bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Voluntary Weight Loss on Bone Mineral Density in Older Overweight Women
Authors: Chao Dinnie , Espeland Mark A. , Farmer Deborah , Register Thomas C. , Lenchik Leon , Applegate William B. , Ettinger Walter H.
Published: April 2015

OBJECTIVES: To examine the effect of diet and exercise‐induced weight loss on bone mineral density in overweight postmenopausal women

DESIGN: A 1‐year prospective, randomized clinical trial.

SETTING: Two university medical school research centers.

PARTICIPANTS: Sixty‐seven overweight postmenopausal women, a subset of the women who participated in the Trial of Nonpharmacological Interventions in the Elderly (TONE) to control hypertension. The participants were assigned randomly to one of four groups: usual care, weight loss only, sodium restriction only, or combined weight loss/sodium restriction.

INTERVENTION: All TONE participants in the treatment groups attended regular dietary intervention sessions to lose weight, reduce sodium intake, or both that they might refrain from using antihypertensive medications for a period of 15 to 36 months (median = 29 months).

MEASUREMENTS: Bone mineral density (BMD) assessed by dual energy X‐ray absorptiometry (DXA), serum and urine markers of bone metabolism, and other demographic and clinical data were collected at baseline, 6 months, and 12 months.

RESULTS: Women assigned to the weight loss interventions lost 9.2 ± 1.2 lbs (mean ± SE) at 6 months and 7.7 ± 2.0 lbs at 12 months compared with 1.8 ± 1.0 lbs at 6 months and 1.9 ± 1.6 lbs at 12 months for those assigned to no weight loss intervention (P < .0001). Weight loss was correlated with a decrease in total body BMD (P = .004) and an increase in osteocalcin (P = .004) after controlling for baseline bone measures, intervention assignment, and other baseline covariates. Regression analyses indicated that total body BMD decreased by 6.25 ± 2.06 g/cm2 × 10−4 for each pound of weight loss.

CONCLUSIONS: Voluntary weight loss in overweight postmenopausal women is associated with modest decrease in total body BMD. Clinicians recommending weight loss for older postmenopausal women may need to include recommendations for reducing the risk of bone loss. J Am Geriatr Soc 48:753–759, 2000.
The Relationship Between Alcohol Problems and Health Functioning of Older Adults in Primary Care Settings
Authors: Blow Frederic C. , Walton Maureen A. , Barry Kristen Lawton , Coyne James C. , Mudd Sharon A. , Copeland Laurel A.
Published: April 2015

OBJECTIVE: The purpose of this study was to determine the relationship between alcohol use and health functioning in a sample of older adults screened in primary care settings.

DESIGN: A cross‐sectional study.

SETTING: Thirty‐seven primary care clinics.

PARTICIPANTS: Older adults (n = 8578; aged 55–97) with regularly scheduled appointments in primary care clinics were screened.

MEASUREMENTS: Participants were categorized based on alcohol consumption levels as abstainers, low‐risk drinkers, and at‐risk drinkers (women: 9 or more drinks/week; men: 12 or more drinks/week). Dependent variables were eight SF‐36 health functioning scales.

RESULTS: Sixty‐one percent of participants were abstainers, 31% were low‐risk drinkers, and 7% were at‐risk drinkers. ANCOVAs found significant effects of drinking status on General Health, Physical Functioning, Physical Role Functioning, Bodily Pain, Vitality, Mental Health, Emotional Role, and Social Functioning, controlling for age and gender, with low‐risk drinkers scoring significantly better than abstainers. At‐risk drinkers had significantly poorer mental health functioning than low‐risk drinkers. Few significant gender differences were found on SF‐36 scales.

CONCLUSIONS: Older adults who are at‐risk drinkers may not present with poor physical health functioning. Future studies are needed to determine the relationship between drinking limits for older adults and other areas of physical and psychosocial health. J Am Geriatr Soc 48:769–774, 2000.
Cognitive Impairment Without Dementia in Older People: Prevalence, Vascular Risk Factors, Impact on Disability. The Italian Longitudinal Study on Aging
Authors: Di Carlo Antonio , Baldereschi Marzia , Amaducci Luigi , Maggi Stefania , Grigoletto Francesco , Scarlato Guglielmo , Inzitari Domenico ,   for the Italian Longitudinal Study on Aging Working Group
Published: April 2015

OBJECTIVES: To investigate prevalence of “cognitive impairment, no dementia” (CIND) in the Italian older population, evaluating the association with cardiovascular disease and the impact on activities of daily living (ADL). CIND may provide pathogenic clues to dementia and independently affect ADL.

DESIGN: Cross‐sectional examination in the context of the Italian Longitudinal Study on Aging.

SETTING: Random population sample from eight Italian municipalities.

PARTICIPANTS: A total of 3425 individuals aged 65–84 years, residing in the community or institutionalized.

MEASUREMENTS: Study participants were screened for cognitive impairment by using the Mini‐Mental State Examination. Trained neurologists examined those scoring <24. CIND diagnosis relied on clinical and neuropsychological examination, informant interview, and assessment of functional activities. Age‐related cognitive decline (ARCD) was diagnosed in CIND cases without neuropsychiatric disorders responsible for the cognitive impairment.

RESULTS: Prevalence was 10.7% for CIND and 7.5% for ARCD, increased with age, and was higher in women. Age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.06‐1.12), stroke (OR, 2.05; 95% CI, 1.26‐3.35) and heart failure (OR, 1.73; 95% CI, 1.11‐2.68) were significantly and positively associated with CIND at multivariate analysis. Education (OR, 0.61; 95% CI, 0.56‐0.65) and smoking (OR, 0.72; 95% CI, 0.54‐0.98) showed a negative correlation. Age and myocardial infarction were positively associated with ARCD, whereas a negative correlation was found for education and smoking. The effect of smoking was no more significant either on CIND or ARCD considering current habits or “pack year” exposure. CIND showed an independent impact on ADL (OR, 1.88; 95% CI, 1.41‐2.49).

CONCLUSIONS: CIND is very frequent in older people. The effect of demographic variables and vascular conditions offers opportunities for prevention. The association with functional impairment is useful to evaluate the burden of disability and healthcare demands. J Am Geriatr Soc 48:775–782, 2000.
A High Diagnostic Rate in Older Patients Attending an Integrated Syncope Clinic
Authors: Youde J. , Ruse C. , Parker S. , Fotheby M.
Published: April 2015

OBJECTIVES: To describe the findings in the first year of an integrated syncope clinic for older patients and to review the published literature on “integrated” syncope clinics investigating older people.

DESIGN: Review of syncope clinic database and Medline search for relevant literature.

SETTING: Outpatient syncope clinics in two district hospitals in the same city.

PARTICIPANTS: Secondary referrals from the in‐ and outpatient population with recurrent unexplained presyncopal and syncopal symptoms.

RESULTS: The results of testing in 76 patients over the age of 60 years were available for analysis. A diagnosis was achieved in 67 (88%) of the patients with 76% of the diagnoses being cardiovascular in origin. The prevalence rates of neurocardiogenic syncope (32%) and carotid sinus syndrome (17%), however, differed from previously reported rates.

CONCLUSIONS: Evaluation of presyncopal and syncopal events in an “integrated syncope clinic” achieves a high diagnostic yield in older subjects. J Am Geriatr Soc 48:783–787, 2000.
Association of Alzheimer's Disease and Smoking: The Case for Sibling Controls
Authors: Debanne Sara M. , Rowland Douglas Y. , Riedel Tatiana M. , Cleves Mario A.
Published: April 2015

OBJECTIVES: To study the association between cigarette smoking and Alzheimer's Disease (AD).

DESIGN: Intrafamily case‐control, with sibling controls and a variable number of controls per case.

SETTING: AD cases were identified through the Research Registry of the University Hospitals of the Cleveland/Case Western Reserve University Alzheimer Center.

PARTICIPANTS: Study subjects were 86 probable AD cases (index cases) and all of their full siblings, alive or dead, aged ≥ 50 years, a total of 238 subjects.

MEASUREMENTS: Exposure for each individual was ascertained with a questionnaire answered by several informants. Cognitive status of siblings of the AD cases (impaired or intact) was ascertained by telephone using validated instruments. Diagnosis of dementia in cognitively impaired siblings of index cases was not attempted.

RESULTS: Chi‐square analysis tested for departure from a random distribution of disease across smokers and non‐smokers within families. No significant departure was found utilizing all families (P > .40) nor utilizing those families where only the index case was affected (P > .90). Conditional logistic regression evaluated the association within families, controlling for age, sex, and education. Analyses both included and excluded secondary cases of cognitive impairment. No association was found between smoking and disease (OR = 1.26; 95% confidence interval, 0.66‐2.42, and OR = 1.42; 95% confidence interval, 0.69‐2.89, respectively).

CONCLUSIONS: No significant association was found between smoking and cognitive status. Further, analyses based on the comparison of persons with AD with their unaffected siblings also suggest that smoking does not decrease the risk of AD. J Am Geriatr Soc 48:800–806, 2000.
Pharmacotherapy of Lower Limb Diabetic Ulcers
Authors: Temple Mary E. , Nahata Milap C.
Published: April 2015

OBJECTIVE: To discuss the pathophysiology, microbiology, and pharmacotherapy of lower extremity (LE) diabetic ulcers.

DATA SOURCES: A MEDLINE search from 1966 to April 1999 was conducted. The search was limited to humans and English‐language journals. Key search words included “diabetic ulcer,” “fluoroquinolones,” “beta‐lactam,” “hyperbaric oxygen,” “diabetes mellitus,” “diabetic foot,” and “growth factor.”

STUDY SELECTION: Randomized and nonrandomized studies were selected for review. Results of randomized, placebo‐controlled studies were emphasized more than nonrandomized results.

DATA SYNTHESIS: LE ulcers are a common cause of hospitalization, and cause significant morbidity and mortality. Staphylococcus aureus is the most common pathogen in non‐limb‐threatening infections; Gram‐negative bacteria and anaerobes are most prevalent in limb‐threatening and life‐threatening infections. Oral antibiotic therapy may be used in non‐limb‐threatening infections, if adequate response is achieved in 24–48 hours; otherwise, intravenous antibiotics should be started. Intravenous antibiotics should be the initial therapy for limb‐threatening or life‐threatening ulcers. Antimicrobial therapy of at least 10–14 days has been effective in treating LE ulcers in the absence of osteomyelitis. Growth factors offer another treatment alternative, although only becaplermin is currently approved for diabetic ulcers.

CONCLUSION: Antibiotic therapy has been effective for the treatment of LE diabetic ulcers. However, further studies are required to identify optimal antibiotics and dosage regimens. Growth factors may have a role but additional research is needed to determine when best to initiate this therapy. J Am Geriatr Soc 48:822–828, 2000.
Pressure Ulcers Among Patients Admitted To Home Care
Authors: Ferrell Bruce A. , Josephson Karen , Norvid Peter , Alcorn Harry
Published: April 2015

CONTEXT: Pressure ulcers are an understudied problem in home care.

OBJECTIVE: To determine the prevalence of pressure ulcers among patients admitted to home care services, describe the demographic and health characteristics associated with pressure ulcers in this setting, and identify the percentage of these patients at risk for developing pressure ulcers.

DESIGN: Cross‐sectional survey of patients on admission to home care agencies.

SETTING: Forty‐one home care agencies in 14 states.

PATIENTS: A consecutive sample of 3048 patients admitted March 1 through April 30, 1996 (86% of all admissions). Subjects had a mean age of 75 years; 63% were female and 85% white.

MAIN OUTCOME MEASURES: Demographic, social, and clinical characteristics, functional status (Katz activities of daily living scale and Lawton instrumental activities of daily living scale), mental status (Katzman Short Memory‐Orientation‐Concentration test), pressure ulcer risk (Braden Scale), pressure ulcer status (Bates‐Jensen Pressure Ulcer Status Tool), and a checklist of pressure‐reducing devices and wound care products being used.

RESULTS: In the total sample of 3048 patients, 9.12% had pressure injuries: 37.4% had more than one ulcer and 14.0% had three or more ulcers. Considering the worst ulcer for each subject, 40.3% had Stage II and 27% had Stage III or IV injuries. Characteristics associated with pressure ulcers included recent institutional discharge, functional impairment, incontinence, and having had a previous ulcer. About 30% of subjects were at risk for new pressure ulcers. Pressure‐relieving devices and other wound care strategies appeared to be underutilized and often indiscriminately applied.

CONCLUSIONS: There is substantial need for pressure ulcer prevention and treatment in home care settings.
Outcomes of Percutaneous Endoscopic Gastrostomy Among Older Adults in a Community Setting
Authors: Callahan Christopher M. , Haag Kathy M. , Weinberger Morris , Tierney William M. , Buchanan Nancy N. , Stump Timothy E. , Nisi Rod
Published: April 2015

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) has become the preferred method to provide enteral tube feeding to older adults who have difficulty eating, but the impact of PEG on patient outcomes is poorly understood. The objective of this study was to describe changes in nutrition, functional status, and health‐related quality of life among older adults receiving PEG.

DESIGN: A prospective cohort study.

SETTING: A small community of approximately 60,000 residents served by two hospital systems.

PARTICIPANTS: One hundred fifty patients aged 60 and older receiving PEG from one of the four gastroenterologists practicing in the targeted community.

MEASUREMENTS: Patients were assessed at baseline and every 2 months for 1 year to obtain clinical characteristics, process of care data, physical and cognitive function, subjective health status, nutritional status, complications, and mortality.

RESULTS: Over a 14‐month period, 150 patients received PEG tubes in the targeted community; the mean age was 78.9. The most frequent indications for the PEG were stroke (40.7%), neurodegenerative disorders (34.7%), and cancer (13.3%). All measures of functional status, cognitive status, severity of illness, comorbidity, and quality of life demonstrated profound and life‐threatening impairment; 30‐day mortality was 22% and 1‐year mortality was 50%. Among patients surviving 60 days or more, at least 70% had no significant improvement in functional, nutritional, or subjective health status. Serious complications were rare, but most patients experienced symptomatic problems that they attributed to the enteral tube feeding.

CONCLUSIONS: PEG tube feeding in severely and chronically ill older adults can be accomplished safely. However, there are important patient burdens associated with the PEG and there was limited evidence that the procedure improves functional, nutritional, or subjective health status in this cohort of older adults. The issues raised in this descriptive study provide impetus for a randomized trial of PEG tube feeding compared with alternative methods of patient care for older adults with difficulty eating.
Nursing Assistants Detect Behavior Changes in Nursing Home Residents that Precede Acute Illness: Development and Validation of an Illness Warning Instrument
Authors: Boockvar Kenneth , Brodie H. Daniel , Lacks Mark
Published: April 2015

BACKGROUND: Acute illness causes considerable morbidity and mortality in nursing home residents but is often difficult to recognize early. Nursing assistants often notice early signs of acute illness but do not methodically document or communicate their observations with medical staff.

OBJECTIVE: To enhance nursing assistants' observation and documentation of signs of acute illness by developing a validated, standardized instrument for communication with medical staff.

DESIGN: Observational cohort study.

SETTING: Urban not‐for‐profit nursing home.

SUBJECTS AND METHODS: Candidate instrument items were generated in focus group interviews with nursing home staff. Twenty‐three nursing assistants completed the instrument on 74 nursing home residents over 4 weeks. Acute illness, the primary outcome, was identified by nurse report and chart review and determined according to preset criteria.

MEASUREMENTS: Predictive validity was assessed by determining the relationship between instrument responses and development of acute illness within 7 days. Interobserver agreement was calculated between morning and afternoon nursing assistants' responses. Convergent validity was assessed by comparing instrument responses with three standard status indicators.

RESULTS: The instrument consisted of 12 items that assessed behavioral and functional status changes. Residents with an instrument‐recorded change were more likely to develop an acute illness within 7 days than those with no change (risk ratio 4.1, 95% confidence interval 2.6, 6.3). A final five‐item instrument had a sensitivity of 53% and a specificity of 93% for acute illness. Nursing assistants' documentation of signs of illness preceded chart documentation by an average of 5 days. Interobserver agreement between morning and afternoon nursing assistants was 76%. Correlation of responses with standard indicators of functional, mental, and global status was high.

CONCLUSIONS: A new instrument developed for nursing assistants to document behavioral and functional status changes in nursing home residents demonstrates fair sensitivity and high specificity for acute illness. Close monitoring of patients with a positive instrument might avert morbidity and mortality from acute illness by allowing earlier treatment.
Idiopathic Senile Gait Disorders Are Signs of Subclinical Disease
Authors: Bloem B. R. , Gussekloo J. , Lagaay A. M. , Remarque E. J. , Haan J. , Westendorp R. G. J.
Published: April 2015

OBJECTIVES: To evaluate survival and causes of death in subjects with idiopathic senile gait disorders.

DESIGN: A population‐based longitudinal study.

SETTING: Survival analysis of the oldest old within the Leiden 85‐plus Study.

PARTICIPANTS: We distinguished three different groups according to their gait: subjects with a normal gait (n = 25), subjects with senile gait disorders (n = 14), and subjects with gait disorders due to known disease (n = 87). The mean age was 90 years in all groups (range 87 to 97 years).

MEASUREMENTS: The risk of all cause mortality and cardiovascular mortality was estimated over 5 years of follow‐up in a Cox‐proportional hazards model, adjusted for age and sex.

RESULTS: Eighty‐nine of 126 subjects died during follow‐up. Mean survival differed among the three groups (P log‐rank = .01). All cause mortality risk was increased in subjects with senile gait disorders compared with subjects with a normal gait (RR = 2.8; 95% CI, 1.1–7.3, P = .03) and was similar to subjects with gait disorders caused by known disease (RR = 1.2; 95% CI: .6–2.5, P = .6). Mortality caused by cardiovascular disease also differed among the three groups (P log‐rank = .03). The risk of cardiovascular death in subjects with senile gait disorders was twofold greater than in subjects with a normal gait (RR = 2.1; 95% CI, 0.4–10.3).

CONCLUSIONS: Senile gait disorders are related to subclinical, perhaps cardiovascular, disease. Senile gait disorders should not be accepted as an inevitable, benign concomitant of the normal aging process.
Characteristics of Nondisabled Older Persons Who Perform Poorly in Objective Tests of Lower Extremity Function
Authors: Ferrucci Luigi , Penninx Brenda W. J. H. , Leveille Suzanne G. , Corti Maria‐Chiara , Pahor Marco , Wallace Robert , Harris Tamara B. , Havlik Richard J. , MD Jack M. Guralnik
Published: April 2015

OBJECTIVES: It has been suggested that nondisabled older persons with poor performance of lower extremity function are ideal targets for interventions of disability prevention. However, health‐related factors associated with poor performance are largely unknown. Using data from a representative sample of nondisabled older persons, this study identifies the diseases and biological markers that characterize this group of the population.

DESIGN AND PARTICIPANTS: A total of 3381 persons aged 71 or older, interviewed and administered a battery of physical performance tests at the sixth annual follow‐up of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), who reported no need for help in walking 1/4 mile or climbing stairs.

MEASUREMENTS: Lower extremity performance was measured using a short battery of tests including assessment of standing balance, a timed 2.4‐m walk, and timed test of rising 5 times from a chair. Chronic conditions were ascertained as self‐report of a physician diagnosis. Data on previous hospitalizations were obtained from the Medicare database. Nonfasting blood samples were obtained and processed with standard methods.

RESULTS: In a multivariate analysis, older age, female gender, higher BMI, history of hip fracture and diabetes, one or more hospital admissions for acute infection in the last 3 years, lower levels of hemoglobin and albumin, and higher leukocytes and γ‐glutamyl transferase were all associated independently with poor performance.

CONCLUSIONS: Screening for older patients who are not disabled but have poor lower extremity performance selects a subgroup of the population with a high percentage of women, high prevalence of diabetes and hip fracture, and high levels of biological markers of inflammation. This group represents about 10% of the US population 70 to 90 years old. These findings should be considered in planning specifically tailored interventions for disability prevention in this subgroup.
Cellular Ionic Alterations with Age: Relation to Hypertension and Diabetes
Authors: Barbagallo Mario , Gupta Raj K. , Dominguez Ligia J. , Resnick Lawrence M.
Published: April 2015

BACKGROUND: Cytosolic free calcium (Cai) and magnesium (Mgi) are vital to cellular homeostasis and function.

OBJECTIVE: To evaluate cellular divalent cations in normal subjects at different ages and their relationship to ion levels in essential hypertension and diabetes.

DESIGN: A cross‐sectional study.

SETTING: A university hospital in New York.

PARTICIPANTS: A total of 103 subjects (32 older, 71.1 ± 1.2 y/o, and 71 young/middle aged subjects, 51.1 ± 2.3 y/o).

INTERVENTION: Oral glucose tolerance test.

MEASUREMENTS: 19F and 31P NMR spectroscopy were used to measure Cai and Mgi levels in erythrocytes from normal (>65 y/o, n = 11; <65 y/o, n = 26), hypertensive (EH) (>65 y/o, n = 9; <65 y/o, n = 30), and type 2 diabetic (DM) (>65 y/o, n = 12; <65 y/o, n = 15) subjects; these levels were also compared with glucose and insulin levels before and after oral glucose loading.

RESULTS: Fasting Mgi levels were lower (207 ± 7.8 vs 236 ± 7.5 μM; P < .05) and Cai higher (32.2 ± 3.0 vs 20.3 ± 1.8 nM; P < .05) in older than in younger normal subjects. For all normal subjects, the greater the age, the higher the Cai (r = 0.622, P = .004) and the lower the Mgi (r = –0.423; P = .011). However, no significant (P = NS) differences in Mgi or Cai levels were observed between older normal and young/middle‐aged subjects with EH (Mgi = 189.7 ± 5.9 vs 182.6 ± 9.8 μM; Cai = 33.8 ± 4.9 vs 35.6 ± 4.0 nM) or DM (Mgi = 182.8 ± 10.9 vs 180.8 ± 8.1 μM; Cai = 33.6 ± 4.3 vs 39.7 ± 5.9 nM). Significant relationships were also found between cellular ion content, blood pressure, and glycemic indices.

CONCLUSIONS: Aging is associated with the onset of altered Cai and Mgi levels, indistinguishable from those observed in hypertension and diabetes, independent of age. We suggest that these ionic changes may be clinically significant, underlying the predisposition of older subjects to cardiovascular and metabolic diseases.
Geographic Variation in Hospice Use Prior to Death
Authors: Virnig Beth A. , Kind Sara , McBean Marshall , Fisher Elliott
Published: April 2015

OBJECTIVES: To examine national variation in use of the Medicare hospice benefit by older individuals before their death, and to identify individual characteristics and local market factors associated with hospice use.

DESIGN: Retrospective analysis of Medicare administrative data.

SETTING: Hospice care.

PARTICIPANTS: Older Medicare enrollees who died in 1996.

MEASUREMENTS: Rate of hospice use per 1000 older Medicare beneficiary deaths.

RESULTS: Overall, 155 of every 1000 older Medicare beneficiaries who die use hospice before death. This rate is significantly higher among younger older persons (P < .001), non‐blacks (P < .001), persons living in wealthier areas (P < .001), and persons in urban areas (P < .001). Areas with a higher proportion of non‐cancer diagnoses among hospice users have higher rates of hospice use for both cancer and non‐cancer reasons than areas with a majority of hospice users having cancer diagnoses (P < .001). Hospice use is higher in areas with fewer hospital beds per capita (P < .001), areas with lower in‐hospital death rates (P < .001), and areas with higher HMO enrollment (P < .001). Rates of hospice use are also positively related to average reimbursements for health care (P < .001) and to physicians per capita (P < .001). In the largest metropolitan statistical areas (MSAs), rates of hospice use vary more than 11‐fold from a low of 35.15 (Portland, ME) to a high of 397.2 per 1000 deaths (Ft. Lauderdale, FL).

CONCLUSIONS: The wide variation in hospice use suggests that there is great potential to increase the number of users of the Medicare hospice benefit.
Emotional Well‐Being Predicts Subsequent Functional Independence and Survival
Authors: Ostir Glenn V. , Markides Kyriakos S. , Black Sandra A. , Goodwin James S.
Published: April 2015

OBJECTIVE: To determine whether positive affect has an independent effect on functional status, mobility, and survival in an older Mexican American sample.

DESIGN: A 2‐year prospective cohort study.

SETTING: Five Southwestern states: Texas, California, Arizona, New Mexico, and Colorado.

PARTICPANTS: A population‐based sample of 2282 Mexican Americans aged 65 to 99 who reported no functional limitations at baseline interview.

MEASUREMENTS: In‐home interviews in 1993–1994 and again in 1995–1996 assessed demographic variables, health conditions, activities of daily living, performance‐based mobility, survival, and a rating of positive and negative affect.

RESULTS: In multivariate analyses, there was a direct relationship between positive affect scores at baseline and mobility, functional status, and survival 2 years later, controlling for functional status, sociodemographic variables, major chronic conditions, body mass index (BMI), smoking status, drinking status, and negative affect at baseline. Subjects with high positive affect were half as likely (odds ratio (OR) = 0.48; 95% confidence interval (CI) 0.29, 0.93) to become disabled in activities of daily living (ADLs), two‐thirds as likely (OR = 0.64; 95% CI 0.51, 0.79) to have a slow walking speed, and half as likely (OR 0.53; 95% CI 0.30, 0.93) to have died during the 2‐year follow‐up compared to those with lower positive affect scores.

CONCLUSIONS: Our results support the concept that positive affect, or emotional well‐being, is different from the absence of depression or negative affect. Positive affect seems to protect individuals against physical declines in old age. J Am Geriatr Soc 48: 473–478, 2000.
Improvement in Quality‐of‐Life Measures and Stimulation of Weight Gain After Treatment with Megestrol Acetate Oral Suspension in Geriatric Cachexia: Results of a Double‐Blind, Placebo‐Controlled Study
Authors: Yeh Shing‐Shing , Wu Suh‐Yuh , Lee Tai‐Ping , Olson Jeffery S. , Stevens Michael R. , Dixon Troy , Schuster Michael W.
Published: April 2015

BACKGROUND: Weight loss among older patients is a severe problem, associated with an increased incidence of infections, decubiti, and death. Megestrol acetate (MA) causes weight gain in cachectic cancer and AIDS patients, but its effects in older cachectic patients are unknown.

OBJECTIVE: To compare the effects of MA oral suspension (O.S.), 800 mg/day, versus placebo on weight in geriatric nursing home patients with weight loss or low body weight.

DESIGN: Twelve‐week, randomized, double‐blind, placebo‐controlled trial with a 13‐week follow‐up period.

SETTING: Veterans Administration Medical Center (VMAC) nursing home.

PATIENTS: Nursing home patients with weight loss of ≥5% of usual body weight over the past 3 months, or body weight 20% below their ideal body weight.

INTERVENTIONS: Patients were randomly assigned to receive placebo or MA 800 mg/day for 12 weeks and were then followed for 13 weeks off treatment.

MEASUREMENTS: Primary outcome was measured by weight and appetite change. Secondary outcome measures included sense of well‐being, enjoyment of life, change in depression scale, laboratory nutrition parameters, energy intake counts, body composition, and adverse events.

RESULTS: At 12 weeks there were no significant differences in weight gain between treatment groups, whereas MA‐treated patients reported significantly greater improvement in appetite, enjoyment of life, and well‐being. Body composition was not statistically different between the two groups. At Week 25 (3 months after treatment), 61.9% of MA‐treated patients had gained ≥1.82 kg (4 lbs) compared to 21.7% of placebo patients.

CONCLUSIONS: In geriatric patients with weight loss or low body weight MA improves appetite and well‐being after 12 weeks of treatment. During the 3 months of MA treatment, there was no statistically significant weight gain (≥4 lbs). Three months after treatment, weight gain (≥4 lbs) was significantly increased in MA‐treated patients. J Am Geriatr Soc 48: 485–492, 2000.
The Effects of Physical Activity on Mortality in the Jerusalem 70‐Year‐Olds Longitudinal Study
Authors: Stessman J. , Maaravi Y. , Hammerman‐Rozenberg R. , Cohen A.
Published: April 2015

OBJECTIVE: To study the association between physical activity and mortality in older men and women.

DESIGN: A community‐based cohort study: the Jerusalem 70‐Year‐Olds Longitudinal Study.

PARTICIPANTS: A systematically selected and representative sample of all residents of the western part of Jerusalem born in 1920–1921: 456 subjects, 25% of the total population.

MEASUREMENTS: An extensive social and medical profile was developed by extensive interview and physical and ancillary examination. Medical diagnoses were established and subjects reported their level of regular physical activity.

RESULTS: Unadjusted mortality at 6‐year follow‐up was significantly greater for subjects reporting no regular exercise than for those walking as little as 4 hours weekly (23.4% vs 9.9%, odds ratio (OR) = 2.77; 95% confidence interval (CI), 1.64–4.69). The significance of these benefits was demonstrated for males as well as for females (30.28% vs 12.14%, P < .001, 16.19% vs 6.86%, P = .036, respectively). Logistic regression analysis demonstrated the survival advantage to be independent of gender, smoking, subjective economic hardship, or preexisting medical conditions (hypertension; diabetes; coronary artery, cerebrovascular, renal, and respiratory diseases; anemia; and malignancy). Increased regularity of activity correlated with declining mortality. The odds ratios for mortality compared to the sedentary group were 0.73 (CI, 0.33–1.62) for those doing sports activity at least twice weekly, 0.41 (CI, 0.19–0.91) for those walking at least 4 hours weekly, 0.14 (CI, 0.04–0.50) for those exercising daily, and 0.40 (CI, 0.22–0.72) for all levels of physical activity combined.

CONCLUSIONS: These results suggest that regular physical activity confers increased survival in the aged. It is proposed that older people be encouraged to engage in regular, moderate physical activity. J Am Geriatr Soc 48: 499–504, 2000.
Reasons Given by Older People for Limitation or Avoidance of Leisure Time Physical Activity
Authors: Satariano William A. , Haight Thaddeus J. , Tager Ira B.
Published: April 2015

OBJECTIVES: This study investigates reasons given by older people for limitation or avoidance of physical exercise.

DESIGN: Community‐based longitudinal study of free‐living persons age 55 years or older in Sonoma, California.

METHODS: Baseline standardized interviews were conducted (n = 2046) as part of a longitudinal study of aging and physical performance. Seventeen reasons for limitation or avoidance of physical activities were evaluated, with responses grouped as: no limitations, medical, non‐medical, and combined medical and non‐medical reasons. Patterns of physical activity and medical conditions and direct measures of physical function were evaluated in relation to reasons for activity limitation by multinomial logistic regression.

RESULTS: Women reported more limitations/avoidance of physical activity than men (81.0% vs 73.5%). Medical reasons increased with age. Reduced walking speed and depressive symptomatology were associated with a combination of medical and non‐medical reasons in both sexes. Living arrangements were associated with non‐medical reasons for women but were not for men. Non‐medical reasons were associated with a 20 to 30% reduction in the number of subjects who reported physical activity at recommended levels.

DISCUSSION: Non‐medical factors are important determinants of activity limitation and should serve as targets for patient care providers and future interventions to improve participation in physical activity by older people. J Am Geriatr Soc 48: 505–512, 2000.
Community Characteristics Associated with Elder Abuse
Authors: Jogerst Gerald J. , Dawson Jeffrey D. , Hartz Arthur J. , Ely John W. , Schweitzer L. A.
Published: April 2015

OBJECTIVES: To help define the relationship between elder abuse rates and counties' demographics, healthcare resources, and social service characteristics.

DESIGN: County‐level data from Iowa were analyzed to test the association between county characteristics and rates of elder abuse between 1984 and 1993 using univariate correlation analysis and stagewise linear regression.

SETTING: Ninety‐nine counties in Iowa.

PARTICIPANTS: Iowa residents aged 65 years and older.

MEASUREMENTS: County‐level population‐adjusted numbers of abused elderly, abused children, children in poverty, high school dropouts, physicians and other healthcare providers, hospital beds, social workers and caseworkers in the Department of Human Services (DHS).

RESULTS: Community characteristics that had a positive association with rates of reported or substantiated elder abuse at the P < .001 level were population density, children in poverty, and reported child abuse. Lower substantiated elder abuse rates were associated at P < .05 with higher community rates of high school dropouts, number of chiropractors, and number of nurse practitioners. After adjusting for number of DHS caseworkers and reported child abuse rates (a surrogate for workload) a district effect persists for substantiated elder abuse cases (P = .002).

CONCLUSION: County demographics are risk factors for reported and substantiated elder abuse. The strongest risk factor for reported elder abuse was reported child abuse. The difference in districts may reflect differences in resources and/or differing characteristics of caseworkers who substantiate elder abuse. The risk factors may reflect conditions that influence the amount of elder abuse or the detection of existing elder abuse. J Am Geriatr Soc 48: 513–518, 2000.
A Prospective Study of the Effect of Fracture on Measured Physical Performance: Results from the MacArthur Study – MAC
Authors: Greendale Gail A. , DeAmicis Tracy A. , Bucur Alexander , Bretsky Phil , Rowe John W. , Reuben David B. , Seeman Teresa
Published: April 2015

OBJECTIVE: To examine the impact of fractures on measured physical performance and to assess whether specific fractures have unique sequelae.

SUBJECTS: 762 men and women, aged 70 to 79 at baseline, who were part of the MacArthur Study of Successful Aging.

DESIGN: A longitudinal case‐cohort: those with prevalent fractures at baseline were excluded; cases were persons with a medically diagnosed hip, arm, spine, or wrist fracture during the follow‐up period (1988–1995).

MEASURES: Eight physical performance tests: turning a circle, walking fast, chair stands, timed tap, tandem stand, grip strength, single leg stand, and balance (average of single leg and tandem stands) measured at baseline and follow‐up.

ANALYSIS: Two fracture groups were defined: (1) those with incident wrist fractures (n = 7) and (2) those with a fracture of the hip, arm, or spine (combined fractures group, n = 16). Change in physical performance was analyzed using crude, age‐adjusted, and multiply‐adjusted ANCOVA models.

RESULTS: The combined fracture group demonstrated statistically significant (P < .05) declines seven of eight of the performance tests compared with individuals without fractures. In contrast, individuals with wrist fractures did not experience a statistically significant decline in any performance measure compared with the no fracture group.

CONCLUSIONS: Relative to those without fractures, individuals with a hip, arm, or clinical spinal fracture show similar global declines in physical performance, whereas those with wrist fracture demonstrate no physical performance decrements. J Am Geriatr Soc 48: 546–549, 2000.
Testosterone Improves Rehabilitation Outcomes in Ill Older Men
Authors: Bakhshi Virat , Elliott Marjorie , Gentili Angela , Godschalk Michael , Mulligan Thomas
Published: April 2015

OBJECTIVES: To determine whether testosterone supplementation improves rehabilitation outcomes in ill older men.

DESIGN: A randomized, placebo‐controlled, double‐blind study.

SETTING: A Geriatric Evaluation and Management (GEM) unit based at a university‐ affiliated Veterans Affairs Medical Center.

PARTICIPANTS: Fifteen men aged 65 to 90 years admitted to the GEM for rehabilitation.

INTERVENTION: Subjects were randomized to receive weekly intramuscular injections with testosterone enanthate 100 mg or placebo.

MEASUREMENTS: Task‐specific performance using the Functional Independence Measure (FIM) and grip strength was measured at the onset of the study and at the time of discharge from the GEM.

RESULTS: At baseline, FIM scores were similar between the placebo and the testosterone group (73.7 vs 70.7, P = .637), as was grip strength (49.7 vs 55.3 pounds, P = .555). At discharge from the GEM, testosterone‐treated patients had improved FIM scores compared with baseline (93.6 vs 70.7; P = .012) and grip strength (68.7 vs 55.3 pounds; P = .033). In the placebo group there was no significant improvement of FIM scores compared with baseline (78.0 versus 73.7; P = .686) or of grip strength (48.9 vs 49.7 pounds; P = .686).

CONCLUSIONS: Testosterone supplementation may improve rehabilitation outcomes in ill older men. J Am Geriatr Soc 48: 550–553, 2000.
Update on Electroconvulsive Therapy (ECT) in Older Adult
Authors: Kelly Karen G. , Zisselman Marc
Published: April 2015

Electroconvulsive therapy (ECT) is used increasingly in the older adult population for major depression, particularly when depression is not responsive to medications, when antidepressants are not tolerated due to side effects, or when depression is accompanied by life‐threatening complications such as severe weight loss or catatonia where a rapid definitive response is required. ECT is considered a low‐risk procedure that can be successfully done in medically ill older adults, but it is associated with a brief period of increased blood pressure and pulse leading to increased myocardial oxygen demand. ECT may cause delirium, particularly in the cognitively impaired older. As successful management of older patients undergoing a course of ECT often involves geriatricians and other medical practitioners, this review provides an update on the indications for ECT, how it is done, the common complications seen after the procedure, and its efficacy. Finally, specific recommendations for management are made. J Am Geriatr Soc 48: 560–566, 2000.
Self‐Care Practices Used by Older Men and Women to Manage Urinary Incontinence: Results from the National Follow‐up Survey on Self‐Care and Aging
Authors: II T. M. Johnson , Kincade J. E. , Bernard S. L. , Busby‐Whitehead J. , DeFriese G. H.
Published: April 2015

OBJECTIVES: To estimate the extent to which self‐care practices are employed by older adults with urinary incontinence (UI); to determine how demographic and functional status measures are associated with self‐care practice use; and to explore the relationship between contacting a doctor and disposable pad use.

DESIGN: A cross‐sectional analysis of a national probability sample using multiple logistic regression.

SETTING: Responses of subjects with UI (n = 787) from the 1993–1994 National Follow‐up Survey on Self‐Care and Aging, a follow‐up survey of older Medicare beneficiaries living in the community within the contiguous United States drawn in 1990–1991

MEASURES: Subject responses about UI, fecal incontinence, dressing, eating, bathing, Instrumental Activities of Daily Living (IADL), Mobility Activities of Daily Living (MADL), age, gender, place of residence, race, education, proxy response to the survey, and self‐reported medical conditions.

RESULTS: Self‐care practices used by more than 25% of respondents with UI included using disposable pads, limiting trips, and limiting fluids. Among older adults with incontinence, more women used disposable pads (44.5%; 95% CI, 36.9–52.1) and performed exercises (14.2%; 95% CI, 9.7–18.9) than did men (15.1%; 95% CI, 8.1–22.1; and 4.3%; 95% CI, 1.0–7.7, respectively). Bi‐variate analysis showed respondents with severe UI or fecal incontinence reported greater use of self‐care practices. In multivariate models of the three most commonly used self‐care practices, measures of UI severity were not always associated independently with self‐care practice use, whereas ADL measures of functional status were. Disposable pad use was positively independently associated (OR 3.36; 95% CI, 2.01–5.63) in multivariate models with contacting a doctor about incontinence, even after controlling for age, gender, demographics, and self‐reported medical conditions.

CONCLUSIONS: Use by older adults of self‐care practices to manage urinary incontinence is predicted independently in multivariate models by measures of functional status such as dressing, eating, bathing, IADLs or MADLs, but not by all UI measures. Disposable pad users had increased odds of contacting a doctor, suggesting that self‐care practices and formal medical care are not always inversely related. J Am Geriatr Soc 48:894–902, 2000.
Using Structured Implicit Review to Assess Quality of Care in the Program of All‐inclusive Care for the Elderly (PACE)
Authors: Pacala James T. , Kane Robert L. , Atherly Adam J. , Smith Maureen A.
Published: April 2015

OBJECTIVE: To develop a quality assessment tool for care rendered to enrollees in the Program for All‐inclusive Care of the Elderly (PACE) that can discriminate care quality ratings across PACE sites.

DESIGN: Structured implicit review (SIR) of medical records by trained geriatricians and geriatric nurse practitioners.

SETTING: Eight PACE sites.

PARTICIPANTS: Older adults enrolled in a PACE program for at least 6 months (n = 313).

MEASUREMENTS: Process and outcome measures for both overall care and 14 specific conditions (tracers) managed up to 1 year.

RESULTS: Overall care quality was judged to be above a community standard in 56% and below standard in 8% of cases. Process of care was rated as very good or good in 70% of the cases. Outcomes depended on how questions were phrased: only 19% of cases improved, whereas 28% were judged to have fared better than expected given their condition at baseline. The SIR method produced ratings demonstrating considerable variability across the sites; three of the sites consistently showed poorer quality ratings than the other five.

CONCLUSIONS: PACE care was generally assessed to be of good quality, but with room for improvement. Despite significant limitations of poor interrater reliability for process of care measures, excessive time involved for the reviews, and lack of a control group, the SIR method was able to consistently discriminate quality ratings among PACE sites. A modified version of the assessment instrument could prove useful in a quality improvement program for PACE care. J Am Geriatr Soc 48:903–910, 2000.
The Impact of Legislation on Psychotropic Drug Use in Nursing Homes: A Cross‐National Perspective
Authors: Hughes Carmel M. , Lapane Kate L. , Mor Vincent , MD Naoki Ikegami , Jónsson Pálmi V. , Ljunggren Gunnar , Sgadari Antonio
Published: April 2015

OBJECTIVES: To quantify the impact of legislation on nursing home residents, psychotropic drug use, and the occurrence of falls in the US compared with five countries with no such regulation.

DESIGN: A retrospective cross‐sectional study

SETTING: Nursing homes in five US states and selected nursing homes in Denmark, Iceland, Italy, Japan, and Sweden

PARTICIPANTS: Residents in nursing homes in five US states and the aforementioned countries during 1993–1996

MAIN OUTCOME MEASURES: Using data collected using the Minimum Data Set, logistic regression provided estimates of the legislative effects on the use of antipsychotics and antianxiety/hypnotics while simultaneously adjusting for potential confounders. The occurrence of falls was evaluated similarly.

RESULTS: Prevalence of antipsychotic and/or antianxiety/hypnotic use varied substantially across countries. After adjustment for differences in age, gender, presence of psychiatric/neurologic conditions, and physical and cognitive functioning, residents in Denmark, Italy, and Sweden were at least twice as likely to receive these drugs (Denmark Odds Ratio (OR)=2.32; 95% Confidence Intervals (CI), 2.15–2.51; Italy OR = 2.05; 95% CI, 1.78–2.34; Sweden OR=2.50; 95% CI, 2.16–2.90); in Iceland, the risk was increased to greater than 6 times (OR=6.54; 95% CI, 5.75–7.44) that of the US. Residents were less likely to fall in Italy, Iceland, and Japan compared with the US, despite more extensive use of psychotropic medication, whereas residents in Sweden and Denmark were more likely to fall.

CONCLUSIONS: Policy has had an impact on the prescribing of psychotropic medication in US nursing homes compared with other countries, but it is unclear if this is translated into better outcomes for residents.J Am Geriatr Soc 48:931–937, 2000.