Abstract:
OBJECTIVES:To determine the extent to which disease-related symptoms and impairments, which constitute measures of disease severity or targets of therapy, account for the associations between chronic diseases and universal health outcomes. DESIGN:Cross-sectional. SETTING:The Cardiovascular Health Study (CHS) and the Health, Aging and Body Composition Study (Health ABC). PARTICIPANTS:Five thousand six hundred fifty-four CHS members and 2,706 Health ABC members. MEASUREMENTS:Diseases included heart failure (HF), chronic obstructive pulmonary disease (COPD), osteoarthritis, and cognitive impairment. The universal health outcomes included self-rated health, basic and instrumental activities of daily living (ADLs and IADLs), and death. Disease-related symptoms and impairments included HF symptoms and ejection fraction (EF) for HF, Dyspnea Scale and forced expiratory volume in 1 second for COPD, joint pain for osteoarthritis, and executive function for cognitive impairment. RESULTS:The diseases were associated with the universal health outcomes (P<.001) except osteoarthritis with death (both cohorts) and cognitive impairment with self-rated health (Health ABC). Symptoms and impairments accounted for 30% or more of each disease's effect on the universal health outcomes. In CHS, for example, HF was associated with one fewer (0.918) ADL and IADL performed without difficulty than no HF; HF symptoms accounted for 27% of this effect and EF for only 5%. The hazard ratio for death with HF was 6.5 (95% confidence interval=4.7-8.9) with EF accounting for 40% and HF symptoms for only 14%. CONCLUSION:Disease-related symptoms and impairments accounted for much of the significant associations between the four chronic diseases and the universal health outcomes. Results support considering universal health outcomes as common metrics across diseases in clinical decision-making, perhaps by targeting the disease-related symptoms and impairments that contribute most strongly to the effect of the disease on the universal health outcomes.
journal_name
J Am Geriatr Socjournal_title
Journal of the American Geriatrics Societyauthors
Tinetti ME,McAvay G,Chang SS,Ning Y,Newman AB,Fitzpatrick A,Fried TR,Harris TB,Nevitt MC,Satterfield S,Yaffe K,Peduzzi Pdoi
10.1111/j.1532-5415.2011.03576.xsubject
Has Abstractpub_date
2011-09-01 00:00:00pages
1618-27issue
9eissn
0002-8614issn
1532-5415journal_volume
59pub_type
杂志文章abstract::While skin tears are a common occurrence in the institutionalized elderly population, nothing has been written about this problem. We retrospectively studied all incident reports during a 1-year period at a large, urban, long-term-care facility to identify residents with skin tears. The overall incidence of skin tears...
journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.1991.tb03599.x
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abstract::The management of older patients with chronic medical conditions dominates medical practice. Cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) in patients aged 65 and older have reached epidemic proportions. Using elements of the Chronic Care Model (CCM), a quality improvement project was undertaken to re...
journal_title:Journal of the American Geriatrics Society
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doi:10.1111/jgs.14672
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doi:10.1111/jgs.17033
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1985.tb02855.x
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journal_title:Journal of the American Geriatrics Society
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journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.1977.tb00648.x
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journal_title:Journal of the American Geriatrics Society
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更新日期:2002-04-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
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abstract::Falls are among the most common unwanted events in older hospital inpatients, but evidence of effective prevention is still limited compared with that in the community and in long-term care facilities. This article describes a prevention program and its effects on the incidence of falls in geriatric hospital wards. It...
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journal_title:Journal of the American Geriatrics Society
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doi:10.1111/j.1532-5415.2008.02025.x
更新日期:2008-12-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1985.tb04186.x
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journal_title:Journal of the American Geriatrics Society
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journal_title:Journal of the American Geriatrics Society
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journal_title:Journal of the American Geriatrics Society
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journal_title:Journal of the American Geriatrics Society
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journal_title:Journal of the American Geriatrics Society
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1984.tb02021.x
更新日期:1984-04-01 00:00:00
abstract::A cohort of 3,595 white women aged 40-77 years was followed for an average of 10 years during which 84 new cases of hip fracture were identified. Triceps skinfold thickness and arm muscle area measured at baseline were examined as possible risk factors for hip fracture controlling for physical activity, height, menopa...
journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
doi:10.1111/j.1532-5415.1989.tb01562.x
更新日期:1989-01-01 00:00:00
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journal_title:Journal of the American Geriatrics Society
pub_type: 杂志文章
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更新日期:2015-06-01 00:00:00