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C. Barrett Bowling - One of the best experts on this subject based on the ideXlab platform.
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Association of Nondisease-Specific Problems with Mortality, Long-Term Care, and Functional Impairment among Older Adults Who Require Skilled Nursing Care after Dialysis Initiation
Clinical journal of the American Society of Nephrology : CJASN, 2016Co-Authors: C. Barrett Bowling, Laura C. Plantinga, Rasheeda K. Hall, Anna Mirk, Rebecca Zhang, Nancy G. KutnerAbstract:Background and objectives The majority of older adults who initiate dialysis do so during a hospitalization, and these patients may require post-acute skilled nursing facility (SNF) care. For these patients, a focus on Nondisease-specific problems, including cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy, may be more relevant to outcomes than the traditional disease-oriented approach. However, the association of the burden of Nondisease-specific problems with mortality, transition to long-term care (LTC), and functional impairment among older adults receiving SNF care after dialysis initiation has not been studied. Design, setting, participants, & measurements We identified 40,615 Medicare beneficiaries ≥65 years old who received SNF care after dialysis initiation between 2000 and 2006 by linking renal disease registry data with the Minimum Data Set. Nondisease-specific problems were ascertained from the Minimum Data Set. We defined LTC as ≥100 SNF days and functional impairment as dependence in all four essential activities of daily living at SNF discharge. Associations of the number of Nondisease-specific problems (≤1, 2, 3, and 4–6) with 6-month mortality, LTC, and functional impairment were examined. Results Overall, 39.2% of patients who received SNF care after dialysis initiation died within 6 months. Compared with those with ≤1 Nondisease-specific problems, multivariable adjusted hazard ratios (95% confidence interval) for mortality were 1.26 (1.19 to 1.32), 1.40 (1.33 to 1.48), and 1.66 (1.57 to 1.76) for 2, 3, and 4–6 Nondisease-specific problems, respectively. Among those who survived, 37.1% required LTC; of those remaining who did not require LTC, 74.7% had functional impairment. A higher likelihood of transition to LTC (among those who survived 6 months) and functional impairment (among those who survived and did not require LTC) was seen with a higher number of problems. Conclusions Identifying Nondisease-specific problems may help patients and families anticipate LTC needs and functional impairment after dialysis initiation.
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Nondisease-Specific Problems and All-Cause Mortality among Older Adults with CKD: The REGARDS Study
Clinical journal of the American Society of Nephrology : CJASN, 2014Co-Authors: C. Barrett Bowling, John N Booth, Orlando M. Gutiérrez, Manjula Kurella Tamura, Lei Huang, Meredith L. Kilgore, Suzanne E. Judd, David G. Warnock, William M. Mcclellan, Richard M. AllmanAbstract:Background and objectives The term “Nondisease-specific” has been used to describe problems that cross multiple domains of health and are not necessarily the result of a single underlying disease. Although individuals with reduced eGFR and elevated albumin-to-creatinine ratio have many comorbidities, the prevalence of and outcomes associated with Nondisease-specific problems have not been well studied. Design, setting, participants, & measurements Participants included 3557 black and white United States adults $75 years of age from the Reasons for Geographic and Racial Differences in Stroke Study. Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Hazard ratios for mortality over a median (interquartile range) of 5.4 (4.2–6.9) years of follow-up associated with one, two, or three to six Nondisease-specific problems were calculated and stratified by eGFR ($60, 45–59, and ,45 ml/min per 1.73 m 2 ) and separately, albumin-to-creatinine ratio (,30, 30–299, and $300 mg/g). Secondary outcomes included hospitalizations and emergency department visits over 1.8 (0.7–4.0) and 2.3 (0.9–4.7) years of follow-up, respectively. Results The prevalence of Nondisease-specific problems was more common at lower eGFR and higher albuminto-creatinine ratio levels. Within each eGFR and albumin-to-creatinine ratio strata, the risk for mortality was higheramongthosewithagreaternumberofNondisease-specificproblems.Forexample,amongthosewithan eGFR=45–59 ml/min per 1.73 m2, the multivariable adjusted hazard ratios (95% confidence intervals) for mortality associated with one, two, or three to six Nondisease-specific problems were 1.17 (0.78 to 1.76), 1.95 (1.24 to 3.07), and 2.44 (1.39 to 4.27;P trend,0.001). Risk for hospitalization and emergency department visits washigheramongthosewithmoreNondisease-specificproblemswithineGFRandalbumin-to-creatinineratio strata.
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Nondisease‐Specific Problems and All‐Cause Mortality in the REasons for Geographic and Racial Differences in Stroke Study
Journal of the American Geriatrics Society, 2013Co-Authors: C. Barrett Bowling, John N Booth, Monika M Safford, Heather E Whitson, Christine S Ritchie, Virginia G Wadley, Mary Cushman, Virginia J Howard, Richard M. Allman, Paul MuntnerAbstract:Objectives: To evaluate the association between six Nondisease-specific problems (problems that cross multiple domains of health) and mortality in middle-aged and older adults. Design: Prospective, observational cohort. Setting: U.S. population sample. Participants: Participants included 23,669 black and white U.S. adults aged 45 and older enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Measurements: Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Age-stratified (
John N Booth - One of the best experts on this subject based on the ideXlab platform.
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Nondisease-Specific Problems and All-Cause Mortality among Older Adults with CKD: The REGARDS Study
Clinical journal of the American Society of Nephrology : CJASN, 2014Co-Authors: C. Barrett Bowling, John N Booth, Orlando M. Gutiérrez, Manjula Kurella Tamura, Lei Huang, Meredith L. Kilgore, Suzanne E. Judd, David G. Warnock, William M. Mcclellan, Richard M. AllmanAbstract:Background and objectives The term “Nondisease-specific” has been used to describe problems that cross multiple domains of health and are not necessarily the result of a single underlying disease. Although individuals with reduced eGFR and elevated albumin-to-creatinine ratio have many comorbidities, the prevalence of and outcomes associated with Nondisease-specific problems have not been well studied. Design, setting, participants, & measurements Participants included 3557 black and white United States adults $75 years of age from the Reasons for Geographic and Racial Differences in Stroke Study. Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Hazard ratios for mortality over a median (interquartile range) of 5.4 (4.2–6.9) years of follow-up associated with one, two, or three to six Nondisease-specific problems were calculated and stratified by eGFR ($60, 45–59, and ,45 ml/min per 1.73 m 2 ) and separately, albumin-to-creatinine ratio (,30, 30–299, and $300 mg/g). Secondary outcomes included hospitalizations and emergency department visits over 1.8 (0.7–4.0) and 2.3 (0.9–4.7) years of follow-up, respectively. Results The prevalence of Nondisease-specific problems was more common at lower eGFR and higher albuminto-creatinine ratio levels. Within each eGFR and albumin-to-creatinine ratio strata, the risk for mortality was higheramongthosewithagreaternumberofNondisease-specificproblems.Forexample,amongthosewithan eGFR=45–59 ml/min per 1.73 m2, the multivariable adjusted hazard ratios (95% confidence intervals) for mortality associated with one, two, or three to six Nondisease-specific problems were 1.17 (0.78 to 1.76), 1.95 (1.24 to 3.07), and 2.44 (1.39 to 4.27;P trend,0.001). Risk for hospitalization and emergency department visits washigheramongthosewithmoreNondisease-specificproblemswithineGFRandalbumin-to-creatinineratio strata.
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Nondisease specific problems and all cause mortality in the reasons for geographic and racial differences in stroke study
Journal of the American Geriatrics Society, 2013Co-Authors: Barrett C Bowling, John N Booth, Monika M Safford, Heather E Whitson, Christine S Ritchie, Virginia G Wadley, Mary Cushman, Virginia J HowardAbstract:Objectives: To evaluate the association between six Nondisease-specific problems (problems that cross multiple domains of health) and mortality in middle-aged and older adults. Design: Prospective, observational cohort. Setting: U.S. population sample. Participants: Participants included 23,669 black and white U.S. adults aged 45 and older enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Measurements: Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Age-stratified (<65, 65�74, ?75) hazard ratios for all-cause mortality were calculated for each problem individually and according to number of problems. Results: One or more Nondisease-specific problems occurred in 40% of participants younger than 65, 45% of those aged 65 to 74, and 55% of those aged 75 and older. Compared with participants with none of these problems, the multivariable adjusted hazard ratio for all-cause mortality associated with each additional Nondisease-specific problem was 1.34 (95% confidence interval (CI) = 1.23�1.46) for participants younger than 65, 1.24 (95% CI = 1.15�1.35) for those aged 65 to 74, and 1.30 (95% CI = 1.21�1.39) for those aged 75 and older. Conclusion: Nondisease-specific problems were associated with mortality across a wide age spectrum. Future studies should explore whether treating these problems will improve survival and identify innovative healthcare models to address multiple Nondisease-specific problems simultaneously.
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Nondisease‐Specific Problems and All‐Cause Mortality in the REasons for Geographic and Racial Differences in Stroke Study
Journal of the American Geriatrics Society, 2013Co-Authors: C. Barrett Bowling, John N Booth, Monika M Safford, Heather E Whitson, Christine S Ritchie, Virginia G Wadley, Mary Cushman, Virginia J Howard, Richard M. Allman, Paul MuntnerAbstract:Objectives: To evaluate the association between six Nondisease-specific problems (problems that cross multiple domains of health) and mortality in middle-aged and older adults. Design: Prospective, observational cohort. Setting: U.S. population sample. Participants: Participants included 23,669 black and white U.S. adults aged 45 and older enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Measurements: Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Age-stratified (
Virginia J Howard - One of the best experts on this subject based on the ideXlab platform.
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Nondisease specific problems and all cause mortality in the reasons for geographic and racial differences in stroke study
Journal of the American Geriatrics Society, 2013Co-Authors: Barrett C Bowling, John N Booth, Monika M Safford, Heather E Whitson, Christine S Ritchie, Virginia G Wadley, Mary Cushman, Virginia J HowardAbstract:Objectives: To evaluate the association between six Nondisease-specific problems (problems that cross multiple domains of health) and mortality in middle-aged and older adults. Design: Prospective, observational cohort. Setting: U.S. population sample. Participants: Participants included 23,669 black and white U.S. adults aged 45 and older enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Measurements: Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Age-stratified (<65, 65�74, ?75) hazard ratios for all-cause mortality were calculated for each problem individually and according to number of problems. Results: One or more Nondisease-specific problems occurred in 40% of participants younger than 65, 45% of those aged 65 to 74, and 55% of those aged 75 and older. Compared with participants with none of these problems, the multivariable adjusted hazard ratio for all-cause mortality associated with each additional Nondisease-specific problem was 1.34 (95% confidence interval (CI) = 1.23�1.46) for participants younger than 65, 1.24 (95% CI = 1.15�1.35) for those aged 65 to 74, and 1.30 (95% CI = 1.21�1.39) for those aged 75 and older. Conclusion: Nondisease-specific problems were associated with mortality across a wide age spectrum. Future studies should explore whether treating these problems will improve survival and identify innovative healthcare models to address multiple Nondisease-specific problems simultaneously.
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Nondisease‐Specific Problems and All‐Cause Mortality in the REasons for Geographic and Racial Differences in Stroke Study
Journal of the American Geriatrics Society, 2013Co-Authors: C. Barrett Bowling, John N Booth, Monika M Safford, Heather E Whitson, Christine S Ritchie, Virginia G Wadley, Mary Cushman, Virginia J Howard, Richard M. Allman, Paul MuntnerAbstract:Objectives: To evaluate the association between six Nondisease-specific problems (problems that cross multiple domains of health) and mortality in middle-aged and older adults. Design: Prospective, observational cohort. Setting: U.S. population sample. Participants: Participants included 23,669 black and white U.S. adults aged 45 and older enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Measurements: Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Age-stratified (
Richard M. Allman - One of the best experts on this subject based on the ideXlab platform.
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Nondisease-Specific Problems and All-Cause Mortality among Older Adults with CKD: The REGARDS Study
Clinical journal of the American Society of Nephrology : CJASN, 2014Co-Authors: C. Barrett Bowling, John N Booth, Orlando M. Gutiérrez, Manjula Kurella Tamura, Lei Huang, Meredith L. Kilgore, Suzanne E. Judd, David G. Warnock, William M. Mcclellan, Richard M. AllmanAbstract:Background and objectives The term “Nondisease-specific” has been used to describe problems that cross multiple domains of health and are not necessarily the result of a single underlying disease. Although individuals with reduced eGFR and elevated albumin-to-creatinine ratio have many comorbidities, the prevalence of and outcomes associated with Nondisease-specific problems have not been well studied. Design, setting, participants, & measurements Participants included 3557 black and white United States adults $75 years of age from the Reasons for Geographic and Racial Differences in Stroke Study. Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Hazard ratios for mortality over a median (interquartile range) of 5.4 (4.2–6.9) years of follow-up associated with one, two, or three to six Nondisease-specific problems were calculated and stratified by eGFR ($60, 45–59, and ,45 ml/min per 1.73 m 2 ) and separately, albumin-to-creatinine ratio (,30, 30–299, and $300 mg/g). Secondary outcomes included hospitalizations and emergency department visits over 1.8 (0.7–4.0) and 2.3 (0.9–4.7) years of follow-up, respectively. Results The prevalence of Nondisease-specific problems was more common at lower eGFR and higher albuminto-creatinine ratio levels. Within each eGFR and albumin-to-creatinine ratio strata, the risk for mortality was higheramongthosewithagreaternumberofNondisease-specificproblems.Forexample,amongthosewithan eGFR=45–59 ml/min per 1.73 m2, the multivariable adjusted hazard ratios (95% confidence intervals) for mortality associated with one, two, or three to six Nondisease-specific problems were 1.17 (0.78 to 1.76), 1.95 (1.24 to 3.07), and 2.44 (1.39 to 4.27;P trend,0.001). Risk for hospitalization and emergency department visits washigheramongthosewithmoreNondisease-specificproblemswithineGFRandalbumin-to-creatinineratio strata.
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Nondisease‐Specific Problems and All‐Cause Mortality in the REasons for Geographic and Racial Differences in Stroke Study
Journal of the American Geriatrics Society, 2013Co-Authors: C. Barrett Bowling, John N Booth, Monika M Safford, Heather E Whitson, Christine S Ritchie, Virginia G Wadley, Mary Cushman, Virginia J Howard, Richard M. Allman, Paul MuntnerAbstract:Objectives: To evaluate the association between six Nondisease-specific problems (problems that cross multiple domains of health) and mortality in middle-aged and older adults. Design: Prospective, observational cohort. Setting: U.S. population sample. Participants: Participants included 23,669 black and white U.S. adults aged 45 and older enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Measurements: Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Age-stratified (
Heather E Whitson - One of the best experts on this subject based on the ideXlab platform.
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Nondisease specific problems and all cause mortality in the reasons for geographic and racial differences in stroke study
Journal of the American Geriatrics Society, 2013Co-Authors: Barrett C Bowling, John N Booth, Monika M Safford, Heather E Whitson, Christine S Ritchie, Virginia G Wadley, Mary Cushman, Virginia J HowardAbstract:Objectives: To evaluate the association between six Nondisease-specific problems (problems that cross multiple domains of health) and mortality in middle-aged and older adults. Design: Prospective, observational cohort. Setting: U.S. population sample. Participants: Participants included 23,669 black and white U.S. adults aged 45 and older enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Measurements: Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Age-stratified (<65, 65�74, ?75) hazard ratios for all-cause mortality were calculated for each problem individually and according to number of problems. Results: One or more Nondisease-specific problems occurred in 40% of participants younger than 65, 45% of those aged 65 to 74, and 55% of those aged 75 and older. Compared with participants with none of these problems, the multivariable adjusted hazard ratio for all-cause mortality associated with each additional Nondisease-specific problem was 1.34 (95% confidence interval (CI) = 1.23�1.46) for participants younger than 65, 1.24 (95% CI = 1.15�1.35) for those aged 65 to 74, and 1.30 (95% CI = 1.21�1.39) for those aged 75 and older. Conclusion: Nondisease-specific problems were associated with mortality across a wide age spectrum. Future studies should explore whether treating these problems will improve survival and identify innovative healthcare models to address multiple Nondisease-specific problems simultaneously.
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Nondisease‐Specific Problems and All‐Cause Mortality in the REasons for Geographic and Racial Differences in Stroke Study
Journal of the American Geriatrics Society, 2013Co-Authors: C. Barrett Bowling, John N Booth, Monika M Safford, Heather E Whitson, Christine S Ritchie, Virginia G Wadley, Mary Cushman, Virginia J Howard, Richard M. Allman, Paul MuntnerAbstract:Objectives: To evaluate the association between six Nondisease-specific problems (problems that cross multiple domains of health) and mortality in middle-aged and older adults. Design: Prospective, observational cohort. Setting: U.S. population sample. Participants: Participants included 23,669 black and white U.S. adults aged 45 and older enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Measurements: Nondisease-specific problems included cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy. Age-stratified (
