Outcomes of surgical management of total HIP replacement in patients aged 65 years and older: cemented versus cementless femoral components and lateral or anterolateral versus posterior anatomical approach.

This observational study compared the outcomes of 271 cases of hip osteoarthritis receiving primary total hip replacement (patients 65 years of age and older) from numerous surgeons in 12 Baltimore region hospitals from 1991-1993. The independent variables studied were: (a) totally non-cemented prostheses (non-cemented femoral component, non-cemented acetabular component) versus hybrid prostheses (cemented femoral component, non-cemented acetabular component), and (b) lateral or anterolateral surgical approach versus posterior surgical approach. Outcomes included complications during the initial hospitalization, hospital length of stay, hospital cost, readmission, and reported and/or observed physical, instrumental, neuromuscular and affective functioning and pain at 2, 6, and 12 months post surgery.

Measurement of activity in older adults: reliability and validity of the Step Activity Monitor.

The purpose of this study was to test the reliability and validity of the Step Activity Monitor (SAM) when used with older adults. A total of 30 subjects with a mean age of 86 +/- 6.1 participated in the study.

The effect of social support on exercise behavior in older adults.

The purpose of this study was to test the relationship among social supports related to exercise (family, friends, and expert support), self-efficacy expectations, outcome expectations, and exercise behavior in a sample of older adults living in a continuing care retirement community. The sample included 74 older adults with a mean age of 85.6 +/- 5.

Resident contact with family and friends following nursing home admission.

Purpose: This study explored factors that are related to the level of contact (number of visits and calls) between newly admitted nursing home residents and their family and friends. In addition to reexamining factors studied previously, several new factors were explored: contact level prior to nursing home placement, dementia status, and resident race.

Design And Methods: Interviews were conducted with the significant others of 1,441 residents from a representative sample of nursing homes in Maryland.

Model testing for reliability and validity of the Outcome Expectations for Exercise Scale.

Background: Development of a reliable and valid measure of outcome expectations for exercise appropriate for older adults will help establish the relationship between outcome expectations and exercise. Once established, this measure can be used to facilitate the development of interventions to strengthen outcome expectations and improve adherence to regular exercise in older adults.

Objectives: Building on initial psychometrics of the Outcome Expectation for Exercise (OEE) Scale, the purpose of the current study was to use structural equation modeling to provide additional support for the reliability and validity of this measure.

Serum and urine markers of bone metabolism during the year after hip fracture.

Objective: As part of a larger study to describe indices of recovery during the year after hip fracture, the current prospective study investigated longitudinal changes in serum and urine markers of bone metabolism for the year after hip fracture and related them to bone mineral density (BMD).

Design: A representative subset of participants provided serum and urine samples and had bone density measured at 3, 10, 60, 180, and 365 days postfracture.

Setting: Two Baltimore hospitals.

Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes.

Context: Hip fracture is a common clinical problem that leads to considerable mortality and disability. A need exists for a practical means to monitor and improve outcomes, including function, for patients with hip fracture.

Objectives: To identify and compare the importance of significant prefracture predictors of functional status and mortality at 6 months for patients hospitalized with hip fracture and to compare risk-adjusted outcomes for hospitals providing initial care.

Relationship between aggressive behaviors and depression among nursing home residents with dementia.

Background: Verbal and physical aggression are common behavior problems among nursing home residents with dementia. Depression among nursing home residents is also a common but underdiagnosed disorder.

Method: Data collected on 1101 residents with dementia, newly admitted to a sample of 59 nursing homes across Maryland, were analyzed to determine if there was a relationship between depression and physical and verbal aggression.

The methodologic quality of clinical trials on regional anesthesia for cataract surgery.

Objective: To assess the methodologic quality of published randomized trials of regional anesthesia management strategies for cataract surgery.

Design: Literature review and analysis.

Method: We performed a systematic search of the literature to identify all articles pertaining to regional anesthesia for cataract surgery on adults.

Synthesis of the literature on the effectiveness of regional anesthesia for cataract surgery.

Objective: To synthesize the findings of the randomized trials of regional anesthesia management strategies for cataract surgery.

Design: Literature review and analysis.

Method: The authors performed a systematic search of the literature to identify all articles pertaining to regional anesthesia during cataract surgery on adults.

Extending gerontological research through linking investigators' studies to public-use datasets.

Purpose: Public-use datasets can extend data collected by individual investigators in various ways: making external comparisons, providing additional data on individual respondents, and creating internal comparison groups. The authors describe the advantages and limitations of these methods and practical and conceptual issues in combining investigator-initiated and public-use datasets.

Design And Methods: These issues are illustrated with a study of functional decline among 674 patients following hospitalization for hip fracture that was augmented with data from a public-use dataset, the Established Populations for Epidemiologic Studies of the Elderly (EPESE).

Medical care for nursing home residents: differences by dementia status. Epidemiology of Dementia in Nursing Homes Research Group.

Objective: To understand the use of medical services by nursing home residents.

Design: Descriptive, longitudinal study comparing medical service use of residents by dementia status and describing the use of medical services following detection of fever or infection.

Setting: Fifty-nine randomly selected nursing homes in Maryland from 1992 to 1995.

The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: diagnosis by expert panel. Epidemiology of Dementia in Nursing Homes Research Group.

This study estimated the prevalence of dementia in 2,285 new admissions age 65+ to a statewide sample of 59 nursing homes in Maryland, 1992-1995. Dementia was ascertained according to DSM-III-R criteria by an expert panel of geriatric psychiatrists, neurologists, and a geriatrician using detailed information collected by trained lay evaluators from residents, family, staff, and medical records. Admissions to Maryland nursing homes are similar to admissions to nursing homes elsewhere in the United States.

The validity of the minimum data set in measuring the cognitive impairment of persons admitted to nursing homes.

Objectives: This study examined the construct validity of two cognitive scales from the federally mandated Minimum Data Set (MDS) of the nursing home Resident Assessment Instrument.

Design: A cross-sectional comparisons of the MDS measures, with scales provided by the resident, a proxy person, and nursing staff.

Setting: Subjects residing in 59 nursing homes (NHs) in Maryland from 1992 to 1995.

Outcome expectations for exercise scale: utility and psychometrics.

Objectives: The purpose of this study was to develop a measure of outcome expectations for exercise specifically for the older adult (The Outcome Expectations for Exercise [OEE] Scale), and to test the reliability and validity of this measure in a sample of older individuals. This scale was developed based on Bandura's theory of self-efficacy and the work of prior researchers in the development of measures of outcome expectations.

Methods: The OEE scale, which was completed during a face-to-face interview, was tested in a sample of 175 residents in a continuing care retirement community.

Racial differences in the prevalence of dementia among patients admitted to nursing homes.

Objective: The purpose of this study was to determine the prevalence of dementia among black and white residents on admission to nursing homes and to determine whether demographic and health characteristics known to be associated with dementia were correlated with dementia in this population.

Methods: Data from medical records and structured interviews with family members, nursing staff, and nursing home residents were gathered for 2,285 persons newly admitted to nursing homes in Maryland from 1992 to 1995. A stratified sample of 59 nursing homes was used.

Delirium on hospital admission in aged hip fracture patients: prediction of mortality and 2-year functional outcomes.

Background: Hip fracture patients are at increased risk of confusion or delirium due to the trauma associated with the injury and the rapid progression to hospitalization and surgery, in addition to the pain and loss of function experienced. Hip fracture patients who develop delirium may require longer hospital stays, are more often discharged to long-term care, and have a generally poor prognosis for returning home or regaining function in activities of daily living (ADL).

Methods: The present study examines the impact of delirium present on hospital admission in a sample of 682 non-demented, aged hip fracture patients residing in the community at the time of their fracture.

Recovery from hip fracture in eight areas of function.

Background: This report describes changes in eight areas of functioning after a hip fracture, identifies the point at which maximal levels of recovery are reached in each area, and evaluates the sequence of recuperation across multiple functional domains. METHODS. Community-residing hip fracture patients (n = 674) admitted to eight hospitals in Baltimore, Maryland, 1990-1991 were followed prospectively for 2 years from the time of hospitalization.

Change in muscle mass and muscle strength after a hip fracture: relationship to mobility recovery.

Background: Hip fracture in elderly persons has a serious impact on long-term physical function. This study determines the change in muscle strength and muscle mass after a hip fracture, and the associations between these changes and mobility recovery.

Methods: Ninety community-dwelling women aged 65 years and older who had recently experienced a fracture of the proximal femur were included in the study.

Surveillance for uterine abnormalities in tamoxifen-treated breast carcinoma survivors: a community based study.

Background: Tamoxifen-treated breast carcinoma survivors are at elevated risk of endometrial carcinoma. Whether to recommend annual surveillance for uterine abnormalities in this population is currently under debate.

Methods: This study was a cross-sectional, community-based investigation of tamoxifen use and the frequency of surveillance for endometrial carcinomas in 541 women with breast carcinoma.

Low bone mineral density and risk of fracture in white female nursing home residents.

Context: Low bone mineral density (BMD) is a strong risk factor for fracture in community-dwelling white women, but the relationship in white female nursing home residents, for whom fracture rates are highest, is less clear.

Objective: To assess the relative contribution of low BMD to fracture risk in nursing home residents.

Design: Prospective cohort study with baseline data collected April 1995 to June 1997, with 18 months of follow-up.

Correlates of bone mineral density in nursing home residents.

Purpose: To explore correlates of bone mineral density (BMD) in nursing home residents, examining factors associated with BMD in community cohorts and factors prevalent among nursing home residents.

Methods: A cross sectional study of 2156 elderly residents from a representative state-wide sample of 47 nursing homes in Maryland. Data consisted of BMD scans of the distal radius and ulna; information on comorbidities, activities, behavior and medications abstracted from medical charts and interviews; and observation of cognitive and neuromuscular performance.