195 results on '"Fillenbaum, Gerda G."'
Search Results
152. Association Between Oral Health and Cognitive Status: A Systematic Review.
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Wu, Bei, Fillenbaum, Gerda G., Plassman, Brenda L., and Guo, Liang
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COGNITION , *ORAL hygiene - Abstract
A correction to the article "Association Between Oral Health and Cognitive Status: A Systematic Review" which was published in a previous issue is presented.
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- 2016
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153. Consortium to Establish a Registry for Alzheimer's Disease (CERAD).
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Fillenbaum, Gerda G. and Heyman, Albert
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ALZHEIMER'S disease ,MEDICAL needs assessment ,MEDICAL equipment ,CLINICAL psychology - Abstract
The article offers information on the standardized instruments and assessments developed by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) and funded by the National Institute on Aging in the U.S. The primary assessments developed by CERAD include a clinical battery, a neuropsychological battery and a neuropathological assessment.
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- 2002
154. OARS Methodology.
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Fillenbaum, Gerda G.
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OARS Multidimensional Functional Assessment Questionnaire ,GERIATRIC assessment ,MULTIDIMENSIONAL scaling ,PSYCHIATRY -- Methodology ,GERIATRIC psychiatry - Abstract
The article offers focuses on the Older Americans Resources and Services methodology. The method was developed to assess alternative strategies to institutionalizing frail order adults. A three-element model was developed to assess adults at all levels of functioning using a multidimensional perspective and to examine the impact of the identified service packages on persons defined in terms of their multidimensional functional profiles.
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- 2002
155. Once Validated, Always Validated?
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Fillenbaum, Gerda G.
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PSYCHOMETRICS , *REGIONAL disparities , *REGIONAL differences , *STATISTICAL sampling - Abstract
The author discusses the article in this issue, "Reliability and Validity of the Older Americans Resources and Services (OARS) Social Resources Scale in Six European Countries," by Vanessa Burholt and colleagues. She notes that the study discussed in this article serves to remind researchers that an assessment developed in one location or with a certain sample may perform differently with another sample or at a different location.
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- 2007
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156. Falls in African American and white community-dwelling elderly residents.
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Hanlon JT, Landerman LR, Fillenbaum GG, Studenski S, Hanlon, Joseph T, Landerman, Lawrence R, Fillenbaum, Gerda G, and Studenski, Stephanie
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Background: Few studies have examined the relationship of race to falls. This study evaluated the association between potential risk factors and falls in a representative sample of 1049 African American and 1947 white participants of the second in-person wave of the Duke Established Populations for Epidemiologic Studies of the Elderly.Methods: Information about sociodemographic characteristics, health-related behaviors, health status, visual function, and drug use was determined during baseline in-home interviews. Three years later, falls in the previous 12 months were assessed by self-report.Results: One or more falls occurred in 22.2% of the participants. Nearly half the fallers reported more than one fall. Multivariable analysis revealed that African Americans were less likely than whites to have any fall (adjusted odds ratio [OR] 0.77, 95% confidence interval [CI] 0.62-0.94). Increased age and education, arthritis, diabetes, and history of broken bones were also significant (p <.05) independent risk factors for any fall. In multivariable analyses comparing those with two or more falls to those with none, again, increased age and education, arthritis, and diabetes were significant (p <.05) independent risk factors while smoking was protective. Race was not a significant predictor of multiple falls (adjusted OR 0.90, 95% CI 0.64-1.26).Conclusions: Similar sociodemographic characteristics and health problems appear to be important risk factors for any and multiple falls in community-dwelling African American and white elderly residents, with white elders at greater risk of one-time falls. [ABSTRACT FROM AUTHOR]- Published
- 2002
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157. Identifying Frailty in Hospitalized Older Adults with Significant Coronary Artery Disease.
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Purser, Jama L., Kuchibhatla, Maragatha N., Fillenbaum, Gerda G., Harding, Tina, Peterson, Eric D., and Alexander, Karen P.
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CORONARY disease , *HOSPITAL patients , *FRAIL elderly , *INPATIENT care , *OLDER people , *COHORT analysis , *HOSPITAL wards , *HEART disease related mortality - Abstract
OBJECTIVES: To characterize physiological variation in hospitalized older adults with severe coronary artery disease (CAD) and evaluate the prevalence of frailty in this sample, to determine whether single-item performance measures are good indicators of multidimensional frailty, and to estimate the association between frailty and 6-month mortality. DESIGN: Observational cohort study. SETTING: Inpatient hospital cardiology ward. PARTICIPANTS: Three hundred nine consecutive inpatients aged 70 and older admitted to a cardiology service (n=309; 70% male, 84% white) with minimum two-vessel CAD determined using cardiac catheterization. MEASUREMENTS: Two standard frailty phenotypes (Composite A and Composite B), usual gait speed, grip strength, chair stands, cardiology clinical variables, and 6-month mortality. RESULTS: Prevalence of frailty was 27% for Composite A versus 63% for Composite B. Utility of single-item measures for identifying frailty was greatest for gait speed (receiver operating characteristic curve c statistic=0.89 for Composite A, 0.70 for Composite B) followed by chair-stands (c=0.83, 0.66) and grip strength (c=0.78, 0.57). After adjustment, composite scores and single-item measures were individually associated with higher mortality at 6 months. Slow gait speed (≤0.65 m/s) and poor grip strength (≤25 kg) were stronger predictors of 6-month mortality than either composite score (gait speed odds ratio (OR)=3.8, 95% confidence interval (CI)=1.1–13.1; grip strength OR=2.7, 95% CI=0.7–10.0; Composite A OR=1.9, 95% CI=0.60–6.1; chair-stand OR=1.5, 95% CI=0.5–5.1; Composite B OR=1.3, 95% CI=0.3–5.2). CONCLUSION: Gait speed frailty was the strongest predictor of mortality in a population with CAD and may add to traditional risk assessments when predicting outcomes in this population. [ABSTRACT FROM AUTHOR]
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- 2006
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158. Metabolic Syndrome Predicts Mobility Decline in a Community-Based Sample of Older Adults.
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Blazer, Dan G., Hybels, Celia F., and Fillenbaum, Gerda G.
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INTERNAL migration , *METABOLIC syndrome , *OLDER people , *SOCIODEMOGRAPHIC factors , *REGRESSION analysis - Abstract
OBJECTIVES: To determine whether metabolic syndrome is an independent predictor of decline in mobility in an elderly community sample. DESIGN: Biracial community-based prospective cohort study. SETTING: Urban and rural areas of central North Carolina. PARTICIPANTS: One thousand two hundred twenty-nine older African Americans and whites, mean age 77.0, who were participants in the Duke Established Populations for Epidemiologic Studies of the Elderly. MEASUREMENTS: Sociodemographic data and data on mobility (a subset of items from the Rosow-Breslau scale), depression (Center for Epidemiological Studies Depression Scale), self-report of medical conditions, body mass index, cognitive function (Short Portable Mental Status Questionnaire), blood pressure, height, and waist circumference. High-density lipoprotein cholesterol, triglycerides, and blood glucose were available from blood samples. Metabolic syndrome was calculated for subjects with complete data. RESULTS: Twenty-nine percent of the sample met criteria for metabolic syndrome. In bivariate analyses, age, sex, race, education, cognitive impairment, depression, impairment in mobility, history of stroke and heart disease, and metabolic syndrome at baseline were associated with a decline in mobility 4 years later. Regression analysis controlling for the above variables demonstrated that metabolic syndrome persisted as an independent and highly significant predictor of decline in mobility. CONCLUSION: These findings suggest that metabolic syndrome may be a distinct risk factor for mobility decline in community-dwelling older people. [ABSTRACT FROM AUTHOR]
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- 2006
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159. Factores predictivos del empleo de antidepresivos por la población geriátrica: ¿han cambiado con el paso del tiempo?
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Blazer, Dan G., Hybels, Celia F., Fillenbaum, Gerda G., and Pieper, Carl F.
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ANTIDEPRESSANTS , *DEPRESSION in old age , *PSYCHIATRIC drugs , *GERIATRIC psychiatry , *SEROTONIN uptake inhibitors , *THERAPEUTICS - Abstract
El empleo de antidepresivos aumentó considerablemente en la población anciana con la introducción de los fármacos de nueva generación, como los inhibidores selectivos de la recaptación de serotonina. Los autores analizaron tos datos de dos intervalos de seguimiento-1986-1987 a 1989-1990 (intervalo 1) y 1992-1993 a 1996-1997 (intervalo 2)-en una cohorte comunitaria de 4,162 ancianos para determinar las variables predictivas del futuro consumo de antidepresivos. Método: Se obtuvo información sobre la toma de antidepresivos, las características demográficas y sanitarias y las categorías de síntomas depresivos (afectividad positiva, afectividad negativa, quejas somáticas y problemas interpersonales). Se utilizó a regresión logística para controlar, simultáneamente, múltiples variables que pronosticaban la toma de antidepresivos durante los dos intervalos. Se utilizó la regresión logística de medidas repetidas (con ecuaciones de estimación generalizada) para modelar la probabilidad de la toma de antidepresivos corrigiendo el efecto del tiempo. Resultados: La utilización anterior de antidepresivos y la raza blanca fueron variables predictivas potentes de la futura toma de antidepresivos durante ambos intervalos de tiempo. La afectividad negativa fue el único factor predictivo nuevo significativo de la toma de antidepresivos durante el intervalo 1, mientras que las puntuaciones bajas en afectividad positiva, las alteraciones cognitivas y un estado de salud más precario fueron variables predictivas nuevas, significativas durante el intervalo 2. En un modelo de medidas repetidas, la raza, el consumo anterior de antidepresivos, el estado de salud precario, las puntuaciones bajas en afectividad positiva y las quejas somáticas variaron como factores predictivos a lo largo del tiempo. La afectividad negativa y las alteraciones cognitivas fueron variables predictivas fiables a lo largo del tiempo. Conclusiones: Los factores predictivos de la toma de antidepresivos por parte de los ancianos han evolucionado con el paso del tiempo, destacando ahora entre ellos las medidas de la calidad de vida relacionada con la salud, como la afectividad positiva, el estado de salud y las quejas somáticas. [ABSTRACT FROM PUBLISHER]
- Published
- 2005
160. Predictors of Antidepressant Use Among Older Adults: Have They Changed Over Time?
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Blazer, Dan G., Hybels, Celia F., Fillenbaum, Gerda G., and Pieper, Carl F.
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ANTIDEPRESSANTS , *SEROTONIN , *COGNITION disorders , *DEPRESSED persons , *OLDER people , *HEALTH status indicators - Abstract
Objective: Antidepressant use increased substantially among older adults with the introduction of the new-generation medications such as the selective serotonin re-uptake inhibitors. The authors analyzed data from two follow-up intervals -- 1986-1987 to 1989-1990 (interval 1) and 1992-1993 to 1996-1997 (interval 2)-from a community-based cohort of 4,162 older adults to determine predictors of future antidepressant use. Method: Information on antidepressant use, demographic and health characteristics, and categories of depressive symptoms-positive affect, negative affect, somatic complaints, and interpersonal problems-were obtained. Logistic regression was used to control simultaneously for multiple variables predicting antidepressant use during the two intervals. Repeated-measures logistic regression (with generalized estimating equations) was employed to model the probability of antidepressant use, with adjustment for the effect of time. Results: Prior antidepressant use and white race were strong predictors of future use during both intervals. Negative affect was the only additional significant predictor of use during interval 1. In contrast, low positive affect scores, cognitive impairment, and poorer health were additional significant predictors during interval 2. In a repeated-measures model, race, prior antidepressant use, poor health, low positive affect scores, and somatic complaints varied as predictors over time. Negative affect and cognitive impairment were consistent predictors over time. Conclusions: The predictors of antidepressant use by older adults changed over time, with health-related measures of quality of life, such as positive affect, health status, and somatic complaints, becoming more prominent as predictors of use. [ABSTRACT FROM AUTHOR]
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- 2005
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161. Asking family about memory loss. Is it helpful?
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Watson, Lea C, Lewis, Carmen L, and Fillenbaum, Gerda G
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DIAGNOSIS of dementia , *MEMORY disorders , *COMPARATIVE studies , *FAMILIES , *NEUROPSYCHOLOGICAL tests , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *RESEARCH funding , *EVALUATION research , *CROSS-sectional method , *DIAGNOSIS - Abstract
Objective: To compare a family informant's report of memory loss in an older family member to standardized clinical diagnoses of cognitive impairment.Setting: Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), a 10-year longitudinal study of community dwellers aged 65 and greater in five counties of North Carolina.Participants: A stratified random sample of potentially demented participants was selected from the second wave of the Duke EPESE using responses to a brief cognitive screen. A neuropsychological battery was administered to these participants, and their family informants were asked whether they recognized memory loss in the participant. One hundred fifty-seven participants completed the full evaluation and also had an available family informant.Main Outcome Measures: Family informant's report of memory loss (yes, no, sometimes) compared to expert consensus diagnosis of cognitive impairment or dementia.Results: There was poor concordance between the clinical diagnoses of cognitive impairment or dementia and the family informant's recognition of memory loss (kappa=-0.05; P=.74). When informants reported memory loss, 30% of participants were found not to have a cognitive loss. Among participants in whom family informants reported no memory loss, 75% were diagnosed with dementia or cognitive impairment (sensitivity, 0.70, 95% confidence interval [CI], 0.61 to 0.78; specificity, 0.24, 95% CI, 0.13 to 0.40; positive predictive value, 70%; negative predictive value, 25%).Conclusions: Asking family members about memory loss in a patient may be an unreliable strategy to detect dementia. [ABSTRACT FROM AUTHOR]- Published
- 2005
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162. Medication use patterns among demented, cognitively impaired and cognitively intact community-...
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Schmader, Kenneth E., Hanlon, Joseph T., Fillenbaum, Gerda G., Huber, Marc, Pieper, Carl, and Horner, Ronald
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OLDER people , *DEMENTIA , *DRUG abuse - Abstract
Examines whether medication use patterns vary with the level of cognitive function such as cognitive impairment, dementia and intact cognition, in a sample of the Duke Established Populations for Epidemiologic Studies of the Elderly. Criteria used to refer a participant for a clinical dementia evaluation; Information on cognitive impairment; Comparison between the cognitive intact, cognitively impaired and demented participants.
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- 1998
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163. Relations of a Marker of Endothelial Activation (s-VCAM) to Function and Mortality in Community-Dwelling Older Adults.
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Huffman, Kim M., Pieper, Carl F., Kraus, Virginia B., Kraus, William E., Fillenbaum, Gerda G., and Cohen, Harvey J.
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GERIATRIC assessment , *BIOMARKERS , *FUNCTIONAL loss in older people ,MORTALITY risk factors - Abstract
Background. We wished to determine if a marker of endothelial dysfunction/activation soluble vascular cell adhesion molecule (s-VCAM)—was related to functional status and mortality in community-dwelling older adults independent of the known effects of markers of inflammation and coagulation. Methods. Data came from the third and fourth in-person waves of the Duke Established Populations for Epidemiologic Studies of the Elderly. Participants (aged ≥ 71 years) had participated in a blood draw (N = 1,551) from which concentrations of s-VCAM, interleukin-6, and D-dimer were determined. Information was gathered in-person on demographics, health behaviors, chronic health conditions, and functional status (Katz, Rosow–Breslau, Nagi). Death was determined through the National Death Index. Multivariable regression analysis was used to examine the adjusted association of s-VCAM with functional status; Cox proportional hazards models ascertained hazard of mortality. Results. Controlled analyses indicated that cross-sectionally, but not longitudinally (4 years later), greater s-VCAM concentrations were associated with poorer function as measured by the Katz and Rosow–Breslau scales (p < .05 for both), independent of interleukin-6 and D-dimer. In controlled analyses, s-VCAM (p = .002), D-dimer (p = .008), and interleukin-6 (p = .01) were independently related to 4-year mortality; 1 SD increase in log concentration conferred 1.2-, 1.1-, and 1.2-fold increases in mortality, respectively. The greatest hazard of mortality was observed within the first year after measurement. s-VCAM concentrations were not predictive of 15-year mortality. Conclusions. Independent of inflammation and coagulation markers, endothelial dysfunction serves as a marker of, and potentially contributes causally to, poor function and death in community-dwelling older adults. [ABSTRACT FROM PUBLISHER]
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- 2011
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164. Black-White Disparity in Disability: The Role of Medical Conditions.
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Whitson, Heather E., Hastings, S. Nicole, Landerman, Lawrence R., Fillenbaum, Gerda G., Cohen, Harvey J., and Johnson, Kimberly S.
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ANALYSIS of variance , *ARTHRITIS , *CEREBROVASCULAR disease , *COGNITION disorders , *COMPUTER software , *CONFIDENCE intervals , *DIABETES , *EPIDEMIOLOGY , *BONE fractures , *HEALTH status indicators , *HIP joint injuries , *LONGITUDINAL method , *MARRIAGE , *MENTAL health surveys , *MYOCARDIAL infarction , *OBESITY , *PEOPLE with disabilities , *PROBABILITY theory , *RACE , *RESEARCH funding , *SEX distribution , *T-test (Statistics) , *VISION disorders , *DATA analysis , *MULTIPLE regression analysis , *SOCIOECONOMIC factors , *CROSS-sectional method - Abstract
To describe the independent contributions of selected medical conditions to the disparity between black and white people in disability rates, controlling for demographic and socioeconomic factors. Cross-sectional analysis of a community-based cohort. Urban and rural counties of central North Carolina. Two thousand nine hundred sixty-six adults aged 68 and older participating in the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE). Self-reported data on sociodemographic characteristics and medical conditions, Short Portable Mental Status Questionnaire, activities of daily living (ADLs). Fifty-five percent of the cohort was black. Blacks were more likely than whites to report disability (odds ratio=1.39, 95% confidence interval= 1.15-1.68). Controlling for age, sex, marital status, and socioeconomic status, blacks were more likely to be obese and have diabetes mellitus, and less likely to report vision problems, fractures, and heart attacks. The higher prevalence of obesity and diabetes mellitus in blacks, after adjustment for sociodemographic factors, accounted for more than 30% of the black-white difference in disability. Conversely, the black-white disability gap would be approximately 45% wider if whites had a lower prevalence of fractures and vision impairment, similar to their black peers. Higher rates of obesity and diabetes mellitus in older black Americans account for a large amount of the racial disparity in disability, even after controlling for socioeconomic differences. Culturally appropriate interventions that lower the prevalence or the functional consequences of obesity and diabetes mellitus in blacks could substantially decrease this racial health disparity. [ABSTRACT FROM AUTHOR]
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- 2011
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165. Antidiabetic Drug Therapy of African-American and White Community-Dwelling Elderly Over a 10-Year Period.
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Lindblad, Catherine L., Hanlon, Joseph T., Artz, Margaret B., Fillenbaum, Gerda G., and McCarthy, Teresa C.
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DRUG utilization , *DIABETES , *HEALTH of older people - Abstract
To determine the prevalence and predictors of antidiabetic medication use over a 10-year period in a general population of African-American and white community-dwelling elderly. Survey. Five adjacent counties (one urban and four rural) in the Piedmont area of North Carolina. Those aged 65 and older present at the baseline (n=4,136), second (n=3,234), third (n=2,508), and fourth (n=1,633) in-person waves of the Duke Established Populations for Epidemiologic Studies of the Elderly. The use of six discrete categories of antidiabetic medications (insulin, first-generation oral sulfonylureas, second-generation oral sulfonylureas, metformin, oral combination therapy, and insulin combination therapy) was determined. Multivariate analyses, using weighted data adjusted for sampling design, were conducted to assess the association between antidiabetic medication use and race and other sociodemographic, health-status, and access-to-healthcare factors at baseline and 10 years later. Antidiabetic medications were taken by 21.4% of the population at baseline; this increased to 28.1% at the 10-year follow-up ( P<.001). Insulin was the most commonly used drug at baseline (7.9%). The use of second-generation sulfonylureas increased, and use of first-generation sulfonylureas decreased over the 10-year time period. Combination antidiabetic therapy and metformin use was infrequent throughout the study. Multivariate analyses revealed that, at baseline, African Americans were nearly twice as likely (adjusted odds ratio (AOR)=1.93, 95% confidence interval (CI)=1.46–2.54) to receive any antidiabetic medication as their white counterparts. Other significant ( P<.05) factors were hypertension (AOR=1.38, 95% CI=1.03–1.84), stroke (AOR=1.98, 95% CI=1.43–2.73), one or more mobility difficulties (AOR=1.29, 95% CI=1.01–1.66), continuity of care (AOR=1.74, 95% CI=1.20–2.54), and multiple doctor visits (1–4 visits, AOR=1.69, 95% CI=1.08–2.65; ≥5 visits, AOR=3.15, 95% CI=1.95–5.07). Being underweight (AOR=0.45, 95% CI=0.30–0.67) and being cognitively impaired (AOR=0.60, 95% CI=0.41–0.87) were factors significantly ( P<.05) associated with a decreased risk of antidiabetic medication use. At the 10-year follow-up, similar trends were seen associating these sociodemographic, health-status, and access-to-healthcare factors with antidiabetic medication use. Antidiabetic medication use is common and increases over time for community-dwelling elderly. Race is significantly associated with antidiabetic medication use, even after controlling for other sociodemographic, health-status, and access-to-healthcare variables. [ABSTRACT FROM AUTHOR]
- Published
- 2003
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166. CERAD (Consortium to Establish a Registry for Alzheimer's Disease) Neuropsychology Assessment Battery: 35 Years and Counting.
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Fillenbaum GG and Mohs R
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- Humans, Aged, Aged, 80 and over, Psychometrics, Cross-Sectional Studies, Neuropsychology, Neuropsychological Tests, Registries, Alzheimer Disease diagnosis, Alzheimer Disease psychology
- Abstract
Background: In 1986, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was mandated to develop a brief neuropsychological assessment battery (CERAD-NAB) for AD, for uniform neuropsychological assessment, and information aggregation. Initially used across the National Institutes of Aging-funded Alzheimer's Disease Research Centers, it has become widely adopted wherever information is desired on cognitive status and change therein, particularly in older populations., Objective: Our purpose is to provide information on the multiple uses of the CERAD-NAB since its inception, and possible further developments., Methods: Since searching on "CERAD neuropsychological assessment battery" or similar terms missed important information, "CERAD" alone was entered into PubMed and SCOPUS, and CERAD-NAB use identified from the resulting studies. Use was sorted into major categories, e.g., psychometric information, norms, dementia/differential dementia diagnosis, epidemiology, intervention evaluation, genetics, etc., also translations, country of use, and alternative data gathering approaches., Results: CERAD-NAB is available in ∼20 languages. In addition to its initial purpose assessing AD severity, CERAD-NAB can identify mild cognitive impairment, facilitate differential dementia diagnosis, determine cognitive effects of naturally occurring and experimental interventions (e.g., air pollution, selenium in soil, exercise), has helped to clarify cognition/brain physiology-neuroanatomy, and assess cognitive status in dementia-risk conditions. Surveys of primary and tertiary care patients, and of population-based samples in multiple countries have provided information on prevalent and incident dementia, and cross-sectional and longitudinal norms for ages 35-100 years., Conclusion: CERAD-NAB has fulfilled its original mandate, while its uses have expanded, keeping up with advances in the area of dementia.
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- 2023
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167. Causal analysis identifies small HDL particles and physical activity as key determinants of longevity of older adults.
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Kraus VB, Ma S, Tourani R, Fillenbaum GG, Burchett BM, Parker DC, Kraus WE, Connelly MA, Otvos JD, Cohen HJ, Orenduff MC, Pieper CF, Zhang X, and Aliferis CF
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- Humans, Aged, Cohort Studies, Longevity, Exercise
- Abstract
Background: The hard endpoint of death is one of the most significant outcomes in both clinical practice and research settings. Our goal was to discover direct causes of longevity from medically accessible data., Methods: Using a framework that combines local causal discovery algorithms with discovery of maximally predictive and compact feature sets (the "Markov boundaries" of the response) and equivalence classes, we examined 186 variables and their relationships with survival over 27 years in 1507 participants, aged ≥71 years, of the longitudinal, community-based D-EPESE study., Findings: As few as 8-15 variables predicted longevity at 2-, 5- and 10-years with predictive performance (area under receiver operator characteristic curve) of 0·76 (95% CIs 0·69, 0·83), 0·76 (0·72, 0·81) and 0·66 (0·61, 0·71), respectively. Numbers of small high-density lipoprotein particles, younger age, and fewer pack years of cigarette smoking were the strongest determinants of longevity at 2-, 5- and 10-years, respectively. Physical function was a prominent predictor of longevity at all time horizons. Age and cognitive function contributed to predictions at 5 and 10 years. Age was not among the local 2-year prediction variables (although significant in univariable analysis), thus establishing that age is not a direct cause of 2-year longevity in the context of measured factors in our data that determine longevity., Interpretation: The discoveries in this study proceed from causal data science analyses of deep clinical and molecular phenotyping data in a community-based cohort of older adults with known lifespan., Funding: NIH/NIA R01AG054840, R01AG12765, and P30-AG028716, NIH/NIA Contract N01-AG-12102 and NCRR 1UL1TR002494-01., Competing Interests: Declaration of interests Drs. Connelly and Otvos are employees of and own stock in Labcorp, the commercial provider of the NMR LipoProfile blood test. Additional institutional NIH funding is declared for Dr. Zhang (RO1 AG070146) and Dr. Ma (RO1AG070146 and RO1 HL153497) and consulting fees to Dr. Ma related to this work from the Duke Claude D. Pepper Older Americans Independence Center NIH/NIA P30-AG028716 grant. The remaining authors declare no competing interests. The funding sources provided funding only and had no role in writing of the manuscript or the decision to submit it for publication. No author has been paid to produce this manuscript. The authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2022
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168. Determinants of Maintenance and Recovery of Function in a Representative Older Community-Resident Biracial Sample.
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Fillenbaum GG, Sloane R, Burchett BM, Hall K, Pieper CF, Whitson HE, and Colón-Emeric CS
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- Aged, Female, Health Status, Humans, Longitudinal Studies, Male, Recovery of Function, Activities of Daily Living, White People
- Abstract
Objectives: Focus on decline in performance of activities of daily living (ADL) has not been matched by studies of recovery of function. Advised by a broad conceptual model of physical resilience, we ascertain characteristics that identify (1) maintenance, (2) decline, and (3) recovery of personal self-maintenance activities over six years in an older, community representative, African American and white sample., Design: Longitudinal study, analyses included descriptive statistics and repeated measures proportional hazards., Setting/participants: Community-representative participants of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), unimpaired at baseline (n = 3187; 46% white, 54% African American; 64% female, 36% male), followed annually for up to 6 years., Measures: Data included information on basic activities of daily living (BADL), demographic characteristics, health status, social services provided and received, household size, neighborhood safety, and survival status., Results: Over 6 years, ∼75% remained unimpaired, of whom 30% were unimpaired when they dropped out or died. Of ∼25% who became impaired, just under half recovered. Controlled analyses indicated that those who became impaired were in poorer health, younger, and more likely to be African American. Characteristics of recovery included younger age, not hospitalized in the previous year, and larger household size., Conclusions/implications: Maintenance of health status facilitated continued unimpaired BADL. While decline was associated with poorer health, younger age, and being African American, recovery was also associated with younger age, together with larger household size, and no further deterioration in health as measured here. Maintenance of good health is preferred, but following decline in functioning, increased effort to improve health and avoid further decline, which takes into account not only physical but also personal social conditions, is needed., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.)
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- 2020
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169. Racial Differences in Change in Physical Functioning in Older Male Veterans with HIV.
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McKellar MS, Kuchibhatla MN, Oursler KAK, Crystal S, Akgün KM, Crothers K, Gibert CL, Nieves-Lugo K, Womack J, Tate JP, and Fillenbaum GG
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- Age Factors, Aged, Aged, 80 and over, Biomarkers blood, HIV Infections complications, HIV Infections diagnosis, Humans, Longitudinal Studies, Male, Middle Aged, Quality of Life, Race Factors, Surveys and Questionnaires, Black or African American statistics & numerical data, Aging, HIV Infections ethnology, Veterans statistics & numerical data, White People statistics & numerical data
- Abstract
Little is known about longitudinal change in physical functioning of older African American/Black and White HIV-infected persons. We examined up to 10 years of data on African American ( N = 1,157) and White ( N = 400) men with HIV infection and comparable HIV-negative men ( n = 1,137 and 530, respectively), age 50-91 years from the Veterans Aging Cohort Study Survey sample. Physical functioning was assessed using the SF-12 (12-Item Short Form Health Survey) physical component summary (PCS) score. Mixed-effects models examined association of demographics, health conditions, health behaviors, and selected interactions with PCS score; HIV biomarkers were evaluated for HIV-infected persons. PCS scores were approximately one standard deviation below that of the general U.S. population of similar age. Across the four HIV/race groups, over time and through ages 65-75 years, PCS scores were maintained; differences were not clinically significant. PCS score was not associated with race or with interactions among age, race, and HIV status. CD4 and viral load counts of African American and White HIV-infected men were similar. Older age, low socioeconomic status, chronic health conditions and depression, lower body mass index, and smoking were associated with poorer PCS score in both groups. Exercising and, counterintuitively, being HIV infected were associated with better PCS score. Among these older African American and White male veterans, neither race nor HIV status was associated with PCS score, which remained relatively stable over time. Chronic disease, depression, and lack of exercise were associated with lower PCS score. To maintain independence in this population, attention should be paid to controlling chronic conditions, and emphasizing good health behaviors.
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- 2019
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170. Use of mental health services by community-resident adults with DSM-IV anxiety and mood disorders in a violence-prone area: São Paulo, Brazil.
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Fillenbaum GG, Blay SL, Mello MF, Quintana MI, Mari JJ, Bressan RA, and Andreoli SB
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- Adolescent, Adult, Aged, Brazil, Cities, Cross-Sectional Studies, Diagnostic and Statistical Manual of Mental Disorders, Female, Humans, International Classification of Diseases, Male, Middle Aged, Young Adult, Mental Health Services, Mood Disorders therapy, Patient Acceptance of Health Care, Violence psychology
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Background: While under-use of mental health services by adults with anxiety and/or depression is well established, use in a violence-prone area, and as a function of diagnosis and personality characteristics such resilience, is little known. We examine the sociodemographic and personality characteristics (specifically resilience), associated with use of mental health services in a violence-prone city by those with anxiety, depression, and their comorbidity., Methods: The structured Composite International Diagnostic Interview was used to identify 12-month DSM-IV- and ICD-10-defined anxiety and depression in a cross-sectional, representative, community-resident sample age 15-75y (N = 2536) in São Paulo, Brazil, and their use of mental health services. Resilience was determined by the Wagnild and Young scale. Analyses, using weighted, design-corrected statistical tests, included frequency measures and multivariable logistic regression., Results: Mental health services were used by 10% with only anxiety, 22% with only depression, and 34% with comorbidity, with odds of use in controlled analyses doubling from anxiety to depression to comorbidity. Use was significantly higher among those who were white, older (age >30 years, with substantial social support, low resilience, living in low homicide rate areas; use was not affected by experience of traumatic events. Psychiatrists, general practitioners, and psychologists were the primary providers., Limitations: Cross-sectional design CONCLUSIONS: Contrary to expectation, use was greater among residents of lower homicide areas, and was not associated with personal traumatic experience. This may reflect increased immunity to violence in higher homicidal rate areas, lower resilience, and poorer access to services. Increased access to mental health services is needed., (Copyright © 2019 Elsevier B.V. All rights reserved.)
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- 2019
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171. 12-month prevalence and concomitants of DSM-IV depression and anxiety disorders in two violence-prone cities in Brazil.
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Blay SL, Fillenbaum GG, Mello MF, Quintana MI, Mari JJ, Bressan RA, and Andreoli SB
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- Adolescent, Adult, Aged, Anxiety, Anxiety Disorders psychology, Brazil epidemiology, Cities, Comorbidity, Cross-Sectional Studies, Depressive Disorder epidemiology, Depressive Disorder psychology, Diagnostic and Statistical Manual of Mental Disorders, Female, Humans, Logistic Models, Male, Mental Health, Middle Aged, Prevalence, Violence psychology, Young Adult, Anxiety Disorders epidemiology, Violence statistics & numerical data
- Abstract
Background: Estimating 12-month prevalence of depression, anxiety, and comorbid anxiety/depression in noninstitutionalized adults (age 15-75) in two violence-prone cities., Methods: The Composite International Diagnostic Interview v2.1 (Portuguese), administered in population-representative surveys (age 15-75) in São Paulo (N = 2536) and Rio de Janeiro (N = 1208), yielded 12-month prevalence of violent events experienced, and DSM-IV diagnoses of depression and anxiety, which were classified into mutually exclusive groups: 1) no anxiety/depression; 2) anxiety only; 3) depression only; 4) comorbid anxiety/depression. Weighted analyses estimated 12-month prevalence, multinomial logistic regression compared the demographic characteristics of the diagnosis groups, and association with experienced violence., Results: Twelve-month prevalence of anxiety alone, depression alone, and comorbid anxiety/depression was 12.7% (of whom 24.9% were also depressed), 4.9% (of whom 46.2% had anxiety), and 4.2% respectively for São Paulo; and 12.1% (18.2% of whom were depressed), 4.6% (37.0% with anxiety), and 2.7% respectively for Rio de Janeiro. All conditions were approximately twice as prevalent in women than in men in both cities. In São Paulo, comorbidity was associated with age under 60, depression alone was more prevalent among 30-59 year olds, but in 23-29 year-olds in Rio de Janeiro. Exposure to violence increased the odds of anxiety, depression, and their comorbidity. With rare exception, marital status, education, and race/ethnicity were not associated with anxiety, depression, or their comorbidity., Limitations: Cross-sectional design., Conclusions: Prevalence rates for all conditions were high, and particularly associated with exposure to violence. Means to ameliorate violence, and its mental health effects, particularly for women, are needed., (Copyright © 2018 Elsevier B.V. All rights reserved.)
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- 2018
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172. A Cumulative Deficit Laboratory Test-based Frailty Index: Personal and Neighborhood Associations.
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King KE, Fillenbaum GG, and Cohen HJ
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- Aged, Biomarkers blood, Cross-Sectional Studies, Ethnicity, Female, Humans, Internal-External Control, Longitudinal Studies, Male, Risk Assessment, Social Class, Social Environment, Clinical Laboratory Techniques methods, Frail Elderly, Geriatric Assessment, Residence Characteristics
- Abstract
Objectives: To explore the association between a newly developed cumulative laboratory-based frailty index (FI) and intrinsic (personal) and extrinsic (social, environmental) characteristics., Design: Cross-sectional longitudinal study., Setting: The third and fourth waves of the community-representative, five-county, 10-year Duke Established Populations for Epidemiologic Studies of the Elderly study, carried out in a health service-rich area., Participants: Cognitively intact survivors of the third wave (N = 1,740), who provided blood samples for standard laboratory work., Measurements: Biomarkers (n = 28) were measured to develop a cumulative deficit laboratory test-based FI (Duke FI) derived from standard laboratory tests: SMAC-24 chemistry panel, high-density lipoprotein cholesterol panel, and complete blood count. Information was gathered on scales assessing intrinsic characteristics (personal locus of control, life satisfaction, self-esteem, depressive symptomatology) and extrinsic characteristics (support received from and provided to family and friends, stressful life events, neighborhood disadvantage)., Results: The newly developed Duke FI had content, construct, concurrent, and predictive validity. In addition to sex, race, and income, the Duke FI was associated at the intrinsic level with locus of control, self-esteem, life satisfaction, and depressive symptomatology (each P < .01) and at the extrinsic level with provision (P < .01) and with receipt of instrumental help (P < .10), social stressors (P < .03), and neighborhood disadvantage (P < .01) in unadjusted analysis; race fully explained neighborhood disadvantage., Conclusion: Intrinsic (personality) characteristics and personally close extrinsic characteristics (contacts with family and friends, personal stressors) are associated with laboratory test-based frailty, as is neighborhood disadvantage, although in this accessible, health service-rich environment, race fully explained association with neighborhood disadvantage, suggesting that interventions to reduce frailty in residents in such an environment should pay particular attention to characteristics that immediately affect the individual., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)
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- 2017
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173. A New Method of Identifying Characteristics of Needing Help to Take Medications in an Older Representative Community-Dwelling Population: The Older Adults Medication Assist Scale.
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Jamerson BD, Fillenbaum GG, Sloane R, and Morey MC
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- Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Cognition, Cross-Sectional Studies, Female, Geriatric Assessment, Humans, Independent Living, Longitudinal Studies, Male, North Carolina, Retrospective Studies, Socioeconomic Factors, Surveys and Questionnaires, Chronic Disease drug therapy, Health Services Needs and Demand, Medication Adherence statistics & numerical data
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Objectives: To determine the sociodemographic characteristics, health conditions, and cognitive and functional status associated with baseline prevalence and new need for help taking medication 3 years later and to construct a brief scale indicative of need for help taking medications., Design: Retrospective cross-sectional and 3-year longitudinal study., Setting: Five-county area in north-central Piedmont, North Carolina., Participants: Representative community-dwelling sample of black and white individuals aged 65 and older (N = 4,136)., Measurements: Information was obtained in person in participants' homes using structured questionnaires. Health conditions included sensory impairment and self-report of physician-diagnosed conditions. Cognitive status was assessed using the 10-item Short Portable Mental Status Questionnaire. Functional status was assessed using the three-item Rosow-Breslau scale, the five-item Katz activity of daily living scale, and a modified six-item Older Americans Resources and Services instrumental activities of daily living scale., Results: Characteristics associated with need for help taking medications were aged 80 and older, being male, living with others, having four or more chronic conditions, and impaired cognitive or functional status (c-statistic 0.94, 77.1% sensitivity, 87.9% specificity). Predictors of new need for help with medications 3 years later included aged 75 and older at baseline, being male, and impaired cognitive and functional status (c-statistic 0.75)., Conclusion: This brief scale can help identify persons needing help with medications and could be useful in assisting clinicians with medication management., Competing Interests: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper., (© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.)
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- 2016
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174. Trajectory classes of body mass index in a representative elderly community sample.
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Kuchibhatla MN, Fillenbaum GG, Kraus WE, Cohen HJ, and Blazer DG
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- Aged, Aged, 80 and over, Body Height, Body Weight, Depression etiology, Educational Status, Female, Humans, Independent Living, Longitudinal Studies, Male, North Carolina epidemiology, Obesity complications, Obesity psychology, Overweight ethnology, Prevalence, Risk Factors, Sampling Studies, Sex Distribution, Surveys and Questionnaires, Weight Loss ethnology, Black or African American, Aging ethnology, Black People statistics & numerical data, Body Mass Index, Health Status, Obesity ethnology, White People statistics & numerical data
- Abstract
Background: It is unclear whether distinct weight-related trajectory classes, differing in course, demographics, and health characteristics, exist in the elderly population., Methods: Data came from the 10-year (1986-1996) Duke Established Populations for Epidemiologic Studies of the Elderly study of 3,861 black (54%) and white (46%) participants aged 65-105 years. Latent-class trajectories of body mass index (BMI: kg/m(2)) based on self-reported weight and height at baseline, 3, 6, and 10 years later were determined using generalized mixture models. Polytomous logistic regression was used to identify baseline demographic and health characteristics that distinguished the trajectories, and 10-year postbaseline data to confirm the findings., Results: We identified three trajectories: normal weight (BMI ~24, 27.6% of the sample), overweight (BMI ~26, 65.1%), and obese (BMI ~31, 7.3%). Demographic characteristics distinguished the three trajectories: highest odds of blacks, women, and less education in the obese trajectory, lowest in the normal-weight trajectory. Obese and overweight differed adversely from normal-weight trajectories, but not significantly from each other on cognitive impairment, hypertension, and diabetes. Depressive symptomatology was more prevalent in the obese; they were also younger. There was no association with cancer or heart disease., Conclusion: Distinct trajectories and course of BMI were present in this older population. Weight loss increased with increase in BMI class. Although demographic characteristics distinguished all trajectory classes, adverse health characteristics distinguished the overweight and obese classes from the normal-weight class, but not from each other. Problems associated with education and health are present at study entry and should be addressed earlier in life.
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- 2013
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175. Trajectory classes of depression in a randomized depression trial of heart failure patients: a reanalysis of the SADHART-CHF trial.
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Kuchibhatla MN and Fillenbaum GG
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- Aged, Antidepressive Agents adverse effects, Chronic Disease, Depression physiopathology, Double-Blind Method, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Remission Induction methods, Sertraline adverse effects, Time Factors, Treatment Outcome, Antidepressive Agents therapeutic use, Depression drug therapy, Heart Failure complications, Models, Statistical, Sertraline therapeutic use
- Abstract
Objective: The objective of this article was to determine whether, in drug intervention trials, growth mixture modeling (GMM) is able to identify drug-responsive trajectory classes that are not evident in traditional growth modeling approaches., Methods: We reanalyzed acute phase (biweekly data up to 7 occasions) and longitudinal (12 months) data on the 469 patients in the SADHART-CHF study of the safety and efficacy of sertraline for depression in patients with heart failure. GMM was used to identify the trajectory classes present in the treatment and placebo groups, based on Hamilton Depression Rating Scale scores., Results: Two distinct trajectory classes were identified in the treatment group: (1) chronic depressives (12%), who remained depressed through the treatment phase; and (2) responders (88%), who had scores indicating nondepression at the conclusion of the acute phase. At baseline, chronic depressives were distinguished by higher Hamilton Depression Rating Scale scores, the presence of implantable cardioverter defibrillators, and a history of anxiety. During follow-up, they were more likely to have unstable angina. Only responders remitted (70%). Three distinct trajectories were identified in the placebo group: (1) moderating depressives (19%), (2) temporary improvers (13%), and (3) responders (68%). At baseline, the classes differed in mean Hamilton Depression Rating Scale scores, responders' scores falling between the other 2 classes, and the proportion with renal disease. Only remission differed at follow-up: responders (76%), moderating depressives (21%), and temporary improvers (3%). Where the traditional analytic approach found improvement from moderate to mild depression but no significant treatment effect, GMM found response in 20% more people in the treatment group than in the placebo group., Conclusions: Unlike conventionally used, standard analytic approaches, which focus on intervention impact at study end or change from baseline to study end, GMM enables maximum use of repeated data to identify unique trajectories of latent classes that are responsive to the intervention., (Copyright © 2011 Elsevier HS Journals, Inc. All rights reserved.)
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- 2011
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176. Accuracy of self-reported height and weight in a community-based sample of older African Americans and whites.
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Fillenbaum GG, Kuchibhatla MN, Whitson HE, Batch BC, Svetkey LP, Pieper CF, Kraus WE, Cohen HJ, and Blazer DG
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- Age Factors, Aged, Aged, 80 and over, Analysis of Variance, Body Mass Index, Female, Health Surveys, Humans, Male, Reproducibility of Results, Sex Factors, Black or African American psychology, Black or African American statistics & numerical data, Body Height, Body Weight, Self Disclosure, White People psychology, White People statistics & numerical data
- Abstract
Background: To ascertain accuracy of self-reported height, weight (and hence body mass index) in African American and white women and men older than 70 years of age., Method: The sample consisted of cognitively intact participants at the third in-person wave (1992-1993) of the Duke Established Populations for Epidemiologic Studies of the Elderly (age 71 and older, N = 1761; residents of five adjacent counties, one urban, four rural). During in-person, in-home interviews using trained interviewers, height and weight were self-reported (and measured later in the same visit using a standardized protocol), and information were obtained on race, sex, and age., Results: Accuracy of self-reported height and weight was high (intraclass correlation coefficient 0.85 and 0.97, respectively) but differed as a function of race and age. On average, all groups overestimated their height; whereas (non-Hispanic) white men and women underestimated their weight, African Americans overestimated their weight. Overestimation of height and weight was more marked in persons 85 years and older. Specificity for overweight (body mass index [kg/m(2)] ≥ 25) and obesity (body mass index ≥ 30) ranged from 0.90 to 0.99 for African Americans and whites, but sensitivity was better for African Americans (overweight: 0.81, obesity: 0.89), than for whites (0.66 and 0.57, respectively)., Conclusions: Height and weight self-reported by African Americans and whites over the age of 70 can be used in epidemiological studies, with greater caution needed for self-reports of whites, and of persons 85 years of age or older.
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- 2010
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177. Identifying a national death index match.
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Fillenbaum GG, Burchett BM, and Blazer DG
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- Algorithms, Epidemiologic Methods, Humans, Social Security statistics & numerical data, United States epidemiology, Cause of Death, Data Collection methods, Death Certificates, Mortality
- Abstract
Data from the National Death Index (NDI) are frequently used to determine survival status in epidemiologic or clinical studies. On the basis of selected information submitted by the investigator, NDI returns a file containing a set of candidate matches. Although NDI deems some matches as perfect, multiple candidate matches may be available for other cases. Working across data from the Duke University site of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), NDI, and the Social Security Death Index (SSDI), the authors found that, for this Established Populations for Epidemiologic Studies of the Elderly cohort of 1,896 cases born before 1922 and alive as of January 1, 1999, a match on Social Security number plus additional personal information (specific combinations of last name, first name, month of birth, day of birth) resulted in agreement between NDI and Social Security Death Index dates of death 94.7% of the time, while comparable agreement was found for only 12.3% of candidate decedents who did not have the required combination of information. Thus, an easy to apply algorithm facilitates accurate identification of NDI matches.
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- 2009
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178. Correlates of and relationship among lifetime alcohol abuse and alcohol dependence in older community residents in Brazil.
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Fillenbaum GG, Blay SL, Andreoli SB, and Gastal FL
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- 2009
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179. Equity of access to outpatient care and hospitalization among older community residents in Brazil.
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Blay SL, Fillenbaum GG, Andreoli SB, and Gastal FL
- Subjects
- Age Factors, Aged, Aged, 80 and over, Brazil, Cross-Sectional Studies, Female, Humans, Insurance Coverage statistics & numerical data, Male, Middle Aged, Morbidity, National Health Programs statistics & numerical data, Socioeconomic Factors, Ambulatory Care statistics & numerical data, Cross-Cultural Comparison, Health Services Accessibility statistics & numerical data, Health Services for the Aged statistics & numerical data, Healthcare Disparities statistics & numerical data, Hospitalization statistics & numerical data
- Abstract
Objective: To determine whether, as mandated by Brazilian law, health care (outpatient care, hospitalization) among older community residents is based on health-related criteria and not on other characteristics., Research Design: Cross-sectional, population-representative., Subjects: Multistage, random sample of 7040 household residents aged >or=60 years in the state of Rio Grande do Sul, Brazil., Measures: Structured in-person interviews to determine sociodemographic characteristics, self-reported health conditions, psychiatric status, outpatient service use within the previous 6 months, and number of hospitalizations within the previous 12 months., Results: Seventy two percent reported an outpatient visit, 20% reported hospitalization. In controlled analyses, being female, older, unemployed, having private health insurance, increased the odds of an outpatient visit. Males, older persons, the insured, and more educated were more likely to report hospitalization. Race/ethnicity and religious affiliation were not associated with outpatient or hospital use. Pneumonia, heart disease, and urinary tract infection were particularly associated with both outpatient visits and hospitalization; diabetes, hypertension, and cancer with outpatient visit; stroke, cancer and psychiatric disorder with hospitalization; and heart disease, pneumonia, and psychiatric disorder with multiple hospitalizations., Conclusions: Use of health services did not differ by race/ethnicity or religion, but private health insurance facilitated outpatient access, and increased education facilitated hospitalization. Gender, age, and employment status likely reflected differential health needs. Improved access is needed for older persons lacking private health insurance, and those with little education. Patients with psychiatric problems merit increased attention to reduce excessive hospitalization.
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- 2008
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180. Home or nursing home: does place of residence affect longevity in patients with Alzheimer's disease? The experience of CERAD patients.
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Peterson BL, Fillenbaum GG, Pieper CF, and Heyman A
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- Aged, Aged, 80 and over, Algorithms, Alzheimer Disease ethnology, Alzheimer Disease physiopathology, Female, Humans, Longevity, Male, Mental Processes physiology, Middle Aged, Proportional Hazards Models, Time Factors, United States epidemiology, White People psychology, Alzheimer Disease mortality, Home Care Services statistics & numerical data, Institutionalization, Nursing Homes statistics & numerical data, Survival Analysis, White People statistics & numerical data
- Abstract
There is concern that life is curtailed when patients with Alzheimer's disease (AD) are institutionalized. To determine whether placement in a nursing home reduces their remaining years of life, we examined the experience of White patients with AD (n=890) enrolled in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Proportional hazards survival analysis using the landmark approach (with the landmark set to 12 months after CERAD entry and reevaluated at succeeding 6-month time intervals through 5 years) indicated that longevity at home and in the nursing home was comparable. Thus, in these patients enrolled at tertiary care medical centers, living at home or in a nursing home did not affect time to death. These data suggest that when home care is no longer feasible, families and nurses counseling them should not feel that they are curtailing life by placing an AD patient in a nursing home.
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- 2008
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181. Does lack of social support lead to more ED visits for older adults?
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Hastings SN, George LK, Fillenbaum GG, Park RS, Burchett BM, and Schmader KE
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- Aged, Aged, 80 and over, Female, Humans, Male, North Carolina, Outpatients, Prospective Studies, Social Isolation, Emergency Service, Hospital statistics & numerical data, Social Support
- Abstract
Objective: The goals of this study were to (1) determine whether level of social support and living situation predicted emergency department (ED) use among older adults and (2) identify correlates of ED visits according to whether the patient was admitted to the hospital., Methods: Secondary analysis of a longitudinal, prospective study was conducted., Results: In adjusted analyses, subjects who lived alone were 60% more likely to visit the ED than those who lived solely with their spouse. Neither type nor level of social support as measured by the Duke Social Support Index predicted ED use. Indicators of poor physical health (prior hospitalization, poorer self-rated health, and functional disability) were predictors of ED visits that resulted in hospitalization; however, these were not significantly associated with outpatient ED visits., Discussion: Older adults who live alone are more likely to visit the ED. Additional study is needed to understand the determinants of outpatient ED visits.
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- 2008
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182. Geographical segregation and IL-6: a marker of chronic inflammation in older adults.
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Purser JL, Kuchibhatla MN, Miranda ML, Blazer DG, Cohen HJ, and Fillenbaum GG
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AIM: To examine environmental sociodemographic risks of high IL-6, a marker of chronic inflammation in older adults. METHODS: We spatially linked 1990 USA Census tract demographic and economic measures to a prospective cohort study of representative community residents aged 71 years and older, from over 1700 of whom a cytokine protein and biological marker of chronic inflammation. IL-6, was collected. Using generalized interactive mixed models, we modeled 1989-1990 individual and census level risk factors for the dependent variable high IL-6 between 1992-1993 (high IL-6 = upper quartile: >2.96 pg/ml). RESULTS: After individual health risk adjustment, IL-6 remained elevated in communities with greater densities of poor older adults (odd ratio [OR]: 1.25 per 10% increase in exposure. 95% confidence interval [CI]: 1.05, 1.48) and in racially segregated communities (OR: 1.14 per 10% increase in exposure. 95% CI: 1.04, 1.25). CONCLUSIONS: Socially disadvantaged environments may influence IL-6, a biomarker of age-associated inflammation.
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- 2008
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183. Depression morbidity in later life: prevalence and correlates in a developing country.
- Author
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Blay SL, Andreoli SB, Fillenbaum GG, and Gastal FL
- Subjects
- Activities of Daily Living classification, Activities of Daily Living psychology, Age Factors, Aged, Aged, 80 and over, Brazil, Cross-Sectional Studies, Depressive Disorder diagnosis, Depressive Disorder psychology, Female, Geriatric Assessment statistics & numerical data, Health Surveys, Humans, Male, Middle Aged, Personality Assessment, Socioeconomic Factors, Statistics as Topic, Depressive Disorder epidemiology, Developing Countries
- Abstract
Objective: To investigate the one-month prevalence of depression morbidity and its association with sociodemographic characteristics, health and functional status, and use of health services in community residents aged 60 years and over in Brazil., Methods: This study used a cross-sectional design of face-to-face interviews (N = 7,040) in Rio Grande do Sul State, Brazil. Participants were household residents aged 60 years and older. Measurements included the Short Psychiatric Evaluation Schedule (six-item version) and questionnaire that assessed sociodemographic characteristics, self-reported health status, systemic illnesses, activities of daily living (ADL), use of medical services, and social support., Results: The overall prevalence of depression morbidity was 22% (men: 18%, women: 25.2%). In controlled analyses, younger age, low income, rural origin, never or no longer married, poor self-rated health, presence of systemic illnesses, visual, hearing, or ADL impairments, hospitalization in the past 12 months, and lack of exercise or employment were significantly associated with depression morbidity, whereas living alone was nearly so associated. Gender, education, minority race, or outpatient visits in the previous six months were not associated with depression morbidity., Conclusion: The overall prevalence of depression morbidity was among the highest previously reported for older persons. In controlled analyses, prevalence declined as age increased, and rates were higher for those with lower income and poorer social, health, and functional status, but did not differ significantly by gender, education, or race/ethnicity. Increased attention should be paid to identifying depression morbidity in those with adverse circumstances and to identifying ameliorating interventions.
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- 2007
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184. Effect of cancer screening and desirable health behaviors on functional status, self-rated health, health service use and mortality.
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Fillenbaum GG, Burchett BM, Kuchibhatla MN, Cohen HJ, and Blazer DG
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- Activities of Daily Living, Black or African American statistics & numerical data, Aged, Aged, 80 and over, Female, Hospitalization statistics & numerical data, Humans, Logistic Models, Male, Mass Screening, Multivariate Analysis, Proportional Hazards Models, White People statistics & numerical data, Health Behavior, Health Services statistics & numerical data, Health Status, Mortality, Neoplasms diagnosis
- Abstract
Objectives: To determine whether some health behaviors of older people (e.g., obtaining cancer screens) have a limited and others (e.g., exercise) have a broad association with population-level health status 4 to 6 years later., Design: Longitudinal cohort., Setting: North Carolina five-county urban and rural area., Participants: Representative community residents aged 71 and older (Duke Established Populations for Epidemiologic Studies of the Elderly; African American, n=1,256; white, n=974) who provided information on cancer screening and health behaviors., Measurements: Demographics, health conditions, functional status, health service use, health insurance. Dependent measures were functional status and self-rated health 4 years later, hospitalization within 4 years, and death within 6 years. Data were analyzed using descriptive statistics, multivariable logistic regression, and Cox proportional hazards., Results: In fully adjusted analyses, cancer screening had no significant protective association with functional status, self-rated health, hospitalization, or death. Smoking was a risk factor for hospitalization (odds ratio (OR)=1.48, 95% confidence interval (CI)=1.07-2.05), and death (hazard rate (HR)=1.81, 95% CI=1.47-2.23). Sufficient food reduced hospitalization (OR=0.38, 95% CI=0.15-0.94) and mortality (HR=0.70, 95% CI=0.49-1.02). Regular exercise protected against poor mobility (OR=0.56, 95% CI=0.41-0.77), and poor self-rated health (OR=0.61, 95% CI=0.45-0.82). Lower activity level increased the hazard of death (HR=1.18, 95% CI=1.03-1.36)., Conclusion: Disease-specific screens are important at an individual level but, because of low incidence of condition and comorbidity, may not be associated with population-level health 4 to 6 years later. Practice of health behaviors with a broader focus is associated, at a population level, with better functional status and self-rated health and lower rates of hospitalization and death 4 to 6 years later.
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- 2007
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185. Provider characteristics related to antidepressant use in older people.
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Fillenbaum GG, Hybels CF, Pieper CF, Konrad TR, Burchett BM, and Blazer DG
- Subjects
- Aged, Aged, 80 and over, Attitude of Health Personnel, Cognition, Female, Follow-Up Studies, Health Status, Humans, Male, Practice Patterns, Physicians', Retrospective Studies, Antidepressive Agents therapeutic use, Depression drug therapy, Drug Prescriptions statistics & numerical data, Health Personnel
- Abstract
Objectives: To determine whether the characteristics of the usual medical care providers of older antidepressant users changed between 1986 and 1997 with the introduction of selective serotonin reuptake inhibitors., Design: Longitudinal study., Setting: Five-county Piedmont area of North Carolina., Participants: Stratified random sample of African-American (n=2,261) and white (n=1,875) community residents aged 65 to 105., Measurements: Sample members provided information on prescription medications, demographic and health status, and usual medical care provider (matched to North Carolina Health Professions Data Systems files to ascertain provider characteristics) in 1986/87, 1989/90, 1992/93, and 1996/97. Most (77.5%) named a provider (name unmatchable for 4.1%). Sample member characteristics were aggregated into probability (propensity) scores summarizing predisposing (demographic), enabling (medical care access), and need (health status) categories. Along with wave of study and whether a provider was named, these were entered as control variables in generalized estimating equation models that examined the association between provider race (white vs nonwhite), sex, age, location of practice, and primary versus specialist care and antidepressant use., Results: The characteristics of the usual medical care providers remained stable over the decade, although prevalence of antidepressant use increased. Two provider characteristics--race and area of practice (but not the interaction between them)--were significantly associated with patients' use of antidepressants. Patients of white physicians and of physicians with urban practices were more likely to use antidepressants., Conclusion: Although use of antidepressants has increased over time, there has been little change in the characteristics of users' usual medical care providers.
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- 2006
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186. Sociodemographic characteristics of the neighborhood and depressive symptoms in older adults: using multilevel modeling in geriatric psychiatry.
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Hybels CF, Blazer DG, Pieper CF, Burchett BM, Hays JC, Fillenbaum GG, Kubzansky LD, and Berkman LF
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- Aged, Cross-Sectional Studies, Demography, Depression diagnosis, Female, Humans, Male, Psychology, Regression Analysis, Severity of Illness Index, Socioeconomic Factors, Depression epidemiology, Depression psychology, Geriatric Psychiatry methods, Residence Characteristics
- Abstract
Objective: Neighborhood sociodemographic characteristics may be important to the mental health of older adults who have decreased mobility and fewer resources. Our objective was to examine the association between neighborhood context and level of depressive symptomatology in older adults in a diverse geographic region of central North Carolina., Methods: The sample included 2,998 adults 65 or older residing in 91 census tracts. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Neighborhoods were characterized by five census-based characteristics: socioeconomic disadvantage, socioeconomic advantage, racial/ethnic heterogeneity, residential stability, and age structure., Results: In ecologic level analyses, level of census tract socioeconomic disadvantage was associated with increased depressive symptoms. To determine whether neighborhood context was associated with depressive symptoms independently of individual characteristics, the authors used multilevel modeling. The authors examined the ability of each of five neighborhood (level 2) characteristics to predict a level 1 outcome (CES-D symptoms) controlling for the effects of individual (level 1) characteristics. Younger age, being widowed, lower income, and having some functional limitations were associated with increased depression symptoms conditional on census tract random effects. However, none of the neighborhood characteristics was significantly associated with depression symptoms, conditional on census tract random effects, either unadjusted or adjusted for individual characteristics., Conclusion: Any observed association between neighborhood sociodemographic characteristics and individual depressive symptoms in our sample may reflect the characteristics of the individuals who reside in the neighborhood rather than the neighborhood characteristics themselves. The use of multilevel modeling is important to separate these effects.
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- 2006
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187. Memory complaint is not necessary for diagnosis of mild cognitive impairment and does not predict 10-year trajectories of functional disability, word recall, or short portable mental status questionnaire limitations.
- Author
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Purser JL, Fillenbaum GG, and Wallace RB
- Subjects
- Aged, Cognition Disorders complications, Cognition Disorders rehabilitation, Diagnosis, Differential, Disease Progression, Female, Follow-Up Studies, Humans, Iowa epidemiology, Male, Memory Disorders diagnosis, Memory Disorders epidemiology, Prevalence, Prognosis, Prospective Studies, Risk Factors, Surveys and Questionnaires, Time Factors, Washington epidemiology, Cognition Disorders diagnosis, Disability Evaluation, Memory Disorders etiology, Mental Status Schedule standards
- Abstract
Objectives: To evaluate the prevalence and utility of memory complaint in a geographically representative cohort and, in cases with mild cognitive impairment (MCI), to determine whether memory complaint alters 10-year trajectories of disability in activities of daily living (ADLs), Short Portable Mental Status Questionnaire (SPMSQ) score, and 20-item word recall., Design: Prospective cohort study., Setting: Washington and Iowa counties, Iowa., Participants: Iowa Established Populations for Epidemiologic Studies of the Elderly (N = 3,673; aged > or =65; 61.3% female; 99.9% white)., Measurements: Age, sex, education, SPMSQ score, 20-item word recall, ADL or instrumental ADL disability, and chronic medical conditions., Results: The prevalence of memory complaint was 34%. Although proportionally more cognitively impaired individuals were in the memory complaint group (34% vs 27%), the pattern of subclassification into cognitively intact and MCI Stage 1 and 2 subgroups was similar for people with and without memory complaint. Median SPMSQ score and number of words recalled at baseline were comparable across memory complaint categories in each subgroup. MCI participants without subjective memory complaint constituted a larger proportion of the overall sample than individuals with subjective memory complaint (460 (14%) vs 295 (8.9%)) and of persons objectively classified as having MCI (61% vs 39%). The distribution of individual 10-year change in ADL disability, SPMSQ score, and word recall were similar for those with and without memory complaint across all subgroups of cognitive impairment., Conclusion: Memory complaint is not necessary for MCI diagnosis and does not distinguish cases with different progression rates in disability or cognitive impairment. 2006.
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- 2006
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188. Mild cognitive impairment and 10-year trajectories of disability in the Iowa Established Populations for Epidemiologic Studies of the Elderly cohort.
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Purser JL, Fillenbaum GG, Pieper CF, and Wallace RB
- Subjects
- Activities of Daily Living classification, Aged, Aged, 80 and over, Cohort Studies, Disease Progression, Female, Follow-Up Studies, Health Surveys, Humans, Iowa, Longitudinal Studies, Male, Neuropsychological Tests statistics & numerical data, Probability, Psychometrics, Alzheimer Disease epidemiology, Amnesia epidemiology, Cognition Disorders epidemiology, Disability Evaluation
- Abstract
Objectives: To apply diagnostic criteria for mild cognitive impairment (MCI) to a geographically representative sample, to estimate the prevalence of MCI, and to estimate 10-year trajectories of incident disability for cognitively intact participants and subgroups with MCI., Design: Prospective cohort; 10 years of follow-up., Setting: Community-based survey of noninstitutionalized population aged 65 and or older in two rural Iowa counties (Washington and Iowa)., Participants: Iowa Established Populations for Epidemiologic Studies of the Elderly (aged > or = 65; N = 3,673; 61.3% female; 99.9% white)., Measurements: Age, sex, education, Short Portable Mental Status Questionnaire (SPMSQ), 20-item word recall, activities of daily living (ADLs), instrumental activities of daily living (IADLs), chronic medical conditions., Results: MCI was prevalent in 24.7% of participants at baseline. Most participants in the overall cohort remained stable or changed slowly (< or = 1 new limitations) over 10 years (63.1% for SPMSQ, 89.3% for word recall, and 61.7% for ADL disability). For MCI/no prevalent IADL disability (Stage 1 MCI), disability progression was similar to that in the cognitively intact subgroup (median = 0.08 vs 0.05 disabilities per year). For MCI plus prevalent IADL disability (Stage 2 MCI), the median rate of change was equivalent to that of the severely impaired (0.23 disabilities per year; interquartile range = 0.12-0.36)., Conclusion: Unlike participants with MCI who reported no IADL limitations, those with such limitations were more likely to develop ADL disability--a prerequisite for a diagnosis of dementia.
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- 2005
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189. Impact of inappropriate drug use on health services utilization among representative older community-dwelling residents.
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Fillenbaum GG, Hanlon JT, Landerman LR, Artz MB, O'Connor H, Dowd B, Gross CR, Boult C, Garrard J, and Schmader KE
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- Aged, Aged, 80 and over, Cohort Studies, Contraindications, Drug Interactions, Drug Therapy, Drug-Related Side Effects and Adverse Reactions, Female, Hospitalization, Humans, Male, Nursing Homes, Prospective Studies, Risk Factors, Surveys and Questionnaires, Drug Prescriptions statistics & numerical data, Drug Utilization Review methods, Health Services statistics & numerical data, Medication Errors statistics & numerical data
- Abstract
Background: There is limited objective information regarding the impact of drugs identified as inappropriate by drug utilization review (DUR) or the Beers drugs-to-avoid criteria on health service use., Objective: The goal of this study was to examine the predictive validity of DUR and the Beers criteria employed to define inappropriate drug use in representative community residents, aged >or=68 years, as determined by the relationship of these criteria to health service use in older community residents., Methods: Data came from participants in the Duke University Established Populations for Epidemiologic Studies of the Elderly seen in 1989/1990 and for whom information was also available 3 years later. Two sets of inappropriate drug use criteria were examined: (1) DUR regarding dosage, duration, duplication, and drug-drug and drug-disease interactions; and (2) the Beers criteria, applied to drug use reported in an in-home interview. Outpatient visits and nursing-home entry were determined by personal report; hospitalization information came from Medicare Part A files from the Centers for Medicare and Medicaid Services., Results: A total of 3165 participants were available at the fourth interview in 1989/1990. The majority were aged >74 years (51.1%), white (64.8%), women (64.7%), had fair or poor health (77.0%), consistently saw the same physician (86.9%), and possessed supplemental health insurance (62.8%). Use of inappropriate drugs meeting DUR criteria, especially for drug-drug or drug-disease interaction problems, was associated with increased outpatient visits (P<0.05) but not with time to hospitalization or time to nursing home entry. The use of inappropriate drugs according to the Beers criteria was associated with reduced time to hospitalization (adjusted hazard ratio, 1.20; 95% CI, 1.04-1.39) but not to outpatient visits or nursing home entry., Conclusions: Our data suggest that in representative community residents aged >or=68 years, current criteria for inappropriate drug use should be used with caution in evaluating quality of care because they have minimal impact on use of health services. We found increases only in the use of outpatient services (with DUR) and more rapid use of hospitalization (with the Beers criteria).
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- 2004
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190. Use of antibacterial drugs in community-dwelling older persons.
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Guay DR, Artz MB, Hanlon JT, Fillenbaum GG, and Schmader KE
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- Black or African American, Aged, Anti-Bacterial Agents classification, Female, Humans, Male, Southeastern United States, White People, Anti-Bacterial Agents administration & dosage
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- 2003
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191. APOE epsilon4 as a predictor of subjective quality of life in a biracial older person community sample.
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Blazer DG, Fillenbaum GG, Gold DT, Burchett BM, and Hays JC
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- Aged psychology, Alleles, Alzheimer Disease genetics, Black People, Educational Status, Female, Genotype, Humans, Male, Risk Factors, White People, Black or African American, Apolipoproteins E genetics, Health Status, Quality of Life
- Abstract
Unlabelled: The epsilon4 allele of apolipoprotein E (APOE) has been associated with health-related outcomes that may adversely affect quality of life (QOL) in older adults. In the absence of published information, we sought to determine whether the epsilon4 allele was associated with subjective QOL across 5 parameters in a community sample of older adults., Design: Prospective cohort study., Setting: Community-based sample of older adults in North Carolina (Duke site of the Established Populations for Epidemiologic Studies of the Elderly [Duke EPESE])., Participants: Self-responding genotyped sample members (n = 1,880) of whom 1,254 provided longitudinal data., Measurements: APOE genotype and five newly constructed, reliable, and valid measures of subjective QOL derived from the Duke EPESE questionnaire. The 5 parameters measured were social, economic, mental and physical health, and functional status. Control variables included age, gender, race (African American or White), education and urban/rural residence., Results: Among those with good baseline QOL, there was no significant association between the epsilon4 allele and any of the parameters of subjective QOL in longitudinal analyses. In controlled longitudinal analysis, older age women predicted poorer functional status; being African American, and reporting lower education predicted poorer subjective economic well-being; and being African American predicted better self-assessed mental health., Conclusions: This study is among the first to explore the association of the epsilon4 allele with overall QOL. Considered from a public health perspective, these findings challenge the uncritical assumption that the presence of this susceptibility gene in the population implies an excess burden of poor QOL. The findings do not contradict the previous association of epsilon4 with Alzheimer's disease (AD) and other conditions. Such conditions continue to merit full attention.
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- 2003
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192. Assessing risk factors for mortality in elderly White and African American people: implications of alternative analyses.
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Kuchibhatla M and Fillenbaum GG
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- Aged, Aged, 80 and over, Female, Humans, Logistic Models, Male, Proportional Hazards Models, Risk Factors, Black or African American, Black People, Mortality, White People
- Abstract
Purpose: The aim of this study was to ascertain whether the determinants of death differ as a function of type of analysis in a representative sample of older African American and White people with comparable mortality rates., Design and Methods: Participants included all African American (n = 2,261) and White (n = 1,875) people at the Duke site of the Established Populations for Epidemiological Studies of the Elderly. Baseline information used to predict mortality 12 years later included demographic, health, and functional characteristics. Mortality (55% for African American people and 54% for White people) was determined through the National Death Index. Cox proportional hazards models, logistic regression, and tree-based classification analysis were used (separately for African American and White people) to identify risk factors for mortality., Results: Risk factors for mortality were comparable, but the constellation of characteristics indicating higher risk for death differed between African American and White people., Implications: Proportional hazards and logistic regression identified risk factors in general; tree-based classification models identified the characteristics of groups at risk. The analysis used may influence the type and manner of intervention.
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- 2002
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193. APOE epsilon4 and low cholesterol as risks for depression in a biracial elderly community sample.
- Author
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Blazer DG, Burchett BB, and Fillenbaum GG
- Subjects
- Aged, Aged, 80 and over, Apolipoprotein E4, Cross-Sectional Studies, Depressive Disorder psychology, Educational Status, Female, Humans, Longitudinal Studies, Male, Marital Status, North Carolina, Psychiatric Status Rating Scales, Risk Factors, White People psychology, Black or African American psychology, Apolipoproteins E adverse effects, Apolipoproteins E blood, Cholesterol adverse effects, Cholesterol blood, Depressive Disorder blood, Depressive Disorder etiology
- Abstract
Objective: The epsilon4 allele of apolipoprotein (APOE) is known to be associated with a number of adverse health outcomes, yet the association of the allele with depression has not been conclusively determined. The authors explored the hypothesis that the epsilon4 allele is a risk factor for depression among older persons with a low cholesterol level (a known risk factor for depression)., Methods: A biracial community sample of 2,550 older African Americans and Whites in North Carolina was genotyped for APOE, tested for cholesterol, and evaluated for depression at both baseline and 4-year follow-up., Results: No relationship was found between the epsilon4 allele and depression or low cholesterol and depression in either cross-sectional or longitudinal analyses. The interaction of the epsilon4 allele and cholesterol was also not associated with depression in controlled analyses. Female gender, less education, being unmarried, and cognitive impairment were associated with depression in cross-sectional controlled analyses; only cognitive impairment was associated with depression in longitudinal analyses., Conclusion: Despite the association of the epsilon4 allele with a number of adverse health outcomes, as well as the association between depression and cholesterol in previous studies, no association was found between epsilon4 and low cholesterol or depression in cross-sectional and longitudinal analyses. The interaction of epsilon4 and cholesterol was not associated with depression.
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- 2002
194. Apolipoprotein E epsilon4 and risk of mortality in African American and white older community residents.
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Fillenbaum GG, Blazer DG, Burchett BM, Saunders AM, and Taylor DH Jr
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- Black or African American, Aged, Apolipoprotein E4, Genotype, Humans, United States, White People, Apolipoproteins E blood, Mortality
- Abstract
Purpose: The goal of this study was to determine whether the epsilon4 allele of apolipoprotein E is predictive of mortality in a community-based sample., Design and Methods: Of the stratified random household sample of 4,162 participants age 65 years and older enrolled in the Duke site of the Established Populations for Epidemiologic Studies of the Elderly, those included in the present study were the 1,998 who were genotyped for apolipoprotein E (alleles epsilon2, epsilon3, and epsilon4) six years after baseline, and for whom survival status eight years later was known by search of the National Death Index. Information on demographic characteristics, physical and mental health status, functional status, and health services use was determined by structured questionnaires administered in person in the home., Results: The epsilon4 allele did not predict mortality for the group as a whole, or for those who were cognitively impaired. It did predict mortality for those who reported having had a heart attack or stroke., Implications: The apolipoprotein epsilon4 allele-although a risk factor for Alzheimer's disease, heart disease, and stroke-was only found to be a risk factor for mortality for those community residents who had had a heart attack or stroke. Otherwise, for this community-based sample, 71 years of age and older, it did not predict time to death and was not a risk factor for mortality.
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- 2002
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195. Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders.
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Hanlon JT, Fillenbaum GG, Kuchibhatla M, Artz MB, Boult C, Gross CR, Garrard J, and Schmader KE
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- Aged, Aged, 80 and over, Cohort Studies, Female, Geriatric Assessment, Humans, Male, North Carolina, Polypharmacy, Predictive Value of Tests, Self Medication, Activities of Daily Living, Drug Utilization Review, Medication Errors, Mortality
- Abstract
Background: The predictive validity of Drug Utilization Review (DUR) and drugs-to-avoid criteria in elders is unknown., Objectives: To evaluate the relationship between use of inappropriate drugs as determined by these explicit criteria and mortality and decline in functional status in community dwelling elders., Research Design: Cohort study., Subjects: The fourth wave (3234 participants) of the Duke Established Populations for Epidemiologic Studies of the Elderly., Measures: Two sets of inappropriate drug-use criteria: (1) DUR with respect to dosage, duplication, drug-drug interactions, duration, and drug-disease interactions; and (2) Beers-modified criteria regarding drugs-to-avoid were applied to drug use reported in an in-home interview. Death was identified from the National Death Index; change in four functional status measures (basic self-care, intermediate self-care, complex self-management, physical function) was determined during the following 3 years., Results: Use of inappropriate drugs identified by either set of criteria was not significantly associated with mortality. The drugs-to-avoid criteria identified no significant associations between use of these drugs and decline in functional status. With DUR criteria, however, the association between use of inappropriate drugs and basic self-care was significant and pronounced among those with drug-drug or drug-disease interaction problems (Adj. OR 2.04; 95% CI 1.32-3.16)., Conclusions: Identifying the impact of inappropriate drug use may depend on the criteria applied. Further studies are needed that measure additional outcomes and use alternate measures of inappropriate drug use.
- Published
- 2002
- Full Text
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