The proposed research will use major elective abdominal surgery as a model for catastrophic health events to study the natural history of postoperative long-term functional recovery in a cohort of Mexican American elders. Several factors make major elective abdominal surgery a particularly rich model for catastrophic health events: it is frequently performed; it provides controlled access to what is usually an acute, unpredictable event; there is usually little related presurgical symptomatic chronic illness (eg, elective repair of abdominal aortic aneurysm); and it invokes multidimensional disruption of functional independence. Previous studies do not answer questions regarding determinants of functional recovery in the elderly after major abdominal surgery for two primary reasons: (1) they examine only coronary artery bypass operations or lower risk operations done for specific physical impairment (eg, hip fracture repair, hip replacement, cataract surgery) and (2) do not approach the issue with an integrated biomedical psychosocial model of independence.
Specific aims are to (1) describe the impact of major abdominal surgery on functional independence in a cohort of Mexican American elders, (2) map the natural history of functional recovery, and (3) identify important modifiable determinants for long-term postoperative functional outcome. Long-term objectives are development of interventions to enhance functional recovery, prevent disability, and prolong independence in Mexican American elders. The primary hypothesis is that poorer preoperative functional status for five primary modifiable determinants of independence (physical, cognitive, social, affective and medical comorbid status) is associated with worse functional recovery. Subjects who are greater and or equal to 65, scheduled for major elective abdominal operations, and without major debilitating illness likely to drive functional recovery will be recruited from both academic and community sites. Subjects will undergo an extensive battery of instruments to assess functional independence for the five primary modifiable determinants of functional independence preoperatively and postoperatively at five days, one, three, and six months. Multivariable analysis will be used to evaluate the relationship between preoperative status for five primary modifiable determinants and postoperative functional independence, defined by Activities of Daily Living and Instrumental Activities of Daily Living. Results will substantially expand knowledge about predictors of functional recovery after major abdominal surgery in the elderly, will have unique significance for Mexican American elders, and should provide insights for other types of surgery and catastrophic health events. Additionally, the results will help target potential interventions to prevent disability and enhance functional recovery.
| Lawrence, Valerie A; Hazuda, Helen P; Cornell, John E et al. (2004) Functional independence after major abdominal surgery in the elderly. J Am Coll Surg 199:762-72 |
| Hazuda, Helen P; Gerety, Meghan B; Lee, Shuko et al. (2002) Measuring subclinical disability in older mexican americans. Psychosom Med 64:520-30 |
| Katerndahl, D A; Trammell, C (1997) Prevalence and recognition of panic states in STARNET patients presenting with chest pain. J Fam Pract 45:54-63 |
| Hazuda, H P (1997) Minority issues in Alzheimer disease outcomes research. Alzheimer Dis Assoc Disord 11 Suppl 6:156-61 |
| Hazuda, H P (1997) Inclusion of ethnic minorities in sarcopenia research: challenges and strategies. Muscle Nerve Suppl 5:S27-31 |
