ABSTRACT
BACKGROUND: Although asthma can be associated with significant airflow obstruction in those over the age of 65, it is often underdiagnosed and undertreated. OBJECTIVE: To describe severity of asthma, allergy skin test sensitivities, indoor allergen exposures, and the impact on quality of life (QOL) and health status in elderly persons with asthma. METHODS: A cross-sectional data analysis with 80 elderly persons with asthma recruited from medical, geriatric, and allergy/immunology tertiary care centers. Asthma severity was determined by symptoms and measurements of lung function. House dust specimens were collected from mattresses and bedroom carpets and analyzed separately for the major allergens of house dust, using monoclonal antibody-based immunoenzymetric assays. QOL was measured using Juniper's Asthma Quality of Life Questionnaire. Health status was measured using the Short Form Health Survey Medical Outcome Questionnaire which included Ferrans and Powers' Quality of Life Index subscales. RESULTS: Two-thirds of participants had either moderate or severe persistent asthma. Skin tests to a battery of common airborne allergens were positive to at least one allergen in 56 of the 75 participants tested (74.7%). Reservoir dust allergen levels were often high enough to place participants at risk of symptoms or at risk of developing sensitization. Increased asthma severity was associated with significantly lower QOL and a trend toward decreased health status. CONCLUSIONS: Asthma is a significant chronic problem in the elderly. Atopy was common. Asthma severity impacts on these participants' QOL and health status. Results support interventions aimed at identifying allergens precipitating attacks and reducing them in the home.
Subject(s)
Asthma/epidemiology , Hypersensitivity, Immediate/epidemiology , Aged , Air Pollution, Indoor/adverse effects , Air Pollution, Indoor/analysis , Allergens/adverse effects , Animals , Animals, Domestic , Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Asthma/etiology , Asthma/psychology , Baltimore/epidemiology , Bedding and Linens , Cats , Cockroaches/immunology , Dogs , Drug Utilization/statistics & numerical data , Dust , Environmental Exposure , Health Status Indicators , Housing , Humans , Humidity , Hypersensitivity, Immediate/etiology , Hypersensitivity, Immediate/psychology , Insect Proteins/adverse effects , Insect Proteins/immunology , Quality of Life , Severity of Illness Index , Skin Tests , Smoking/epidemiology , Spirometry , Urban PopulationABSTRACT
Aneffective and comprehensive faculty evaluation system provides both formative and summative data for ongoing faculty development. It also provides data for annual faculty evaluation and tenure and promotion decision making. To achieve an effective system, a triad of faculty evaluation data sources--student ratings, teaching portfolio, and peer evaluation--were developed. Concurrently, a system of faculty mentorship was implemented, as well as an administrative structure to effectively use data to assist in merit pay and promotion decisions. Using a comprehensive, evidenced-based system to document, analyze, and improve teaching effectiveness is essential to assuring excellence in teaching and learning.
