Evelyne A Gahbauer

Yale-New Haven Hospital, New Haven, Connecticut, United States

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Publications (29)247.23 Total impact

  • Thomas M Gill, Heather G Allore, Evelyne A Gahbauer, Ling Han
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    ABSTRACT: Increasing evidence suggests that illnesses and injuries leading to restricted activity have adverse functional consequences, but whether the two components of restricted activity have comparable effects is unknown. We evaluated whether an illness/injury leading to bed rest represents a more potent exposure than one leading to cutting down on one's usual activities without bed rest.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 11/2014; · 4.31 Impact Factor
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    ABSTRACT: The objective of this study was to describe the rates of residential relocations over the course of 10.5 years and evaluate differences in these relocation rates according to gender and decedent status. Prospective, longitudinal study with monthly telephone follow-up for up to 126 months. Greater New Haven, CT. There were 754 participants, aged 70 years or older, who were initially community-living and nondisabled in their basic activities of daily living. Residential location was assessed during monthly interviews and included community, assisted living facility, and nursing home. A residential relocation was defined as a change of residential location for at least 1 week and included relocations within (eg, community-community) or between (community- assisted living) locations. We calculated the rates of relocations per 1000 patient-months and evaluated differences by gender and decedent status. Sixty-six percent of participants had at least one residential relocation (range 0-12). Women had lower rates of relocations from nursing home to community (rate ratio [RR] 0.59, P = .02); otherwise, there were no gender differences. Decedents had higher rates of relocation from community to assisted living (RR 1.71, P = .002), from community to nursing home (RR 3.64, P < .001), between assisted living facilities (RR 3.65, P < .001), and from assisted living to nursing home (RR 2.5, P < .001). In decedents, relocations from community to nursing home (RR 3.58, P < .001) and from assisted living to nursing home (RR 3.3, P < .001) were most often observed in the last year of life. Most older people relocated at least once during 10.5 years of follow-up. Women had lower rates of relocation from nursing home to community. Decedents were more likely to relocate to a residential location providing a higher level of assistance, compared with nondecedents. Residential relocations were most common in the last year of life.
    Journal of the American Medical Directors Association 04/2014; · 5.30 Impact Factor
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    ABSTRACT: The frailty index (FI) is used to measure the health status of ageing individuals. An FI is constructed as the proportion of deficits present in an individual out of the total number of age-related health variables considered. The purpose of this study was to systematically assess whether dichotomizing deficits included in an FI affects the information value of the whole index. Secondary analysis of three population-based longitudinal studies of community dwelling individuals: Nova Scotia Health Survey (NSHS, n = 3227 aged 18+), Survey of Health, Ageing and Retirement in Europe (SHARE, n = 37546 aged 50+), and Yale Precipitating Events Project (Yale-PEP, n = 754 aged 70+). For each dataset, we constructed two FIs from baseline data using the deficit accumulation approach. In each dataset, both FIs included the same variables (23 in NSHS, 70 in SHARE, 33 in Yale-PEP). One FI was constructed with only dichotomous values (marking presence or absence of a deficit); in the other FI, as many variables as possible were coded as ordinal (graded severity of a deficit). Participants in each study were followed for different durations (NSHS: 10 years, SHARE: 5 years, Yale PEP: 12 years). Within each dataset, the difference in mean scores between the ordinal and dichotomous-only FIs ranged from 0 to 1.5 deficits. Their ability to predict mortality was identical; their absolute difference in area under the ROC curve ranged from 0.00 to 0.02, and their absolute difference between Cox Hazard Ratios ranged from 0.001 to 0.009. Analyses from three diverse datasets suggest that variables included in an FI can be coded either as dichotomous or ordinal, with negligible impact on the performance of the index in predicting mortality.
    BMC Geriatrics 02/2014; 14(1):25. · 2.34 Impact Factor
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    ABSTRACT: IMPORTANCE Although a serious fall injury is often a devastating event, little is known about the course of disability (ie, functional trajectories) before a serious fall injury or the relationship between these trajectories and those that follow the fall. OBJECTIVES To identify distinct sets of functional trajectories in the year immediately before and after a serious fall injury, to evaluate the relationship between the prefall and postfall trajectories, and to determine whether these results differed based on the type of injury. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study conducted in greater New Haven, Connecticut, from March 16, 1998, to June 30, 2012, in 754 community-living persons aged 70 years or older who were initially nondisabled in their basic activities of daily living. Of the 130 participants who subsequently sustained a serious fall injury, 62 had a hip fracture and 68 had another fall-related injury leading to hospitalization. MAIN OUTCOMES AND MEASURES Functional trajectories, based on 13 basic, instrumental, and mobility activities assessed during monthly interviews, were identified in the year before and the year after the serious fall injury. RESULTS Before the fall, 5 distinct trajectories were identified: no disability in 16 participants (12.3%), mild disability in 34 (26.2%), moderate disability in 34 (26.2%), progressive disability in 23 (17.7%), and severe disability in 23 (17.7%). After the fall, 4 distinct trajectories were identified: rapid recovery in 12 participants (9.2%), gradual recovery in 35 (26.9%), little recovery in 26 (20.0%), and no recovery in 57 (43.8%). For both hip fractures and other serious fall injuries, the probabilities of the postfall trajectories were greatly influenced by the prefall trajectories, such that rapid recovery was observed only among persons who had no disability or mild disability, and a substantive recovery, defined as rapid or gradual, was highly unlikely among those who had progressive or severe disability. The postfall trajectories were consistently worse for hip fractures than for the other serious injuries. CONCLUSIONS AND RELEVANCE The functional trajectories before and after a serious fall injury are quite varied but highly interconnected, suggesting that the likelihood of recovery is greatly constrained by the prefall trajectory.
    JAMA Internal Medicine 08/2013; · 13.25 Impact Factor
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    ABSTRACT: IMPORTANCE Freedom from symptoms is an important determinant of a good death, but little is known about symptom occurrence during the last year of life. OBJECTIVE To evaluate the monthly occurrence of physical and psychological symptoms leading to restrictions in daily activities (ie, restricting symptoms) among older persons during the last year of life and to determine the associations of demographic and clinical factors with symptom occurrence. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study. Comprehensive assessments were completed every 18 months, and monthly interviews were conducted to assess the presence of restricting symptoms. Of 1002 nondisabled community-dwelling individuals 70 years or older in greater New Haven, Connecticut, eligible to participate, 754 agreed and were enrolled between 1998 and 1999. MAIN OUTCOMES AND MEASURES The primary outcome was the monthly occurrence of restricting symptoms as a dichotomous outcome. The monthly mean count of restricting symptoms was a secondary outcome. RESULTS Among the 491 participants who died after their first interview and before June 30, 2011, mean age at death was 85.8 years, 61.9% were women, and 9.0% were nonwhite. The mean number of comorbid conditions was 2.4, and 73.1% had multimorbidity. The monthly occurrence of restricting symptoms was fairly constant from 12 months before death (20.4%) until 5 months before death (27.4%), when it began to increase rapidly, reaching 57.2% in the month before death. In multivariable analysis, age younger than 85 years (odds ratio [OR], 1.30 [95% CI, 1.07-1.57]), multimorbidity (OR, 1.38 [95% CI, 1.09-1.75]), and proximity to time of death (OR, 1.14 per month [95% CI, 1.11-1.16]) were significantly associated with the monthly occurrence of restricting symptoms. Participants who died of cancer had higher monthly symptom occurrence (OR, 1.80 [95% CI, 1.03-3.14]) than participants who died of sudden death, although this difference was only marginally significant (P = .04). Symptom burden did not otherwise differ substantially according to condition leading to death. CONCLUSIONS AND RELEVANCE Restricting symptoms are common during the last year of life, increasing substantially approximately 5 months before death. Our results highlight the importance of assessing and managing symptoms in older patients, particularly those with multimorbidity.
    JAMA Internal Medicine 07/2013; · 13.25 Impact Factor
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    ABSTRACT: Little is known about the deleterious effects of injurious falls relative to those of other disabling conditions or whether these effects are driven largely by hip fractures. From a cohort of 754 community-living elders of New Haven, Connecticut, we matched 122 hospitalizations for an injurious fall (59 hip-fracture and 63 other fall-related injuries) to 241 non-fall-related hospitalizations. Participants (mean age: 85.7 years) were evaluated monthly for disability in 13 activities and admission to a nursing home from 1998 to 2010. For both hip-fracture and other fall-related injuries, the disability scores were significantly greater during each of the first 6 months after hospitalization than for the non-fall-related admissions, with adjusted risk ratios at 6 months of 1.5 (95% confidence interval (CI): 1.3, 1.7) for hip fracture and 1.4 (95% CI: 1.2, 1.6) for other fall-related injuries. The likelihood of having a long-term nursing home admission was considerably greater after hospitalization for a hip fracture and other fall-related injury than for a non-fall-related reason, with adjusted odds ratios of 3.3 (95% CI: 1.3, 8.3) and 3.2 (95% CI: 1.3, 7.8), respectively. Relative to other conditions leading to hospitalization, hip-fracture and other fall-related injuries are associated with worse disability outcomes and a higher likelihood of long-term nursing home admissions.
    American journal of epidemiology 04/2013; · 5.59 Impact Factor
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    ABSTRACT: OBJECTIVES: Across the life span, women live longer than men but experience higher rates of disability. To more completely evaluate these gender differences, the current study set out to compare the trajectories and burden of disability over an extended period between older men and women. DESIGN: Prospective, longitudinal study with 13.5 years of follow-up. SETTING: Greater New Haven, Connecticut. PARTICIPANTS: Participants were 754 persons, aged 70 years or older, who were initially community-living and nondisabled in their basic activities of daily living. MEASUREMENTS: Disability in 13 basic, instrumental, and mobility activities was assessed during monthly interviews, whereas demographic and clinical covariates were measured during comprehensive assessments every 18 months. RESULTS: Five distinct trajectories were identified over successive 18-month intervals: independent, mild disability, mild to moderate disability, moderate disability, and severe disability. Women were more likely than men to experience the moderate and severe disability trajectories, but were less likely to transition from the independent trajectory to a worse disability trajectory during the subsequent 18-month interval. Women were also less likely to die after each of the five trajectories, and these differences were at least marginally significant for all but the independent trajectory. Over the entire duration of follow-up, women suffered from a greater burden of disability than men, but these differences were greatly attenuated after adjustment for the baseline levels of disability. CONCLUSIONS: Gender differences in disability over an extended period can be explained, at least in part, by the higher mortality experienced by older men and the higher initial levels of disability among older women. These results suggest the need to take a life-course approach to better understand gender differences in disability.
    Journal of the American Medical Directors Association 01/2013; · 5.30 Impact Factor
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    ABSTRACT: BACKGROUND: Gender-specific trajectories of lower extremity function (LEF) and the potential for bias in LEF estimation due to differences in survival have been understudied. METHODS: We evaluated longitudinal data from 690 initially nondisabled adults age 70 or older from the Precipitating Events Project. LEF was assessed every 18 months for 12 years using a modified Short Physical Performance Battery (mSPPB). Hierarchical linear models with adjustments for length-of-survival estimated the intraindividual trajectory of LEF and differences in trajectory intercept and slope between men and women. RESULTS: LEF declined following a nonlinear trajectory. In the full sample, and among participants with high (mSPPB 10-12) and intermediate (mSPPB 7-9) baseline LEF, the rate-of-decline in mSPPB was slower in women than in men, with no gender differences in baseline mSPPB scores. Among participants with low baseline LEF (mSPPB ≤6), men had a higher starting mSPPB score, whereas women experienced a deceleration in the rate-of-decline over time. In all groups, participants who survived longer had higher starting mSPPB scores and slower rates-of-decline compared with those who died sooner. CONCLUSIONS: Over the course of 12 years, older women preserve LEF better than men. Nonadjustment for differences in survival results in overestimating the level and underestimating the rate-of-decline in LEF over time.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 11/2012; · 4.31 Impact Factor
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    ABSTRACT: Relatively little is known about why older persons develop long-term disability in community mobility. To identify the risk factors and precipitants for long-term disability in walking a quarter mile and driving a car. Prospective cohort study from March 1998 to December 2009. Greater New Haven, Connecticut. 641 persons, aged 70 years or older, who were active drivers or nondisabled in walking a quarter mile. Persons who were physically frail were oversampled. Candidate risk factors were assessed every 18 months. Disability in community mobility and exposure to potential precipitants, including illnesses or injuries leading to hospitalization or restricted activity, were assessed every month. Disability that lasted 6 or more consecutive months was considered long-term. 318 (56.0%) and 269 (53.1%) participants developed long-term disability in walking and driving, respectively. Seven risk factors were independently associated with walking disability and 8 were associated with driving disability; the strongest associations for each outcome were found for older age and lower score on the Short Physical Performance Battery. The precipitants had a large effect on long-term disability, with multivariate hazard ratios for each outcome greater than 6.2 for hospitalization and greater than 2.4 for restricted activity. The largest differences in absolute risk were generally observed in participants with a specific risk factor who were subsequently hospitalized. The observed associations may not be causal. The severity of precipitants was not assessed. The effect of the precipitants may have been underestimated because their exposure after the initial onset of disability was not evaluated. Long-term disability in community mobility is common among older persons. Multiple risk factors, together with subsequent precipitants, greatly increase the likelihood of long-term mobility disability. National Institute on Aging, National Institutes of Health.
    Annals of internal medicine 01/2012; 156(2):131-40. · 13.98 Impact Factor
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    Thomas M Gill, Evelyne A Gahbauer, Ling Han, Heather G Allore
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    ABSTRACT: Frailty among older persons is a dynamic process, characterized by frequent transitions between frailty states over time. We performed a prospective longitudinal study to evaluate the relationship between intervening hospitalizations and these transitions. We studied 754 nondisabled community-living persons, aged 70 years or older. Frailty, assessed every 18 months for 108 months, was defined on the basis of muscle weakness, exhaustion, low physical activity, shrinking, and slow walking speed. Participants were classified as frail if they met three or more of these criteria, prefrail if they met one or two of the criteria, or nonfrail if they met none of the criteria. Hospitalizations were ascertained every month for a median of 108 months. The exposure rates (95% confidence interval) of hospitalization per 1,000 months, based on frailty status at the start of each 18-month interval, were 19.7 (16.2-24.0) nonfrail, 32.9 (29.8-36.2) prefrail, and 57.2 (52.9-63.1) frail. The likelihood of transitioning from states of greater frailty to lesser frailty (ie, recovering) was consistently lower based on exposure to intervening hospitalizations, with adjusted hazard ratios per each hospitalization ranging from 0.46 (95% confidence interval: 0.21-1.03) for the transition from frail to nonfrail states to 0.52 (95% confidence interval: 0.42-0.65) for the transition from prefrail to nonfrail states. Hospitalization had more modest and less consistent effects on transitions from states of lesser frailty to greater frailty. Nonetheless, transitions from nonfrail to frail states were uncommon in the absence of a hospitalization. Recovery from prefrail and frail states is substantially diminished by intervening hospitalizations. These results provide additional evidence highlighting the adverse consequences of hospitalization in older persons.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 08/2011; 66(11):1238-43. · 4.31 Impact Factor
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    ABSTRACT: OBJECTIVES: To investigate how changes in frailty status and mortality risk relate to baseline frailty state, mobility performance, age, and sex.DESIGN: Cohort study.SETTING: The Yale Precipitating Events Project, New Haven, Connecticut.PARTICIPANTS: Seven hundred fifty-four community-dwelling people aged 70 and older at baseline followed up at 18, 36, and 54 months.MEASUREMENTS: Frailty status, assessed at 18-month intervals, was defined using a frailty index (FI) as the number of deficits in 36 health variables. Mobility was defined as time in seconds on the rapid gait test, in which participants walked back and forth over a 20-foot course as quickly as possible. Multistate transition probabilities were calculated with baseline frailty, mobility, age, and sex estimated using Poisson and logistic regressions in survivors and those who died, respectively.RESULTS: In multivariable analyses, baseline frailty status and age were significantly associated with changes in frailty status and risk of death, whereas mobility was significantly associated with the frailty but not with mortality. At all values of the FI, participants with better mobility were more likely than those with poor mobility to remain stable or to improve. For example, at 54 months, 20.6% (95% confidence interval (CI)=16–25.2) of participants with poor mobility had the same or fewer deficits, compared with 32.4% (95% CI=27.9–36.9) of those with better mobility.CONCLUSION: A multistate transition model effectively measured the probability of change in frailty status and risk of death. Mobility, age, and baseline frailty were significant factors in frailty state transitions.
    Journal of the American Geriatrics Society 02/2011; 59(3):524 - 529. · 4.22 Impact Factor
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    ABSTRACT: Disability among older persons is a complex and highly dynamic process, with high rates of recovery and frequent transitions between states of disability. The role of intervening illnesses and injuries (ie, events) on these transitions is uncertain. To evaluate the relationship between intervening events and transitions among states of no disability, mild disability, severe disability, and death and to determine the association of physical frailty with these transitions. Prospective cohort study conducted in greater New Haven, Connecticut, from March 1998 to December 2008 of 754 community-living persons aged 70 years or older who were nondisabled at baseline in 4 essential activities of daily living: bathing, dressing, walking, and transferring. Telephone interviews were completed monthly for more than 10 years to assess disability and ascertain exposure to intervening events, which included illnesses and injuries leading to either hospitalization or restricted activity. Physical frailty (defined as gait speed >10 seconds on the rapid gait test) was assessed every 18 months through 108 months. Transitions between no disability, mild disability, and severe disability and 3 transitions from each of these states to death, evaluated each month. Hospitalization was strongly associated with 8 of the 9 possible transitions, with increased multivariable hazard ratios (HRs) as high as 168 (95% confidence interval [CI], 118-239) for the transition from no disability to severe disability and decreased HRs as low as 0.41 (95% CI, 0.30-0.54) for the transition from mild disability to no disability. Restricted activity also increased the likelihood of transitioning from no disability to both mild and severe disability (HR, 2.59; 95% CI, 2.23-3.02; and HR, 8.03; 95% CI, 5.28-12.21), respectively, and from mild disability to severe disability (HR, 1.45; 95% CI, 1.14-1.84), but was not associated with recovery from mild or severe disability. For all 9 transitions, the presence of physical frailty accentuated the associations of the intervening events. For example, the absolute risk of transitioning from no disability to mild disability within 1 month after hospitalization for frail individuals was 34.9% (95% CI, 34.5%-35.3%) vs 4.9% (95% CI, 4.7%-5.1%) for nonfrail individuals. Among the possible reasons for hospitalization, fall-related injury conferred the highest likelihood of developing new or worsening disability. Among older persons, particularly those who were physically frail, intervening illnesses and injuries greatly increased the likelihood of developing new or worsening disability. Only the most potent events, ie, those leading to hospitalization, reduced the likelihood of recovery from disability.
    JAMA The Journal of the American Medical Association 11/2010; 304(17):1919-28. · 29.98 Impact Factor
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    Thomas M Gill, Evelyne A Gahbauer, Ling Han, Heather G Allore
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    ABSTRACT: Despite the importance of functional status to older persons and their families, little is known about the course of disability at the end of life. We evaluated data on 383 decedents from a longitudinal study involving 754 community-dwelling older persons. None of the subjects had disability in essential activities of daily living at the beginning of the study, and the level of disability was ascertained during monthly interviews for more than 10 years. Information on the conditions leading to death was obtained from death certificates and comprehensive assessments that were completed at 18-month intervals after the baseline assessment. In the last year of life, five distinct trajectories were identified, from no disability to the most severe disability: 65 subjects had no disability (17.0%), 76 had catastrophic disability (19.8%), 67 had accelerated disability (17.5%), 91 had progressive disability (23.8%), and 84 had persistently severe disability (21.9%). The most common condition leading to death was frailty (in 107 subjects [27.9%]), followed by organ failure (in 82 subjects [21.4%]), cancer (in 74 subjects [19.3%]), other causes (in 57 subjects [14.9%]), advanced dementia (in 53 subjects [13.8%]), and sudden death (in 10 subjects [2.6%]). When the distribution of the disability trajectories was evaluated according to the conditions leading to death, a predominant trajectory was observed only for subjects who died from advanced dementia (67.9% of these subjects had a trajectory of persistently severe disability) and sudden death (50.0% of these subjects had no disability). For the four other conditions leading to death, no more than 34% of the subjects had any of the disability trajectories. The distribution of disability trajectories was particularly heterogeneous among the subjects with organ failure (from 12.2 to 32.9% of the subjects followed a specific trajectory) and frailty (from 14.0 to 27.1% of the subjects followed a specific trajectory). In most of the decedents, the course of disability in the last year of life did not follow a predictable pattern based on the condition leading to death.
    New England Journal of Medicine 04/2010; 362(13):1173-80. · 54.42 Impact Factor
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    Thomas M Gill, Peter H Van Ness, Evelyne A Gahbauer
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    ABSTRACT: To identify the factors associated with accurate recall of prior disability. Cohort study. Greater New Haven, Connecticut. Ninety-two participants, included in each of two analytical samples, who were nondisabled at the present time in four essential activities of daily living (ADLs; bathing, dressing, transferring, and walking) but who had had at least 1 month of disability during the prior year as determined from monthly telephone interviews. Participants who did not need help from another person at the present time were asked to recall whether they had needed help from another person to complete the relevant ADL at any time during the previous 12 months. Forty-five (48.9%) and 46 (50.0%) of the 92 participants accurately recalled having had disability in the prior year in the first and second analytical samples, respectively. Having at least a high school education was the only factor independently associated with accurate recall in the first analytical sample, with an adjusted odds ratio (AOR) of 3.03 (95% confidence interval (CI)=1.11-8.31), whereas a composite disability scale that considered the timing and severity of prior disability was the only factor independently associated with accurate recall in the second analytic sample (AOR=5.38, 95% CI=1.81-16.1). The results of the current study, coupled with those of previous studies, suggest potential strategies that could be used to more completely and accurately ascertain the occurrence of disability in older persons.
    Journal of the American Geriatrics Society 10/2009; 57(10):1897-901. · 4.22 Impact Factor
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    ABSTRACT: To evaluate the association between sleep-wake disturbances and frailty. Cross-sectional. New Haven, Connecticut. Three hundred seventy-four community-living persons aged 78 and older. Frailty was based on the Fried phenotype, and sleep-wake disturbances were defined as daytime drowsiness, based on an Epworth Sleepiness Scale (ESS) score of 10 or greater, and as subthreshold and clinical insomnia, based on Insomnia Severity Index (ISI) scores of 8 to 14 and greater than 14, respectively. Mean age was 84.3; 87 (23.8%) participants were drowsy, 122 (32.8%) had subthreshold insomnia, 38 (10.2%) had clinical insomnia, and 154 (41.2%) were frail. There was a significant association between drowsiness and frailty, with unadjusted and adjusted odds ratios (ORs) of 3.79 (95% confidence interval (CI)=2.29-6.29) and 3.67 (95% CI=2.03-6.61), respectively. In contrast, clinical insomnia was significantly associated with frailty in the unadjusted analysis (OR=2.77, 95% CI=1.36-5.67) but not the adjusted analysis (OR=1.93, 95% CI=0.81-4.61)), and subthreshold insomnia was not associated with frailty in the unadjusted or adjusted analysis. In older persons, sleep-wake disturbances that present with daytime drowsiness, but not insomnia, are independently associated with frailty. Because drowsiness is potentially remediable, future studies should determine whether there is a temporal relationship between drowsiness and frailty, with the ultimate goal of informing interventions to reverse or prevent the progression of frailty.
    Journal of the American Geriatrics Society 09/2009; 57(11):2094-100. · 4.22 Impact Factor
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    Thomas M Gill, Evelyne A Gahbauer, Ling Han, Heather G Allore
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    ABSTRACT: The objective of this study was to identify the factors associated with recovery of prehospital function among older persons admitted to a nursing home with disability after an acute hospitalization. The analytic sample included 292 participants of an ongoing cohort study who had one or more admissions to a nursing home with disability after an acute hospitalization during nearly 10 years of follow-up, yielding a total of 364 "index" nursing home admissions. Information on nursing home admissions, hospitalizations, and disability in essential activities of daily living was ascertained during monthly telephone interviews. Data on potential predictors of functional recovery were collected during comprehensive assessments, which were completed every 18 months for 90 months. Participants were considered to have recovered if they were discharged home within 6 months of their nursing home admission at (or above) their prehospital level of function. Recovery of prehospital function was observed for 115 (31.6%) of the 364 index nursing home admissions. In the multivariate analysis, the strongest associations were observed for the best category of performance, relative to the poorest category, for gross motor coordination (hazard ratio [HR] 13.5, 95% confidence interval [CI] 4.02-45.0) and manual dexterity (HR 10.0, 95% CI 2.94-34.3). Only two other factors were independently associated with recovery of prehospital function: not cognitively impaired (HR 3.0, 95% CI 1.46-6.14) and no significant weight loss (HR 1.96, 95% CI 1.06-3.63). In the setting of an acute hospitalization leading to a nursing home admission with disability, the likelihood of recovering prehospital function is low. The factors associated with recovery include faster performance on tests of gross motor coordination and manual dexterity and the absence of cognitive impairment and significant weight loss.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 09/2009; 64(12):1296-303. · 4.31 Impact Factor
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    Thomas M Gill, Evelyne A Gahbauer, Peter H Van Ness
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    ABSTRACT: To develop and evaluate the psychometric properties of a new bathing disability scale. Reliability and validity study. General community. Two subsets of community-living older persons, selected from an ongoing longitudinal study, who had some degree of bathing disability or were at increased risk for bathing disability, as determined during a comprehensive assessment at 36 (N=199) and 54 (N=213) months, respectively. Not applicable. The bathing disability scale was administered at 36, 54, and 72 months, and changes in scores were assessed between 36 and 54 months and 54 and 72 months, respectively, for the 2 subsets of participants. Convergent construct validity was evaluated by comparisons with changes in activity of daily living (ADL) disability, mobility disability, and the Short Physical Performance Battery (SPPB). Discriminative construct validity was determined by comparisons according to age and physical frailty. Responsiveness was evaluated by comparisons between participants who had and had not been hospitalized and, subsequently, by plotting correlations according to the timing of these hospitalizations. The test-retest reliability was high, with an intraclass correlation coefficient=0.76 (95% confidence interval=0.59-0.94). The internal consistency reliability was excellent with Cronbach alpha=0.91-0.97. Changes in scores on the bathing disability scale were positively correlated with changes in scores in ADL and mobility disability and inversely correlated with changes in scores on the SPPB. A greater decline in scores was observed among the oldest old and those who were physically frail, but these differences did not consistently achieve statistical significance. The scale was responsive to the occurrence and/or timing of intervening hospitalizations. The bathing disability scale is reliable, valid, and responsive and may be suitable for use in clinical trials to evaluate the effectiveness of interventions to enhance independent bathing.
    Archives of physical medicine and rehabilitation 07/2009; 90(6):987-93. · 2.18 Impact Factor
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    Thomas M Gill, Evelyne A Gahbauer, Ling Han, Heather G Allore
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    ABSTRACT: To characterize the functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization. Prospective cohort study of 754 community-living persons aged 70 and older who were initially nondisabled in four essential activities of daily living (ADLs). Greater New Haven, Connecticut. The analytical sample included 296 participants who were newly admitted to a nursing home with disability after an acute hospitalization. Information on nursing home admissions, hospitalizations, and disability in essential ADLs was ascertained during monthly telephone interviews for up to 9 years. Disability was defined as the need for personal assistance in bathing, dressing, walking inside one's home, or transferring from a chair. The median time to the first nursing home admission with disability after an acute hospitalization was 46 months (interquartile range 27.5-75.5), and the mean number+/-standard deviation of ADLs that participants were disabled in upon admission was 3.0+/-1.2. In the month preceding hospitalization, 189 (63.9%) participants had no disability. The most common functional trajectory was discharged home with disability (46.3%), followed by continuous disability in the nursing home (27.4%), discharged home without disability (21.6%), and noncontinuous disability in the nursing home (4.4%). Only 96 (32.4%) participants returned home at (or above) their premorbid level of function. The functional trajectories of older persons admitted to a nursing home with disability after an acute hospitalization are generally poor. Additional research is needed to identify the factors responsible for these poor outcomes.
    Journal of the American Geriatrics Society 01/2009; 57(2):195-201. · 4.22 Impact Factor
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    ABSTRACT: Frailty can be measured in relation to the accumulation of deficits using a frailty index. A frailty index can be developed from most ageing databases. Our objective is to systematically describe a standard procedure for constructing a frailty index. This is a secondary analysis of the Yale Precipitating Events Project cohort study, based in New Haven CT. Non-disabled people aged 70 years or older (n = 754) were enrolled and re-contacted every 18 months. The database includes variables on function, cognition, co-morbidity, health attitudes and practices and physical performance measures. Data came from the baseline cohort and those available at the first 18-month follow-up assessment. Procedures for selecting health variables as candidate deficits were applied to yield 40 deficits. Recoding procedures were applied for categorical, ordinal and interval variables such that they could be mapped to the interval 0-1, where 0 = absence of a deficit, and 1= full expression of the deficit. These individual deficit scores were combined in an index, where 0= no deficit present, and 1= all 40 deficits present. The values of the index were well fit by a gamma distribution. Between the baseline and follow-up cohorts, the age-related slope of deficit accumulation increased from 0.020 (95% confidence interval, 0.014-0.026) to 0.026 (0.020-0.032). The 99% limit to deficit accumulation was 0.6 in the baseline cohort and 0.7 in the follow-up cohort. Multivariate Cox analysis showed the frailty index, age and sex to be significant predictors of mortality. A systematic process for creating a frailty index, which relates deficit accumulation to the individual risk of death, showed reproducible properties in the Yale Precipitating Events Project cohort study. This method of quantifying frailty can aid our understanding of frailty-related health characteristics in older adults.
    BMC Geriatrics 10/2008; 8:24. · 2.34 Impact Factor
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    Thomas M Gill, Evelyne A Gahbauer
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    ABSTRACT: To advance the field of disability assessment, additional developmental work is needed. The objective of this study was to determine the potential value of participant recall when evaluating disability over discrete periods of time. We studied 491 residents of greater New Haven, Connecticut, who were 76 years old or older. Participants completed a comprehensive assessment that included several new questions on disability in four essential activities of daily living (bathing, dressing, transferring, and walking). Participants were also assessed for disability in the same activities during monthly telephone interviews before and after the comprehensive assessment. Chronic disability was defined as a new disability that was present for at least three consecutive months. We found that up to half of the incident disability episodes, which would otherwise have been missed, can be ascertained if participants are asked to recall whether they have had disability "at any time" since the prior assessment; that these disability episodes, which are ascertained by participant recall, confer high risk for the subsequent development of chronic disability, with an adjusted hazard ratio of 2.5 (95% confidence interval, 1.1-5.8); and that participant recall for the absence of disability becomes increasingly inaccurate as the duration of the assessment interval increases, with 2.2%, 6.0%, 6.9%, and 9.1% of participants having inaccurate recall at 1, 3, 6, and 12 months, respectively. Our results demonstrate both the promise and limitations of participant recall and suggest that additional strategies are needed to more completely and accurately ascertain the occurrence of disability among older persons.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 07/2008; 63(6):588-94. · 4.31 Impact Factor

Publication Stats

891 Citations
247.23 Total Impact Points

Institutions

  • 2002–2014
    • Yale-New Haven Hospital
      • Department of Laboratory Medicine
      New Haven, Connecticut, United States
  • 2005–2012
    • Yale University
      • Department of Internal Medicine
      New Haven, CT, United States
  • 2011
    • Dalhousie University
      • Division of Geriatric Medicine
      Halifax, Nova Scotia, Canada
  • 2008
    • Capital District Health Authority of Nova Scotia
      Halifax, Nova Scotia, Canada