Papers by Evelyn Granieri
Environmental health perspectives, Sep 13, 2011
Background and Aims: Methods to evaluate the food and physical activity environment within the sa... more Background and Aims: Methods to evaluate the food and physical activity environment within the same study remain sparse. It is hypothesized that the types of local food retailers will affect indivi...
Academic Medicine, Jul 1, 2004
Circulation, Nov 26, 2013
Background: Individual socioeconomic status (SES) is associated with cardiovascular disease (CVD)... more Background: Individual socioeconomic status (SES) is associated with cardiovascular disease (CVD), but few studies have investigated neighborhood SES and CVD. We hypothesized that CVD prevalence may differ by urban neighborhoods even after adjusting for individual SES. Methods: Adults 59-99 years old from New York City were enrolled in the NHLBI-funded Cardiovascular Health of Seniors and the Built Environment Study from 2009 to 2011 (n=1,453). Geocoded maps using participants addresses were correlated to 2010 US census tract data. Neighborhood median incomes were stratified into the following categories: (highest (H) [$51,712_$160,833], med-high (MH) [$37,084_$51,711], med-low (ML) [$25,615_$37,083], lowest (L) [<$25,615]). Log-linear models generated crude and adjusted (age, race and income) effect estimates. Results: There were 153 cases of myocardial infarction (MI) and 92 cases of heart failure (HF) detected. Over 90% of participants had health insurance. There was a geographic association between ca...
Annals of Internal Medicine, Feb 1, 2011
TO THE EDITOR: Daviglus and colleagues (1) report that no firm conclusions currently can be drawn... more TO THE EDITOR: Daviglus and colleagues (1) report that no firm conclusions currently can be drawn about the association of any modifiable risk factors with Alzheimer disease and, thus, that recommendations for preventing this condition cannot be made. This conclusion is essentially based on a systematic review from an independent panel of health professionals and public representatives who do not specialize in Alzheimer disease, plus presentations by and discussions with the world’s leading experts on this condition (2). The reviewers examined the extensive literature investigating the modifiable risk factors for Alzheimer disease but concluded that the quality of evidence supporting the associations was low or that inconsistent associations were reported (1, 2). However, we believe that a different scenario would emerge if the evidence were evaluated from a life-course perspective. Great efforts have been made aimed at identifying modifiable risk factors for Alzheimer disease from a life-course perspective (3, 4). Research indicates that the occurrence of most cases of Alzheimer disease is likely to be determined by multiple factors experienced over the life span, in which the effect of specific risk factors for this condition largely depends on age. The age-dependent associations with Alzheimer disease have been suggested for several aging-related medical conditions. For example, having elevated blood pressure, body mass index, and total cholesterol levels at a young age and in middle age ( 65 years) is associated with an increased risk for Alzheimer disease, whereas having lower values in late life (age 75 years) is also associated with subsequent development of Alzheimer disease (3, 4). Evidence supporting this age-dependent association is derived mostly from population-based follow-up studies, an approach that is particularly useful in assessing the cause of chronic multifactorial diseases. Results of randomized clinical trials that target those modifiable risk factors by implementing therapeutic interventions, such as antihypertensive and lipid-lowering therapy, have been either inconclusive or disproved. However, these results are not surprising given that almost all of these trials are conducted among elderly people (age 60 years) and dementia is usually a secondary end point (3, 4). Progress in understanding the cause of dementia unfortunately has not yet been successfully translated into any effective intervention programs for the general population. However, the life-course approach should be kept in mind when designing any intervention programs. It has been suggested that some intervention measures implemented in middle age may be effective in reducing the incidence of dementia (5). Thus, current evidence tends to support the theory that interventions targeting multiple modifiable risk factors, if implemented earlier in life, may be more promising in reducing the risk for Alzheimer disease.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2017
Background. Individual neighborhood factors are associated with obesity-related health behaviors ... more Background. Individual neighborhood factors are associated with obesity-related health behaviors and rates; however, there remains a paucity of information characterizing whole environments in these relationships and limited information on the effect for older adults. Methods. Adults, aged 60 or older living in New York City, were enrolled into the Cardiovascular Health of Seniors and the Built Environment between January 2009 and June 2011. Walking audits of all streets within 300-meter buffer zones around residential addresses were conducted resulting in the assessment of 34 different neighborhood features hypothesized to be associated with obesity through physical activity and diet. Outcomes included objective measures of body fat mass (FM), waist circumference (WC), and body mass index (BMI). Stratified linear regression models were used to calculate geographic differences in associations between neighborhood resources and adiposity by gender and age categories in areas where Black, White and Latino residents lived. Results. For women 60-69 years of age living in black areas, neighborhood features resulted in a higher FM than the average Brooklyn neighborhood (Difference (D) =2.15, 95% CI [1.15, 3.15]). Conversely, for women of the same age living in white and Latino areas, a lower prevalence of FM was observed: white areas: (D=-2.01, 95% CI [-3.62,-0.40]); Latino areas: (D=-1.43, 95% CI [-2.72,-0.14]). The direction of the effects remained similar for other age groups, although the estimates were less precise. Estimates of FM were inconsistent across age groups for men living in each of the areas. Other measurements of adiposity showed similar results. Conclusions. The composition of neighborhood features in white and Latino residential areas is protective of adiposity, whereas features located in black areas appear to place residents at greater risk.
BMC Geriatrics, Jul 14, 2011
Background: The use of opioid medications as treatment for chronic non-cancer pain remains contro... more Background: The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Methods: Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Results: Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain. Conclusions: Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.
The journal of nutrition, health & aging, 2016
Objective-Studies suggest protein intake may be associated with lower body weight, but protein ha... more Objective-Studies suggest protein intake may be associated with lower body weight, but protein has also been associated with preservation of lean body mass. Understanding the role of protein in maintaining health for older adults is important for disease prevention among this population. Design-Cross-sectional study of the relationship of dietary protein on body composition. Setting-New York City community centers Participants-1,011 Black, White, and Latino urban men and women 60-99 years of age Measurements-Protein intake was assessed using two interviewer-administered 24-hour recalls, and body composition was assessed using bioelectrical impedance analysis (BIA) of fat mass (kg) (FM), fat free mass (kg) (FFM), and impedance resistance (Ohms). Statistical Analysis-Indices of FM and FFM were calculated by dividing BIA measurements by height squared (m 2), and percent FFM was calculated by dividing FFM by the sum of FM and FFM. Log linear models adjusting for age (continuous), race/ethnicity, education, physical activity (dichotomized at the median), hypertension, diabetes, and total calories (continuous). Results-Just 33% of women and 50% of men reported meeting the RDA for protein. Both fat free mass index (FFMI) and fat mass index (FMI) were negatively associated with meeting the RDA for protein (Women: FFMI-1.78 95%CI [-2.24,-1.33], FMI-4.12 95% CI[-4.82,-3.42]
Annals of Internal Medicine, 2011
TO THE EDITOR: Daviglus and colleagues (1) report that no firm conclusions currently can be drawn... more TO THE EDITOR: Daviglus and colleagues (1) report that no firm conclusions currently can be drawn about the association of any modifiable risk factors with Alzheimer disease and, thus, that recommendations for preventing this condition cannot be made. This conclusion is essentially based on a systematic review from an independent panel of health professionals and public representatives who do not specialize in Alzheimer disease, plus presentations by and discussions with the world’s leading experts on this condition (2). The reviewers examined the extensive literature investigating the modifiable risk factors for Alzheimer disease but concluded that the quality of evidence supporting the associations was low or that inconsistent associations were reported (1, 2). However, we believe that a different scenario would emerge if the evidence were evaluated from a life-course perspective. Great efforts have been made aimed at identifying modifiable risk factors for Alzheimer disease from a life-course perspective (3, 4). Research indicates that the occurrence of most cases of Alzheimer disease is likely to be determined by multiple factors experienced over the life span, in which the effect of specific risk factors for this condition largely depends on age. The age-dependent associations with Alzheimer disease have been suggested for several aging-related medical conditions. For example, having elevated blood pressure, body mass index, and total cholesterol levels at a young age and in middle age ( 65 years) is associated with an increased risk for Alzheimer disease, whereas having lower values in late life (age 75 years) is also associated with subsequent development of Alzheimer disease (3, 4). Evidence supporting this age-dependent association is derived mostly from population-based follow-up studies, an approach that is particularly useful in assessing the cause of chronic multifactorial diseases. Results of randomized clinical trials that target those modifiable risk factors by implementing therapeutic interventions, such as antihypertensive and lipid-lowering therapy, have been either inconclusive or disproved. However, these results are not surprising given that almost all of these trials are conducted among elderly people (age 60 years) and dementia is usually a secondary end point (3, 4). Progress in understanding the cause of dementia unfortunately has not yet been successfully translated into any effective intervention programs for the general population. However, the life-course approach should be kept in mind when designing any intervention programs. It has been suggested that some intervention measures implemented in middle age may be effective in reducing the incidence of dementia (5). Thus, current evidence tends to support the theory that interventions targeting multiple modifiable risk factors, if implemented earlier in life, may be more promising in reducing the risk for Alzheimer disease.
Background: Valid measures of local food environments are needed to quantify disparities in the a... more Background: Valid measures of local food environments are needed to quantify disparities in the availability of healthy foods and estimate the effect of built environments on health. Limited measures are available to describe the fluctuation of food retail environments over time, and how food environments are utilized by older adults. Purpose: This study measured neighborhood environments of older adults living in Brooklyn, NY, using an objective, prospective audit tool in order to document variations in the availability of food retailers and other neighborhood resources over a two-year period. Additionally, neighborhood utilization patterns, which may mitigate exposure to the built environment, were assessed using surveys of participating older adults. Methods: Older adults enrolled in the Cardiovascular Health of Seniors and the Built Environment study in New York City (NYC) between 2009-2011 completed surveys in person at baseline and two years later (n=1,318). Auditors documente...
Otolaryngology–Head and Neck Surgery, 2009
Objective: This guideline provides evidence-based recommendations on managing hoarseness (dysphon... more Objective: This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness. Purpose: The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology—Head and...
Annals of internal medicine, Jan 3, 2010
The National Institute on Aging and the Office of Medical Applications of Research of the Nationa... more The National Institute on Aging and the Office of Medical Applications of Research of the National Institutes of Health convened a State-of-the-Science Conference on 26-28 April 2010 to assess the available scientific evidence on prevention of cognitive decline and Alzheimer disease. This article provides the panel's assessment of the available evidence.
Journal of the American Geriatrics Society, 1999
Journal of the American Geriatrics Society, 1999
Academic Medicine, 2000
For example, we've long invested in emerging scientific disciplines by creating new medical schoo... more For example, we've long invested in emerging scientific disciplines by creating new medical school departments in fields like immunology, developmental biology, biomedical informatics, critical care medicine, computational and systems biology, and structural biology. In parallel, we've built interdisciplinary centers where discoveries in multiple fields can lead to great leaps forward; these include our
Background: The use of opioid medications as treatment for chronic non-cancer pain remains contro... more Background: The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers’ attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers’ experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Methods: Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Results: Most participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line...
Postgraduate Medical Journal
Open Forum Infectious Diseases
Background Respiratory Syncytial Virus (RSV) causes severe respiratory illnesses in infants and o... more Background Respiratory Syncytial Virus (RSV) causes severe respiratory illnesses in infants and older adults. Mortality disproportionately affects the elderly, can exacerbate chronic cardiopulmonary conditions and may result in loss of function. The purpose of this study was to determine the incidence of RSV infection in hospitalized adults and evaluate functional changes associated with RSV hospitalization in older adults ≥60 years. Methods Adults ≥18 years of age admitted with an acute respiratory infection (ARI) or exacerbation of chronic cardiopulmonary disease (e.g. CHF, COPD, asthma) preceded by an ARI within 14 days were screened. Subjects were included if hospitalized for ≥24 hours with laboratory confirmed RSV and residing in two catchment areas (Rochester, NY and New York, NY). Illness history, comorbidities and demographic characteristics were collected at enrollment. Enrolled subjects ≥60 years underwent functional status evaluation retrospectively 2 weeks prior to hospi...
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Papers by Evelyn Granieri