Carol B. Cornman

Functional health status as a predictor of mortality in men and women over 65

This study evaluated the effect of functional health status on mortality in a sample of community-dwelling older people. White and African-American self-respondents to the 1986 National Health Interview Survey Functional Health Supplement (n = 5, 320) were included in the study. Functional health status was measured by a ten-item unidimensional activities of daily living-instrumental activities of daily living (ADL-IADL) scale and a three-item cognitive ADL scale. Proportional hazards regression was used to evaluate the effect of increasing score on the ten-item ADL-IADL scale on risk of mortality over a 5-year period while controlling for demographic, social, and health status covariates. In both men and women, increasing score on the ADL-IADL scale was predictive of mortality, adjusting for increasing age, poor self-rated health, low body mass index in women, and being an unmarried man. These findings indicate that a unidimensional scale consisting of both ADL and IADL items is useful in predicting mortality, controlling for the effect of covariates in sex-specific models.

Co-morbidity associated with dementia.

Purpose: The purpose of this study was to identify common co-morbid conditions associated with dementia subtypes and to evaluate the association of hypertension, diabetes mellitus, atrial fibrillation, congestive heart failure, and anemia with dementia subtypes relative to controls. Methods: Hospital discharge data were used to identify 15,013 subjects from South Carolina with a diagnosis of dementia between 1998 and 1999. A control group of 15,013 persons without dementia was randomly sampled from hospital discharge records and matched to persons with dementia on the basis of age, race, and gender. Multiple hospitalizations for each patient were merged, and repeated diagnoses during separate hospitalizations were counted once. Results: After adjusting for age, race, and gender, persons with Alzheimers disease and dementia associated with medical conditions were less likely to be diagnosed with hypertension, diabetes, congestive heart failure, and atrial fibrillation than were controls. Patients with multiinfarct dementia were also less likely to have congestive heart failure, but were more likely to have diabetes. Anemia was not associated with any dementia subtype. Conclusions: There are distinct differences in comorbid conditions among dementia subtypes. Our research does not support previous studies that suggest a circulatory component to the development of Alzheimers disease.

Providing Shelter to Nursing Home Evacuees in Disasters: Lessons From Hurricane Katrina

OBJECTIVES We examined nursing home preparedness needs by studying the experiences of nursing homes that sheltered evacuees from Hurricane Katrina. METHODS Five weeks after Hurricane Katrina, and again 15 weeks later, we conducted interviews with administrators of 14 nursing homes that sheltered 458 evacuees in 4 states. Nine weeks after Katrina, we conducted site visits to 4 nursing homes and interviewed 4 administrators and 38 staff members. We used grounded theory analysis to identify major themes and thematic analysis to organize content. RESULTS Although most sheltering facilities were well prepared for emergency triage and treatment, we identified some major preparedness shortcomings. Nursing homes were not included in community planning or recognized as community health care resources. Supplies and medications were inadequate, and there was insufficient communication and information about evacuees provided by evacuating nursing homes to sheltering nursing homes. Residents and staff had notable mental health-related needs after 5 months, and maintaining adequate staffing was a challenge. CONCLUSIONS Nursing homes should develop and practice procedures to shelter and provide long-term access to mental health services following a disaster. Nursing homes should be integrated into community disaster planning and be classified in an emergency priority category similar to hospitals.

Ethnic differences in the burden of caregiving

Family caregivers of dementia patients experience varying levels of burden (or stress) associated with care giving tasks. Although this burden may lead to negative health effects for caregivers, very few studies have focused on ethnic differences in the correlates of perceived burden. In a pilot study, we examined correlates of perceived burden associated with providing care for a family member with dementia among African-American (n=20) and white (n=62) caregivers. In this limited sample, we found that mean burden scores were increased among whites if they were the spouse of the patient, and among African-Americans if annual family income was in excess of

Prevention of elder mistreatment in nursing homes: competencies for direct-care staff.

20,000. We found no mean burden score differences for either group by past use of a variety of services. Although these results are preliminary, this ongoing study has the potential to provide needed information on sources and correlates of perceived burden among rural African-American and white caregivers.

The value of strength training for older adults.

Existing training on elder mistreatment in nursing homes focuses on detection and reporting of abuse, with little training specifically targeted toward prevention of mistreatment before it occurs. We used qualitative interviews with nursing home staff, policy makers, and related professionals to identify training needs. Based on participant accounts, we drafted a number of competencies essential for caregiver training to prevent mistreatment in nursing homes. Competencies include those dealing with definitions and policies, risks for mistreatment, communication and respect in relationships with residents, and development of a cooperative work environment. Competencies are discussed along with illustrative examples, and implications for practice and policy are addressed.

Evaluating hospital care for individuals with Alzheimer's disease using inpatient quality indicators

Health in older adults can best be measured in terms of functional status. Skeletal muscle strength has been reported to be a determinant of functional status in older individuals. Two major contributors to the decline in muscle function as a person ages are disuse and physical inactivity. Declining muscle function through a loss of muscular strength may decrease functional independence and mobility and increase the risk for falls and injuries, physical frailty, and disability. Older individuals lacking an appropriate amount of muscular strength may not be able to perform various activities of daily living, which are important indicators of independence.

Impact of a Medication Management System on Nursing Home Admission Rate in a Community-Dwelling Nursing Home–Eligible Medicaid Population

The purpose of this study was to determine whether persons with Alzheimers disease (AD) were at greater risk for in-hospital mortality than non-AD patients as a result of poor quality of care. The study focused on six common medical conditions that result in hospital mortality. Using 1995 to 2000 data from New York state (n = 7,021,065), analysts compared mortality risk for individuals with and without AD. Among men, adjusted odds of death were greater for those with AD for gastrointestinal (GI) hemorrhage (+52 percent), congestive heart failure (CHF) (+42 percent), hip fracture (+35 percent), and acute myocardial infarction (AMI) (+30 percent) (all p < .0001). Among women, AD did not affect risks for most conditions. The results of the study show that men with AD are at higher risk of hospital mortality for common medical conditions, which may indicate poor quality of care. Their risk of hospital death was greater than that of men without AD for AMI, CHF, hip fracture, and GI hemorrhage. Their risk was also greater than that of women with AD for CHF, pneumonia, hip fracture, and GI hemorrhage. With the exception of pneumonia, this risk difference notably exceeded the analogous difference between women and men without AD. Hospital staff should be alerted to greater mortality risk for men with AD, as this risk may indicate lower quality of care.

Application of capture-recapture methodology to estimate the prevalence of dementia in South Carolina

BACKGROUND Community-dwelling frail elderly have an increased need for effective medication management to reside in their homes and delay or avoid admission to nursing homes. OBJECTIVE The objective of this study was to examine the impact of a medication management system on nursing home admission within the community-dwelling frail elderly. METHODS This prospective cohort study compared nursing home admission rates in intervention and control clients of a state Medicaid home and community-based waiver program. Groups were matched on age (±5 years), race, gender, and waiver program start date (±120 days). The medication management service consisted of 2 parts: 1) prescription medicines dispensed from the clients local pharmacy in a calendar card, and 2) a coordinating service by a health educator to address medication-related problems as they arose. The primary dependent variable was admission to a nursing home. RESULTS A total of 273 clients agreed to participate, enrolled, and had at least 1 prescription dispensed. The matched control group was composed of 800 other clients. The client sample was 72 years of age, 73% (785/1073) non-white, 75% (804/1073) female, and enrolled in the waiver program approximately 50 months. The 2 groups were similar on all demographic variables examined. Six clients (2.2%) in the intervention group and 40 clients (5.0%) in the control group were admitted to a nursing home at least once during the study period. Logistic regression was used to test the model predicting at least 1 nursing home admission. Control group clients were 2.94 times more likely to be admitted to a nursing home than clients in the intervention group. CONCLUSIONS The medication management service implemented within this study was effective in reducing nursing home admissions in a group of frail community-dwelling elderly.

The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer's disease: A matched case-control study.

PURPOSE The purpose of this study was to estimate the prevalence of dementia in individuals 65 years of age and older in the state of South Carolina using capture-recapture methodology. METHODS We linked data from the Department of Mental Health admissions, inpatient admissions, and emergency room visits. Separate log-linear models were used to obtain estimates of the underascertainment-corrected prevalence of dementia in twelve age-gender-race subgroups, which were summed to estimate the prevalence of dementia in the total population. RESULTS We found an overall prevalence of dementia of 14% in South Carolina for persons 65 years of age and older using capture-recapture methodology. This estimate of persons with dementia is 25% higher than the identified cases of dementia in the South Carolina Alzheimers Disease Registry (10.5%). CONCLUSIONS Although capture-recapture methods are prone to limitations, they can be used to more accurately estimate the prevalence of dementia in a geographic area.