Featured Publications
Cognitive Aging Trajectories and Burdens of Disability, Hospitalization and Nursing Home Admission Among Community-living Older Persons
Han L, Gill TM, Jones BL, Allore HG. Cognitive Aging Trajectories and Burdens of Disability, Hospitalization and Nursing Home Admission Among Community-living Older Persons. The Journals Of Gerontology Series A 2015, 71: 766-771. PMID: 26511011, PMCID: PMC4888384, DOI: 10.1093/gerona/glv159.Peer-Reviewed Original ResearchConceptsNursing home admissionBurden of disabilityCommunity-living older personsHome admissionOlder personsGreater burdenCognitive trajectoriesMini-Mental State ExaminationCommunity-living personsCognitive aging trajectoriesNursing home placementPrecipitating Events ProjectLow incidence rateEquation Poisson modelsRapid cognitive declineBaseline cognitive functionAging trajectoriesGroup-based trajectory modelsThird of participantsADL disabilityHigher baseline cognitive functionInstrumental ADLIncidence rateDaily livingHospitalizationAre China’s oldest-old living longer with less disability? A longitudinal modeling analysis of birth cohorts born 10 years apart
Liu Z, Han L, Feng Q, Dupre ME, Gu D, Allore HG, Gill TM, Payne CF. Are China’s oldest-old living longer with less disability? A longitudinal modeling analysis of birth cohorts born 10 years apart. BMC Medicine 2019, 17: 23. PMID: 30704529, PMCID: PMC6357399, DOI: 10.1186/s12916-019-1259-z.Peer-Reviewed Original ResearchConceptsPartial life expectancyLess disabilityBirth cohortOldest old livingLife expectancyAge groupsHigher healthcare costsDisability-free life expectancySuccessive birth cohortsOldest-old individualsOctogenarian womenMultistate life tablesSubgroup analysisAge 80Healthcare costsRural residenceUrban-rural disparitiesOctogenariansCohortHealth inequalitiesPersonal assistanceDisability transitionsDisabilityNonagenariansSociodemographic heterogeneity
2023
Relationship Between Distressing Symptoms and Changes in Disability After Major Surgery Among Community-living Older Persons
Gill T, Han L, Feder S, Gahbauer E, Leo-Summers L, Becher R. Relationship Between Distressing Symptoms and Changes in Disability After Major Surgery Among Community-living Older Persons. Annals Of Surgery 2023, 279: 65-70. PMID: 37389893, PMCID: PMC10761592, DOI: 10.1097/sla.0000000000005984.Peer-Reviewed Original ResearchConceptsMajor surgeryDistressing symptomsElective surgeryFunctional outcomeOlder personsCommunity-living older personsMultiple distressing symptomsSocioeconomic disadvantageCommunity-living personsTiming of surgerySerious health eventsNumber of disabilitiesSurgerySignificant associationSymptomsHealth eventsRate ratioPotential targetDisabilityUnit increaseDeleterious effectsOutcomesPersonsMultimorbidityAdmission
2021
Visual trajectories and risk of physical and cognitive impairment among older Chinese adults
Cao G, Wang K, Han L, Zhang Q, Yao S, Chen Z, Huang Z, Luo Y, Hu Y, Xu B. Visual trajectories and risk of physical and cognitive impairment among older Chinese adults. Journal Of The American Geriatrics Society 2021, 69: 2877-2887. PMID: 34111310, DOI: 10.1111/jgs.17311.Peer-Reviewed Original ResearchConceptsOlder Chinese adultsIADL disabilityCognitive impairmentChinese adultsADL disabilityFunctional impairmentCognitive functionMini-Mental State Examination scoreProgressive declineChinese Longitudinal Healthy Longevity SurveyState Examination scoreModerate declineGroup-based trajectory modelsKatz scaleLawton scalePotential confoundersLongevity SurveyImpairmentDecline trajectoriesChinese versionDisabilityLongitudinal studyAdultsRiskExamination scores
2020
Functional Effects of Intervening Illnesses and Injuries After Hospitalization for Major Surgery in Community-living Older Persons
Gill TM, Han L, Gahbauer EA, Leo-Summers L, Murphy TE, Becher RD. Functional Effects of Intervening Illnesses and Injuries After Hospitalization for Major Surgery in Community-living Older Persons. Annals Of Surgery 2020, 273: 834-841. PMID: 33074902, PMCID: PMC8370041, DOI: 10.1097/sla.0000000000004438.Peer-Reviewed Original ResearchConceptsMajor surgeryED visitsRestricted activityFunctional statusFunctional declineOlder personsCommunity-living older personsAdjusted hazard ratioAdverse functional outcomesCommunity-living personsEmergency department visitsTraditional risk factorsCorresponding odds ratiosFunctional effectsIllness/injuryHazard ratioDepartment visitsFunctional recoveryFunctional outcomeRisk factorsOdds ratioHospitalizationSurgeryInjuryVisitsRisk Factors for Disability After Emergency Department Discharge in Older Adults
Nagurney JM, Han L, Leo‐Summers L, Allore HG, Gill TM. Risk Factors for Disability After Emergency Department Discharge in Older Adults. Academic Emergency Medicine 2020, 27: 1270-1278. PMID: 32673434, PMCID: PMC7749835, DOI: 10.1111/acem.14088.Peer-Reviewed Original ResearchConceptsLower extremity weaknessDisability burdenRisk factorsOlder adultsED visitsPhysical frailtyLongitudinal multivariable modelsEmergency department dischargeModifiable risk factorsCommunity-living personsCandidate risk factorsEmergency department experienceED dischargeNonmodifiable factorsMultivariable analysisRisk stratificationFunctional outcomeIndependent associationMultivariable modelOngoing longitudinal studyMonthly interviewsAnalytic sampleFunctional activityAdultsVisitsRisk Factors and Precipitants of Severe Disability Among Community-Living Older Persons
Gill TM, Han L, Gahbauer EA, Leo-Summers L, Murphy TE. Risk Factors and Precipitants of Severe Disability Among Community-Living Older Persons. JAMA Network Open 2020, 3: e206021. PMID: 32484551, PMCID: PMC7267844, DOI: 10.1001/jamanetworkopen.2020.6021.Peer-Reviewed Original ResearchMeSH KeywordsActivities of Daily LivingAgedAged, 80 and overConnecticutDisability EvaluationDisabled PersonsEmergency Service, HospitalFemaleGlobal Burden of DiseaseHospitalizationHumansMaleProspective StudiesQuality of LifeRecovery of FunctionRisk FactorsSeverity of Illness IndexWounds and InjuriesConceptsEmergency department visitsRisk factorsCatastrophic disabilitySevere disabilityDepartment visitsProgressive disabilityOlder community-living adultsCommunity-living older personsIndependent risk factorProspective cohort studyCommunity-living personsGreater New HavenCommunity-living adultsPotential risk factorsCandidate risk factorsNon-Hispanic white participantsQuality of lifeLong-term careCohort studyMultivariable analysisMean ageFunctional statusMAIN OUTCOMEPotential precipitantsDaily livingDisability and Recovery After Hospitalization for Medical Illness Among Community‐Living Older Persons: A Prospective Cohort Study
Dharmarajan K, Han L, Gahbauer EA, Leo‐Summers L, Gill TM. Disability and Recovery After Hospitalization for Medical Illness Among Community‐Living Older Persons: A Prospective Cohort Study. Journal Of The American Geriatrics Society 2020, 68: 486-495. PMID: 32083319, PMCID: PMC7735402, DOI: 10.1111/jgs.16350.Peer-Reviewed Original ResearchConceptsAcute medical illnessProspective cohort studyMedical illnessNew disabilityCohort studySelf-managing health conditionsCommunity-living older personsHealth conditionsImmediate transitional periodCommunity-living personsPost-discharge careChronic health conditionsMean recovery timeSubgroup of personsMobility activitiesIncident disabilityHospital dischargePeriod of vulnerabilityMonth 2Follow-up interviewHospitalizationDisability prevalenceOlder personsPrior monthIllnessFactors Associated With Insidious and Noninsidious Disability
Gill TM, Murphy TE, Gahbauer EA, Leo-Summers L, Han L. Factors Associated With Insidious and Noninsidious Disability. The Journals Of Gerontology Series A 2020, 75: 2125-2129. PMID: 31907523, PMCID: PMC7566549, DOI: 10.1093/gerona/glaa002.Peer-Reviewed Original ResearchConceptsRisk factorsIllness/injuryInsidious disabilityLower extremity muscle weaknessNon-Hispanic white raceExtremity muscle weaknessCommunity-living personsEmergency department visitsPoor manual dexterityCox analysisDepartment visitsMultivariable analysisDisability outcomesMuscle weaknessWhite raceDaily livingCognitive impairmentBivariate analysisType of disabilityManual dexterityDisabilityInjuryOutcomesModest differencesDifferent mechanisms
2018
Functional trajectories before and after a new cancer diagnosis among community-dwelling older adults
Presley CJ, Han L, Leo-Summers L, Hurria A, Gross CP, Davidoff AJ, Allore HG, Gill TM. Functional trajectories before and after a new cancer diagnosis among community-dwelling older adults. Journal Of Geriatric Oncology 2018, 10: 60-67. PMID: 29937422, PMCID: PMC6526705, DOI: 10.1016/j.jgo.2018.05.017.Peer-Reviewed Original ResearchConceptsNew cancer diagnosesFunctional trajectoriesRisk factorsCancer diagnosisDistinct functional trajectoriesTotal disability scorePotential risk factorsGroup-based trajectory modelsParticipants 70Disability scoresOlder adultsMonthly assessmentsDiagnosisMobility activitiesIdentified participantsDisabilityParticipantsYearsDiabetes, Heart Disease, and Dementia: National Estimates of Functional Disability Trajectories
Vroomen J, Han L, Monin JK, Lipska KJ, Allore HG. Diabetes, Heart Disease, and Dementia: National Estimates of Functional Disability Trajectories. Journal Of The American Geriatrics Society 2018, 66: 766-772. PMID: 29521414, PMCID: PMC5906138, DOI: 10.1111/jgs.15284.Peer-Reviewed Original ResearchConceptsHeart diseaseDisability trajectoriesPossible dementiaNational estimatesChronic conditionsGreater oddsPhysician-diagnosed chronic conditionsCognitive statusCommunity-dwelling Medicare beneficiariesMultiple chronic conditionsAging Trends StudyComplex survey designGroup-based trajectory modelingADL disabilityNational HealthProbable dementiaDaily livingMultinomial logistic regressionMedicare beneficiariesDiabetesStudy attritionConcurrent conditionsDementiaSociodemographic characteristicsSevere disabilityDisability Prior to Death Among the Oldest-Old in China
Liu Z, Han L, Wang X, Feng Q, Gill TM. Disability Prior to Death Among the Oldest-Old in China. The Journals Of Gerontology Series A 2018, 73: 1701-1707. PMID: 29408957, PMCID: PMC6230206, DOI: 10.1093/gerona/gly010.Peer-Reviewed Original Research
2017
Distressing Symptoms, Disability, and Hospice Services at the End of Life: Prospective Cohort Study
Gill TM, Han L, Leo‐Summers L, Gahbauer EA, Allore HG. Distressing Symptoms, Disability, and Hospice Services at the End of Life: Prospective Cohort Study. Journal Of The American Geriatrics Society 2017, 66: 41-47. PMID: 28895118, PMCID: PMC5777867, DOI: 10.1111/jgs.15041.Peer-Reviewed Original ResearchConceptsProspective cohort studyEnd of lifeHospice admissionCohort studyDistressing symptomsHospice servicesMonths of lifeNumber of disabilitiesMedian durationSubsequent admissionHigh burdenMedicare claimsAdditional disabilitiesAdmissionAdditional monthsSymptomsOlder personsHospiceMonthly interviewsMonthsDisabilityShort durationAdditional strategiesDurationNew HavenThe subsequent course of disability in older persons discharged to a skilled nursing facility after an acute hospitalization
Liu Z, Han L, Leo-Summers L, Gahbauer EA, Allore HG, Gill TM. The subsequent course of disability in older persons discharged to a skilled nursing facility after an acute hospitalization. Experimental Gerontology 2017, 97: 73-79. PMID: 28782593, PMCID: PMC5793887, DOI: 10.1016/j.exger.2017.08.004.Peer-Reviewed Original ResearchConceptsElective major surgerySkilled nursing facilitiesMajor surgeryAcute hospitalizationCritical illnessOlder personsDisability burdenNursing facilitiesSubsequent courseCommunity-living personsRate ratioType of hospitalizationIndex admissionSecondary outcomesSNF admissionFunctional outcomeMore admissionsHospitalizationSurgeryAdmissionIllnessLongitudinal studyDisabilityMobility activitiesExclusive groupsEmergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons
Nagurney JM, Fleischman W, Han L, Leo-Summers L, Allore HG, Gill TM. Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons. Annals Of Emergency Medicine 2017, 69: 426-433. PMID: 28069299, PMCID: PMC5365369, DOI: 10.1016/j.annemergmed.2016.09.018.Peer-Reviewed Original ResearchConceptsCommunity-living older personsED visitsDisability scoresControl groupFunctional declineOlder personsBaseline disability scoresCourse of disabilityHigher disability scoresEmergency department visitsNursing home admissionAdjusted risk ratioAcute hospitalizationSecondary outcomesDepartment visitsHome admissionEmergency departmentMean ageFunctional statusRisk ratioHospitalizationUnmatched groupsNursing homesMeaningful declineRelevant covariates
2015
Trajectories of Disability Among Older Persons Before and After a Hospitalization Leading to a Skilled Nursing Facility Admission
Buurman BM, Han L, Murphy TE, Gahbauer EA, Leo-Summers L, Allore HG, Gill TM. Trajectories of Disability Among Older Persons Before and After a Hospitalization Leading to a Skilled Nursing Facility Admission. Journal Of The American Medical Directors Association 2015, 17: 225-231. PMID: 26620073, PMCID: PMC4769913, DOI: 10.1016/j.jamda.2015.10.010.Peer-Reviewed Original ResearchConceptsSkilled nursing facility admissionsNursing facility admissionsDisability trajectoriesMinimal disabilityOlder personsFacility admissionModerate disabilityCommunity-dwelling older personsMinimal improvementDistinct disability trajectoriesSevere disability scoresProspective cohort studyTrajectories of disabilityShort-term outcomesMild disabilityLikelihood of improvementDisability scoresFirst hospitalizationSecondary outcomesCohort studyMean ageMAIN OUTCOMEDaily livingAdmissionMost older personsThe role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people
Gill TM, Gahbauer EA, Han L, Allore HG. The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people. The BMJ 2015, 350: h2361. PMID: 25995357, PMCID: PMC4443433, DOI: 10.1136/bmj.h2361.Peer-Reviewed Original ResearchMeSH KeywordsActivities of Daily LivingAgedCohort StudiesConnecticutDementiaDisability EvaluationDisabled PersonsDisease ProgressionFemaleFrail ElderlyGeriatric AssessmentHospitalizationHumansMaleMultiple Organ FailureNeoplasmsPrognosisProspective StudiesSeverity of Illness IndexTerminal CareUnited StatesConceptsCourse of disabilityProspective cohort studyHospital admissionTrajectories of disabilitySeverity of disabilityCatastrophic disabilitySevere disabilityCohort studyAcute hospital admissionPalliative care approachMultiple hospital admissionsAdvance care planningPersonal care needsEnd of lifeDisability scoresOlder patientsPotential confoundersOccurrence of admissionMultivariable modelCare planningMAIN OUTCOMECare approachDaily livingCare needsAdmission
2014
Epidemiology of Restricting Fatigue in Older Adults: The Precipitating Events Project
de Rekeneire N, Leo‐Summers L, Han L, Gill TM. Epidemiology of Restricting Fatigue in Older Adults: The Precipitating Events Project. Journal Of The American Geriatrics Society 2014, 62: 476-481. PMID: 24512073, PMCID: PMC4103720, DOI: 10.1111/jgs.12685.Peer-Reviewed Original ResearchConceptsCommunity-living older adultsPhysical frailtyOlder adultsCommunity-living older menEpidemiologic Studies Depression ScaleProspective cohort studySlow gait speedOverall incidence ratePrecipitating Events ProjectCohort studyCumulative incidenceMedian durationGait speedIncidence rateDepression ScaleUsual activitiesOlder menFrailtyDepressionMonthsWomenConsecutive monthsAdultsHigh rateRespective counterparts
2013
Dynamics of functional aging based on latent-class trajectories of activities of daily living
Han L, Allore H, Murphy T, Gill T, Peduzzi P, Lin H. Dynamics of functional aging based on latent-class trajectories of activities of daily living. Annals Of Epidemiology 2013, 23: 87-92. PMID: 23305692, PMCID: PMC3558979, DOI: 10.1016/j.annepidem.2012.11.010.Peer-Reviewed Original ResearchConceptsDaily livingFunctional agingCommunity-living adultsEquation Poisson modelsMost older adultsADL disabilityHigher disabilityPersistent disabilitySubstantial morbidityInstrumental ADLADL independenceDisability trajectoriesLatent class trajectoriesCumulative burdenRestricted activityLow burdenSevere disabilityMorbidityPredominant trajectoriesOlder adultsDisabilityTime trendsFunctional autonomyADLGrowth mixture modelsComparisons Between Older Men and Women in the Trajectory and Burden of Disability Over the Course of Nearly 14 Years
Gill TM, Gahbauer EA, Lin H, Han L, Allore HG. Comparisons Between Older Men and Women in the Trajectory and Burden of Disability Over the Course of Nearly 14 Years. Journal Of The American Medical Directors Association 2013, 14: 280-286. PMID: 23294968, PMCID: PMC3615123, DOI: 10.1016/j.jamda.2012.11.011.Peer-Reviewed Original ResearchConceptsBurden of disabilityOlder menModerate disabilityGender differencesWorse disabilityDisability trajectoriesClinical covariatesDaily livingOlder womenBaseline levelsHigh mortalityGreater burdenSevere disabilityMonthly interviewsLife course approachWomenMild disabilityDisabilityBasic activitiesLongitudinal studyMenMobility activitiesHigh rateHigher initial levelsBurden