Ronald Shor

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Hypnosis as a retrieval cue in posthypnotic amnesia

Journal of Abnormal Psychology, 1985

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The Effect of Medication Use on Urinary Incontinence in Community-Dwelling Elderly Women

Journal of the American Geriatrics Society, 2010

Objectives-To evaluate whether use of certain medications with potential urologic effects is asso... more Objectives-To evaluate whether use of certain medications with potential urologic effects is associated with development of incident urinary incontinence in community-resident older women. Design-Longitudinal cohort study. Setting-Pittsburgh, PA and Memphis, TN. Participants-959 healthy black and white women (aged 65 and older) enrolled in the Health, Aging and Body Composition study without baseline (year 1) self-reported urinary incontinence. Measurements-Use of alpha blockers, anticholinergics, central nervous system medications (opioids, benzodiazepines, antidepressants and antipsychotics), diuretics (thiazide, loop, potassium sparing) and estrogen (all dosage forms) was determined during year 3 interviews. Self-reported

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Association between Opioid–Benzodiazepine Trajectories and Injurious Fall Risk among US Medicare Beneficiaries

Carolina Digital Repository (University of North Carolina at Chapel Hill), 2024

Background/Objectives: Concurrent opioid (OPI) and benzodiazepine (BZD) use may exacerbate injuri... more Background/Objectives: Concurrent opioid (OPI) and benzodiazepine (BZD) use may exacerbate injurious fall risk (e.g., falls and fractures) compared to no use or use alone. Yet, patients may need concurrent OPI-BZD use for co-occurring conditions (e.g., pain and anxiety). Therefore, we examined the association between longitudinal OPI-BZD dosing patterns and subsequent injurious fall risk. Methods: We conducted a retrospective cohort study including non-cancer feefor-service Medicare beneficiaries initiating OPI and/or BZD in 2016-2018. We identified OPI-BZD use patterns during the 3 months following OPI and/or BZD initiation (i.e., trajectory period) using group-based multi-trajectory models. We estimated the time to first injurious falls within the 3month post-trajectory period using inverse-probability-of-treatment-weighted Cox proportional hazards models. Results: Among 622,588 beneficiaries (age ≥ 65 = 84.6%, female = 58.1%, White = 82.7%; having injurious falls = 0.45%), we identified 13 distinct OPI-BZD trajectories: Group (A): Very-low OPI-only (early discontinuation) (44.9% of the cohort); (B): Low OPI-only (rapid decline) (15.1%); (C): Very-low OPI-only (late discontinuation) (7.7%); (D): Low OPI-only (gradual decline) (4.0%); (E): Moderate OPI-only (rapid decline) (2.3%); (F): Very-low BZD-only (late discontinuation) (11.5%); (G): Low BZD-only (rapid decline) (4.5%); (H): Low BZD-only (stable) (3.1%); (I): Moderate BZD-only (gradual decline) (2.1%); (J): Very-low OPI (rapid decline)/Very-low BZD (late discontinuation) (2.9%); (K): Very-low OPI (rapid decline)/Very-low BZD (increasing) (0.9%); (L):

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Preventing Falls in Hospitalized Patients

Clinics in Geriatric Medicine, 2019

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Consistent Differences in Medical Unit Fall Rates: Implications for Research and Practice

Journal of the American Geriatrics Society, 2015

Background and Objectives-There is large cross-sectional variation in fall rates among hospital u... more Background and Objectives-There is large cross-sectional variation in fall rates among hospital units with similar patient populations. It is not known whether the differences underlying this variability are consistent across time. The twofold purpose of this study was to determine the proportion of variation in long-term fall rates attributable to between-unit, rather than within-unit, variability; and to identify unit-and hospital-level characteristics associated with persistently lowand high-fall units. Design, Setting, and Participants-We extracted 24 consecutive months of data on inpatient falls and unit characteristics for non-subspecialty medical units (n=800) in U.S. general hospitals from the National Database of Nursing Quality Indicators®. We identified 80 low-fall and 74 high-fall units based on monthly rankings of fall rates and compared these 2 groups on unit-and hospital-level characteristics. Measurements-Monthly self-reported unit fall rates (falls per 1,000 patient days). Results-An estimated 87% of variation in 24-month fall rates was due to between-unit differences. With the exception of patient days, a proxy for unit bed size, low-and high-fall units did not differ on nurse staffing or any other unit or hospital characteristic variable. Conclusion-There are medical units with persistently low and persistently high fall rates. High-fall units had higher patient volume, suggesting patient turnover as a variable for further study. Understanding additional factors underlying variability in long-term fall rates could lead to sustainable interventions for reducing inpatient falls.

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Principles of drug therapy in older patients: rational drug prescribing

Clinics in Geriatric Medicine, 2002

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Panel I. Drug utilization review: Criteria*

Clinical Pharmacology and Therapeutics, 1991

The prescribing of medications is the most common medical intervention. Drug utilization review (... more The prescribing of medications is the most common medical intervention. Drug utilization review (DUR) is the process by which the quality of drug prescribing is measured against explicitly determined criteria or standards. Because no "gold standard" of prescribing appropriateness exists, we must attempt to designate criteria on the basis of existing information.

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Falls Among Adult Patients Hospitalized in the United States: Prevalence and Trends

Journal of patient safety, 2012

OBJECTIVES: The purpose of this study was to provide normative data on fall prevalence in U.S. ho... more OBJECTIVES: The purpose of this study was to provide normative data on fall prevalence in U.S. hospitals by unit type and to determine the 27-month secular trend in falls before the implementation of the Centers for Medicare and Medicaid Service (CMS) rule, which does not reimburse hospitals for care related to injury resulting from hospital falls. METHODS: We used data from the National Database of Nursing Quality Indicators (NDNQI) collected between July 1, 2006, and September 30, 2008, to estimate prevalence and secular trends of falls occurring in adult medical, medical-surgical, and surgical nursing units. More than 88 million patient days (pd) of observation were contributed from 6100 medical, surgical, and medical-surgical nursing units in 1263 hospitals across the United States. RESULTS: A total of 315,817 falls occurred (rate = 3.56 falls/1000 pd) during the study period, of which, 82,332 (26.1%) resulted in an injury (rate = 0.93/1000 pd). Both total fall and injurious fal...

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Effect of Central Nervous System Medication Use on Decline in Cognition in Community-Dwelling Older Adults: Findings from the Health, Aging and Body Composition Study

Journal of the American Geriatrics Society, 2009

Studenski serves as a consultant to Merck and Co, Eli Lilly, Glaxo Smith Kline, and Asubio. Hilme... more

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Improving the Capture of Fall Events in Hospitals: Combining a Service for Evaluating Inpatient Falls with an Incident Report System

Journal of the American Geriatrics Society, 2008

OBJECTIVES-To determine the utility of a fall evaluation service to improve the ascertainment of ... more OBJECTIVES-To determine the utility of a fall evaluation service to improve the ascertainment of falls in acute care. SETTING-Sixteen adult nursing units (349 beds) in an urban, academically affiliated, community hospital. PARTICIPANTS-Patients admitted to the study units during the study period. INTERVENTION-Nursing staff identifying falls were instructed to notify, using a pager, a trained nurse ''fall evaluator.'' Fall evaluators provided 24-hour-per-day 7-day-per-week coverage throughout the study. Data on patient falls gathered by fall evaluators were compared with falls data obtained through the hospital's incident reporting system. RESULTS-During 51,180 patient-days of observation, 191 falls were identified according to incident reports (3.73 falls/1,000 patient-days), whereas the evaluation service identified 228 falls (4.45 falls/1,000 patient-days). Combining falls reported from both data sources yielded 266 falls (5.20 falls/1,000 patient-days), a 39% relative rate increase compared with incident reports alone (P<.001). For falls with injury, combining data from both sources yielded 79 falls (1.54 injurious falls/1,000 patient-days), compared with 57 falls (1.11 injurious falls/1,000 patient-days) filed in incident reports-a 28% increase (P = .06). In the 16 nursing units, the relative percentage increase of captured fall events using the combined data sources versus the incident reporting system alone ranged from 13% to 125%.

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Antihypertensive Drug Class Use and Differential Risk of Urinary Incontinence in Community-Dwelling Older Women

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2012

Background. Medication use is a potentially reversible cause of urinary incontinence (UI). The ob... more Background. Medication use is a potentially reversible cause of urinary incontinence (UI). The objective of this longitudinal cohort study was to evaluate whether self-reported UI in community-dwelling older women is associated with the use of different classes of antihypertensive agents. Methods. The sample consisted of 959 black and white women aged 72-81 years without baseline (Year 1) UI from the Health, Aging, and Body Composition Study. Use of any antihypertensive from 10 drug classes (ie, alpha blockers [central], alpha blockers [peripheral], angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, beta blockers, calcium channel blockers, diuretics [loop], diuretics [potassium-sparing], diuretics [thiazide], and vasodilators) was determined during Year 3 in-person interviews. The number of unique antihypertensive agents used and the standardized daily dosage were also examined. Self-reported UI, operationally defined as leaking urine at least weekly during the previous 12 months, was assessed at Year 4 visits. Results. A total of 197 women (20.5%) reported UI at Year 4. Although any antihypertensive use, number of agents used, and standardized daily dosage at Year 3 were not associated with UI at Year 4, use of one particular drug class-peripheral alpha blockers (ie, doxazosin, prazosin, and terazosin)-was associated with fourfold greater odds of UI (adjusted odds ratio = 4.47; 95% confidence interval = 1.79-11.21; p = .0014). Further, in post hoc analyses, these odds nearly doubled in those also taking loop diuretics (adjusted odds ratio = 8.81; 95% confidence interval = 1.78-43.53; p = .0076). Conclusion. In community-dwelling older women, peripheral alpha blocker use was associated with UI, and the odds nearly doubled when used with loop diuretics.

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Gait speed predicts decline in attention and psychomotor speed in older adults: the health aging and body composition study

Neuroepidemiology, 2007

Gait speed is cross-sectionally associated with attention and psychomotor speed in older communit... more

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Racial Differences in Glycemic Control in a Well-Functioning Older Diabetic Population: Findings from the Health, Aging and Body Composition study

Diabetes Care, 2003

OBJECTIVE—To evaluate racial differences and factors associated with worse glycemic control in we... more OBJECTIVE—To evaluate racial differences and factors associated with worse glycemic control in well-functioning older individuals with type 2 diabetes. Our hypothesis was that glycemic control would be worse among black than white diabetic individuals but that this association would be explained by differences in severity of diabetes, health status, health care indicators, and social, psychological, or behavorial factors. We further hypothesized that the association of race with poorer glycemic control would be limited to those with lower education or lower income. RESEARCH DESIGN AND METHODS—Cross-sectional analysis of 468 diabetic participants among a cohort of 3,075 nondisabled blacks and whites aged 70–79 years living in the community enrolled in the Health, Aging and Body Composition Study. Glycemic control was measured by the level of HbA1c. RESULTS—A total of 58.5% of the diabetic individuals were black. Although control was poor in all diabetic participants (HbA1c ≥7% in 73....

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Self-reported responsiveness to direct-to-consumer drug advertising and medication use: results of a national survey

BMC Health Services Research, 2011

Background Direct-to-consumer (DTC) marketing of pharmaceuticals is controversial, yet effective.... more Background Direct-to-consumer (DTC) marketing of pharmaceuticals is controversial, yet effective. Little is known relating patterns of medication use to patient responsiveness to DTC. Methods We conducted a secondary analysis of data collected in national telephone survey on knowledge of and attitudes toward DTC advertisements. The survey of 1081 U.S. adults (response rate = 65%) was conducted by the Food and Drug Administration (FDA). Responsiveness to DTC was defined as an affirmative response to the item: "Has an advertisement for a prescription drug ever caused you to ask a doctor about a medical condition or illness of your own that you had not talked to a doctor about before?" Patients reported number of prescription and over-the-counter (OTC) medicines taken as well as demographic and personal health information. Results Of 771 respondents who met study criteria, 195 (25%) were responsive to DTC. Only 7% respondents taking no prescription were responsive, whereas 45...

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Physical function and self-rated health status as predictors of mortality: results from longitudinal analysis in the ilSIRENTE study

BMC Geriatrics, 2008

Background: Physical function measures have been shown to predict negative health-related events ... more Background: Physical function measures have been shown to predict negative health-related events in older persons, including mortality. These markers of functioning may interact with the self-rated health (SRH) in the prediction of events. Aim of the present study is to compare the predictive value for mortality of measures of physical function and SRH status, and test their possible interactions. Methods: Data are from 335 older persons aged ≥ 80 years (mean age 85.6 years) enrolled in the "Invecchiamento e Longevità nel Sirente" (ilSIRENTE) study. The predictive values for mortality of 4-meter walk test, Short Physical Performance Battery (SPPB), hand grip strength, Activities of Daily Living (ADL) scale, Instrumental ADL (IADL) scale, and a SRH scale were compared using proportional hazard models. Kaplan-Meier survival curves for mortality and Receiver Operating Characteristic (ROC) curve analyses were also computed to estimate the predictive value of the independent variables of interest for mortality (alone and in combination). Results: During the 24-month follow-up (mean 1.8 years), 71 (21.2%) events occurred in the study sample. All the tested variables were able to significantly predict mortality. No significant interaction was reported between physical function measures and SRH. The SPPB score was the strongest predictor of overall mortality after adjustment for potential confounders (per SD increase; HR 0.64; 95%CI 0.48-0.86). A similar predictive value was showed by the SRH (per SD increase; HR 0.76; 95%CI 0.59-0.97). The chair stand test was the SPPB subtask showing the highest prognostic value. Conclusion: All the tested measures are able to predict mortality with different extents, but strongest results were obtained from the SPPB and the SRH. The chair stand test may be as useful as the complete SPPB in estimating the mortality risk.

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Drug Burden Index Score and Functional Decline in Older People

The American Journal of Medicine, 2009

Background-The Drug Burden Index (DBI), a measure of exposure to anticholinergic and sedative med... more Background-The Drug Burden Index (DBI), a measure of exposure to anticholinergic and sedative medications, has been independently associated with physical and cognitive function in a cross-sectional analysis of community dwelling older persons participating in the Health, Aging and Body Composition (Health ABC) study. Here we evaluate the association between DBI and functional outcomes in Health ABC participants over five years. Methods-DBI was calculated at years 1 (baseline), 3 and 5 and a measure of the area under the curve for DBI (AUCDB) over the whole study period was devised and calculated. Physical performance was measured using the short physical performance battery (SPPB), usual gait speed, and grip strength. The association of DBI at each time point and AUCDB with year 6 function was analyzed in data from participants with longitudinal functional measures, controlling for sociodemographics, co-morbidities and baseline function. Results-Higher DBI at years 1, 3 and 5 was consistently associated with poorer function at year 6. On multivariate analysis, a one unit increase in AUCDB predicted decreases in SPPB score of 0.08 (p = 0.01), gait speed of 0.01 m/s (p=0.004), and grip strength of 0.27 kg (p=0.004) at year 6. Conclusion-Increasing exposure to medication with anticholinergic and sedative effects, measured with DBI, is associated with lower objective physical function over five years in community dwelling older people.

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Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients

Annals of Internal Medicine, 2012

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Impact of the Hospital-Acquired Conditions Initiative on Falls and Physical Restraints: A Longitudinal Study

Journal of Hospital Medicine

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Surf's up! A geriatrician's introduction to the Internet

Journal of the American Geriatrics Society, 1995

1. J Am Geriatr Soc. 1995 Nov;43(11):1298-302. Surf's up! A geriatrician's introduction... more

A drug burden index to define the functional burden of medications in older people

Archives of internal …, 2007

Background: Older people carry a high burden of illness for which medications are indicated, alon... more Background: Older people carry a high burden of illness for which medications are indicated, along with increased risk of adverse drug reactions. We developed an index to determine drug burden based on pharmacologic principles. We evaluated the relationship of this index to physical and cognitive performance apart from disease indication. Methods: Data from the Health, Aging, and Body Composition Study on 3075 well-functioning communitydwelling persons aged 70 to 79 years were analyzed by multiple linear regression to assess the cross-sectional association of drug burden index with a validated composite continuous measure for physical function, and with the Digit Symbol Substitution Test for cognitive performance. Results: Use of anticholinergic and sedative medications was associated with poorer physical performance score (anticholinergic exposure, 2.08 vs 2.21, PϽ.001; sedative exposure, 2.09 vs 2.19, PϽ.

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