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Özden F, Özkeskin M, Tümtürk İ, Yalçın M. The investigation of cognition, proprioception, sensory and physical function in stroke patients with urinary incontinence. Int Urol Nephrol 2023:10.1007/s11255-023-03647-5. [PMID: 37253930 DOI: 10.1007/s11255-023-03647-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE This study aimed to investigate cognition, proprioception, and sensory/physical function in stroke patients with urinary incontinence (UI). METHODS A prospective cross-sectional study was conducted on 53 individuals with stroke (23 had UI and 21 matched controls). The Incontinence Impact Questionnaire Short Form (IIQ-7) and Urogenital Distress Inventory (UDI-6) were used to assess the patients' UI symptoms. Participants were also evaluated with Mini-Mental State Examination (MMSE), Barthel Index (BI), Fugl-Meyer Sensory Assessment (FMA-S), Five Times Sit to Stand Test (FTSST), Functional Reach Test (FRT) and Proprioception Test. RESULTS FTSST, FRT and FMA-S were better in stroke subjects without UI (p < 0.05). There was a moderate correlation between IIQ-7 with FMA-S, FTSST and proprioception (left extremity) (r1: - 0.415, r2: 0.440, r3: 0.430, p < 0.05) and a low correlation with BI (r: - 0.356, p < 0.05). CONCLUSION Individuals with UI had worse sensory/motor function and static balance. Stroke patients with UI were more dependent, had less sensory function, and had worse lower extremity muscle strength and proprioception as the level of urinary incontinence increased. To reduce urinary incontinence, emphasis on motor/sensory function, balance, and proprioception should be considered.
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Affiliation(s)
- Fatih Özden
- Köyceğiz Vocational School of Health Services, Department of Health Care Services, Muğla Sıtkı Koçman University, Köyceğiz, 48800, Muğla, Turkey.
| | - Mehmet Özkeskin
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ege University, İzmir, Turkey
| | - İsmet Tümtürk
- Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Süleyman Demirel University, Isparta, Turkey
| | - Mustafa Yalçın
- Department of Physiotherapy and Rehabilitation, Bursa Çekirge State Hospital, Bursa, Turkey
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Stevens D, Lane DA, Harrison SL, Lip GYH, Kolamunnage-Dona R. Modelling of longitudinal data to predict cardiovascular disease risk: a methodological review. BMC Med Res Methodol 2021; 21:283. [PMID: 34922465 PMCID: PMC8684210 DOI: 10.1186/s12874-021-01472-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The identification of methodology for modelling cardiovascular disease (CVD) risk using longitudinal data and risk factor trajectories. METHODS We screened MEDLINE-Ovid from inception until 3 June 2020. MeSH and text search terms covered three areas: data type, modelling type and disease area including search terms such as "longitudinal", "trajector*" and "cardiovasc*" respectively. Studies were filtered to meet the following inclusion criteria: longitudinal individual patient data in adult patients with ≥3 time-points and a CVD or mortality outcome. Studies were screened and analyzed by one author. Any queries were discussed with the other authors. Comparisons were made between the methods identified looking at assumptions, flexibility and software availability. RESULTS From the initial 2601 studies returned by the searches 80 studies were included. Four statistical approaches were identified for modelling the longitudinal data: 3 (4%) studies compared time points with simple statistical tests, 40 (50%) used single-stage approaches, such as including single time points or summary measures in survival models, 29 (36%) used two-stage approaches including an estimated longitudinal parameter in survival models, and 8 (10%) used joint models which modelled the longitudinal and survival data together. The proportion of CVD risk prediction models created using longitudinal data using two-stage and joint models increased over time. CONCLUSIONS Single stage models are still heavily utilized by many CVD risk prediction studies for modelling longitudinal data. Future studies should fully utilize available longitudinal data when analyzing CVD risk by employing two-stage and joint approaches which can often better utilize the available data.
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Affiliation(s)
- David Stevens
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK. .,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, L7 8TX, UK.,Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ruwanthi Kolamunnage-Dona
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
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Lee SA, Park EC, Shin J, Ju YJ, Choi Y, Lee HY. Patient and hospital factors associated with 30-day unplanned readmission in patients with stroke. J Investig Med 2018; 67:52-58. [DOI: 10.1136/jim-2018-000748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/23/2018] [Accepted: 06/23/2018] [Indexed: 11/03/2022]
Abstract
Stroke is frequently associated with readmission; moreover, readmission is regarded as an important indicator of the quality of stroke care. Thus, we investigated factors associated with 30-day readmission in patients with stroke in South Korea. We used claims data from 2013 for stroke (I60–I62) patients (n=44 729) in 94 hospitals and classified unplanned readmission according to the Centers for Medicare and Medicaid guidelines. We used multilevel models to investigate patient (age, gender, type of insurance, admission via emergency room, length of stay, type of stroke, Elixhauser Index Score) and hospital (stroke care quality grade, location of hospital, type of hospital, number of doctors and nurses per 100 beds) factors associated with readmission within 30 days of discharge. Among the 44 729 patients admitted due to stroke, 9.2% (n=4124) were readmitted to hospital and 7.6% (n=3379) had unplanned readmissions. Regarding patient characteristics, medical aid and longer hospital stay were associated with 30-day readmission rate. Among hospital factors, patients admitted to a low-grade hospital or a non-capital area hospital were more likely to be readmitted within 30 days of discharge. We identified patient and hospital factors associated with 30-day readmission among stroke patients. In particular, patients admitted to hospitals with higher quality stroke care showed lower readmission rates.
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Öztürk GT, Erden E, Yalçın S, Bölük H, Karabay İ, Sümer G, Durmuş E, Ersöz M, Kara M. Independent predictors of mortality in subacute and chronic stroke patients: A single center study in Turkey. J Back Musculoskelet Rehabil 2017; 30:987-990. [PMID: 28505952 DOI: 10.3233/bmr-160534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although the long-term survival and related predictors have been identified in stroke patients, there is little evidence about the mortality rates and its associated factors in stroke patients treated in rehabilitation units. OBJECTIVE To evaluate 5-year mortality rates of patients with stroke and its relationship with the clinical characteristics after inpatient subacute-chronic rehabilitation. METHODS The files of 1016 stroke patients (482 male, 534 female) who received inpatient rehabilitation program were examined retrospectively. Patients' characteristics and functional ambulation category were recorded at the end of the rehabilitation program. The survival probability was estimated using the Kaplan-Meier method and the univariate effects of predictors were determined using the log-rank test. The possible factors determined with univariate analyses were checked in the Cox regression analysis. RESULTS A total of 273 patients (32%) died within 5 years after stroke. Age (p< 0.001, RR: 1.06, 95% CI: 1.05-1.08), presence of coronary artery disease (p= 0.003, RR: 1.53, 95% CI: 1.16-2.03) and poor walking ability (p< 0.001, RR: 2.06, 95% CI: 1.49-2.86) were independent prognostic factors for increased mortality. CONCLUSIONS About one-third of the rehabilitation patients died within 5 years after stroke. As independent ambulation was a strong predictor for long-term survival, it should be provided via rehabilitation techniques. Future studies are proposed to determine the effects of rehabilitation methods on mortality rates.
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Affiliation(s)
- Gökhan Tuna Öztürk
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Ender Erden
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Süha Yalçın
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Hüma Bölük
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - İlkay Karabay
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Gözde Sümer
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Ebru Durmuş
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Murat Ersöz
- Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Murat Kara
- Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey
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Kawase S, Kowa H, Suto Y, Fukuda H, Kusumi M, Nakayasu H, Nakashima K. Association between Serum Uric Acid Level and Activity of Daily Living in Japanese Patients with Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 26:1960-1965. [PMID: 28689998 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/07/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND An association between serum uric acid and outcomes of ischemic stroke has been reported, but the results are controversial. The aim of this study is to clarify how uric acid may affect activities of daily living after acute ischemic stroke. METHODS Consecutive Japanese patients with acute ischemic stroke were analyzed. Serum uric acid quartiles and activities of daily living at hospitalization and discharge in men and women were examined. Activities of daily living were evaluated using the modified Rankin scale score, and a score of 3 or higher was defined as poor activities of daily living. P values less than .05 were considered significant. RESULTS A total of 987 patients with acute ischemic stroke (591 men; mean age, 72.3 years) were analyzed in this study. We observed a U-shaped relationship between serum uric acid and poor activities of daily living in both men and women at hospitalization and discharge. Multivariate analysis demonstrated that the first quartile group of serum uric acid was significantly associated with poor activities of daily living in both men and women, using the third quartile group as the reference. CONCLUSIONS Lower serum uric acid can be a marker for predicting poor activities of daily living in patients with acute ischemic stroke, irrespective of sex.
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Affiliation(s)
- Shinya Kawase
- Department of Neurology, Sanin Rosai Hospital, Yonago, Japan.
| | - Hisanori Kowa
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yutaka Suto
- Department of Neurology, Tottori Prefectural Central Hospital, Tottori, Japan; Department of Neurology, Matsue Red Cross Hospital, Matsue, Japan
| | - Hiroki Fukuda
- Department of Neurology, Matsue Red Cross Hospital, Matsue, Japan
| | | | - Hiroyuki Nakayasu
- Department of Neurology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kenji Nakashima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Neurology, Matsue Medical Center, Matsue, Japan
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Sato A, Okuda Y, Fujita T, Kimura N, Hoshina N, Kato S, Tanaka S. Cognitive and physical functions related to the level of supervision and dependence in the toileting of stroke patients. Phys Ther Res 2017; 19:32-38. [PMID: 28289579 DOI: 10.1298/ptr.e9904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/26/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE This study aimed to clarify which cognitive and physical factors are associated with the need for toileting assistance in stroke patients and to calculate cut-off values for discriminating between independent supervision and dependent toileting ability. METHOD This cross-sectional study included 163 first-stroke patients in nine convalescent rehabilitation wards. Based on their FIMⓇ instrument score for toileting, the patients were divided into an independent-supervision group and a dependent group. Multiple logistic regression analysis and receiver operating characteristic analysis were performed to identify factors related to toileting performance. The Minimental State Examination (MMSE); the Stroke Impairment Assessment Set (SIAS) score for the affected lower limb, speech, and visuospatial functions; and the Functional Assessment for Control of Trunk (FACT) were analyzed as independent variables. RESULT The multiple logistic regression analysis showed that the FIMⓇ instrument score for toileting was associated with the SIAS score for the affected lower limb function, MMSE, and FACT. On receiver operating characteristic analysis, the SIAS score for the affected lower limb function cut-off value was 8/7 points, the MMSE cut-off value was 25/24 points, and the FACT cut-off value was 14/13 points. CONCLUSION Affected lower limb function, cognitive function, and trunk function were related with the need for toileting assistance. These cut-off values may be useful for judging whether toileting assistance is needed in stroke patients.
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Affiliation(s)
- Atsushi Sato
- Department of Physical Therapy, Yachiyo Rehabilitation College
| | - Yutaka Okuda
- Department of Physical Therapy, Yachiyo Rehabilitation College
| | - Takaaki Fujita
- Department of Rehabilitation, Tohoku Fukushi University; Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences
| | - Norihiko Kimura
- Department of Physical Therapy, Yachiyo Rehabilitation College
| | - Noriyuki Hoshina
- Department of Rehabilitation, Chiba minato Rehabilitation Hospital
| | - Sayaka Kato
- Department of Rehabilitation, Yachiyo Rehabilitation Hospital
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Chinthammit C, Coull BM, Nimworapan M, Bhattacharjee S. Co-occurring Chronic Conditions and Economic Burden among Stroke Survivors in the United States: A Propensity Score-Matched Analysis. J Stroke Cerebrovasc Dis 2017; 26:393-402. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/18/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022] Open
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8
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Kawase S, Kowa H, Suto Y, Fukuda H, Kusumi M, Nakayasu H, Nakashima K. Association between body mass index and outcome in Japanese ischemic stroke patients. Geriatr Gerontol Int 2016; 17:369-374. [DOI: 10.1111/ggi.12713] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/30/2015] [Accepted: 11/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Shinya Kawase
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine; Tottori University; Yonago Japan
| | - Hisanori Kowa
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine; Tottori University; Yonago Japan
| | - Yutaka Suto
- Department of Neurology; Tottori Prefectural Central Hospital; Tottori Japan
| | - Hiroki Fukuda
- Department of Neurology; Matsue Red Cross Hospital; Matsue Japan
| | | | - Hiroyuki Nakayasu
- Department of Neurology; Tottori Prefectural Central Hospital; Tottori Japan
| | - Kenji Nakashima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine; Tottori University; Yonago Japan
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Ostwald SK, Godwin KM, Ye F, Cron SG. Serious adverse events experienced by survivors of stroke in the first year following discharge from inpatient rehabilitation. Rehabil Nurs 2013; 38:254-63. [PMID: 23686536 PMCID: PMC3751976 DOI: 10.1002/rnj.87] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2012] [Indexed: 01/09/2023]
Abstract
PURPOSE To identify the incidence of adverse events (AE) that occurred in stroke survivors during the first year following discharge from inpatient rehabilitation and to determine the type and patterns of AE. METHODS Data were collected for 12 months on events resulting in admissions to the emergency department, hospital, long-term care facility, or death. Descriptive statistics were used to depict the patterns of AE and univariate comparisons were made of the differences between survivors who did or did not experience one or more AE. RESULTS Of the 159 participants, 50% reported a total of 163 AE. Most AE (82.2%) were unexpected and the majority occurred during the first 6 months; 12 recurrent strokes and 6 transient ischemic attacks occcurred. CONCLUSIONS Education on prevention and treatment of common AE is important prior to discharge. Anticipatory guidance may help survivors and caregivers modify their lifestyle and prevent common AE.
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Affiliation(s)
- Sharon K Ostwald
- Center on Aging, School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA.
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10
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Dossa A, Glickman ME, Berlowitz D. Association between mental health conditions and rehospitalization, mortality, and functional outcomes in patients with stroke following inpatient rehabilitation. BMC Health Serv Res 2011; 11:311. [PMID: 22085779 PMCID: PMC3280187 DOI: 10.1186/1472-6963-11-311] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 11/15/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited evidence exists regarding the association of pre-existing mental health conditions in patients with stroke and stroke outcomes such as rehospitalization, mortality, and function. We examined the association between mental health conditions and rehospitalization, mortality, and functional outcomes in patients with stroke following inpatient rehabilitation. METHODS Our observational study used the 2001 VA Integrated Stroke Outcomes database of 2162 patients with stroke who underwent rehabilitation at a Veterans Affairs Medical Center. Separate models were fit to our outcome measures that included 6-month rehospitalization or death, 6-month mortality post-discharge, and functional outcomes post inpatient rehabilitation as a function of number and type of mental health conditions. The models controlled for patient socio-demographics, length of stay, functional status, and rehabilitation setting. RESULTS Patients had an average age of 68 years. Patients with stroke and two or more mental health conditions were more likely to be readmitted or die compared to patients with no conditions (OR: 1.44, p = 0.04). Depression and anxiety were associated with a greater likelihood of rehospitalization or death (OR: 1.33, p = 0.04; OR:1.47, p = 0.03). Patients with anxiety were more likely to die at six months (OR: 2.49, p = 0.001). CONCLUSIONS Patients with stroke with pre-existing mental health conditions may need additional psychotherapy interventions, which may potentially improve stroke outcomes post-hospitalization.
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Affiliation(s)
- Almas Dossa
- Center for Health Quality, Outcomes, and Economic Research, ENRM VA Hospital, Bedford, MA, USA.
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Allen KR, Hazelett SE, Palmer RR, Jarjoura DG, Wickstrom GC, Weinhardt JA, Lada R, Holder CM, Counsell SR. Developing a Stroke Unit Using the Acute Care for Elders Intervention and Model of Care. J Am Geriatr Soc 2003; 51:1660-7. [PMID: 14687400 DOI: 10.1046/j.1532-5415.2003.51521.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Acute Care for Elders (ACE) model of care is a multicomponent intervention that improves outcomes for older patients hospitalized for acute medical illnesses. Likewise, stroke units improve outcomes for patients with acute stroke, yet the descriptions of their structure and approach to stroke management are heterogeneous. The purpose of this article is to describe how implementing the ACE model of care, using a continuous quality-improvement process, can serve as a foundation for a successful stroke unit aimed at improving stroke care. The ACE intervention (a prepared environment, interdisciplinary team management, patient-centered nursing care plans, early discharge planning, and review of medical care) was amplified in a community teaching hospital for stroke-specific care by creating a stroke interdisciplinary team, evidence-based stroke orders and protocols, and a redesigned environment. Administrative data show that the ACE model can be successfully adapted to create a disease-specific program for stroke patients, having the potential to improve the process of care and clinical stroke outcomes.
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Affiliation(s)
- Kyle R Allen
- Department of Medicine, Summa Health System, Akron, Ohio, USA.
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12
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Diehr P, Williamson J, Patrick DL, Bild DE, Burke GL. Patterns of self-rated health in older adults before and after sentinel health events. J Am Geriatr Soc 2001; 49:36-44. [PMID: 11207840 DOI: 10.1046/j.1532-5415.2001.49007.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To describe and compare patterns of change in self-rated health for older adults before death and before and after stroke, myocardial infarction, congestive heart failure, cardiac procedure, hospital admission for cancer, and hip fracture. DESIGN "Event cohort," measuring time in months before and after the event. SETTING Four U.S. communities. PARTICIPANTS 5888 participants in the Cardiovascular Health Study (CHS), sampled from Medicare rolls and followed up to 8 years. Mean age at baseline was 73. MEASUREMENTS Self-rated health, including a category for death, assessed at 6-month intervals, and ascertainment of events. METHODS We examined the percentage that was healthy each month in the 5 years before death and in the 2 years before and after the other events, and compared the patterns to a "no event" group and to one another, using graphs and linear regression. RESULTS For people who died, health status declined slowly until about 9 months before death, when it dropped steeply. Comparing persons equally far from death, health was unrelated to age, but men and whites were healthier than women and blacks. Health for other events declined before the event, dropped steeply at the event, showed some recovery, and then declined further after the event. About 65% to 80% of the subjects were healthy 2 years before their event, but only 35% to 65% were healthy two years afterwards. Patterns were similar although less extreme for the "no event" group. CONCLUSION Visualizing trajectories of health helps us understand how serious health events changes health. Conclusions about change must be drawn with care because of a variety of possible biases. We have described the trajectories in detail. Work is now needed to explain, predict, and possibly prevent such changes in health.
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Affiliation(s)
- P Diehr
- Department of Biostatistics, University of Washington, Seattle 98195, USA
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13
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Wolinsky FD, Wyrwich KW, Gurney JG. Gender differences in the sequelae of hospitalization for acute myocardial infarction among older adults. J Am Geriatr Soc 1999; 47:151-8. [PMID: 9988285 DOI: 10.1111/j.1532-5415.1999.tb04572.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the effect of gender differences among older adults hospitalized for an acute myocardial infarction (AMI) on subsequent health outcomes. DESIGN Secondary analysis of the Longitudinal Study on Aging. Data from baseline interviews (1984) and three biennial (1986, 1988, and 1990) re-interviews were linked to Medicare hospitalization and National Death Index records for 1984-1991. PARTICIPANTS A total of 6071 community-dwelling adults aged 70 years or older at baseline. METHODS Pooled and stratified multivariable models were used to examine gender differences in the independent effects of being hospitalized for an AMI on all-cause mortality, the risk and volume of subsequent hospitalization, and increases in the number of functional limitations. Two comparison groups were used. RESULTS Three hundred fifty-seven AMI cases (6%; 172 women and 185 men) were compared with 3976 hospitalized controls and 1738 nonhospitalized controls. The risk of all-cause mortality for AMI cases was greater than that for either hospitalized controls or nonhospitalized controls (referent), and this increased risk was significantly (P < .001) stronger for women (adjusted hazards ratio (AHR) = 14.24, 95%CI = 10.99, 18.46) than for men (AHR = 9.91, 95%CI = 7.75, 12.67). Overall, AMI cases were also more likely to be hospitalized subsequently than the hospitalized controls (referent; adjusted odds ratio (AOR) = 1.47, 95%CI = 1.17, 1.85), although in the stratified analysis this association held for men (AOR = 1.73, 95%CI = 1.25, 2.41) but not for women (AOR = 1.25, 95%CI = .90, 1.73). Among those subsequently hospitalized, both women and men AMI cases consumed more hospital resources than the hospitalized controls, and there were gender differences suggesting that the effects on total charges and length of stay were greater for women than for men with AMI. Finally, although the AMI cases had greater adjusted mean increases in the number of instrumental activities of daily living limitations and lower body limitations than the nonhospitalized controls, they were no worse off than the hospitalized controls, and there were no gender differences in those effects. CONCLUSION Relative to the appropriate comparison groups, hospitalization for an AMI increases the risk of death and the total costs and lengths of stay of subsequent hospitalizations for women more than for men. Therefore, increased primary prevention, diagnosis, and treatment efforts should be directed toward women.
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Affiliation(s)
- F D Wolinsky
- Saint Louis University School of Public Health, St. Louis, Missouri 63108-3342, USA
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