Open Access. Powered by Scholars. Published by Universities.®
Articles 1 - 12 of 12
Full-Text Articles in Biostatistics
Social Marketing, Stages Of Change, And Public Health Smoking Interventions, Paula Diehr
Social Marketing, Stages Of Change, And Public Health Smoking Interventions, Paula Diehr
Paula Diehr
As a "thought experiment," the authors used a modified stages of change model for smoking to define homogeneous segments within various hypothetical populations. The authors then estimated the population effect of public health interventions that targeted the different segments. Under most assumptions, interventions that emphasized primary and secondary prevention, by targeting the Never Smoker, Maintenance, or Action segments, resulted in the highest nonsmoking life expectancy. This result is consistent with both social marketing and public health principles. Although the best thing for an individual smoker is to stop smoking, the greatest public health benefit is achieved by interventions that target …
Health Benefits Of Increased Walking For Sedentary, Generally Healthy Older Adults: Using Longitudinal Data To Approximate An Intervention Trial, Paula Diehr
Paula Diehr
BACKGROUND: Older adults are often advised to walk more, but randomized trials have not conclusively established the benefits of walking in this age group. Typical analyses based on observational data may have biased results. Here, we propose a "limited-bias," more interpretable estimate of the health benefits to sedentary healthy older adults of walking more, using longitudinal data from the Cardiovascular Health Study. METHODS: The number of city blocks walked per week, collected annually, was classified as sedentary (<7 blocks per>week), somewhat active, or active (>or=28). Analysis was restricted to persons sedentary and healthy in the first 2 years. In Year …
Prevalence, Incidence, And Persistence Of Major Depressive Symptoms In The Cardiovascular Health Study, Stephen M. Thielke Md, Ms, Paula Diehr Phd
Prevalence, Incidence, And Persistence Of Major Depressive Symptoms In The Cardiovascular Health Study, Stephen M. Thielke Md, Ms, Paula Diehr Phd
Paula Diehr
PURPOSE: To explore the association of major depressive symptoms with advancing age, sex, and self-rated health among older adults. DESIGN AND METHODS: We analyzed 10 years of annual assessments in a longitudinal cohort of 5888 Medicare recipients in the Cardiovascular Health Study. Self-rated health was assessed with a single question, and subjects categorized as healthy or sick. Major depressive symptoms were assessed using the Center for Epidemiologic Studies Short Depression Scale, with subjects categorized as nondepressed (score < 10) or depressed (> or =10). Age-, sex-, and health-specific prevalence of depression and the probabilities of transition between depressed and nondepressed states were estimated. RESULTS: The …
Weight, Mortality, Years Of Healthy Life, And Active Life Expectancy In Older Adults, Paula Diehr
Weight, Mortality, Years Of Healthy Life, And Active Life Expectancy In Older Adults, Paula Diehr
Paula Diehr
OBJECTIVES: To determine whether weight categories predict subsequent mortality and morbidity in older adults. DESIGN: Multistate life tables, using data from the Cardiovascular Health Study, a longitudinal population-based cohort of older adults. SETTING: Data were provided by community-dwelling seniors in four U.S. counties: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania. PARTICIPANTS: Five thousand eight hundred eighty-eight adults aged 65 and older at baseline. MEASUREMENTS: The age- and sex-specific probabilities of transition from one health state to another and from one weight category to another were estimated. From these probabilities, future life expectancy, years …
The Number Of Sick Persons In A Cohort, Paula Diehr
The Number Of Sick Persons In A Cohort, Paula Diehr
Paula Diehr
To see if the number of sick persons in a cohort was approximately constant over time, we calculated the number of sick persons in a “research” cohort of older adults followed for up to 14 years, and also in a synthetic birth cohort. Methods: In the research cohort, we calculated the actual number of persons in each health state over time, using eight different definitions of “sick”. For the birth cohort, we estimated the number of sick persons each year after birth. Results: The number of sick persons in the research cohort was approximately constant for 14 years, for all …
Trajectories Of Health For Older Adults Over Time: Accounting Fully For Death, Paula Diehr
Trajectories Of Health For Older Adults Over Time: Accounting Fully For Death, Paula Diehr
Paula Diehr
The process of healthy aging can best be described by plotting the trajectory of health-related variables over time. Unfortunately, graphs including data only from survivors may be misleading because they may confuse patterns of mortality with patterns of change in health. Two approaches for creating graphs that account for death in such situations are 1) to incorporate a category or value for death into the longitudinal health variable and 2) to measure time in years before death or some other event. The first approach has been applied to self-rated health (excellent to poor) and the 36-Item Short-Form Health Survey (SF-36). …
The Aging And Dying Processes And The Health Of Older Adults, Paula Diehr
The Aging And Dying Processes And The Health Of Older Adults, Paula Diehr
Paula Diehr
It is difficult to distinguish changes in health due to aging from those related to dying, because the two processes are highly related. Some potentially treatable conditions may mistakenly be dismissed as due to old age. The goal of this article was to examine the relationships of aging and of dying to changes in 10 health-related variables: self-rated health, depression, ADLs, IADLs, minimental state examination, body mass index, blocks walked per week, bed days, hospitalization, and walking speed (all coded so that higher values were better). We used longitudinal data from the Cardiovascular Health Study to estimate the changes in …
Weight-Modification Trials In Older Adults: What Should The Outcome Measure Be?, Paula Diehr
Weight-Modification Trials In Older Adults: What Should The Outcome Measure Be?, Paula Diehr
Paula Diehr
BACKGROUND: Overweight older adults are often counseled to lose weight, even though there is little evidence of excess mortality in that age group. Overweight and underweight may be more associated with health status than with mortality, but few clinical trials of any kind have been based on maximizing years of healthy life (YHL), as opposed to years of life (YOL). OBJECTIVE: This paper examines the relationship of body mass index (BMI) to both YHL and YOL. Results were used to determine whether clinical trials of weight-modification based on improving YHL would be more powerful than studies based on survival. DESIGN: …
Patterns Of Self-Rated Health In Older Adults Before And After Sentinel Events, Paula Diehr
Patterns Of Self-Rated Health In Older Adults Before And After Sentinel Events, Paula Diehr
Paula Diehr
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 …
Predicting Future Years Of Healthy Life For Older Adults, Paula Diehr
Predicting Future Years Of Healthy Life For Older Adults, Paula Diehr
Paula Diehr
Cost-effectiveness studies often need to compare the cost of a program to the lifetime benefits of the program, but estimates of lifetime benefits are not routinely available, especially for older adults. We used data from two large longitudinal studies of older adults (ages 65-100) to estimate transition probabilities from one health state to another, and used those probabilities to estimate the mean additional years of healthy life that an older adult of specified age, sex, and health status would experience. We found, for example, that 65-year-old women in excellent health can expect 16.8 years of healthy life in the future, …
The Effect Of Age On The Care Of Women With Breast Cancer In Community Hospitals, Paula Diehr, Joe Chu
The Effect Of Age On The Care Of Women With Breast Cancer In Community Hospitals, Paula Diehr, Joe Chu
Paula Diehr
We studied the process of care received by 1,680 female breast cancer patients treated in 17 community hospitals. The probability of receiving various diagnostic, consultation, therapy, or rehabilitation services was almost always significantly associated with patient age for one or more disease stages. Most often there was a linear trend for older patients to receive fewer services (e.g., biopsies prior to definitive treatment, number of lymph nodes examined, chemotherapy, radiation therapy) but other age patterns also were found. Age was not significantly associated with clinical staging or estrogen receptors.
Factors Explaining The Use Of Health Care Services By The Elderly, Paula Diehr, Connie Evashwick
Factors Explaining The Use Of Health Care Services By The Elderly, Paula Diehr, Connie Evashwick
Paula Diehr
The Anderson model of health services utilization, which relates use of service to predisposing, enabling, and need factors, has not often been applied to an elderly population. In this study, the factors of the Andersen model were used prospectively to predict utilization for a population sample of 1,317 elderly persons. Taken alone, the NEED construct was the most important single predictor of use of physician services, hospitalizations, ambulatory care, and home care. PREDISPOSING factors were better predictors of the use of dental services. Some of the variables studied were not related to utilization in the direction that would have been …