in the model mediated the black-white risk of stroke by 63%. CONCLUSIONS - These data suggest that adherence to a Southern style diet may increase the risk of stroke, whereas adherence to a more plant-based diet may reduce stroke risk. Given the consistency of finding a dietary effect on stroke risk across studies, discussing nutrition patterns during risk screening may be an important step in reducing stroke. © 2013 American Heart Association, Inc.

Triebel K.L.,University of Alabama at Birmingham | Novack T.A.,Geriatrics and Palliative Care | Martin R.C.,University of Alabama at Birmingham | Dreer L.E.,University of Alabama at Birmingham | And 2 more authors.
Journal of Head Trauma Rehabilitation | Year: 2016

Objective: To identify neurocognitive predictors of medical decision-making capacity (MDC) in participants with mild and moderate/severe traumatic brain injury (TBI). Setting: Academic medical center. Participants: Sixty adult controls and 104 adults with TBI (49 mild, 55 moderate/severe) evaluated within 6 weeks of injury. Design: Prospective cross-sectional study. Main Measures: Participants completed the Capacity to Consent to Treatment Instrument to assess MDC and a neuropsychological test battery. We used factor analysis to reduce the battery test measures into 4 cognitive composite scores (verbal memory, verbal fluency, academic skills, and processing speed/executive function). We identified cognitive predictors of the 3 most clinically relevant Capacity to Consent to Treatment Instrument consent standards (appreciation, reasoning, and understanding). Results: In controls, academic skills (word reading, arithmetic) and verbal memory predicted understanding; verbal fluency predicted reasoning; and no predictors emerged for appreciation. In the mild TBI group, verbal memory predicted understanding and reasoning, whereas academic skills predicted appreciation. In the moderate/severe TBI group, verbal memory and academic skills predicted understanding; academic skills predicted reasoning; and academic skills and verbal fluency predicted appreciation. Conclusions: Verbal memory was a predictor of MDC in controls and persons with mild and moderate/severe TBI. In clinical practice, impaired verbal memory could serve as a "red flag" for diminished consent capacity in persons with recent TBI. © 2016 Wolters Kluwer Health, Inc.

Wadley V.G.,Geriatrics and Palliative Care | Safford M.M.,University of Alabama at Birmingham | Haley W.E.,University of South Florida | Howard G.,University of Alabama at Birmingham | Roth D.L.,Johns Hopkins University
Journals of Gerontology - Series B Psychological Sciences and Social Sciences | Year: 2013

Objectives. Using a large, national sample, this study examined perceived caregiving strain and other caregiving factors in relation to all-cause mortality. Method. The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is a population-based cohort of men and women aged 45 years and older. Approximately 12% (n = 3,710) reported that they were providing ongoing care to a family member with a chronic illness or disability. Proportional hazards models were used for this subsample to examine the effects of caregiving status measures on all-cause mortality over the subsequent 5-year period, both before and after covariate adjustment. Results. Caregivers who reported high caregiving strain had significantly higher adjusted mortality rates than both no strain (hazard ratio [HR] = 1.55, p = .02) and some strain (HR = 1.83, p = .001) caregivers. The mortality effects of caregiving strain were not found to differ by race, sex, or the type of caregiving relationship (i.e., spouse, parent, child, sibling, and other). Discussion. High perceived caregiving strain is associated with increased all-cause mortality after controlling for appropriate covariates. High caregiving strain constitutes a significant health concern and these caregivers should be targeted for appropriate interventions. © The Author 2012.

Locher J.L.,Geriatrics and Palliative Care | Locher J.L.,Center for Aging | Locher J.L.,Lister Hill Center for Health Policy | Locher J.L.,Comprehensive Cancer Center | And 19 more authors.
Journal of Parenteral and Enteral Nutrition | Year: 2011

Background: Patients with head and neck cancers (HNCs) are at increased risk of experiencing malnutrition, which is associated with poor outcomes. Advances in the treatment of HNCs have resulted in improved outcomes that are associated with severe toxic oral side effects, placing patients at an even greater risk of malnutrition. Prophylactic placement of percutaneous endoscopic gastrostomy (PEG) tubes before treatment may be beneficial in patients with HNC, especially those undergoing more intense treatment regimens. PEG tube placement, however, is not without risks. Methods: A comprehensive review of the literature was conducted. Results: Systematic evidence assessing both the benefits and harm associated with prophylactic PEG tube placement in patients undergoing treatment for HNC is weak, and benefits and harm have not been established. Conclusions: More research is necessary to inform physician behavior on whether prophylactic PEG tube placement is warranted in the treatment of HNC. © 2011 American Society for Parenteral and Enteral Nutrition.

Balogun R.A.,University of Virginia | Balogun S.A.,Geriatrics and Palliative Care | Holroyd S.,University of Virginia
Nephron - Clinical Practice | Year: 2011

Background: Depression is common and associated with increased morbidity and mortality in elderly (≥65 years) hemodialysis patients. Beck's Depression Inventory (BDI) and the Geriatric Depression Scale (GDS) have been used in different cohorts to screen for depression. Objectives: We aimed to evaluate the 15-item GDS (GDS-15) as such a tool in elderly hemodialysis patients and compare it with BDI, a previously validated tool in younger hemodialysis patients. Design: Cross-sectional study. Setting: Four out-patient hemodialysis units; 1 based in a university hospital and 3 based in the community. Participants: Hemodialysis patients aged 65 years and older. Intervention: Both tools were administered to all participants, and a geriatric psychiatrist blinded to the results evaluated them for depression by the gold standard psychiatric interview. Measurements: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for both tools were assessed against the psychiatric interview (n = 62). Results: Patients who were depressed according to the psychiatric interview had significantly higher GDS-15 and BDI scores compared to those not depressed (p < 0.01 both). ROC curves showed high predictive accuracy of the GDS-15 and BDI (area under the curve: 0.808 and 0.729) versus the psychiatric interview. The GDS-15 cutoff with the best diagnostic accuracy was 5 with a sensitivity of 63%, specificity of 82%, PPV of 60% and NPV of 83%. The BDI cutoff with the best diagnostic accuracy was 10 with a sensitivity of 68%, specificity of 77%, PPV of 57% and NPV of 85%. Conclusion: These results provide evidence that the GDS-15 shows validity in comparison to a gold standard and can be used to screen for depression in the elderly hemodialysis population. Copyright © 2010 S. Karger AG, Basel.

Becker D.,Geriatrics and Palliative Care | Becker D.,University of Virginia | May N.,Geriatrics and Palliative Care | Plews-Ogan M.,Geriatrics and Palliative Care
Perspectives in Biology and Medicine | Year: 2012

Alexander Pope, in his Essay on Criticism, proposes that "To err is human; to forgive divine." This essay considers the latter half of that proposition and includes quotes from doctors who participated in a study of learning and growing through adversity. Doctors, like poets, find it necessary to put their moral and psychological dilemma into words. Language shapes the experience and offers a means of partial resolution. © 2012 by The Johns Hopkins University Press.

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