University of Southern California
Division of Occupational Science and Occupational Therapy

Stanley P. Azen PhD

Stanley Azen

Professor, joint appointment with the Keck School of Medicine of USC, Department of Preventive Medicine

Room: SSB 202G
Phone: (323) 442-1810
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Web: http://pibbs.usc.edu/faculty/profile/?fid=170

Biography

Stanley Azen is currently Professor and Co-Director of Biostatistics in the Department of Preventive Medicine at the Keck School of Medicine of USC. Dr. Azen is also Assistant Dean of Research Integrity. At USC, Dr. Azen was one of the "founding fathers" of the Graduate Programs in Biostatistics, Epidemiology, Molecular Epidemiology and Public Health. He is also the Co-Director of the Keck School of Medicine of USC MS program in Clinical and Biomedical Investigations, a "track-based" program to train clinical fellows and junior faculty in research methodology leading to publications and/or a grant proposal. In 1998, he was one of two recipients of the USC Associates Award for Excellence in Teaching, in recognition of his programmatic development and mentoring of students. In 2006, Dr. Azen received an honoary Doctorate in Biomedical Innovations from the University of Salerno, Italy. Dr. Azen is also the Director of the Statistical Consultation and Research Center at USC. The Center is actively involved in the design, conduct and analysis of clinical trials in cancer, cardiovascular disease, diabetes, gerontology and ophthalmology. Research studies range from the evaluation of vitamin B supplements on coronary artery disease to determining the prevalence and risk factors of ocular disease in Latinos and in a multi-ethnic cohort of children.

Research Interests

Dr. Azen has published over 300 scientific papers and two textbooks, including a scientific publication appearing in the Journal of the American Medical Association reporting the benefit of a Lifestyle Redesign® program in independent-living older adults. This study was reported on national radio and television, and had a Nielsen rating of 12.1 million people. Dr. Azen is also the founding editor and Editor-in-Chief of Computational Statistics and Data Analysis, the official journal of the International Association of Statistical Computing, published by Elsevier in Holland. Finally, Dr. Azen continues his career as a professional pianist, performing at two well-known Pasadena restaurants. He has released three albums entitled: "Regressive Moments", "Timed Series", and "Clustering En Stanza".

Education

Doctor of Philosophy (PhD) in Biostatistics
University of California, Los Angeles
1969

Master of Arts (MA) in Mathematics
University of California, Los Angeles
1962

Bachelor of Arts (BA) in Mathematics
University of California, Los Angeles
1960

Publications

Journal Articles

Mazhar, K., Varma, R., Choudhury, F., Mckean-Cowdin, R., Shtir, C. J., & AzenLos Angeles Latino Eye Study Group, S. P. (2011). Severity of diabetic retinopathy and health-related quality of life: The Los Angeles Latino Eye Study. Ophthalmology, 118(4), 649-655. Abstract →← Abstract 

OBJECTIVE: To assess the impact of diabetic retinopathy (DR) and its severity on health-related quality of life (HRQOL) in a population-based sample of Latinos with type 2 diabetes mellitus (DM).
 
DESIGN: Cross-sectional population-based study, the Los Angeles Latino Eye Study (LALES).
 
PARTICIPANTS: We included 1064 LALES participants with DM.
 
METHODS: We measured HRQOL by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and the Medical Outcomes Study 12-item Short Form Health Survey (SF-12). We assessed DR by masked standardized grading of stereoscopic photographs from 7 standard fields. Severity of DR in eyes was graded using a modified Airlie House classification. The severity scores from each eye were then concatenated to create a single per person grade ranging from 1 (no DR in either eye) to 15 (bilateral PDR). Multiple linear regression analyses were performed to determine the independent relationship between severity of DR and HRQOL after adjusting for covariates.
 
MAIN OUTCOME MEASURES: Scores on the NEI-VFQ-25 and SF-12.
 
RESULTS: More severe DR was associated with worse HRQOL scores on all of the NEI-VFQ-25 and SF-12 subscales (P<0.05). Individuals with DR from grade 2 (minimum nonproliferative diabetic retinopathy [NPDR]) through grade 8 (unilateral moderate NPDR) show a modest decline in HRQOL. However, the decline becomes significantly steeper between steps 8 (unilateral moderate NPDR) and 9-15 (bilateral moderate NPDR to bilateral PDR). The domains with the most significant impact were for vision-related daily activities, dependency, and mental health.
 
CONCLUSIONS: Greater severity of DR was associated with lower general and vision-specific HRQOL. Persons with bilateral moderate NPDR had the most substantial decrease in quality of life compared with those with less severe DR. The prevention of incident DR and, more important, its progression from unilateral to bilateral NPDR is likely to have a positive impact on a person's HRQOL and should be considered an important goal in management of individuals with DM.

Duncan, P. W., Sullivan, K. J., Behrman, A. L., Azen, S. P., Wu, S. S., Nadeau, S. E., Dobkin, B. H., Rose, D. K., Tilson, J. K., Cen, S., & Hayden, S. K. (2011). Body-weight-supported treadmill rehabilitation after stroke. New England Journal of Medicine, 364(21), 2026-2036. Abstract →← Abstract 

BACKGROUND: Locomotor training, including the use of body-weight support in treadmill stepping, is a physical therapy intervention used to improve recovery of the ability to walk after stroke. The effectiveness and appropriate timing of this intervention have not been established.
 
METHODS: We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment--moderate (able to walk 0.4 to <0.8 m per second) or severe (able to walk <0.4 m per second)--and randomly assigned them to one of three training groups. One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred (early locomotor training), the second group received this training 6 months after the stroke had occurred (late locomotor training), and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke (home-exercise program). Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks. The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke.
 
RESULTS: At 1 year, 52.0% of all participants had increased functional walking ability. No significant differences in improvement were found between early locomotor training and home exercise (adjusted odds ratio for the primary outcome, 0.83; 95% confidence interval [CI], 0.50 to 1.39) or between late locomotor training and home exercise (adjusted odds ratio, 1.19; 95% CI, 0.72 to 1.99). All groups had similar improvements in walking speed, motor recovery, balance, functional status, and quality of life. Neither the delay in initiating the late locomotor training nor the severity of the initial impairment affected the outcome at 1 year. Ten related serious adverse events were reported (occurring in 2.2% of participants undergoing early locomotor training, 3.5% of those undergoing late locomotor training, and 1.6% of those engaging in home exercise). As compared with the home-exercise group, each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment (P=0.008). Among patients with severe walking impairment, multiple falls were more common in the group receiving early locomotor training than in the other two groups (P=0.02).
 
CONCLUSIONS: Locomotor training, including the use of body-weight support in stepping on a treadmill, was not shown to be superior to progressive exercise at home managed by a physical therapist.

Clark, F. A., Jackson, J. M., Carlson, M. E., Chou, C. P., Cherry, B. J., Jordan-Marsh, M., Knight, B. G., Mandel, D., Blanchard, J., Granger, D. A., Wilcox, R. R., Lai, M. Y., White, B. A., Hay, J. W., Lam, C., Marterella, A., & Azen, S. P. (2011). Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: results of the Well Elderly 2 Randomised Controlled Trial. Journal of Epidemiology and Community Health, . Abstract →← Abstract 

BACKGROUND: Older people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people.
 
METHODS: A randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60-95 years (mean age 74.9±7.7 years; 53% <$12 000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area.
 
RESULTS: Intervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps<0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p<0.02), which was achieved cost-effectively (US $41 218/UK £24 868 per unit). No intervention effect was found for cognitive functioning outcome measures.
 
CONCLUSIONS: A lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people.

Jackson, J. M., Mandel, D., Blanchard, J., Carlson, M. E., Cherry, B. J., Azen, S. P., Chou, C. P., Jordan-Marsh, M., Forman, T., White, B. A., Granger, D., Knight, B. G., & Clark, F. A. (2009). Confronting challenges in intervention research with ethnically diverse older adults: The USC Well Elderly II Trial. Clinical Trials, 6, 90-101. Abstract →← Abstract 

Community-dwelling older adults are at risk for declines in physical health, cognition, and psychosocial well-being. However, their enactment of active and health-promoting lifestyles can reduce such declines. The purpose of this article is to describe the USC Well Elderly II study, a randomized clinical trial designed to test the effectiveness of a healthy lifestyle program for elders, and document how various methodological challenges were addressed during the course of the trial. In the study, 460 ethnically diverse elders recruited from a variety of sites in the urban Los Angeles area were enrolled in a randomized experiment involving a crossover design component. Within either the first or second 6-month phase of their study involvement, each elder received a lifestyle intervention designed to improve a variety of aging outcomes. At 4-5 time points over an 18-24 month interval, the research participants were assessed on measures of healthy activity, coping, social support, perceived control, stress-related biomarkers, perceived physical health, psychosocial well-being, and cognitive functioning to test the effectiveness of the intervention and document the process mechanisms responsible for its effects. The study protocol was successfully implemented, including the enrollment of study sites, the recruitment of 460 older adults, administration of the intervention, adherence to the plan for assessment, and establishment of a large computerized data base. Methodological challenges were encountered in the areas of site recruitment, participant recruitment, testing, and intervention delivery. The completion of clinical trials involving elders from numerous local sites requires careful oversight and anticipation of threats to the study design that stem from: (a) social situations that are particular to specific study sites; and (b) physical, functional, and social challenges pertaining to the elder population.

Sanossian, N., Wu, J., Azen, S. P., & Varma, R. (2008). Prevalence and risk factors for cerebrovascular disease in community-dwelling Latinos. Clinical Neurology and Neurosurgery, 110(10), 985-987. Abstract →← Abstract 

OBJECTIVES: Surveys on stroke prevalence may provide valuable information for planning of healthcare services. Few such studies have been conducted in Latinos and none have been performed in Los Angeles, a County that contains the largest population of Latinos in the United States. We sought to assess the prevalence of self-reported stroke in a population-based sample of community-dwelling Latinos in Los Angeles.
 
PATIENTS AND METHODS: The group comprised of self-identified Latinos aged 40 years and older from six census tracts in Los Angeles participating in a population-based cross-sectional study of ocular disease in Latinos, The Los Angeles Latino Eye Study (LALES). The prevalence of stroke and its association with demographic, biological and behavioral risk factors was determined. Univariate and multiple stepwise logistic regression models were used to calculate odds ratios (ORs).
 
RESULTS: The prevalence of self-reported stroke in 6954 community-dwelling Latinos in Los Angeles was 3.3%. Stroke prevalence increased with age (1.4% age 40-50, 3.3% age 50-65, 7.1% age >65), history of hypertension (OR 2.6, p<0.001), heart disease (OR 4.8, p<0.001) and diabetic retinopathy (OR 2.1, p=0.01).
 
CONCLUSIONS: Renewed efforts directed at early identification and treatment of hypertension and heart disease within the Latino community will mitigate the burden of stroke.

Winstein, C. J., Rose, D. K., Tan, S. M., Lewthwaite, R., Chui, H. C., & Azen, S. P. (2004). A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: A pilot study of immediate and long-term outcomes. Archives of Physical Medicine and Rehabilitation, 85(4), 620-628. Abstract →← Abstract 

OBJECTIVE: To evaluate the immediate and long-term effects of 2 upper-extremity rehabilitation approaches for stroke compared with standard care in participants stratified by stroke severity.
 
DESIGN: Nonblinded, randomized controlled trial (baseline, postintervention, 9mo) design.
 
SETTING: Inpatient rehabilitation hospital and outpatient clinic.
 
PARTICIPANTS: Sixty-four patients with recent stroke admitted for inpatient rehabilitation were randomized within severity strata (Orpington Prognostic Scale) into 1 of 3 intervention groups. Forty-four patients completed the 9-month follow-up.
 
INTERVENTIONS: Standard care (SC), functional task practice (FT), and strength training (ST). The FT and ST groups received 20 additional hours of upper-extremity therapy beyond standard care distributed over a 4- to 6-week period.
 
MAIN OUTCOME MEASURES: Performance measures of impairment (Fugl-Meyer Assessment), strength (isometric torque), and function (Functional Test of the Hemiparetic Upper Extremity [FTHUE]).
 
RESULTS: Compared with SC participants, those in the FT and ST groups had significantly greater increases in Fugl-Meyer motor scores (P=.04) and isometric torque (P=.02) posttreatment. Treatment benefit was primarily in the less severe participants, where improvement in FT and ST group Fugl-Meyer motor scores more than doubled that of the SC group. Similar results were found for the FTHEU and isometric torque. During the long term, at 9 months, the less severe FT group continued to make gains in isometric muscle torque, significantly exceeding those of the ST group (P<.05).
 
CONCLUSIONS: Task specificity and stroke severity are important factors for rehabilitation of arm use in acute stroke. Twenty hours of upper extremity-specific therapy over 4 to 6 weeks significantly affected functional outcomes. The immediate benefits of a functional task approach were similar to those of a resistance-strength approach, however, the former was more beneficial in the long-term.

Gilliland, S. S., Azen, S. P., Perez, G. E., & Carter, J. S. (2002). Strong in body and spirit: Lifestyle intervention for Native American adults with diabetes in New Mexico. Diabetes Care, 25(1), 78-83. Abstract →← Abstract 

OBJECTIVE: To determine the effects of a culturally appropriate diabetes lifestyle intervention for Native Americans on risk factors for complications of diabetes.
 
RESEARCH DESIGN AND METHODS: A nonrandomized, community-based diabetes intervention trial was conducted in three Native American sites in New Mexico from 1993-1997. Participants were assigned to intervention or control based on community of residence. Intervention sessions were held approximately 6 weeks apart over approximately 10 months. The intervention was delivered in site A in family and friends (FF) groups (n = 32); site B received the same intervention in one-on-one (OO) appointments (n = 39); and site C received usual medical care (UC) (n = 33) (total participants, n = 104). Primary change in HbA(1c) level was assessed at 1 year.
 
RESULTS: Adjusted mean change in HbA(1c) value varied significantly across the three arms at 1 year (P = 0.05). The UC arm showed a statistically significant increase in adjusted mean HbA(1c) change (1.2%, P = 0.001), whereas both intervention arms showed a small nonsignificant (P > 0.05) increase in the adjusted mean change (0.5% and 0.2% for FF and OO arms, respectively). The increase was statistically significantly smaller in the combined intervention arms (0.4%) compared with the UC arm (1.2%, P = 0.02).
 
CONCLUSIONS: Lifestyle intervention has the potential to substantially reduce microvascular complications, mortality, and health care utilization and costs if the change is sustained over time.

Frank, G., Blackhall, L., Murphy, S. T., Michel, V., Azen, S. P., Preloran, H., & Browner, C. (2002). Ambiguity and hope: Disclosure preferences of less acculturated elderly Mexican Americans concerning terminal cancer - A case story. Cambridge Quarterly of Health Care Ethics, 11(2), 117-126. Abstract →← Abstract 

A major shift has taken place since the 1960s concerning disclosure to patients that they have a diagnosis of cancer and that their disease is considered terminal. Full disclosure is now considered the patient's right in the United States. However, there remain many countries in which nondisclosure is still the norm. When patients from those countries are diagnosed with cancer in America, differences in attitudes and expectations can cause conflict and misunderstanding.

Hay, J., LaBree, L., Luo, R., Clark, F. A., Carlson, M. E., Mandel, D., Zemke, R., Jackson, J. M., & Azen, S. P. (2002). Cost-effectiveness of preventive occupational therapy for independent-living older adults. Journal of the American Geriatrics Society, 50(8), 1381-1388. Abstract →← Abstract 

OBJECTIVES:To evaluate the cost-effectiveness of a 9-month preventive occupational therapy (OT) program in the Well-Elderly Study: a randomized trial in independent-living older adults that found significant health, function, and quality of life benefits attributable to preventive OT.
 
DESIGN:A randomized trial.
 
SETTING:Two government-subsidized apartment complexes.
 
PARTICIPANTS:One hundred sixty-three culturally diverse volunteers aged 60 and older.
 
INTERVENTION:An OT group, a social activity group (active control), and a nontreatment group (passive control).
 
MEASUREMENTS:Use of healthcare services was determined by telephone interview during and after the treatment phase. A conversion algorithm was applied to the RAND 36-item Short Form Health Survey to derive a preference-based health-related quality of life index, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio for preventive OT relative to the combined control group.
 
RESULTS:Costs for the 9-month OT program averaged $548 per subject. Postintervention healthcare costs were lower for the OT group ($967) than for the active control group ($1,726), the passive control group ($3,334), or a combination of the control groups ($2,593). The quality of life index showed a 4.5% QALY differential (OT vs combined control), P < .001. The cost per QALY estimates for the OT group was $10,666 (95% confidence interval = $6,747–$25,430). For the passive and active control groups, the corresponding costs per QALY were $13,784 and $7,820, respectively.
 
CONCLUSION:In this study, preventive OT demonstrated cost-effectiveness in conjunction with a trend toward decreased medical expenditures.

Clark, F. A., Azen, S. P., Carlson, M. E., Mandel, D., LaBree, L., Hay, J., Zemke, R., Jackson, J. M., & Lipson, L. (2001). Embedding health-promoting changes into the daily lives of independent-living older adults: Long-term follow-up of occupational therapy intervention. Journal of Gerontology: Psychological Sciences and Social Sciences, 56B, 60-63. Abstract →← Abstract 

The Well Elderly Study was a randomized trial in independent-living older adults that found significant health, function, and quality of life benefits attributable to a 9-month program in preventive occupational therapy (OT). All participants completing the trial were followed for an additional 6 months without further intervention and then reevaluated using the same battery of instruments. Long-term benefit attributable to preventive OT was found for the quality of interaction scale of the Functional Status Questionnaire and for six of eight scales on the RAND SF-36: physical functioning, role functioning, vitality, social functioning, role emotional, and general mental health (p < .05). Approximately 90% of the therapeutic gain observed following OT treatment was retained in follow-up. The finding of a sustained effect for preventive OT is of great public health relevance given the looming health care cost crisis associated with our nation's expanding elderly population.

Jackson, J. M., Kennedy, B. L., Mandel, D., Carlson, M. E., Cherry, B., Fanchiang, S., Ding, L., Zemke, R., Azen, S. P., LaBree, L., & Clark, F. A. (2000). Derivation and pilot assessment of a health promotion program for Mandarin-speaking Chinese older adults. The International Journal of Aging & Human Development, 50(2), 127-149. Abstract →← Abstract 

Describes methods used to adapt a health care program so that it would better meet the needs of a group of well, older Mandarin-speaking Chinese residents of Los Angeles. Outcomes from a pilot experiment are presented that are consistent with the notion that the adapted program was effective in reducing health-related declines among participants.

Azen, S. P., Palmer, J., Carlson, M. E., Jackson, J. M., Cherry, B., Fanchiang, S., & Clark, F. A. (1999). Psychometric properties of a Chinese translation of the SF-36 Health Survey Questionnaire in the well elderly study. Journal of Aging and Health, 11(2), 240-251. Abstract →← Abstract 

This study seeks to evaluate the psychometric properties of a Chinese translation of the 36-item Short Form Health Survey (SF-36) in the Well Elderly Study: a randomized clinical trial designed to evaluate the effectiveness of preventive occupational therapy services specifically tailored for multiethnic, independent-living, older adults. Translation and back-translation procedures were used to obtain appropriate meanings for the SF-36 survey questions and to ensure face, functional, and conceptual equivalence. Statistical analyses demonstrated satisfactory reliability and validity, with the results generally similar to those reported for older Anglo adults. As the percentage of older adults of diverse ethnicity increases, the need for health care research and service strategies that can effectively include multiple ethnicities becomes paramount. The results of this study suggest that a Chinese translated SF-36 can be used to assess multiple dimensions of health in a Mandarin-speaking population of older adults.

Blackhall, L., Frank, G., Murphy, S. T., Michel, V., Palmer, J., & Azen, S. P. (1999). Ethnicity and attitudes towards life sustaining technology. Social Science and Medicine, 48(12), 1779-1789. Abstract →← Abstract 

The ethical and legal implications of decisions to withhold and withdraw life support have been widely debated. Making end-of-life decisions is never easy, and when the cultural background of doctor and patient differ, communication about these issues may become even more difficult. In this study, we examined the attitudes of people aged 65 and older from different ethnic groups toward foregoing life support. To this end, we conducted a survey of 200 respondents from each of four ethnic groups: European-American, African-American, Korean-American and Mexican-American (800 total), followed by in-depth ethnographic interviews with 80 respondents. European-Americans were the least likely to both accept and want life-support (p < 0.001). Mexican-Americans were generally more positive about the use of life-support and were more likely to personally want such treatments (p < 0.001). Ethnographic interviews revealed that this was due to their belief that life-support would not be suggested if a case was truly hopeless. Compared to European-Americans, Korean-Americans were very positive regarding life-support (RR = 6.7, p < 0.0001); however, they did not want such technology personally (RR = 1.2, p = 0.45). Ethnographic interviews revealed that the decision of life support would be made by their family. Compared to European-Americans, African-Americans felt that it was generally acceptable to withhold or withdraw life-support (RR = 1.6, p = 0.06), but were the most likely to want to be kept alive on life-support (RR = 2.1, p = 0.002). Ethnographic interviews documented a deep distrust towards the health care system and a fear that health care was based on one's ability to pay. We concluded that (a) ethnicity is strongly related to attitudes toward and personal wishes for the use of life support in the event of coma or terminal illness, and (b) this relationship was complex and in some cases, contradictory.

Frank, G., Blackhall, L., Michel, V., Murphy, S. T., Azen, S. P., & Park, K. (1998). A discourse of relationships in bioethics: Patient autonomy and end-of-life decision-making among elderly Korean-Americans. Medical Anthropology Quarterly, 12(4), 403-423. Abstract →← Abstract 

A two-year, multidisciplinary study (N = 800) was conducted on attitudes about end-of-life decision making among elderly individuals in four ethnic groups (African American, European American, Korean American, and Mexican American). On a quantitative survey, Korean Americans reported negative attitudes about the use of life-sustaining technology for themselves but positive attitudes about its use in general. This article reports on an interview with a 79-year-old typical Korean American respondent to explain the contradiction in the survey data. Expectations among elderly Korean Americans include protecting family members with a life-threatening illness from being informed of their diagnosis and prognosis, and doing everything to keep them alive. Two conclusions, one substantive and the other methodological, are drawn: First, the bioethics discourse on individual rights (patientautonomy) is insufficient to explain the preferences of many Korean Americans and must be supplemented with a discourse on relationships. Second, the rigorous use of qualitative, narrative methods clarifies quantitative data and should not be dismissed as "anecdotal." fbioethics, endof- life decision making, ethnicity, Asian Americans, qualitative methods, narrative]

Clark, F. A., Azen, S. P., Zemke, R., Jackson, J. M., Carlson, M. E., Hay, J., Mandel, D., Josephson, K., Cherry, B., Hessel, C., Palmer, J., & Lipson, L. (1997). Occupational therapy for independent-living older adults: A randomized controlled trial. Journal of the American Medical Association, 278(16), 1321-1326. Link to full text Abstract →← Abstract 

Preventive health programs may mitigate against the health risks of older adulthood. OBJECTIVE: To evaluate the effectiveness of preventive occupational therapy (OT) services specifically tailored for multiethnic, independent-living older adults. Design.-A randomized controlled trial. SETTING: Two government subsidized apartment complexes for independent-living older adults. SUBJECTS: A total of 361 culturally diverse volunteers aged 60 years or older. INTERVENTION: An OT group, a social activity control group, and a nontreatment control group. The period of treatment was 9 months. MAIN OUTCOME MEASURES: A battery of self-administered questionnaires designed to measure physical and social function, self-rated health, life satisfaction, and depressive symptoms. RESULTS: Benefit attributable to OT treatment was found for the quality of interaction scale on the Functional Status Questionnaire (P=.03), Life Satisfaction Index-Z (P=.03), Medical Outcomes Study Health Perception Survey (P=.05), and for 7 of 8 scales on the RAND 36-Item Health Status Survey, Short Form: bodily pain (P=.03), physical functioning (P=.008), role limitations attributable to health problems (P=.02), vitality (P=.004), social functioning (P=.05), role limitations attributable to emotional problems (P=.05), and general mental health (P=.02). CONCLUSIONS: Significant benefits for the OT preventive treatment group were found across various health, function, and quality-of-life domains. Because the control groups tended to decline over the study interval, our results suggest that preventive health programs based on OT may mitigate against the health risks of older adulthood.

Murphy, S. T., Palmer, J., Azen, S. P., Frank, G., Michel, V., & Blackhall, L. (1996). Ethnicity and advance care directives. Journal of Law, Medicine & Ethics, 24(2), 108-117.

Blackhall, L., Murphy, S., Frank, G., Michel, V., & Azen, S. P. (1995). Ethnicity and attitudes toward patient autonomy. Journal of the American Medical Association, 274(10), 820-825. Abstract →← Abstract 

OBJECTIVE--To study differences in the attitudes of elderly subjects from different ethnic groups toward disclosure of the diagnosis and prognosis of a terminal illness and toward end-of-life decision making. DESIGN--Survey. SETTING--Thirty-one senior citizen centers within Los Angeles County, California. RESPONDENTS--A stratified quota sample of 200 subjects aged 65 years and older self-identified as being from each of four ethnic groups: European American, African American, Korean American, or Mexican American (N = 800). MAIN OUTCOME MEASURES AND RESULTS--Korean Americans (47%) and Mexican Americans (65%) were significantly less likely than European Americans (87%) and African Americans (88%) to believe that a patient should be told the diagnosis of metastatic cancer. Korean Americans (35%) and Mexican Americans (48%) were less likely than African Americans (63%) and European Americans (69%) to believe that a patient should be told of a terminal prognosis and less likely to believe that the patient should make decisions about the use of life-supporting technology (28% and 41% vs 60% and 65%). Instead, Korean Americans and Mexican Americans tended to believe that the family should make decisions about the use of life support. On stepwise multiple logistic regression, ethnicity was the primary factor related to attitudes toward truth telling and patient decision making. CONCLUSIONS--Korean-American and Mexican-American subjects were more likely to hold a family-centered model of medical decision making rather than the patient autonomy model favored by most of the African-American and European-American subjects. This finding suggests that physicians should ask their patients if they wish to receive information and make decisions or if they prefer that their families handle such matters.

Saeki, K., Clark, F. A., & Azen, S. P. (1985). Performance of Japanese and Japanese-American children on the Motor Accuracy Revised and Design Copying Test: A cross-cultural study. American Journal of Occupational Therapy, 39(2), 103-109. Link to full text Abstract →← Abstract 

This study investigates whether cultural differences affect childrens' performances on the Design Copying (DC) and Motor Accuracy-Revised (MAC-R) Tests of the Southern California Sensory Integration Tests. The DC and the MAC-R were administered to 98 children who were born in Japan and lived there at least during the first year of life and to 82 children who were of Japanese descent but who were born in America. Average test scores of the Japanese and Japanese-American children were compared with those of the American children, on whom the tests were standardized. Results of the tests requiring right-hand performance revealed that both groups of Japanese-descent children performed better than the standardization group of American children; the Japan-born children performed the best. We base these findings on the influence that culture has on the development of a child.

Shuer, J., Clark, F. A., & Azen, S. P. (1980). Vestibular function in mildly mentally retarded adults. American Journal of Occupational Therapy, 34(10), 664-670. Link to full text Abstract →← Abstract 

The purpose of this study was to compare the duration of nystagmus in mildly mentally retarded and normal adults as measured by the Southern California Postrotary Nystagmus Test. The results revealed that the retarded males demonstrated attenuated duration of nystagmus. These findings support the need for further investigation of possible sensory integrative deficits in this population so that proper treatment can be provided.

Clark, F. A., Miller, L., Thomas, J., Kucherawy, D., & Azen, S. P. (1978). A comparison of operant and sensory integrative methods on developmental parameters in profoundly retarded adults. American Journal of Occupational Therapy, 32, 86-92.

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