Showing papers by "Robert G. Cumming published in 2007"
TL;DR: Long-term follow-up of this older population confirms that the risk of ARM progression is related strongly to the severity of early-stage lesions, and provides evidence-based criteria for identifying persons at high risk of developing late ARM.
323 citations
TL;DR: To determine the effectiveness of a 16‐week community‐based tai chi program in reducing falls and improving balance in people aged 60 and older.
Abstract: OBJECTIVES: To determine the effectiveness of a 16-week community-based tai chi program in reducing falls and improving balance in people aged 60 and older. DESIGN: Randomized, controlled trial with waiting list control group. SETTING: Community in Sydney, Australia. PARTICIPANTS: Seven hundred two relatively healthy community-dwelling people aged 60 and older (mean age 69). INTERVENTION: Sixteen-week program of communitybased tai chi classes of 1 hour duration per week. MEASUREMENTS: Falls during 16 and 24 weeks of follow-up were assessed using a calendar method. Balance was measured at baseline and 16-week follow-up using six balance tests. RESULTS: Falls were less frequent in the tai chi group than in the control group. Using Cox regression and time to first fall, the hazard ratio after 16 weeks was 0.72 (95% confidence interval (CI) 50.51‐1.01, P 5.06), and after 24 weeks it was 0.67 (95% CI 50.49‐0.93, P 5.02). There was no difference in the percentage of participants who had one or more falls. There were statistically significant differences in changes in balance favoring the tai chi group on five of six balance tests. CONCLUSION: Participation in once per week tai chi classes for 16 weeks can prevent falls in relatively healthy community-dwelling older people. J Am Geriatr Soc 55:1185–1191, 2007.
275 citations
TL;DR: The aim is to determine the efficacy of vision and eye examinations, with subsequent treatment of vision problems, for preventing falls and fractures in frail older people.
Abstract: OBJECTIVES: To determine the efficacy of vision and eye examinations, with subsequent treatment of vision problems, for preventing falls and fractures in frail older people. DESIGN: Randomized, controlled trial. SETTING: Community in Sydney, Australia. PARTICIPANTS: Six hundred sixteen men and women aged 70 and older (mean age 81) recruited mainly from people attending outpatient aged care services. INTERVENTIONS: The intervention group received comprehensive vision and eye examinations conducted by a study optometrist. The optometrist arranged for new eyeglasses for 92 subjects and referred 24 for a home visit with an occupational therapist, 17 for glaucoma management, and 15 for cataract surgery. The control group received usual care. MEASUREMENTS: Falls and fractures during 12 months of follow-up were ascertained according to self-report using a monthly postcard system. RESULTS: Fifty-seven percent of subjects fell at least once during follow-up. Falls occurred more frequently in the group randomized to receive the vision intervention (65% fell at least once; 758 falls in total) than in the control group (50% fell at least once; 516 falls in total). The falls rate ratio using the negative binomial model was 1.57 (95% confidence interval (CI)=1.20-2.05, P=.001). Fractures were also more frequent in the intervention group (31 fractures) than the control group (18 fractures; relative risk from proportional hazards model 1.74, 95% CI=0.97-3.11, P=.06). CONCLUSION: In frail older people, comprehensive vision and eye assessment, with appropriate treatment, does not reduce, and may even increase, the risk of falls and fractures. Language: en
164 citations
TL;DR: Sleep disturbances are common in older people and are associated with their risk of falling, and Internet-based surveys may be a useful adjunct method for research in Older people.
Abstract: Background. Sleep disturbances are common in older people and may contribute to risk of falling. Methods. Cross-sectional studies were performed in hostels and with an Internet-based survey. Questionnaires on falls and sleep disturbances were undertaken with clinical measures of cognition, mobility, blood pressure, and vision in the participants in hostels. Results. There were 150 participants in hostels (mean age 81 +/- 8 years) and 150 respondents to the Internet survey (mean age 70 +/- 5 years). Sleep disturbances were reported by most participants in both the hostel and Internet studies. In hostel participants, falls were associated with poor sleep quality (odds ratio = 4.5, 95% confidence interval, 1.9-12.2; p =.002) and number of nocturnal awakenings (2.5 +/- 1.5 vs 2.0 +/- 1.4, p =.04). Other risk factors for falls in these persons included Geriatric Depression Scale score, pain, Timed Get Up and Go Test score, and the use of diuretics. In the Internet respondents, risk factors for falls included poor health rating and the use of spectacles, bifocals, and walking aids; fewer falls were reported by those participants without any sleep disturbances. Conclusions. Sleep disturbances are common in older people and are associated with their risk of falling. Internet-based surveys may be a useful adjunct method for research in older people. Language: en
131 citations
TL;DR: Higher fall rate, history of previous fracture, lower BUA, lower body weight, cognitive impairment and better balance as significant independent risk factors for fracture are revealed in the frail elderly.
Abstract: Introduction
When subjects are selected on the basis of fall risk alone, therapies for osteoporosis have not been effective In a prospective study of elderly subjects at high risk of falls, we investigated the influence of bone strength and fall risk on fracture
129 citations
TL;DR: Cataract predicted increased mortality in persons 49 years and older, and ARMD predicted mortality in people aged 49 to 74 years.
Abstract: Objective To assess the association of visual impairment, age-related macular degeneration (ARMD), and cataract with long-term mortality. Methods At baseline, 3654 persons 49 years and older were examined in the Blue Mountains Eye Study (1992-1994). Standardized photographic grading was used to assess ARMD and cataract. Mortality and causes of death occurring between baseline and December 31, 2003, were obtained via data linkage with the Australian National Death Index. Age-standardized mortality rates were calculated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were assessed using Cox models. Result Age-standardized mortality was higher in persons with vs without visual impairment (54.0% vs 34.0%), ARMD (45.8% vs 33.7%), and cataract (39.2% vs 29.5%). After adjusting for factors that predict mortality, neither visual impairment (HR, 1.3; 95% CI, 0.98-1.7) nor ARMD (HR, 1.0; 95% CI, 0.8-1.3) was significantly associated with all-cause mortality in all ages. Among persons younger than 75 years, however, ARMD predicted higher all-cause mortality (HR, 1.6; 95% CI, 1.0-2.4). Any cataract (HR, 1.3; 95% CI, 1.0-1.5) and cortical (HR, 1.2; 95% CI, 0.97-1.4), nuclear (HR, 1.2; 95% CI, 0.98-1.5), and posterior subcapsular (HR, 1.3; 95% CI, 1.0-1.7) cataract were also associated with higher all-cause mortality. Conclusion Cataract predicted increased mortality in persons 49 years and older, and ARMD predicted mortality in persons aged 49 to 74 years.
108 citations
TL;DR: Adjuvant radiotherapy to the primary site after surgical excision is recommended in early-stage Merkel cell carcinoma, and Involved regional lymph nodes should be treated with radiotherapy with or without lymphadenectomy.
Abstract: Background
Wide surgical excision, lymph node dissection, and radiotherapy have been used with varying efficacy in the management of early-stage Merkel cell carcinoma.
97 citations
TL;DR: It is found that subjects reporting pain with moderate to severe level of pain‐related interference with activities were more likely to report any falls or multiple falls in the past 12 months than subjects not reporting pain.
82 citations
TL;DR: To compare consequences for patients with proximal femoral fractures sustained in the hospital with patients who sustained PFFs in the community, a large number of them will be discharged to the community.
Abstract: OBJECTIVES: To compare consequences for patients with proximal femoral fractures (PFFs) sustained in the hospital with patients who sustained PFFs in the community.
DESIGN: Data were collected from inpatient notes and incident reports of patients admitted to hospitals over a 6-year period. All patients aged 75 and older sustaining a PFF in the hospital were identified and matched according to sex, age, and fracture date with patients who sustained a PFF in the community.
SETTING: Illawarra region hospitals, New South Wales, Australia.
PARTICIPANTS: Forty-three patients with a hospital-acquired PFF and 43 patients with a community-acquired PFF; mean age was 84.0 (range 75–92), and 67% were women.
MEASUREMENTS: Outcomes at hospital discharge and circumstances of hospital-acquired PFF.
RESULTS: Comparing outcomes of subjects with hospital versus community-acquired PFF revealed that 12 versus four died in the hospital (P=.03), 14 versus five were discharged to long-term nursing care facilities (P=.02), six versus 18 returned to preadmission ambulation (P=.004), and four versus 24 returned to preadmission activity of daily living status (P<.001). The median postfracture length of stay was 46 days for subjects with hospital-acquired PFF versus 32 days for those sustaining a PFF in the community (P<.01). Review of circumstances of the 43 hospital-acquired fractures revealed that 26 occurred in subacute wards, 25 occurred in bedrooms, 25 occurred at night, and 38 occurred while unsupervised.
CONCLUSION: Patients with hospital-acquired PFF have poor outcomes. Adequate supervision, provision of hip protectors in the hospital, and strategies that address fracture circumstances may hold the keys to prevention.
70 citations
TL;DR: Although the overall rate of retinal detachment was low, it was significantly higher in those with a delayed interval between cataract surgery and vitrectomy, and was significantly associated with a poorer visual outcome.
58 citations
TL;DR: These results should be interpreted cautiously because haloperidol and chlorpromazine are used in broader clinical contexts, but in the absence of data from randomized trials, the safety profile of haloperIDol should not be assumed to be benign.
Abstract: Objective To establish the instantaneous relative risk (RR) of death associated with individual antipsychotic drugs, carbamazepine and sodium valproate for those 65 years and older. Methods Subjects dispensed antipsychotic drugs, sodium valproate or carbamazepine in 2003 or 2004 were analyzed as incident (N = 16,634) or prevalent (N = 9,831) users. Survival curves, mortality rates, and Cox proportional hazards models over two time periods were used to explore risk of death. The models were adjusted for age, sex, residential status, and psychotropic and medical drug dispensing. Olanzapine subjects were the reference group in the Cox regression. Subanalyses were performed for incident subjects with more than 30 days of follow-up and those dispensed cholinesterase inhibitors. Results In the adjusted Cox proportional hazards models, haloperidol dispensing was consistently associated with an increased risk of death compared with olanzapine users (relative risk [RR] for incident users: 2.26, 95% confidence intervals (CI): 2.08–2.47; Wald statistic: 345.36, df=1, p ≤0.001). There was some evidence of decreased survival with dispensing of higher haloperidol doses, although confounding by medical comorbidity cannot be excluded. Chlorpromazine (RR: 1.39, 95% CI: 1.15–1.67; Wald statistic: 12.08, df=1, p Conclusion These results should be interpreted cautiously because haloperidol and chlorpromazine are used in broader clinical contexts. However, in the absence of data from randomized trials, the safety profile of haloperidol should not be assumed to be benign. Antipsychotic drugs should not be studied as an aggregated group because their associated risks are not uniform.
TL;DR: This study supports the findings from other data linkage studies that atypical antipsychotics medications are not associated with increased risk of death compared with conventional antipsychotic drugs.
Abstract: Objective: To establish the instantaneous relative risk (RR) associated with the dispensing of individual antipsychotic drugs, carbamazepine and valproate for those ≥65 years who resided in an aged...
TL;DR: The effectiveness of recruitment strategies used for a randomised trial of a fall prevention program are described to describe the effectiveness of these strategies in a drop prevention program.
Abstract: Objectives:To describe the effectiveness of recruitment strategies used for a randomised trial of a fall prevention program.
Methods:Community-residing persons (n = 310) aged 70 years or older and at risk of falling were recruited using promotional materials, health professional referrals, media, community presentations, mail outs, and friends/relatives. Mail and telephone recruitment strategies were able to be compared to actual recruitment yields, with costs reported for each.
Results:Mail outs by organisations had response rates between 3.1 and 7.7%, with recruitment yields between 1.8 and 4.4%. Local media editorials were low cost and useful. Gender and physical status of participants varied according to the recruitment method, with multisources producing a reasonably representative sample.
Conclusions:Databases and mail outs using personalised letters were the most effective recruitment strategies for a community-based preventive program. This study contributes to the expanding evidence of the kinds of recruitment that are more effective, considering the context of the study and the intervention.
TL;DR: The value of comparing data from multiple cohort studies using the example of self‐rated health (SRH) is demonstrated using the Example of SRH to demonstrate the value of comparisons.
Abstract: Objective: To demonstrate the value of comparing data from multiple cohort studies using the example of self-rated health (SRH).
Methods: Seven Australian cohort studies including comparable data on SRH were identified. Comparisons of the distributions of SRH were conducted, and logistic regression was used to evaluate age, sex and education effects within studies. A nationally representative survey was used as a statistical reference to determine how studies differed from the Australian population in frequencies of responses.
Results: Ratings of SRH declined with increasing age. Low education was associated with higher frequencies of fair/poor SRH even in young adulthood but there were no sex differences. Results for smaller studies did not necessarily differ from nationally representative studies.
Conclusion: Collaborative reanalysis of Australian cohort permits analysis of health outcomes from a large numbers of participants. Health outcomes and their sociodemographic determinants may be more comprehensively evaluated through such collaborative projects.
01 Jan 2007
TL;DR: In this paper, the authors found that any cataract (HR, 1.3; 95% CI, 0.98-1.7) was associated with higher all-cause mortality.
Abstract: After adjusting for factors that predict mortality, neither visualimpairment(HR,1.3;95%CI,0.98-1.7)norARMD (HR,1.0;95%CI,0.8-1.3)wassignificantlyassociatedwith all-causemortalityinallages.Amongpersonsyoungerthan 75years,however,ARMDpredictedhigherall-causemortality (HR, 1.6; 95% CI, 1.0-2.4). Any cataract (HR, 1.3; 95% CI, 1.0-1.5) and cortical (HR, 1.2; 95% CI, 0.971.4), nuclear (HR, 1.2; 95% CI, 0.98-1.5), and posterior subcapsular (HR, 1.3; 95% CI, 1.0-1.7) cataract were also associated with higher all-cause mortality. Conclusion: Cataract predicted increased mortality in persons 49 years and older, and ARMD predicted mortality in persons aged 49 to 74 years.