Lisa Fredman - Academia.edu (original) (raw)

Papers by Lisa Fredman

Research paper thumbnail of Caregiving, Mortality, and Mobility DeclineThe Health, Aging, and Body Composition (Health ABC) Study

Archives of Internal Medicine, 2008

Context-Although caregivers report more stress than non-caregivers, few studies have found greate... more Context-Although caregivers report more stress than non-caregivers, few studies have found greater health decline in older caregivers. We hypothesized that caregivers may be more physically active than non-caregivers, which may protect them from health decline. Objective-To evaluate total, and race-and gender-specific risk of mortality and functional decline in elderly caregivers versus non-caregivers, and whether these associations were mediated by total physical activity (including daily routine, leisure-time exercise, and caregiving activity). Design and setting-The Health, Aging and Body Composition (Health ABC) study, a cohort study of 3075 healthy adults, aged 70-79 years in 1997-1998 who resided in Memphis, Tennessee or Pittsburgh, Pennsylvania and were followed through their eighth year of participation. Participants-Participants were classified as caregivers (n=680, 22%) or non-caregivers (n=2369) if they reported providing "regular care or assistance for a child or a disabled or sick adult". Main Outcome Measure-All-cause mortality and incident mobility limitation, defined as reported difficulty walking ¼ mile or climbing 10 steps on two consecutive semi-annual contacts. Results-Overall, 20.6% of caregivers died and 50.9% developed mobility limitation, versus 22.0% and 48.9% of non-caregivers, respectively. Associations with health outcomes differed by race and gender. Mortality and mobility limitation rates were 1.5 times higher in white caregivers compared to non-caregivers (e.g., among white females, adjusted hazards ratio for mortality, HR = 1.6, 1.0-2.5), but were lower in black female caregivers versus non-caregivers (e.g., HR for mortality = 0.9, 0.5-1.4). Physical activity mediated these associations in most race-gender

Research paper thumbnail of Neighborhood socioeconomic status and the incidence of hypertension in the black women's health study

Research paper thumbnail of Circulating 25-hydroxyvitamin D levels and frailty status in older women

Context: Vitamin D deficiency and frailty are common with aging, but the association between thes... more Context: Vitamin D deficiency and frailty are common with aging, but the association between these conditions is uncertain. Objective: To determine the association between 25-hydroxyvitamin D (25(OH)D) levels and prevalent and incident frailty status among older women. Design: Cross-sectional and longitudinal analyses of a prospective cohort study.

Research paper thumbnail of When it hurts, a positive attitude may help: The association of positive affect with daily walking in knee OA: the MOST study

While depressive symptoms and knee pain are independently known to impede daily walking in older ... more While depressive symptoms and knee pain are independently known to impede daily walking in older adults, it is unknown whether positive affect promotes daily walking. This study investigated this association among adults with knee osteoarthritis (OA) and examined whether knee pain modified this association. This study is a cross-sectional analysis of the Multicenter Osteoarthritis Study. We included 1,018 participants (mean ± SD age 63.1 ± 7.8 years, 60% women) who had radiographic knee OA and had worn a StepWatch monitor to record their number of steps per day. High and low positive affect and depressive symptoms were based on the Center for Epidemiologic Studies Depression Scale. Knee pain was categorized as present in respondents who reported pain on most days at both a clinic visit and a telephone screening. Compared to respondents with low positive affect (27% of all respondents), those with high positive affect (63%) walked a similar number of steps per day, while those with depressive symptoms (10%) walked less (adjusted β -32.6 [95% confidence interval (95% CI) -458.9, 393.8] and -579.1 [95% CI -1,274.9, 116.7], respectively). There was a statistically significant interaction of positive affect by knee pain (P = 0.0045). Among the respondents with knee pain (39%), those with high positive affect walked significantly more steps per day (adjusted β 711.0 [95% CI 55.1, 1,366.9]) than those with low positive affect. High positive affect was associated with more daily walking among adults with painful knee OA. Positive affect may be an important psychological factor to consider for promoting physical activity among people with painful knee OA.

Research paper thumbnail of Female editorship is an important indicator of gender imbalance

Research paper thumbnail of Plasma B vitamins, homocysteine, and their relation with bone loss and hip fracture in elderly men and women

Context: Elevated homocysteine is a strong risk factor for osteoporotic fractures among elders, y... more Context: Elevated homocysteine is a strong risk factor for osteoporotic fractures among elders, yet it may be a marker for low B-vitamin status. Objective: Our objective was to examine the associations of plasma concentrations of folate, vitamin B12, vitamin B6, and homocysteine with bone loss and hip fracture risk in elderly men and women. Design: This was a longitudinal follow-up study of the Framingham Osteoporosis Study. Setting: Community dwelling residents of Framingham, MA, were included in the study. Participants: A total of 1002 men and women (mean age 75 yr) was included in the study. Main Outcome Measures: Baseline (1987-1989) blood samples were used to categorize participants into plasma B-vitamin (normal, low, deficient) and homocysteine (normal, high) groups. Femoral neck bone mineral density (BMD) measured at baseline and 4-yr follow-up was used to calculate annual percent BMD change. Incident hip fracture was assessed from baseline through 2003. Results: Multivariable-adjusted mean bone loss was inversely associated with vitamin B6 (P for trend 0.01). Vitamins B12 and B6 were inversely associated with hip fracture risk (all P for trend Ͻ 0.05), yet associations were somewhat attenuated and not significant after controlling for baseline BMD, serum vitamin D, and homocysteine. Participants with high homocysteine (Ͼ14 mol/liter) had approximately 70% higher hip fracture risk after adjusting for folate and vitamin B6, but this association was attenuated after controlling for vitamin B12 (hazard ratio ϭ 1.49; 95% confidence interval 0.91, 2.46). Conclusions: Low B-vitamin concentration may be a risk factor for decreased bone health, yet does not fully explain the relation between elevated homocysteine and hip fracture. Thus, homocysteine is not merely a marker for low B-vitamin status.

Research paper thumbnail of Caregiving Intensity and Change in Physical Functioning Over a 2-Year Period: Results of the Caregiver-Study of Osteoporotic Fractures

American Journal of Epidemiology, 2009

It is unknown whether caregivers who perform more caregiving tasks have a greater decline in heal... more It is unknown whether caregivers who perform more caregiving tasks have a greater decline in health from higher stress or less decline because of better health, staying active, or psychological factors. This 1999À2004 US study examined caregiving intensity and 2-year change in performance-based functioning among 901 elderly women from the Caregiver-Study of Osteoporotic Fractures sample. Caregivers were categorized as high (n ¼ 167) or low (n ¼ 166) intensity based on how many activities of daily living they performed for the care recipient. Caregiving intensity status and physical performance score (sum of quartiles of walking pace, grip strength, and chair-stand speed; range, 0-9) were assessed at baseline and at 2 annual follow-up interviews. At baseline, high-intensity caregivers reported the most stress but had the best physical functioning; noncaregivers (n ¼ 568) had the poorest physical functioning (adjusted scores ¼ 5.09 vs. 4.54, P ¼ 0.03). Low-intensity caregivers declined more than noncaregivers over 2 years, but high-intensity caregivers did not (adjusted difference ¼ À0.33, P ¼ 0.07 vs. 0.03, P ¼ 0.89). Among respondents with the same caregiving status at baseline and 1-year interviews, high-intensity caregivers maintained the highest physical performance throughout follow-up. Higher levels of physical performance persisted over 2 years among high-intensity caregivers, which did not support the traditional stress hypothesis. activities of daily living; caregivers; disability evaluation Abbreviations: ADL, activities of daily living; IADL, instrumental activities of daily living; SOF, Study of Osteoporotic Fractures.

Research paper thumbnail of Self-ratings of Health and Change in Walking Speed Over 2 Years: Results From the Caregiver-Study of Osteoporotic Fractures

American Journal of Epidemiology, 2011

Although poorer self-rated health (SRH) is associated with increased mortality, less is known abo... more Although poorer self-rated health (SRH) is associated with increased mortality, less is known about its impact on functioning. This study evaluated whether poorer SRH was associated with decline in walking speed and whether caregiving, often considered an indicator of chronic stress, modified this relation. The sample included 891 older US women from the Caregiver-Study of Osteoporotic Fractures. SRH was assessed at the baseline Caregiver-Study of Osteoporotic Fractures interview, conducted in 1999-2001, and was categorized as fair/poor or excellent/good. Rapid walking speed over 2, 3, or 6 m was measured at baseline and 2 annual follow-up interviews. Respondents with fair/poor SRH walked significantly slower at baseline than those with excellent/good health (mean ¼ 0.8 (standard deviation, 0.3) vs. 1.0 (standard deviation, 0.3) m/second, P < 0.001). In adjusted linear mixed models of percentage change in walking speed, respondents with fair/poor SRH experienced a greater decline in walking speed than those with excellent/good SRH (À5.66% vs. À0.60%, P ¼ 0.01). Caregivers with fair/ poor SRH declined more than noncaregivers (À9.26% vs. À4.09%). High-intensity caregivers had the largest decline (À12.88%), whereas low-intensity caregivers in excellent/good SRH had no decline (2.61%). In summary, poorer SRH was associated with decline in walking speed in older women, and the stress of caregiving may have exacerbated its impact.

Research paper thumbnail of Comparison of frequency and outcome of major gastrointestinal hemorrhage in patients with atrial fibrillation on versus not receiving warfarin therapy (from the ATRIA and ATRIA-CVRN cohorts)

The American journal of cardiology, 2015

To date, there have been few studies evaluating outcomes of patients with atrial fibrillation (AF... more To date, there have been few studies evaluating outcomes of patients with atrial fibrillation (AF) who have experienced gastrointestinal (GI) hemorrhages. We examined short- and long-term mortality of major GI hemorrhage in patients with AF on and off warfarin in recent clinical care. We evaluated this association in the large Anticoagulation and Risk Factors in Atrial fibrillation (ATRIA) and ATRIA-Cardiovascular Research Network (CVRN) California community-based cohorts of patients with AF (study years 1996 to 2003 and 2006 to 2009, respectively), where all events were clinician adjudicated. We used proportional hazards regression with propensity score adjustment to estimate the short- (30 days) and long-term (>30 days for 1 year) mortality rate ratio for patients using warfarin compared with those who were not using warfarin at the time of GI hemorrhage. In the 414 ATRIA participants with major GI hemorrhage, 54% were taking warfarin at the time of the hemorrhage; in the 361 A...

Research paper thumbnail of The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies

Osteoporosis International, 2003

The contribution of hip fracture to the risk of subsequent fractures is unclear. Data from the Ba... more The contribution of hip fracture to the risk of subsequent fractures is unclear. Data from the Baltimore Hip Studies and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) were used. Baltimore subjects enrolled at the time of hip fracture ( n=549) and EPESE subjects without previous fractures at baseline ( n=10,680) were followed for 2-10 years. Self-reported nonhip skeletal fracture was the outcome, and hip fracture was a time-varying covariate in a survival analysis stratified by study site. The model was adjusted for race, sex, age, BMI, stroke, cancer, difficulty walking across a room, dependence in grooming, dependence in transferring, and cognitive impairment. The rate of all subsequent self-reported fractures after hip fracture was 10.4 fractures/100 person-years. The unadjusted hazard of nonhip skeletal fracture was 2.52 (95% confidence interval 2.05 to 3.12) for subjects with hip fracture compared with subjects without; when adjusted for other known fracture risk factors the hazard ratio was 1.62 (1.30 to 2.02). Men and women had a similar relative risk increase. The increased risk of secondary fracture after hip fracture persisted over time. A hip fracture is associated with a 2.5-fold increased risk of subsequent fracture, which is not entirely explained by prefracture risk factors. Careful attention to secondary prevention is warranted in these patients.

Research paper thumbnail of Relation of Social Network Characteristics to 5Year Mortality among Young-Old versus Old-Old White Women in an Urban Community

This study examines age-related differences in the association between social network characteris... more This study examines age-related differences in the association between social network characteristics and mortality for aged white women. Subjects include a community-dwelling sample of white women aged &65 years (n = 806), who lived in northeast Baltimore, Maryland, in 1984. Three characteristics of social networks were measured: availability of network resources; contact with network resources; and integration into the neighborhood.

Research paper thumbnail of Leisure-time exercise and overall physical activity in older women caregivers and non-caregivers from the Caregiver-SOF study

Preventive Medicine, 2006

Background. Elderly caregivers report less leisure-time physical activity than same-aged non-care... more Background. Elderly caregivers report less leisure-time physical activity than same-aged non-caregivers. However, through caregiving tasks, caregivers may be as physically active as non-caregivers. This study compared leisure-time exercise and overall physical activity in elderly women caregivers and non-caregivers.

Research paper thumbnail of Sleep Problems in Elderly Women Caregivers Depend on the Level of Depressive Symptoms: Results of the Caregiver–Study of Osteoporotic Fractures

Journal of the American Geriatrics Society, 2000

OBJECTIVES: To determine whether depressive symptoms modify the association between caregiving an... more OBJECTIVES: To determine whether depressive symptoms modify the association between caregiving and sleep problems in elderly women. DESIGN: Cross-sectional study conducted in four communities in 1999 to 2001. SETTING: Home-based interviewer-administered questionnaires. PARTICIPANTS: Three hundred seventy-five caregiver and 694 noncaregiver participants from the Study of Osteoporotic Fractures. MEASUREMENTS: Self-reported frequency of three sleep problems in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble falling back asleep. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D), excluding the sleep disturbance item. RESULTS: In adjusted analyses, caregivers did not report more sleep problems than noncaregivers, although respondents with high depressive symptoms (CES-D !16) were twice as likely to report each sleep problem. When depressive symptoms and caregiving were considered together, caregivers with high depressive symptoms were most likely to report sleep problems (adjusted odds ratios ranging from 2.5, 95% confidence interval (CI) 5 1.2-5.2 for trouble falling asleep to 4.0, 95% CI 5 2.0-7.8 for waking early, compared with nondepressed noncaregivers). By contrast, there was no difference in sleep problems between caregivers and noncaregivers who were not depressed. The combination of high depressive symptoms and high-stress caregiving situations (e.g., caring for a spouse or a person with dementia, or living with the care recipient) also increased the likelihood of sleep problems. CONCLUSION: Caregivers with high levels of depressive symptoms reported sleep problems more than nondepressed noncaregivers. These results underscore the importance of screening elderly female caregivers for depressive symptoms and sleep problems. J Am Geriatr Soc 55:

Research paper thumbnail of Positive Affect and Incidence of Frailty in Elderly Women Caregivers and Noncaregivers: Results of Caregiver–Study of Osteoporotic Fractures

Journal of the American Geriatrics Society, 2000

OBJECTIVES: To determine whether positive affect is associated with a lower incidence of frailty ... more OBJECTIVES: To determine whether positive affect is associated with a lower incidence of frailty over 2 years in elderly community-dwelling women and to test the stressbuffering hypothesis by evaluating whether these associations differed in caregivers and noncaregivers. DESIGN: Prospective cohort study with three annual interviews conducted in four U.S. communities between 1999 and 2004. SETTING: Home-based interviews. PARTICIPANTS: Three hundred thirty-seven caregiver and 617 noncaregiver participants from the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF) who were not frail at the baseline Caregiver-SOF interview. MEASUREMENTS: High and low positive affect and depressive symptoms were derived from the baseline 20-item Center for Epidemiologic Studies Depression Scale. Frailty was the development of three or more indicators (weight loss, exhaustion, slow walking speed, or weak grip strength) at the first or second follow-up interview. RESULTS: Respondents' mean age was 81.2. Caregivers and noncaregivers had similar levels of positive affect (56.3% vs 58.3%) and frailty incidence (15.4% vs 15.9%) but differed in perceived stress (mean Perceived Stress Scale score 16.7 vs 14.8, Po.001). Frailty risk was lower in respondents with high positive affect than in those with low positive affect in the total sample (adjusted hazard ratio (HR) 5 0.49, 95% confidence interval (CI) 5 0.35-0.70), caregivers (adjusted HR 5 0.44, 95% CI 5 0.24-0.80) and noncaregivers (adjusted HR 5 0.50, 95% CI 5 0.32-0.77). CONCLUSION: These findings add to the evidence that positive affect protects against health decline in older adults, although it had no additional stress-buffering effect on health in elderly caregivers. J Am Geriatr Soc 57: 627-633, 2009.

Research paper thumbnail of Female hip fracture patients had poorer performance-based functioning than community-dwelling peers over 2-year follow-up period

Journal of Clinical Epidemiology, 2005

Background and Objectives: Compare performance-based functioning over 2 years among elderly women... more Background and Objectives: Compare performance-based functioning over 2 years among elderly women hip fracture patients vs. community-dwelling older women.

Research paper thumbnail of Caregiving and Cognitive Function in Older Women: Evidence for the Healthy Caregiver Hypothesis

Journal of Aging and Health, 2012

Recent findings of better health outcomes in older caregivers than noncaregivers suggest a health... more Recent findings of better health outcomes in older caregivers than noncaregivers suggest a healthy caregiver hypothesis (HCH) model may be more appropriate than the stress process model for evaluating the health effects of caregiving. In a cross-sectional study, we tested the HCH on two cognitive domains: verbal memory and processing speed. Participants from the Caregiver Study of Osteoporotic Fractures who had a 2-year follow-up interview were categorized as continuous caregivers (n = 194), former caregivers (n = 148), or continuous noncaregivers (n = 574). The Hopkins Verbal Learning Test (HVLT; memory) and Digit Symbol Substitution Task (DSST; processing speed) were administered at the follow-up interview. Continuous caregivers had better memory performance and processing speed than continuous noncaregivers: adjusted mean scores for HVLT were 18.38 versus 15.80 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001), and for DSST were 35.91 versus 34.38 (p = .09). Results support the HCH model for cognitive outcomes in older women caregivers; however, the relationship may be domain specific.

Research paper thumbnail of Are All Caregivers Created Equal? Stress in Caregivers to Adults With and Without Dementia

Journal of Aging and Health, 2006

Caregiving for older adults is stressful; however, by treating caregivers as a homogenous group, ... more Caregiving for older adults is stressful; however, by treating caregivers as a homogenous group, it is possible that stress-related factors are misrepresented for some. This study of 349 elderly caregivers explored mediators of the caregiving / stress relationship for caregivers to adults with (n = 106), and without (n = 243) dementia. The sample was from the Caregiver Study of Osteoporotic Fractures (CG-SOF), ancillary to SOF, a four-site cohort of 9,704 women. Stress was higher (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) in dementia than nondementia caregivers (m = 19.85; 16.45). For caregivers overall, intensity and recipient problems were associated with stress but mediated through role captivity. However, relationships differed when stratified by recipient dementia status. Only recipient problems among nondementia caregivers was mediated through captivity. Results confirm previous findings of lower stress among nondementia caregivers and suggest that different factors influence caregivers&amp;amp;amp;amp;amp;amp;amp;amp;#39; appraisal of the situation, including their perception of stress, based on recipients&amp;amp;amp;amp;amp;amp;amp;amp;#39; dementia status.

Research paper thumbnail of Pragmatic and Internal Validity Issues in Sampling in Caregiver Studies: A Comparison of Population-Based, Registry-Based, and Ancillary Studies

Journal of Aging and Health, 2004

Studies of caregivers illustrate a classic sampling dilemma: maximizing recruitment without compr... more Studies of caregivers illustrate a classic sampling dilemma: maximizing recruitment without compromising study validity. Because caregivers are defined in relation to a care recipient, sampling methods are often determined by pragmatic decisions such as access, efficiency, and costs. However, overlooking validity may result in selection bias, misclassification of caregiver status, and the confounding of results. Validity and pragmatic concerns were compared in four caregiver studies that used different sampling frames: community based, Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease registry, and ancillary studies to existing epidemiologic studies. Systematic comparison of validity and of pragmatic aspects of sampling frames, recruitment methods, and participation rates, with attention to caregiver identification, inclusion criteria, and sample restriction. All studies used task-based inclusion criteria. Caregiver participation rates ranged from 81% to 96%, with higher rates in community-based and registry-based studies than in ancillary studies. The latter studies benefited from unbiased selection of noncaregivers. Regardless of sampling frame, standard task-based inclusion criteria to define caregivers may enhance validity.

Research paper thumbnail of Social functioning in community residents with depression and other psychiatric disorders: results of the New Haven Epidemiologic catchment area study

Journal of Affective Disorders, 1988

Social functioning was compared among 4913 community participants with current depression, past d... more Social functioning was compared among 4913 community participants with current depression, past depression, other psychiatric disorders and no psychiatric history, from the New Haven Epidemiologic Catchment Area Wave I survey. Respondents with current major depressive disorder (1.5%) (based on the Diagnostic Interview Schedule) reported significantly poorer intimate relationships and less satisfying social interactions than respondents with past depression or other current disorders. Respondents with no psychiatric history (77%) reported significantly more active and satisfying social interactions than persons with any psychiatric disorder. These social functioning and depression associations were similar among males and females, and corroborated results from patient samples.

Research paper thumbnail of Physicians and Family Caregivers: A Model for Partnership

JAMA: The Journal of the American Medical Association, 1993

Primary care physicians need a strong and effective model to guide their relationships with famil... more Primary care physicians need a strong and effective model to guide their relationships with family caregivers, key resources for the frail elderly. Caregivers provide a significant proportion of the home care needed by the rapidly growing number of frail elderly living in the community. Caregiving exacts a physical, psychological, social, and emotional toll that no intervention strategies have proven powerful enough to offset. An effective relationship model would acknowledge the key linkage role of the primary care physician, recognize that caregivers and patients form interdependent units, and affirm a care partnership between the physician and caregiver. In this model, the physician conducts periodic assessments of the caregiver as well as the patient; uses a comprehensive home-based approach to care and services; provides training to caregivers, particularly in managing difficult behavior; validates the role of caregiver; and acts as case manager. Educational opportunities and reimbursement structures should be modified to encourage physicians to use the partnership model.

Research paper thumbnail of Caregiving, Mortality, and Mobility DeclineThe Health, Aging, and Body Composition (Health ABC) Study

Archives of Internal Medicine, 2008

Context-Although caregivers report more stress than non-caregivers, few studies have found greate... more Context-Although caregivers report more stress than non-caregivers, few studies have found greater health decline in older caregivers. We hypothesized that caregivers may be more physically active than non-caregivers, which may protect them from health decline. Objective-To evaluate total, and race-and gender-specific risk of mortality and functional decline in elderly caregivers versus non-caregivers, and whether these associations were mediated by total physical activity (including daily routine, leisure-time exercise, and caregiving activity). Design and setting-The Health, Aging and Body Composition (Health ABC) study, a cohort study of 3075 healthy adults, aged 70-79 years in 1997-1998 who resided in Memphis, Tennessee or Pittsburgh, Pennsylvania and were followed through their eighth year of participation. Participants-Participants were classified as caregivers (n=680, 22%) or non-caregivers (n=2369) if they reported providing "regular care or assistance for a child or a disabled or sick adult". Main Outcome Measure-All-cause mortality and incident mobility limitation, defined as reported difficulty walking ¼ mile or climbing 10 steps on two consecutive semi-annual contacts. Results-Overall, 20.6% of caregivers died and 50.9% developed mobility limitation, versus 22.0% and 48.9% of non-caregivers, respectively. Associations with health outcomes differed by race and gender. Mortality and mobility limitation rates were 1.5 times higher in white caregivers compared to non-caregivers (e.g., among white females, adjusted hazards ratio for mortality, HR = 1.6, 1.0-2.5), but were lower in black female caregivers versus non-caregivers (e.g., HR for mortality = 0.9, 0.5-1.4). Physical activity mediated these associations in most race-gender

Research paper thumbnail of Neighborhood socioeconomic status and the incidence of hypertension in the black women's health study

Research paper thumbnail of Circulating 25-hydroxyvitamin D levels and frailty status in older women

Context: Vitamin D deficiency and frailty are common with aging, but the association between thes... more Context: Vitamin D deficiency and frailty are common with aging, but the association between these conditions is uncertain. Objective: To determine the association between 25-hydroxyvitamin D (25(OH)D) levels and prevalent and incident frailty status among older women. Design: Cross-sectional and longitudinal analyses of a prospective cohort study.

Research paper thumbnail of When it hurts, a positive attitude may help: The association of positive affect with daily walking in knee OA: the MOST study

While depressive symptoms and knee pain are independently known to impede daily walking in older ... more While depressive symptoms and knee pain are independently known to impede daily walking in older adults, it is unknown whether positive affect promotes daily walking. This study investigated this association among adults with knee osteoarthritis (OA) and examined whether knee pain modified this association. This study is a cross-sectional analysis of the Multicenter Osteoarthritis Study. We included 1,018 participants (mean ± SD age 63.1 ± 7.8 years, 60% women) who had radiographic knee OA and had worn a StepWatch monitor to record their number of steps per day. High and low positive affect and depressive symptoms were based on the Center for Epidemiologic Studies Depression Scale. Knee pain was categorized as present in respondents who reported pain on most days at both a clinic visit and a telephone screening. Compared to respondents with low positive affect (27% of all respondents), those with high positive affect (63%) walked a similar number of steps per day, while those with depressive symptoms (10%) walked less (adjusted β -32.6 [95% confidence interval (95% CI) -458.9, 393.8] and -579.1 [95% CI -1,274.9, 116.7], respectively). There was a statistically significant interaction of positive affect by knee pain (P = 0.0045). Among the respondents with knee pain (39%), those with high positive affect walked significantly more steps per day (adjusted β 711.0 [95% CI 55.1, 1,366.9]) than those with low positive affect. High positive affect was associated with more daily walking among adults with painful knee OA. Positive affect may be an important psychological factor to consider for promoting physical activity among people with painful knee OA.

Research paper thumbnail of Female editorship is an important indicator of gender imbalance

Research paper thumbnail of Plasma B vitamins, homocysteine, and their relation with bone loss and hip fracture in elderly men and women

Context: Elevated homocysteine is a strong risk factor for osteoporotic fractures among elders, y... more Context: Elevated homocysteine is a strong risk factor for osteoporotic fractures among elders, yet it may be a marker for low B-vitamin status. Objective: Our objective was to examine the associations of plasma concentrations of folate, vitamin B12, vitamin B6, and homocysteine with bone loss and hip fracture risk in elderly men and women. Design: This was a longitudinal follow-up study of the Framingham Osteoporosis Study. Setting: Community dwelling residents of Framingham, MA, were included in the study. Participants: A total of 1002 men and women (mean age 75 yr) was included in the study. Main Outcome Measures: Baseline (1987-1989) blood samples were used to categorize participants into plasma B-vitamin (normal, low, deficient) and homocysteine (normal, high) groups. Femoral neck bone mineral density (BMD) measured at baseline and 4-yr follow-up was used to calculate annual percent BMD change. Incident hip fracture was assessed from baseline through 2003. Results: Multivariable-adjusted mean bone loss was inversely associated with vitamin B6 (P for trend 0.01). Vitamins B12 and B6 were inversely associated with hip fracture risk (all P for trend Ͻ 0.05), yet associations were somewhat attenuated and not significant after controlling for baseline BMD, serum vitamin D, and homocysteine. Participants with high homocysteine (Ͼ14 mol/liter) had approximately 70% higher hip fracture risk after adjusting for folate and vitamin B6, but this association was attenuated after controlling for vitamin B12 (hazard ratio ϭ 1.49; 95% confidence interval 0.91, 2.46). Conclusions: Low B-vitamin concentration may be a risk factor for decreased bone health, yet does not fully explain the relation between elevated homocysteine and hip fracture. Thus, homocysteine is not merely a marker for low B-vitamin status.

Research paper thumbnail of Caregiving Intensity and Change in Physical Functioning Over a 2-Year Period: Results of the Caregiver-Study of Osteoporotic Fractures

American Journal of Epidemiology, 2009

It is unknown whether caregivers who perform more caregiving tasks have a greater decline in heal... more It is unknown whether caregivers who perform more caregiving tasks have a greater decline in health from higher stress or less decline because of better health, staying active, or psychological factors. This 1999À2004 US study examined caregiving intensity and 2-year change in performance-based functioning among 901 elderly women from the Caregiver-Study of Osteoporotic Fractures sample. Caregivers were categorized as high (n ¼ 167) or low (n ¼ 166) intensity based on how many activities of daily living they performed for the care recipient. Caregiving intensity status and physical performance score (sum of quartiles of walking pace, grip strength, and chair-stand speed; range, 0-9) were assessed at baseline and at 2 annual follow-up interviews. At baseline, high-intensity caregivers reported the most stress but had the best physical functioning; noncaregivers (n ¼ 568) had the poorest physical functioning (adjusted scores ¼ 5.09 vs. 4.54, P ¼ 0.03). Low-intensity caregivers declined more than noncaregivers over 2 years, but high-intensity caregivers did not (adjusted difference ¼ À0.33, P ¼ 0.07 vs. 0.03, P ¼ 0.89). Among respondents with the same caregiving status at baseline and 1-year interviews, high-intensity caregivers maintained the highest physical performance throughout follow-up. Higher levels of physical performance persisted over 2 years among high-intensity caregivers, which did not support the traditional stress hypothesis. activities of daily living; caregivers; disability evaluation Abbreviations: ADL, activities of daily living; IADL, instrumental activities of daily living; SOF, Study of Osteoporotic Fractures.

Research paper thumbnail of Self-ratings of Health and Change in Walking Speed Over 2 Years: Results From the Caregiver-Study of Osteoporotic Fractures

American Journal of Epidemiology, 2011

Although poorer self-rated health (SRH) is associated with increased mortality, less is known abo... more Although poorer self-rated health (SRH) is associated with increased mortality, less is known about its impact on functioning. This study evaluated whether poorer SRH was associated with decline in walking speed and whether caregiving, often considered an indicator of chronic stress, modified this relation. The sample included 891 older US women from the Caregiver-Study of Osteoporotic Fractures. SRH was assessed at the baseline Caregiver-Study of Osteoporotic Fractures interview, conducted in 1999-2001, and was categorized as fair/poor or excellent/good. Rapid walking speed over 2, 3, or 6 m was measured at baseline and 2 annual follow-up interviews. Respondents with fair/poor SRH walked significantly slower at baseline than those with excellent/good health (mean ¼ 0.8 (standard deviation, 0.3) vs. 1.0 (standard deviation, 0.3) m/second, P < 0.001). In adjusted linear mixed models of percentage change in walking speed, respondents with fair/poor SRH experienced a greater decline in walking speed than those with excellent/good SRH (À5.66% vs. À0.60%, P ¼ 0.01). Caregivers with fair/ poor SRH declined more than noncaregivers (À9.26% vs. À4.09%). High-intensity caregivers had the largest decline (À12.88%), whereas low-intensity caregivers in excellent/good SRH had no decline (2.61%). In summary, poorer SRH was associated with decline in walking speed in older women, and the stress of caregiving may have exacerbated its impact.

Research paper thumbnail of Comparison of frequency and outcome of major gastrointestinal hemorrhage in patients with atrial fibrillation on versus not receiving warfarin therapy (from the ATRIA and ATRIA-CVRN cohorts)

The American journal of cardiology, 2015

To date, there have been few studies evaluating outcomes of patients with atrial fibrillation (AF... more To date, there have been few studies evaluating outcomes of patients with atrial fibrillation (AF) who have experienced gastrointestinal (GI) hemorrhages. We examined short- and long-term mortality of major GI hemorrhage in patients with AF on and off warfarin in recent clinical care. We evaluated this association in the large Anticoagulation and Risk Factors in Atrial fibrillation (ATRIA) and ATRIA-Cardiovascular Research Network (CVRN) California community-based cohorts of patients with AF (study years 1996 to 2003 and 2006 to 2009, respectively), where all events were clinician adjudicated. We used proportional hazards regression with propensity score adjustment to estimate the short- (30 days) and long-term (>30 days for 1 year) mortality rate ratio for patients using warfarin compared with those who were not using warfarin at the time of GI hemorrhage. In the 414 ATRIA participants with major GI hemorrhage, 54% were taking warfarin at the time of the hemorrhage; in the 361 A...

Research paper thumbnail of The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies

Osteoporosis International, 2003

The contribution of hip fracture to the risk of subsequent fractures is unclear. Data from the Ba... more The contribution of hip fracture to the risk of subsequent fractures is unclear. Data from the Baltimore Hip Studies and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) were used. Baltimore subjects enrolled at the time of hip fracture ( n=549) and EPESE subjects without previous fractures at baseline ( n=10,680) were followed for 2-10 years. Self-reported nonhip skeletal fracture was the outcome, and hip fracture was a time-varying covariate in a survival analysis stratified by study site. The model was adjusted for race, sex, age, BMI, stroke, cancer, difficulty walking across a room, dependence in grooming, dependence in transferring, and cognitive impairment. The rate of all subsequent self-reported fractures after hip fracture was 10.4 fractures/100 person-years. The unadjusted hazard of nonhip skeletal fracture was 2.52 (95% confidence interval 2.05 to 3.12) for subjects with hip fracture compared with subjects without; when adjusted for other known fracture risk factors the hazard ratio was 1.62 (1.30 to 2.02). Men and women had a similar relative risk increase. The increased risk of secondary fracture after hip fracture persisted over time. A hip fracture is associated with a 2.5-fold increased risk of subsequent fracture, which is not entirely explained by prefracture risk factors. Careful attention to secondary prevention is warranted in these patients.

Research paper thumbnail of Relation of Social Network Characteristics to 5Year Mortality among Young-Old versus Old-Old White Women in an Urban Community

This study examines age-related differences in the association between social network characteris... more This study examines age-related differences in the association between social network characteristics and mortality for aged white women. Subjects include a community-dwelling sample of white women aged &65 years (n = 806), who lived in northeast Baltimore, Maryland, in 1984. Three characteristics of social networks were measured: availability of network resources; contact with network resources; and integration into the neighborhood.

Research paper thumbnail of Leisure-time exercise and overall physical activity in older women caregivers and non-caregivers from the Caregiver-SOF study

Preventive Medicine, 2006

Background. Elderly caregivers report less leisure-time physical activity than same-aged non-care... more Background. Elderly caregivers report less leisure-time physical activity than same-aged non-caregivers. However, through caregiving tasks, caregivers may be as physically active as non-caregivers. This study compared leisure-time exercise and overall physical activity in elderly women caregivers and non-caregivers.

Research paper thumbnail of Sleep Problems in Elderly Women Caregivers Depend on the Level of Depressive Symptoms: Results of the Caregiver–Study of Osteoporotic Fractures

Journal of the American Geriatrics Society, 2000

OBJECTIVES: To determine whether depressive symptoms modify the association between caregiving an... more OBJECTIVES: To determine whether depressive symptoms modify the association between caregiving and sleep problems in elderly women. DESIGN: Cross-sectional study conducted in four communities in 1999 to 2001. SETTING: Home-based interviewer-administered questionnaires. PARTICIPANTS: Three hundred seventy-five caregiver and 694 noncaregiver participants from the Study of Osteoporotic Fractures. MEASUREMENTS: Self-reported frequency of three sleep problems in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble falling back asleep. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D), excluding the sleep disturbance item. RESULTS: In adjusted analyses, caregivers did not report more sleep problems than noncaregivers, although respondents with high depressive symptoms (CES-D !16) were twice as likely to report each sleep problem. When depressive symptoms and caregiving were considered together, caregivers with high depressive symptoms were most likely to report sleep problems (adjusted odds ratios ranging from 2.5, 95% confidence interval (CI) 5 1.2-5.2 for trouble falling asleep to 4.0, 95% CI 5 2.0-7.8 for waking early, compared with nondepressed noncaregivers). By contrast, there was no difference in sleep problems between caregivers and noncaregivers who were not depressed. The combination of high depressive symptoms and high-stress caregiving situations (e.g., caring for a spouse or a person with dementia, or living with the care recipient) also increased the likelihood of sleep problems. CONCLUSION: Caregivers with high levels of depressive symptoms reported sleep problems more than nondepressed noncaregivers. These results underscore the importance of screening elderly female caregivers for depressive symptoms and sleep problems. J Am Geriatr Soc 55:

Research paper thumbnail of Positive Affect and Incidence of Frailty in Elderly Women Caregivers and Noncaregivers: Results of Caregiver–Study of Osteoporotic Fractures

Journal of the American Geriatrics Society, 2000

OBJECTIVES: To determine whether positive affect is associated with a lower incidence of frailty ... more OBJECTIVES: To determine whether positive affect is associated with a lower incidence of frailty over 2 years in elderly community-dwelling women and to test the stressbuffering hypothesis by evaluating whether these associations differed in caregivers and noncaregivers. DESIGN: Prospective cohort study with three annual interviews conducted in four U.S. communities between 1999 and 2004. SETTING: Home-based interviews. PARTICIPANTS: Three hundred thirty-seven caregiver and 617 noncaregiver participants from the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF) who were not frail at the baseline Caregiver-SOF interview. MEASUREMENTS: High and low positive affect and depressive symptoms were derived from the baseline 20-item Center for Epidemiologic Studies Depression Scale. Frailty was the development of three or more indicators (weight loss, exhaustion, slow walking speed, or weak grip strength) at the first or second follow-up interview. RESULTS: Respondents' mean age was 81.2. Caregivers and noncaregivers had similar levels of positive affect (56.3% vs 58.3%) and frailty incidence (15.4% vs 15.9%) but differed in perceived stress (mean Perceived Stress Scale score 16.7 vs 14.8, Po.001). Frailty risk was lower in respondents with high positive affect than in those with low positive affect in the total sample (adjusted hazard ratio (HR) 5 0.49, 95% confidence interval (CI) 5 0.35-0.70), caregivers (adjusted HR 5 0.44, 95% CI 5 0.24-0.80) and noncaregivers (adjusted HR 5 0.50, 95% CI 5 0.32-0.77). CONCLUSION: These findings add to the evidence that positive affect protects against health decline in older adults, although it had no additional stress-buffering effect on health in elderly caregivers. J Am Geriatr Soc 57: 627-633, 2009.

Research paper thumbnail of Female hip fracture patients had poorer performance-based functioning than community-dwelling peers over 2-year follow-up period

Journal of Clinical Epidemiology, 2005

Background and Objectives: Compare performance-based functioning over 2 years among elderly women... more Background and Objectives: Compare performance-based functioning over 2 years among elderly women hip fracture patients vs. community-dwelling older women.

Research paper thumbnail of Caregiving and Cognitive Function in Older Women: Evidence for the Healthy Caregiver Hypothesis

Journal of Aging and Health, 2012

Recent findings of better health outcomes in older caregivers than noncaregivers suggest a health... more Recent findings of better health outcomes in older caregivers than noncaregivers suggest a healthy caregiver hypothesis (HCH) model may be more appropriate than the stress process model for evaluating the health effects of caregiving. In a cross-sectional study, we tested the HCH on two cognitive domains: verbal memory and processing speed. Participants from the Caregiver Study of Osteoporotic Fractures who had a 2-year follow-up interview were categorized as continuous caregivers (n = 194), former caregivers (n = 148), or continuous noncaregivers (n = 574). The Hopkins Verbal Learning Test (HVLT; memory) and Digit Symbol Substitution Task (DSST; processing speed) were administered at the follow-up interview. Continuous caregivers had better memory performance and processing speed than continuous noncaregivers: adjusted mean scores for HVLT were 18.38 versus 15.80 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001), and for DSST were 35.91 versus 34.38 (p = .09). Results support the HCH model for cognitive outcomes in older women caregivers; however, the relationship may be domain specific.

Research paper thumbnail of Are All Caregivers Created Equal? Stress in Caregivers to Adults With and Without Dementia

Journal of Aging and Health, 2006

Caregiving for older adults is stressful; however, by treating caregivers as a homogenous group, ... more Caregiving for older adults is stressful; however, by treating caregivers as a homogenous group, it is possible that stress-related factors are misrepresented for some. This study of 349 elderly caregivers explored mediators of the caregiving / stress relationship for caregivers to adults with (n = 106), and without (n = 243) dementia. The sample was from the Caregiver Study of Osteoporotic Fractures (CG-SOF), ancillary to SOF, a four-site cohort of 9,704 women. Stress was higher (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) in dementia than nondementia caregivers (m = 19.85; 16.45). For caregivers overall, intensity and recipient problems were associated with stress but mediated through role captivity. However, relationships differed when stratified by recipient dementia status. Only recipient problems among nondementia caregivers was mediated through captivity. Results confirm previous findings of lower stress among nondementia caregivers and suggest that different factors influence caregivers&amp;amp;amp;amp;amp;amp;amp;amp;#39; appraisal of the situation, including their perception of stress, based on recipients&amp;amp;amp;amp;amp;amp;amp;amp;#39; dementia status.

Research paper thumbnail of Pragmatic and Internal Validity Issues in Sampling in Caregiver Studies: A Comparison of Population-Based, Registry-Based, and Ancillary Studies

Journal of Aging and Health, 2004

Studies of caregivers illustrate a classic sampling dilemma: maximizing recruitment without compr... more Studies of caregivers illustrate a classic sampling dilemma: maximizing recruitment without compromising study validity. Because caregivers are defined in relation to a care recipient, sampling methods are often determined by pragmatic decisions such as access, efficiency, and costs. However, overlooking validity may result in selection bias, misclassification of caregiver status, and the confounding of results. Validity and pragmatic concerns were compared in four caregiver studies that used different sampling frames: community based, Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease registry, and ancillary studies to existing epidemiologic studies. Systematic comparison of validity and of pragmatic aspects of sampling frames, recruitment methods, and participation rates, with attention to caregiver identification, inclusion criteria, and sample restriction. All studies used task-based inclusion criteria. Caregiver participation rates ranged from 81% to 96%, with higher rates in community-based and registry-based studies than in ancillary studies. The latter studies benefited from unbiased selection of noncaregivers. Regardless of sampling frame, standard task-based inclusion criteria to define caregivers may enhance validity.

Research paper thumbnail of Social functioning in community residents with depression and other psychiatric disorders: results of the New Haven Epidemiologic catchment area study

Journal of Affective Disorders, 1988

Social functioning was compared among 4913 community participants with current depression, past d... more Social functioning was compared among 4913 community participants with current depression, past depression, other psychiatric disorders and no psychiatric history, from the New Haven Epidemiologic Catchment Area Wave I survey. Respondents with current major depressive disorder (1.5%) (based on the Diagnostic Interview Schedule) reported significantly poorer intimate relationships and less satisfying social interactions than respondents with past depression or other current disorders. Respondents with no psychiatric history (77%) reported significantly more active and satisfying social interactions than persons with any psychiatric disorder. These social functioning and depression associations were similar among males and females, and corroborated results from patient samples.

Research paper thumbnail of Physicians and Family Caregivers: A Model for Partnership

JAMA: The Journal of the American Medical Association, 1993

Primary care physicians need a strong and effective model to guide their relationships with famil... more Primary care physicians need a strong and effective model to guide their relationships with family caregivers, key resources for the frail elderly. Caregivers provide a significant proportion of the home care needed by the rapidly growing number of frail elderly living in the community. Caregiving exacts a physical, psychological, social, and emotional toll that no intervention strategies have proven powerful enough to offset. An effective relationship model would acknowledge the key linkage role of the primary care physician, recognize that caregivers and patients form interdependent units, and affirm a care partnership between the physician and caregiver. In this model, the physician conducts periodic assessments of the caregiver as well as the patient; uses a comprehensive home-based approach to care and services; provides training to caregivers, particularly in managing difficult behavior; validates the role of caregiver; and acts as case manager. Educational opportunities and reimbursement structures should be modified to encourage physicians to use the partnership model.