bluuebunny/crossref_metadata_2025 huggingface dataset:
Alzheimer's Disease and Driving: Prediction and Assessment of Driving Performance
Authors: Fox Gillian K. , Bowden Stephen C. , Bashford Guy M. , Smith Dennis S.
Published: April 2015

OBJECTIVES: To examine driving competence in a group of drivers diagnosed with probable Alzheimer's Disease (AD) in terms of a standardized open road evaluation and expert judgments. To examine the validity of a standardized medical examination, including administration of the Mini‐Mental Status Exam (MMSE), and a standardized neuropsychological assessment as predictors of open road driving performance.

DESIGN: A prospective investigation with consecutively referred subjects.

SETTING: Coorabel Driver Assessment Centre, Royal Rehabilitation Centre Sydney, Australia.

PARTICIPANTS: Nineteen subjects with a diagnosis of probable AD.

MEASUREMENTS: A standardized clinical medical examination, a standardized neuropsychological assessment, and a standardized open road driving evaluation. The driving evaluation provided a correct driving actions score. The outcome measure was the expert judges' rating of overall driving competence, which was termed the final on‐road result.

RESULTS: Seven subjects passed the on‐road driving evaluation, and 12 failed. MMSE was found to be a significant predictor of final on‐road result. The physician's prediction, the neuropsychology test scores, and the neuropsychologist's prediction were not found to be significantly associated with the final on‐road result. The on‐road driving evaluation was a reliable test.

CONCLUSION: Inasmuch as all subjects except one were still driving and all wished to continue to drive, it is important to note that 63.2% of subjects failed the on‐road evaluation. Conversely, 36.8% were judged safe to drive, suggesting that AD diagnosis alone may be insufficient criteria for cessation of driving. A standardized road test may be the only appropriate means of determining driving competence in people diagnosed with AD.
Preadipocyte Function and Aging: Links Between Age‐Related Changes in Cell Dynamics and Altered Fat Tissue Function
Authors: Kirkland James L. , Dobson Deborah E.
Published: April 2015

OBJECTIVE: To review recent findings about changes with age in the replication and differentiation of preadipocytes, the progenitor cells in fat tissue that are capable of differentiating into fat cells, and to examine possible links between these alterations and age‐related changes in fat tissue function.

DESIGN: A survey and analysis of recent literature concerning changes in preadipocyte and fat cell function with age.

CONCLUSIONS: Intrinsic aging changes in fat cells and preadipocytes as well as in factors extrinsic to fat tissue (such as food intake and absorption and hormonal status) contribute to age‐related alterations in fat tissue function and cellularity. Changes with age in preadipocyte number, replicative potential, and capacity for differentiation, which may be linked to aging changes in fat cell size, number, and function, have been identified. The decline in preadipocyte capacity for differentiation and the associated decline in fat cell lipogenic capacity may be particularly important in contributing to the decrease in fat mass and alterations in fat tissue function that occur between middle‐ and old age. These declines result from blunting of the changes in gene expression that occur during preadipocyte differentiation and may, in turn, be related to altered regulation of particular transcription factors that control the preadipocyte differentiation program and maintenance of fat cell function.
Association of the Resident Assessment Instrument (RAI) with Changes in Function, Cognition, and Psychosocial Status
Authors: Phillips Charles D. , Morris John N. , Hawes Catherine , Fries Brant E. , Mor Vincent , Nennstiel Marianne , Iannacchione Vincent
Published: April 2015

OBJECTIVE: To evaluate the impact of the Resident Assessment Instrument (RAI) on changes in nursing home residents' functional status, cognitive status, and psychosocial well‐being.

DESIGN: A quasi‐experiment involving the collection of longitudinal data on two cohorts of nursing home residents. One cohort was assessed before the implementation of the RAI, and the other was assessed after the implementation of the new assessment process.

SETTING AND PARTICIPANTS: Over 2000 nursing home residents in 267 nursing homes located in 10 geographic areas were assessed during the pre‐RAI period. In the post‐RAI period, 2000 new residents in 254 of the same facilities were assessed.

INTERVENTION: RAI implementation began in October 1990 and continued until October 1991. The RAI includes a structured, multidimensional resident assessment and problem identification system designed to form the basis for residents' care plans.

MEASUREMENTS: All residents were assessed at baseline and at 6 months using the Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS) and its protocols. All data were collected by research nurses employed and trained by the research team.

RESULTS: Implementation of the RAI significantly reduced the rate of decline in seven of the nine outcomes under consideration. Reductions in improvement were also observed in all outcomes. In activities of daily living, social engagement, and cognitive function, the reduced decline far outweighed any reductions in improvement. In mood problems, problem behaviors, and understanding others, however, reductions in improvement were greater than any reductions in decline. Changes in the rates of decline and improvement were not uniform across all residents.

CONCLUSION: The RAI may have improved the quality of care of nursing home residents by reducing overall rates of decline in important areas of resident function. However, this innovation may have generated trade‐offs in that it may have reduced improvement rates in some areas of function. The system's implementation also seems to have focused staff's attention on the needs and strengths of specific subpopulations of residents. Revisions of the RAI must assist staff in generalizing their efforts to all residents and to increasing improvement rates, especially in areas related to mood and behavior.
A Commitment to Change: Revision of HCFA's RAI
Authors: Morris John N. , Nonemaker Sue , Murphy Katharine , Hawes Catherine , Fries Brant E. , Mor Vincent , Phillips Charles
Published: April 2015

OBJECTIVE: To describe the reliability of new assessment items and their clinical utility as judged by experienced nurse assessors, based on the results from the field test of Version 2.0 of the Resident Assessment Instrument (RAI).

DESIGN: Independent dual assessment of residents of nursing facilities by staff nurses using a draft of Version 2.0 of the minimum data set (MDS).

SETTING AND PARTICIPANTS: A total of 187 randomly selected residents from 21 nursing homes in seven states volunteered to test Version 2.0 of the MDS.

MEASUREMENT: The full array of MDS assessment items included measures in the following areas: Background information, cognitive patterns, communication/hearing, vision, mood and behavior, psychosocial well‐being, physical functioning and structural problems, continence, disease diagnoses, health condition, oral/nutritional status, dental status, skin condition, activity pursuit patterns, medications, special treatments and procedures, and discharge potential and overall status.

RESULTS: Evaluative data address issues of MDS item utility and reliability. For new items, almost all achieved a reasonably high‐weighted Kappa interrater reliability; revised items also surpassed earlier items, and with the updated training materials, even the non‐changed items had higher average reliability levels. Based on the success of the field test and the positive response of the industry, Version 2.0 of the RAI has been adopted, and HCFA has initiated a more long‐range process to update further the RAI when necessary.

CONCLUSION: Findings support the reliability and clinical utility of the new and revised assessment items incorporated by HCFA in Version 2.0 of the MDS.
Comprehensive Clinical Assessment in Community Setting: Applicability of the MDS‐HC
Authors: Morris John N. , Fries Brant E. , Steel Knight , Ikegami Naoki , Bernabei Roberto , Carpenter G. Iain , Gilgen Ruedi , Hirdes John P. , Topinková Eva
Published: April 2015

OBJECTIVE: To describe the results of an international trial of the home care version of the MDS assessment and problem identification system (the MDS‐HC), including reliability estimates, a comparison of MDS‐HC reliabilities with reliabilities of the same items in the MDS 2.0 nursing home assessment instrument, and an examination of the types of problems found in home care clients using the MDS‐HC.

DESIGN: Independent, dual assessment of clients of home‐care agencies by trained clinicians using a draft of the MDS‐HC, with additional descriptive data regarding problem profiles for home care clients.

SETTING AND PARTICIPANTS: Reliability data from dual assessments of 241 randomly selected clients of home care agencies in five countries, all of whom volunteered to test the MDS‐HC. Also included are an expanded sample of 780 home care assessments from these countries and 187 dually assessed residents from 21 nursing homes in the United States.

MEASUREMENTS: The array of MDS‐HC assessment items included measures in the following areas: personal items, cognitive patterns, communication/hearing, vision, mood and behavior, social functioning, informal support services, physical functioning, continence, disease diagnoses, health conditions and preventive health measures, nutrition/hydration, dental status, skin condition, environmental assessment, service utilization, and medications.

RESULTS: Forty‐seven percent of the functional, health status, social environment, and service items in the MDS‐HC were taken from the MDS 2.0 for nursing homes. For this item set, it is estimated that the average weighted Kappa is .74 for the MDS‐HC and .75 for the MDS 2.0. Similarly, high reliability values were found for items newly introduced in the MDS‐HC (weighted Kappa = .70). Descriptive findings also characterize the problems of home care clients, with subanalyses within cognitive performance levels.

CONCLUSION: Findings indicate that the core set of items in the MDS 2.0 work equally well in community and nursing home settings. New items are highly reliable. In tandem, these instruments can be used within the international community, assisting and planning care for older adults within a broad spectrum of service settings, including nursing homes and home care programs. With this community‐based, second‐generation problem and care plan‐driven assessment instrument, disability assessment can be performed consistently across the world.
Depression Without Sadness: Functional Outcomes of Nondysphoric Depression in Later Life
Authors: Gallo Joseph J. , Rabins Peter V. , Lyketsos Constantine G. , Tien Allen Y. , Anthony James C.
Published: April 2015

OBJECTIVES: We hypothesized that depressive symptoms not meeting full standard criteria for Major Depression would be associated with significant functional impairment among older adults over the course of a 13‐year follow‐up interval. Specifically, we developed criteria for a form of depression whose core symptoms did not include sadness or dysphoria.

DESIGN: Population‐based 13‐year follow‐up survey.

SETTING: Community‐dwelling adults living in East Baltimore in 1981.

PARTICIPANTS: Subjects were the 1612 participants of the Baltimore sample of the Epidemiologic Catchment Area Program aged 50 years and older at the initial interview in 1981.

MEASUREMENTS: The subjects were sorted into four categories based on their responses at baseline: (1) persons meeting standard criteria for Major Depression; (2) persons meeting alternative criteria for depression with dysphoria or (3) without dysphoria; and (4) a comparison category of persons not meeting any criteria for depression (“non‐cases”). The mortality and functional status of each group were compared after a 13‐year follow‐up interval.

RESULTS: Compared with non‐cases, participants aged 50 years and older who reported depressive symptoms but who denied sadness or dysphoria (nondysphoric depression) were at increased risk for death (relative risk (RR) = 1.70; 95% confidence interval (CI) (1.09, 2.67)), impairment in activities of daily living (RR = 3.76; 95% CI (1.73, 8.14)), impairment in instrumental activities of daily living (RR = 5.07; 95% CI (2.24, 11.44)), psychologic distress (RR = 3.68; 95% CI (1.47, 9.21)), and cognitive impairment (RR = 3.00; 95% CI (1.31, 6.89)) after a 13‐year follow‐up interval. The findings were not wholly explained by potentially influential baseline characteristics such as age, education, selected comorbid medical conditions, and functional status.

CONCLUSION: Among adults aged 50 years and older, nondysphoric depression may be as important as Major Depression in relation to the development of functional disability and other long‐term outcomes.
Cognitive Markers Preceding Alzheimer's Dementia in the Healthy Oldest Old
Authors: Howieson Diane B. , Dame Alison , Camicioli Richard , Sexton Gary , Payami Haydeh , Kaye Jeffrey A.
Published: April 2015

OBJECTIVE: To look for preclinical markers of Alzheimer's dementia in a sample of healthy, oldest old individuals.

DESIGN: Prospective, longitudinal study of individuals examined at yearly intervals with neuropsychological tests selected to be sensitive to the early detection of dementia.

PARTICIPANTS: One hundred and thirty‐nine community‐dwelling, functionally independent, healthy individuals 65 to 106 years of age who met strict criteria for lack of dementia at entry. Incident dementia cases consisted of 16 volunteers all 80 years old or older who developed dementia of the Alzheimer's type and 31 volunteers 80 years old and older showing no evidence of dementia during a mean 2.8‐year follow‐up interval.

MEASUREMENTS: Scores on 10 neuropsychological measures were analyzed for the initial examination when none of the volunteers showed clinical evidence of dementia and for the two subsequent yearly examinations.

RESULTS: Individuals who subsequently developed dementia showed evidence of verbal memory impairment at their initial examination, which was a mean of 2.8 years before clinical evidence of dementia. The average yearly incidence rate for dementia in those 80 years of age and older was 12%. Performance of individuals who did not development dementia remained relatively stable during follow‐up for up to 5 years.

CONCLUSION: Alzheimer's disease has a preclinical stage in which verbal memory decline is the earliest sign. Dementia in the oldest old is distinguishable from age‐related cognitive decline.
Identifying Hospitalized Older Patients At Varying Risk For Physical Performance Decline: A New Approach
Authors: Winograd Carol Hutner , Lindenberger Elizabeth C. , Chavez Catherine M. , Mauricio Maritess P. , Shi Hong , Bloch Daniel A.
Published: April 2015

OBJECTIVE: A classification tree analysis identifies patient groups at varying risk for decline in physical performance 1 year after hospitalization.

DESIGN: Prospective cohort study.

SETTING: Tertiary care VAMC.

PARTICIPANTS: A total of 507 acutely ill hospitalized male veterans aged 65 years and older.

MEASUREMENTS: Eighteen admission characteristics were considered as potential predictors: demographic data, medical diagnoses, functional status (e.g., ADL and IADL), geriatric conditions (e.g., incontinence, vision impairment, weight change), mental status, depression, and physical functioning (measured by self‐report (MOS‐PFR) and the Physical Performance and Mobility Examination (PPME)). Outcome measure was change in PPME status at 12‐months post‐admission.

RESULTS: Patients with the greatest risk for decline had both high baseline physical performance (PPME ≥ 9) and at least moderate self‐report limitations on physical functioning (MOS‐PFR ≤ 36, mean = 30.8). Patients with the lowest risk of decline had impaired baseline physical performance (PPME ≤ 8) but fewer self‐report limitations on physical functioning (MOS‐PFR ≥ 31, mean = 37.4) and two or less geriatric conditions.

CONCLUSIONS: The predictive role of self‐report functioning suggests that perception of the impact of health on one's own physical functioning is associated with future performance. The number of geriatric conditions is also an important predictor of physical performance change. By identifying patient risk groups based on geriatric conditions, physical performance, and self‐report physical functioning, future targeting strategies may improve physical performance outcomes for hospitalized older adults.
Effects of Age, Physical Training, and Physical Fitness on Coronary Heart Disease Risk Factors in Older Track Athletes at Twenty‐Year Follow‐up
Authors: Mengelkoch Larry J. , Pollock Michael L. , Limacher Marian C. , Graves James E. , Shireman Rachel B. , Riley William J. , Lowenthal David T. , Leon Arthur S.
Published: April 2015

OBJECTIVE: To compare current coronary heart disease (CHD) risk factor values in older athletes with mid‐life measures and to examine the associations between changes in CHD risk factors with aging, physical training, and physical fitness.

DESIGN: Prospective study with three longitudinal evaluation points: initial (T1), 10‐year (T2), and 20‐year (T3). Subjects were selected because of their elite status in Masters track competition.

SETTING: University and medical center laboratories

PARTICIPANTS: Participants were 60 to 92 years of age and included 21 of the initial 27 subjects. At T3, subjects were divided into three groups, based on physical activity levels: high intensity (H), remained elite in national and international competition (n = 9); moderate intensity (M) continued frequent rigorous endurance training but rarely competed (n = 10); and low intensity (L) greatly reduced their training volume and intensity (n = 2).

MEASUREMENTS: Smoking history; family history of coronary or cerebrovascular disease; resting blood pressure; resting electrocardiogram (ECG); serum total cholesterol, plasma glucose; body weight, % body fat, body mass index, waist:hip ratio; training pace and mileage; maximal oxygen consumption V̇O2 max).

MAIN RESULTS: Several risk factors (smoking, diabetes, obesity) were never present, and the prevalence of other risk factors (family history of cardiovascular disease, abnormal resting ECG) remained low through T3 (≤ 14% of subjects). Mean systolic and diastolic blood pressure remained low without medication, but diastolic blood pressure measurements had the greatest redistribution between evaluation periods of any risk factor (r = .16, P = .479, T1 to T2). Mean total cholesterol was lower at T2 (‐13%, P = .005) and T3 (‐14%, P = .019) compared with T1. Change in V̇O2 max was correlated with changes in body weight (r = ‐.44, P = .048) and % fat (r = ‐.52, P = .015) from T1 to T2, whereas age was correlated to changes in systolic blood pressure (r = ‐.61, P = .003) and total cholesterol (r = ‐.49, P = .023) from T2 to T3.

CONCLUSIONS: The prevalence of CHD risk factors remained low, and mean risk factor values remained low and generally stable in older athletes who had maintained habitual exercise training. J Am Geriatr Soc 45:1446–1453, 1997.
Hypokalemia and Potassium Excretion in Stroke Patients
Authors: Gariballa Salah E. , Robinson Thompson G. , Fotherby Martin D.
Published: April 2015

OBJECTIVES: To determine (1) the prevalence of hypokalemia (plasma potassium ≥ 3.4 mmol/L) in a group of stroke patients in comparison with age‐ and sex‐ matched groups of patients having sustained a myocardial infarction or having mild hypertension and (2) the association between plasma potassium concentration and stroke outcome.

DESIGN: Observational study.

PARTICIPANTS: A total of 421 consecutive stroke patients admitted to a teaching hospital, 150 consecutive patients 50 years or older with myocardial infarction admitted to the hospitals Coronary Care Unit, and 161 out‐patients 60 years or older with borderline and established hypertension.

MEASUREMENTS: All stroke and cardiac patients had plasma urea and electrolytes estimated within 2 hours of hospital admission; in the hypertensive group blood samples were taken in clinic. Stroke patients had blood pressure, stroke severity (Barthel score) and smoking status recorded. A sub‐group of 61 stroke patients and all 79 hypertensive patients not taking antihypertensive medication had 24‐hour urine electrolyte excretion measured. Outcome (independent, dependent, or dead) at 3 months post‐stroke was established in 349 patients.

RESULTS: Hypokalemia occurred more frequently in stroke patients than in patients with myocardial infarction (84 (20%) vs 15 (10%),P= .008) or patients with hypertension (84 (20%) vs 13 (8%),P< .001), even when patients taking diuretics were excluded from analysis (56 (19%) vs 12 (9%) of cardiac group,P= .014 and 56 (19%) vs 4 (5%) of hypertensive group,P= .005, respectively). 24‐hour urine excretion of potassium and the potassium: creatinine ratio was lower in stroke patients than in hypertensive patients (41 ± 21 vs 62 ± 25 mmol/24 hour,P= .001, 5.5 ± 2.2 vs 7.4 ± 2.6 mmol/24 hour,P= .001, respectively). On survival analysis, a lower plasma potassium on admission to hospital was associated with an increased chance of death, independent of age, stroke severity, history of hypertension, blood pressure level, or smoking history (hazard ratio 1.73 (95% CI: 1.03 − 2.9) for a 1 mmol/L lower plasma potassium concentration).

CONCLUSIONS: Hypokalemia post stroke is common and may be associated with a poor outcome. J Am Geriatr Soc 45:1454–1458, 1997.
MODELS OF GERIATRICS PRACTICE*: A Model for Nurse Case‐Managed Home Care Using Televideo
Authors: Rooney Earl M. , Studenski Stephanie A. , Roman Linda L.
Published: April 2015

OBJECTIVE: To determine the feasibility of implementing a home care program, utilizing two‐way interactive televideo, as a lower cost alternative to traditional in‐home care.

SETTING: Registered nurses used a proprietary telehome care system to provide home care services to patients in congregate senior apartments and individual patient homes during 1996.

PARTICIPANTS: A total of 46 patients from five sites in Kansas and Missouri, with multiple medical problems, who were living at home, were enrolled in the program.

INTERVENTION: All enrolled patients received an individualized, computer integrated, nursing care plan that utilized outcome‐based clinical pathways and scheduled televideo nursing interventions. All enrolled patients received a comprehensive initial in‐home assessment as well as comprehensive follow‐up in‐home assessments every 60 days. Patients received an average of four telehome care visits per week for an average of 12.25 minutes per visit. Nurses were estimated to be able to perform approximately 24 telehome care visits per day using the system.

CONCLUSIONS: A comprehensive home care program that combines two‐way interactive televideo with standardized, computerized patient assessments and care planning can provide nursing services in the home effectively. Telehome care may be a cost‐effective complement to traditional, in‐home care. J Am Geriatr Soc 45: 1523–1528, 1997.
A Survey of Management Practices for Isolated Systolic Hypertension
Authors: McAlister Finlay A. , Teo Koon K. , Laupacis Andreas
Published: April 2015

OBJECTIVE: To determine the management practices of clinicians for patients with isolated systolic hypertension, with particular attention to treatment thresholds, medication choices, and target blood pressures.

DESIGN: Self‐administered questionnaire.

SETTING: Edmonton, Alberta, a large Canadian city.

PARTICIPANTS: A random sample of 348 family physicians and 125 internists.

MEASUREMENTS: Demographics of the respondents, first and second choice of antihypertensives, treatment thresholds, and target blood pressures for patients with isolated systolic hypertension.

RESULTS: Excluding 54 nondeliverable questionnaires, a response rate of 67% (281 surveys) was obtained. The responding clinicians reported treatment thresholds and target blood pressures consistent with the evidence from randomized clinical trials and the recommendations of the Canadian Hypertension Society and the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Thiazide diuretics were recommended as first line therapy by 74% of internists and 58% of family physicians. Angiotensin converting enzyme inhibitors were the most frequently chosen second line drug (27% of internists and 45% of family physicians).

CONCLUSIONS: The reported management practices of this group of clinicians are consistent with the evidence from randomized clinical trials and the recommendations of national consensus guidelines.
CONGESTIVE HEART FAILURE IN OLDER PERSONS
Authors: Aronow Wilbert S. , Tresch Donald , Aronow Wilbert S.
Published: April 2015

OBJECTIVE: To review the management of congestive heart failure (CHF), with emphasis on older adults.

DATA SOURCES: A computer‐assisted search of the English language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.

STUDY SELECTION: Studies on the management of CHF were screened for review. Studies in older people and recent studies were emphasized.

DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving the older persons. Relevant articles were reviewed in depth.

DATA SYNTHESIS: Available data about the management of CHF, with emphasis on studies involving older people, were summarized.

CONCLUSIONS: Left ventricular ejection fraction (LVEF) should be measured in all older persons with CHF. Underlying causes of CHF should be treated when possible. Precipitating causes of CHF should be treated. Older persons with CHF associated with an abnormal LVEF should be treated with a low sodium diet and with diuretics plus angiotensin‐ converting enzyme (ACE) inhibitors. If CHF persists, digoxin should be added to the therapeutic regimen. If CHF still persists, isosorbide dinitrate plus hydralazine should be added. If CHF still persists, a beta blocker should also be used. Calcium channel blockers should not be used. Older persons with CHF associated with a normal LVEF should be treated with a low sodium diet and with diuretics plus ACE inhibitors. If CHF persists, a beta blocker or isosorbide dinitrate plus hydralazine or a calcium channel blocker should be added to the therapeutic regimen. If sinus rhythm is present, digoxin should not be used. The role of angiotensin II receptor antagonists such as losartan in the treatment of CHF is under investigation.
When Will The Biology of Aging Become Useful? Future Landmarks in Biomedical Gerontology
Authors: Miller Richard A.
Published: April 2015

Where should we look to find the causes of and cure for aging? This essay considers a number of scientific discoveries, not yet made, that might dramatically increase the proportion of biogerontologists doing useful work. I will consider, in turn, problems and prospects in the areas of comparative biology, mammalian and invertebrate genetics, biomarker research, caloric restriction, and clonal senescence and then conclude with a discussion of potential links between aging and late life disease.
Bone Mineral Density and Aortic Calcification: The Study of Osteoporotic Fractures
Authors: Vogt Molly T. , Valentin Ria San , Forrest Kimberly Y‐Z. , Nevitt Michael C. , Cauley Jane A.
Published: April 2015

OBJECTIVE: To investigate the relationship between bone mineral density (in the axial and appendicular skeleton) and calcification of the aorta.

DESIGN: Cross‐sectional study.

SETTING: Community‐based study.

PARTICIPANTS: A total of 2051 women aged 65 years and older enrolled in the Study of Osteoporotic Fractures.

MEASUREMENTS: Bone mineral density (BMD) at the hip, spine, calcaneus, proximal and distal radius; calcification of the aorta (AC); demographic and lifestyle variables; dietary history; functional status; blood pressure; anthropomorphic measures.

RESULTS: The prevalence of AC increased with age, ranging from 60% at ages 65 to 69 years to 96% at 85 years and older. BMD in women with calcified arterial plaques was lower (P < .001) when compared with those with no plaques, at all sites measured except the lumbar spine. After adjustment for age, BMD at the hip, spine and calcaneus was not associated with the presence of plaques; only a weak association between BMD and AC remained at the distal and proximal radius. The independent correlates of AC were age, smoking status, systolic blood pressure, coffee drinking, central obesity and a history of diabetes or stroke; current estrogen use was protective.

CONCLUSIONS: The results of this study indicate that osteopenia and the deposition of calcific plaques in the wall of the aorta are independent processes that occur as women age. They are probably not causally linked.
Cardiopulmonary Resuscitation Policies in Long‐Term Care Facilities
Authors: Kane Richard S. , Burns Edith A.
Published: April 2015

OBJECTIVES: To describe CPR policies and the procedures for discussing CPR policies of Wisconsin long‐term care facilities.

DESIGN: Mail survey and telephone interview.

MEASUREMENTS: Information about CPR policy, how policy is disclosed to residents and by whom, emergency medical technician team (EMT) response time, and number of CPR attempts during 1993.

RESULTS: The 1994 survey response rate was 85% (346/404 facilities). Four percent of responding facilities maintain a policy of never initiating CPR. Another 23% never initiate CPR but would call an EMT. Lack of efficacy was the usual basis for policies never initiating CPR. About 15% of facilities would initiate CPR only on residents who had previously indicated a preference. On individuals who had not made an advanced directive decision, 57% of facilities would initiate CPR in the event of an arrest. Almost 30% of facilities offering CPR would initiate CPR on unwitnessed arrests. Approximately 51% of all facilities assigned a social worker alone to discuss CPR policy and preference, whereas 12.5% assigned a physician alone or as part of a team. During 1993, an estimated 118 attempts at CPR were reported for 172 facilities with a total of 19,596 licensed beds, for a frequency of one CPR attempt per 166 beds per year.

CONCLUSIONS: Poor efficacy in this population was the main reason given for policies of never initiating CPR. Specific factors relating to CPR efficacy, such as EMT response time and ease of maintaining trained staff, were not major influences. Almost 30% of facilities offering CPR would perform it in unwitnessed situations, despite unlikely success. Many decisions about CPR may not be fully informed as nurses and physicians are not often assigned to discuss advance directives with residents or surrogates. Utilization of CPR in nursing homes offering resuscitation is low.
Sleep Disturbances in Parkinson's Disease Patients and Spouses
Authors: Smith Marcia C. , Ellgring Heiner , Oertel Wolfgang H.
Published: April 2015

OBJECTIVES: The prevalence of self‐rated sleep disturbance in patients with Parkinson's disease (PD) and their spouses was compared with healthy controls, and the association of sleep disturbance with demographic, psychological, and disease variables was assessed.

DESIGN: The sleep ratings from three groups, PD patients, their spouses, and healthy controls, were compared using analyses of variance. Stepwise regressions were used to predict sleep disturbance for each group and gender.

SETTING: Participants completed questionnaires as part of a nationwide survey in Germany.

PARTICIPANTS: Participants included 153 PD‐spouse pairs and a group of 103 healthy controls.

MEASUREMENTS: Zung Self‐Rating Depression Scale and self‐ratings of sleep disturbance, stress level, and disease symptoms (for PD patients).

RESULTS: Sleep disturbances were significantly higher in women than in men in all groups. For PD patients, sleep disturbance occurred frequently in 25% of male and 41% of female participants and was best predicted by the patient's depression rating. For spouses, frequent sleep disturbance was reported by 27% of male and 48% of females and was likewise predicted by the spouse's own rating of depression. A second, relatively less common type of sleep disturbance was also reported by spouses. This disturbance was associated with waking during the night to help the patient and was best predicted by patient factors.

CONCLUSION: Improvement of sleep quality of caregivers may be an important component of treatment to reduce distress caused by PD.
Age‐Related Changes in Facial Skin Contours and Rheology
Authors: Henry Frédérique , Piérard‐Franchimont Claudine , Cauwenbergh Geert , Piérard Gérald E.
Published: April 2015

OBJECTIVES: To evaluate the age effect on both the mechanical properties and wrinkling of facial skin. This topic has not previously been addressed in the literature.

DESIGN: A total of 180 white women aged 18 to 67 years participated in the study. Each of the 5 decades of age was represented by 30 subjects, with the exception of menopausal women aged 48 to 57 years who were allocated to two groups of 30 according to the use or non‐use of hormone replacement therapy (HRT).

SETTING: A University medical center, Belgian SSTC Research Unit 5596.

MEASUREMENTS: Mechanical properties of the skin were measured on the face using a computerized suction device. Skin contours were assessed using optical profilometry and computerized image analysis.

RESULTS: Skin aging of the face is characterized by a progressive increase in extensibility associated with a decreased elasticity. The loss of tonicity is accompanied by a progressive deepening of facial creases. HRT appears to limit the age‐related rheological changes without showing a preventive effect on wrinkling of facial skin.

CONCLUSION: Aging of facial skin resembles, in some ways, the features previously reported on sun‐protected areas of the forearms. HRT has a beneficial effect that may slow the overall process of aging without, however, limiting the number and depth of wrinkles.
Effect of a Single Dose of Diazepam on Balance Measures in Older People
Authors: Cutson Toni M. , Gray Shelly L. , Hughes Michael A. , Carson Stanley W. , Hanlon Joseph T.
Published: April 2015

OBJECTIVE: This study examines the effect of a single dose of diazepam on a spectrum of balance measures in healthy older subjects. The measures include static (postural sway), dynamic (anterior tibialis muscle activation latency), and a complex self‐initiated task of balance (functional reach) in addition to neuropsychological tests of attention.

DESIGN: A double‐blind, two‐period, cross‐over trial.

SETTING: The community surrounding a university hospital.

PARTICIPANTS: Community‐dwelling, nonsmoking volunteers 65 years of age and older
MEASUREMENTS: Measures included response to unexpected perturbation (platform/EMG muscle latency), self‐initiated perturbation (functional reach), and a static measure of balance (postural sway). Neurocognitive tests (digital symbol substitution test, card sorting) were included to document the cognitive effect.

RESULTS: Twelve nonsmoking healthy subjects (average age = 70.4 years (66–76 years)) participated. The anterior tibialis muscle latency increased in response to a sudden perturbation with diazepam compared with placebo (TA latency 149 ms vs 142 ms, P < .001). Neurocognitive tests were adversely affected for 90 minutes after diazepam administration compared with placebo (P < .05). Other measures did not demonstrate significant effect of diazepam.

CONCLUSIONS: This is among the first reports showing that benzodiazepines affect neuromuscular processing related to balance control. Increased muscle latency to sudden perturbations may represent an effect of diazepam upon the oligosynaptic spinal reflex distinct from the sedation. Surface electromyography may be a valuable noninvasive tool for future studies of drug effect on balance and falls risk among older people.
Consistency of Physician Judgments of Capacity to Consent in Mild Alzheimer's Disease
Authors: Marson Daniel C. , McInturff Bronwyn , Hawkins Lauren , Bartolucci Alfred , Harrell Lindy E.
Published: April 2015

OBJECTIVE: To investigate the agreement of physician judgments of capacity to consent to treatment for normal and demented older adults.

DESIGN: Subjects were individually administered a standardized consent capacity interview. Physicians viewed videotapes of these interviews and made judgments of capacity to consent to treatment.

SETTING: University medical center.

PARTICIPANTS: Subjects assessed for competency (N = 45) were 16 normal older controls and 29 patients with mild Alzheimer's disease (AD). Five medical center physicians with experience assessing the competency of dementia patients were recruited from the specialties of geriatric psychiatry, geriatric medicine, and neurology.

MEASUREMENTS: Subjects were videotaped responding to a standardized consent capacity interview (SCCI) designed to evaluate capacity to consent to treatment. Study physicians blinded to subject diagnosis individually viewed each SCCI videotape and made a judgment of competent or incompetent to consent. Agreement of physician judgments was evaluated using percentage agreement, kappa, and logistic regression.

RESULTS: Competency judgments of physicians showed high agreement for controls but low agreement for AD patients. Physicians as a group achieved 98% judgment agreement for the controls but only 56% judgment agreement for the mild AD patients. The physician group kappa for controls was 1.00 (P < .0001) and differed significantly (P < .0001) from the physician group kappa of .14 (P = .44) for AD patients, indicative of a real difference in the ability of the study physicians to judge consistently competency across the two groups. Similarly, logistic regression analysis showed significant variability in physician judgments for the AD group (χ2 = 63.8, P < .0001) but not for the control group (χ2 = 4.1, P = 1.00). Within the AD group, pairwise analyses revealed significant judgment disagreement (P < .01) for seven of the 10 physician pairs.

CONCLUSIONS: Experienced physicians demonstrated significant agreement judging the competency of older controls, but significant disagreement judging the competency of mild AD patients. Physician judgment currently does not represent a gold standard for determining consent capacity of dementia patients. Standardized assessment instruments and clinical training may improve the agreement and accuracy of physician competency judgments.
Cognitive Models That Predict Physician Judgments of Capacity to Consent in Mild Alzheimer's Disease
Authors: Marson Daniel C. , Hawkins Lauren , McInturff Bronwyn , Harrell Lindy E.
Published: April 2015

OBJECTIVE: To identify cognitive measures that predict consent capacity of normal and demented older adults as judged by experienced physicians. This study is a companion to the physician competency judgment research reported in this issue.

DESIGN: Predictor models for competency judgments of individual physicians were developed using independent patient neuropsychological test measures and discriminant function analyses (DFA).

SETTING: University medical center.

PARTICIPANTS: Subjects were 16 normal older controls and 29 patients with mild AD (MMSE ≥ 20). Five experienced medical center physicians were recruited as competency decision‐makers.

MEASUREMENTS: Subjects were videotaped responding to a standardized consent capacity interview (SCCI) designed to evaluate capacity to consent to treatment. Interview subjects were also independently administered (off videotape) a battery of neuropsychological measures theoretically and empirically linked to competency function. Study physicians blinded to subject diagnosis and neuropsychological test performance individually viewed each SCCI videotape and made a judgment of competent or incompetent to consent to treatment. Stepwise DFA identified neuropsychological predictors of each physician's competency judgments for the full sample (N = 45). Classification DFAs determined how accurately these predictor models classified competency outcomes assigned by the individual physician.

RESULTS: Cognitive models differed across individual physicians and were related to stringency of judgments for AD patients. Under stepwise DFA, delayed verbal recall (R2 = .57, P < .0001) predicted judgments of Physician 1 (incompetency rate of 90% for AD patients), short term verbal recall (R2 = .43, P < .0001) predicted judgments of Physician 2 (incompetency rate of 52%), phonemic word fluency (R2 = .27, P < .001) predicted judgments of Physician 3 (incompetency rate of 24%), and visuomotor tracking/sequencing (R2 = .31, P < .001) predicted judgments of Physician 4 (incompetency rate of 14%). (No predictor model was available for Physician 5 as this physician found all subjects to be competent). These single predictor solutions correctly classified 93%, 87%, 87%, and 96% of cases for Physicians 1–4, respectively. Use of two predictor solutions achieved successful classification rates between 98% and 100%.

CONCLUSIONS: We identified two cognitive models of consent capacity as judged by physicians: (1) verbal recall and (2) simple executive function. The verbal recall model predicted judgments of physicians likely to find mild AD patients incompetent, whereas the executive function model predicted judgments of physicians likely to find mild AD patients competent. Assessment of verbal recall and simple executive functions may provide important information in the clinical evaluation of capacity to consent to treatment.
Assessing Attentiveness in Older Hospital Patients: Global Assessment Versus Tests of Attention
Authors: O'Keeffe Shaun T. , Gosney Margot A.
Published: April 2015

OBJECTIVES: Impairment of attentiveness is a cardinal symptom of delirium. We examined the relationship between bedside tests of attention and a global rating of attentiveness in older hospital patients and sought to identify cut‐off points on the tests of attention that might be helpful in the diagnosis of delirium.

SETTING AND PARTICIPANTS: Subjects were 110 patients admitted to an acute geriatric unit.

MEASUREMENTS: Subjects were assessed by two physicians. One physician rated global attentiveness on a 10‐cm visual analog scale following general conversation with the patient. The second physician determined whether patients met DSM‐3 criteria for delirium or dementia and administered four tests of attentiveness: Digit Span Forwards (DSF), Digit Span Backwards (DSB), Vigilance ‘A’ test (VAT), and a timed Digit Cancellation Test (DCT).

MAIN RESULTS: Of the 87 patients who completed the study, 18 were delirious and 17 demented. There was no difference between demented and delirious patients on the VAT, DSF, or MMSE tests; other comparisons between demented and delirious patients and between delirious patients and those with neither delirium nor dementia were significant. All tests of attention except DSF were significantly correlated with the global rating.

CONCLUSION: Simple bedside tests of attention can aid identification of delirium.
Aging and Cancer: The Double‐Edged Sword of Replicative Senescence
Authors: Campisi Judith
Published: April 2015

Normal cells do not divide indefinitely. This trait, termed the finite replicative life span of cells, limits the capacity for cell division by a process termed cellular or replicative senescence. Replicative senescence is thought to be a tumor suppression mechanism and also a contributor to organismic aging. This article reviews what is known about the genetics and molecular biology of cell senescence. It discusses the evidence that replicative senescence suppresses tumorigenesis, at least in young organisms, and that it also contributes to the aging of mitotic tissues. Finally, it puts forth the somewhat unorthodox view that, in older organisms, senescent cells may actually contribute to carcinogenesis.
Criteria for Enrolling Dementia Patients in Hospice
Authors: Luchins Daniel J. , Hanrahan Patricia , Murphy Kathleen
Published: April 2015

OBJECTIVE: Because survival time varies greatly, it is difficult for dementia patients to meet a key criterion for eligibility for the Medicare hospice benefit: a 6‐month survival time. We have developed criteria for the Medicare hospice benefit that include the characteristics of advanced dementia and related medical complications. The purpose of the study was to determine survival time among dementia patients who met these criteria. Additionally, because the National Hospice Organization (NHO) developed its own guidelines while the study was in progress, we retrospectively examined the application of these guidelines to our sample.

DESIGN: Two cohorts of hospice patients were studied longitudinally, each for 2 years.

SETTING: Nine Midwestern hospice programs. PARTICIPANTS: Forty‐seven patients were enrolled in home hospice and institutional hospice settings.

MEASUREMENTS: Survival time consisted of the number of days between enrollment in the hospice program and death or the end of the study. Other measures included Activities of Daily Living, ratings of Appetite, Nourishment, and Mobility, Functional Assessment Staging (FAST), a Medical Complications Checklist, and a care plan concerning the use of medications for acute illness.

RESULTS: Our hospice enrollment criteria predicted a median survival time of 4 months and a mean survival time of 6.9 months; 38% of patients survived for more than 6 months. FAST scores and Mobility ratings were significantly related to survival time. However, 41% could not be scored on the FAST as their disease progression was not ordinal. Among patients who could be scored on the FAST and who had reached Stage Seven C, their mean survival time was 3.2 months compared with 18 months among those who could be scored and had not reached this stage and 8.6 months among patients whose disease progression was not ordinal, .001. When the palliative care plans were examined, less aggressive care plans resulted in shorter survival times, P <.01.

CONCLUSION: Our hospice enrollment criteria identified a group with a median survival time of 4 months and a mean survival time of 6.9 months. Using NHO criteria relying on the FAST allows the identification of a subgroup with very high mortality and a short time until death. Although the FAST can identify a subgroup of appropriate candidates for hospice, sole reliance on this measure might decrease access to hospice care for many dementia patients. J Am Geriatr Soc 45: 1054–1059, 1997.