bluuebunny/crossref_metadata_2025 huggingface dataset:
Health‐Life Expectancy According to Various Functional Levels
Authors: Sauvaget Catherine , Tsuji Ichiro , Aonuma Takanori , Hisamichi Shigeru
Published: April 2015

OBJECTIVES: To estimate disability‐free life expectancy according to three functional levels.

DESIGN: A 2‐year prospective study of older residents in a rural Japanese community. The functional ability of each individual was determined with self‐completed questionnaires at baseline (1994) and at follow‐up (1996).

SETTING AND PARTICIPANTS: All residents of Wakuya Town, Japan, who were aged 65 years or older at the start of the study in 1994 (n = 3590).

MEASUREMENTS: Single‐year increment‐decrement life tables were constructed from mortality rates and incidence of disability rates. Independent life expectancies in three functional areas: basic activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility, were estimated for each sex and each year of age.

RESULTS: The incidence and prevalence of disability were similar in men and women. For both sexes, independent life in IADL was shorter than independent life in ADL and mobility. The development and progression of disability were different between sexes: men experienced disability at a younger age and at a faster rate than women.

CONCLUSIONS: The slow progress of disability, with a longer duration in a disabled state among women, induces a heavy burden on health and welfare resources. Interventions to delay the onset of disability in women should reduce the economic burden to society as well as improve the quality of life. Prospective studies to look at the process of disablement, based on direct observation, are needed to confirm the gender differences. J Am Geriatr Soc 47:1326–1331,1999.
APOE 4 and Hip Fracture Risk in a Community‐Based Study of Older Adults
Authors: Johnston Janet M. , Cauley Jane A. , Ganguli Mary
Published: April 2015

OBJECTIVES: To investigate whether the APOE 4 allele was associated with increased risk of hip fracture in an older community‐based sample and whether such an increased risk was independent of dementia and history of falling.

DESIGN: Case‐control study nested within a prospective community study.

SETTING: The Monongahela Valley Independent Elders Survey (MoVIES), an ongoing prospective community study of older adults in southwestern Pennsylvania.

PARTICIPANTS: A total of 899 MoVIES participants (63.9% women; mean age, 76.2 years, SD = 4.9 years), who provided both information on hip fractures and blood samples for genotyping.

MEASUREMENTS: Interview questions regarding hip fractures and falls, polymerase chain reaction to determine APOE genotype, and clinical assessment using a standardized protocol to determine the presence or absence of dementia.

RESULTS: Twenty‐five subjects reported having hip fractures in the year preceding screening interviews. Subjects with one or two APOE 4 alleles were twice as likely as subjects without an APOE 4 allele to report hip fractures (age‐adjusted OR = 2.1,95% CI: 0.9–4.7). Based on multivariate analysis, subjects with a history of falling were more likely to report hip fractures (OR = 4.7, 95% CI: 2.1–10.8). After adjusting for history of falls and diagnosis of dementia, subjects with an APOE 4 allele were still twice as likely to report hip fractures (adjusted OR = 2.1, 95% CI: 0.9 – 4.7).

CONCLUSIONS: The APOE 4 allele appears to be a risk factor for hip fracture, independent of the effect of dementia and falling. Theoretically, this may be mediated by alterations in vitamin K metabolism. Caution should be used in interpreting these results, because the 95% confidence intervals for the odds ratios include 1. J Am Geriatr Soc 47:1342–1345,1999.
Prevalence of Antidepressant Use Among Older People: Population‐Based Observations
Authors: Mamdani Muhammad , Herrmann Nathan , Austin Peter
Published: April 2015

OBJECTIVE: To assess the prevalence of antidepressant use with respect to age, gender, and time during a 5‐year period from 1993 to 1997.

DESIGN: A retrospective, population‐based study in which data regarding a cross‐sectional series of annual antidepressant use were obtained from administrative claims and census databases for more than 1.4 million older persons during calendar years 1993 through 1997.

PARTICIPANTS: All residents of Ontario aged 65 or older.

MAIN OUTCOME MEASURES: Changes in the prevalence of antidepressant users as a function of age group, gender, and time.

RESULTS: A general, positive, linear trend in the prevalence of antidepressant users with increasing age group was consistently detected regardless of gender and year assessed (P < .001 for both genders and all years). The age‐adjusted relative risk of women being dispensed an antidepressant relative to men was significantly higher during each year but seemed to decrease slightly over time: 1.74 (95% CI, 1.72‐1.76) in 1993 and 1.65 (95% CI, 1.63‐1.67) in 1997. The multiple linear regression model revealed significant relationships between the prevalence of antidepressant users and increasing age group, female gender, and increasing year of assessment (P < .001 for each variable). The prevalence was observed to range from a low of 5.6% in 65 to 69‐year‐old men in 1993 to a high of 17.2% among 85 to 89‐year‐old women in 1997.

CONCLUSIONS: Our findings reveal that the prevalence of antidepressant users is dynamic and is significantly and independently associated with age, gender, and time of assessment. J Am Geriatr Soc 47:1350–1353,1999.
Assessment of Agitation in Alzheimer's Disease: The Agitated Behavior in Dementia Scale
Authors: Logsdon Rebecca G. , Teri Linda , Weiner Myron F. , Gibbons Laura E. , Raskind Murray , Peskind Elaine , Grundman >Michael , Koss Elisabeth , Thomas Ronald G. , Thai Leon J. ,   Alzheimer's Disease Cooperative Study
Published: April 2015

OBJECTIVES: To develop and evaluate the psychometric properties of a new measure of agitation, the Agitated Behavior in Dementia scale (ABID). The ABID consists of 16 items designed specifically to evaluate frequency of and caregiver reaction to common agitated behaviors in community‐residing dementia patients.

DESIGN: The ABID was administered at the baseline assessment of a multi‐site controlled treatment study to reduce agitation in Alzheimer's Disease (AD). Reliability was assessed by evaluating internal consistency and test‐retest correlations. Validity was assessed by examining correlations with other constructs, including demographics, cognitive status, and overall behavioral disturbance.

SETTING: Twenty‐one sites across the US, comprising the Alzheimer's Disease Cooperative Study, contributed subjects to the investigation.

PARTICIPANTS: A total of 148 community‐residing AD patients, living with a spouse or adult relative who acted as an informant. Mean age was 75 years, and mean Mini‐Mental State Exam (MMSE) score was 13.

MEASUREMENTS: Cognitive status was assessed using the MMSE. Behavioral disturbance was assessed using the Behavior Rating Scale for Dementia of the Consortium to Establish a Registry for Alzheimer's Disease, the Revised Memory and Behavior Problems Checklist, and the Cohen‐Mansfield Agitation Inventory.

RESULTS: Reliability of the ABID was excellent, with internal consistency of 0.70 and test‐retest reliability of 0.60 to 0.73. Validity was confirmed by correlations with related measures and lack of correlation with unrelated constructs.

CONCLUSIONS: The ABID is brief, easy to administer, and provides objectively anchored observations of problems. It is a promising measure for studies of community‐residing AD patients. J Am Geriatr Soc 47:1354–1358,1999.
A Simple Test of Central Processing Speed: An Extension of the Short Blessed Test
Authors: Ball Linda J. , Bisher Gordon B. , Birge Stanley J.
Published: April 2015

OBJECTIVE: To evaluate the efficacy and reliability of a simple measure of central processing speed: the time to recite the months of the year in reverse order, from the Short Blessed Test of Orientation, Concentration, and Memory (SBT).

DESIGN: Cross‐sectional and longitudinal designs were used to establish validity and test‐retest reliability.

SETTING: Participants' homes and by telephone interview.

PARTICIPANTS: An age‐stratified sample of 120 community‐dwelling women, aged 67–94, randomly selected from Medicare recipients of the St. Louis Metropolitan Statistical Area.

MEASUREMENTS: Dependent variables were the SBT, the Trail Making Test, computer‐generated simple and choice reaction time, and time to say the months of the year backward (TMYB). The independent variable was age.

RESULTS: Significant Pearson product‐moment correlations were obtained for Trail Making and TMYB with a simple and choice reaction time after controlling for age and cognitive status. An exponential relationship was observed between age and TMYB, expressed both cross‐sectionally and as rate of change. Test‐retest reliability for TMYB was 0.90.

CONCLUSIONS: TMYB is a valid and reliable measure of central processing speed that compares favorably to the more elaborate and time‐consuming Trail Making B test. Because of its simplicity and ease of administration, this test provides the clinician with a practical measure of central processing speed. TMYB extends the utility of the widely used Short Blessed Test by measuring this additional and important domain of brain function. J Am Geriatr Soc 47:1359–1363,1999.
Sleep Problems as a Risk Factor for Falls in a Sample of Community‐Dwelling Adults Aged 64–99 years
Authors: Brassington Glenn S. , King Abby C. , Bliwise Donald L.
Published: April 2015

OBJECTIVES: The purpose of this study was to determine if reported nighttime sleep problems and daytime sleepiness were associated with reported falling during the previous 12 months in a representatively sampled older adult population.

DESIGN: Random‐digit dial telephone survey.

SETTING: Representatively sampled older adult population living in northern California.

PARTICIPANTS: Participants were 971 women and 555 men, aged 64 to 99 years.

MEASUREMENTS: Twenty‐minute telephone interview adapted from the National Health Interview Survey.

RESULTS: Two hundred and eighty‐four participants reported falling during the previous 12 months (19% of the sample). Significantly more women fell than men (20% and 14%, respectively, P < .001). The following variables were significant risk factors for falling in univariate analyses: female gender, being unmarried, living alone, income less than $15,000 per year, difficulty walking, having more than one chronic medical condition, history of cardiovascular disease, hypertension, arthritis, sensory impairment, psychological difficulties, and nighttime sleep problems. All of the nighttime sleep problem variables remained significant risk factors for falling after controlling for other risk factors for falling.

CONCLUSIONS: The results provide support for an independent association between reported sleep problems and falls in an older population. One of the implications of these data is that behavioral research focusing on the effectiveness of insomnia treatment in old age should not only examine typical sleep‐related outcomes (e.g., total time asleep, number of awakenings) but also the occurrence of falls as well.
Moderate Alcohol Consumption and Hearing Loss: A Protective Effect
Authors: Popelka Michael M. , Cruickshanks Karen J. , Wiley Terry L. , Tweed Theodore S. , Klein Barbara E.K. , Klein Ronald , Nondahl David M.
Published: April 2015

OBJECTIVE: To determine if moderate alcohol consumption is associated inversely with hearing loss in a large population based study of older adults.

DESIGN: Cross‐sectional population based cohort study. Data are from the 1993–1995 examinations for the population based Epidemiology of Hearing Loss Study (EHLS) (n = 3571) and the Beaver Dam Eye Study (BDES) (n = 3722).

SETTING: Midwestern community of Beaver Dam, Wisconsin.

PARTICIPANTS: Residents of Beaver Dam aged 43 to 84 in 1987–1988 were eligible for the BDES (examinations in 1988–1990 and 1993–1995). During 1993–1995, this same cohort was eligible to participate in the baseline examination for the EHLS.

MEASUREMENTS: Hearing thresholds were measured by pure tone air and bone conduction audiometry (250–8000 Hz.). History of alcohol consumption in the past year, heavy drinking (ever), medical history, occupation, noise exposure, and other lifestyle factors were ascertained by a questionnaire that was administered as an interview.

RESULTS: In multiple logistic regression analyses controlling for potential confounders, moderate alcohol consumption (>140 grams/week) was inversely associated with hearing loss (PTA.5,1,2,4 >25 dB HL; odds ratio [OR] = .71, 95% confidence interval [CI] = .52, .97; where PTA is pure tone average). A similar association was found for moderate hearing loss (PTA.5,1,2,4 >40 dB HL; OR = 0.49, 95% CI = 0.32, 0.74). Alcohol consumption was associated inversely with the odds of having a low frequency hearing loss (OR = 0.61) or a high frequency hearing loss (OR = 0.60). These findings did not vary significantly by age or gender. There was an increase in the odds of having a high frequency hearing loss (OR = 1.35, 95% CI = 1.04, 1.75), in those with a history of heavy drinking (≥4 drinks/day). Including cardiovascular disease or its related factors did not significantly attenuate the protective effect.

CONCLUSIONS: There is evidence of a modest protective association of alcohol consumption and hearing loss in these cross‐sectional data. This finding is in agreement with a small body of evidence suggesting that hearing loss is not an inevitable component of the aging process.
Cognitive Decline Is Associated with Systemic Oxidative Stress: The EVA Study
Authors: Berr Claudine , Balansard Bertrand , Arnaud Josianne , Roussel Anne‐Marie , Alpérovitch Annick ,   EVA Study Group
Published: April 2015

OBJECTIVE: To determine whether systemic oxidative stress status is associated with cognitive decline.

DESIGN: A longitudinal population‐based study.

SETTING: A cohort study of older subjects in Nantes, France.

PARTICIPANTS: A total of 1166 high cognitive functioning subjects aged 60 to 70 in the Etude du Vieillissement Artériel (EVA) cohort with a 4 year follow‐up.

MEASUREMENTS: Subjects completed a baseline interview and a global cognitive test (Mini‐Mental Status Examination (MMSE)). Blood samples were obtained at baseline to determine plasma levels of selenium, carotenoids, thiobarbituric acid reactant substances (TBARS), an indicator of lipoperoxidation, and red blood cell vitamin E. Risk of cognitive decline, defined as a loss of 3 points in MMSE score between baseline and the 4 year follow‐up, was assessed by oxidative stress level.

RESULTS: Subjects with the highest levels of TBARS show an increased risk of cognitive decline (adjusted odds ratio (OR) = 2.25; confidence interval (CI) 95% = 1.26–4.02). This result is reinforced in the lower antioxidant status subgroup. Subjects with low levels of selenium have an increased risk of cognitive decline (OR = 1.58; CI 95% = 1.08–2.31) after adjustment for various confounding factors.

CONCLUSIONS: These results suggest that increased levels of oxidative stress and/or antioxidant deficiencies may pose risk factors for cognitive decline. The direct implication of oxidative stress in vascular and neurodegenerative mechanisms that lead to cognitive impairment should be further explored.
Influenza Outbreak Detection and Control Measures in Nursing Homes in the United States
Authors: Zadeh Mina M. , Bridges Carolyn Buxton , Thompson William W. , Arden Nancy H. , Fukuda Keiji
Published: April 2015

OBJECTIVE: To evaluate the use of influenza vaccine, rapid influenza testing, and influenza antiviral medication in nursing homes in the US to prevent and control outbreaks.

METHODS: Survey questionnaires were sent to 1017 randomly selected nursing homes in nine states. Information was collected on influenza prevention, detection and control practices, and on outbreaks during three influenza seasons (1995–1998).

RESULTS: The survey response rate was 78%. Influenza vaccine was offered to residents and staff by 99% and 86%, respectively, of nursing homes. Among nursing homes offering the influenza vaccine, the average vaccination rate was 83% for residents and 46% for staff. Sixty‐seven percent of the nursing homes reported having access to laboratories with rapid antigen testing capabilities, and 19% reported having a written policy for the use of influenza antiviral medications for outbreak control. Nursing homes from New York, where organized education programs on influenza detection and control have been conducted for many years, were more likely to have reported a suspected or laboratory‐confirmed influenza outbreak (51% vs 10%, P = .01), to have access to rapid antigen testing for influenza (92% vs 63%, P = .01), and to use antivirals for prophylaxis and treatment of influenza A for their nursing home residents (94% vs 55%, P = .01) compared with nursing homes from the other eight states.

CONCLUSIONS: Influenza outbreaks among nursing home residents can lead to substantial morbidity and mortality when prevention measures are not rapidly instituted. However, many nursing homes in this survey were neither prepared to detect nor to control influenza A outbreaks. Targeted, sustained educational efforts can improve the detection and control of outbreaks in nursing homes.
The Protective Effect of Emotional Vitality on Adverse Health Outcomes in Disabled Older Women
Authors: Penninx Brenda W.J.H. , Guralnik Jack M. , Bandeen‐Roche Karen , Kasper Judith D. , Simonsick Eleanor M. , Ferrucci Luigi , Fried Linda P.
Published: April 2015

OBJECTIVE: Although the adverse physical health consequences of negative emotions have been studied extensively, much less is known about the potential impact of positive emotions. This study examines whether emotional vitality protects against progression of disability and mortality in disabled older women.

DESIGN: A community‐based study, The Women's Health and Aging Study.

PARTICIPANTS: A total of 1002 moderately to severely disabled women aged 65 years and older living in the community.

MEASUREMENTS: Emotional vitality was defined as having a high sense of personal mastery, being happy, and having low depressive symptomatology and anxiety. The onset of new disability was determined by semiannual assessments of disability in performing activities of daily living (ADLs), walking across a room, walking ¼ mile, and lifting/carrying 10 pounds. Mortality status was determined by proxy interviews and linkage with death certificates. Survival analyses with time to onset of specific disabilities (among those not disabled at baseline) and time to mortality were performed and adjusted for age, baseline level of difficulty, physical performance, and chronic conditions.

RESULTS: Three hundred fifty‐one of the 1002 older disabled women studied were emotionally vital. Among women without the specific disability at baseline, emotional vitality was associated with a significantly decreased risk for incident disability performing ADLs (RR = 0.81, 95% CI = 0.66–0.99), for incident disability walking one‐quarter mile (RR = 0.73, 95% CI = 0.59–0.92), and for incident disability lifting/carrying 10 pounds (RR = 0.77, 95% CI = 0.63–0.95). Emotional vitality was also associated with a lower risk of dying (RR = 0.56, 95% CI = 0.39–0.80). These results were not simply caused by the absence of depression since protective health effects remained when emotionally vital women were compared with 334 women who were not emotionally vital and not depressed.

CONCLUSIONS: Emotional vitality in older disabled women reduces the risk for subsequent new disability and mortality. Our findings suggest that positive emotions can protect older persons against adverse health outcomes.
Geriatric‐Based Versus General Wards for Older Acute Medical Patients: A Randomized Comparison of Outcomes and Use of Resources
Authors: Asplund Kjell , Gustafson Yngve , Jacobsson Catrine , Bucht Gösta. , Wahlin Anders , Peterson Jonas , Blom Jan‐Olof , Ängquist Karl‐Axel
Published: April 2015

BACKGROUND: The effects of residence in an acute geriatrics‐based ward (AGW) with emphasis on early rehabilitation and discharge planning for older patients with acute medical illnesses were assessed. Outcome and use of resources were compared with those of patients treated in general medical wards (MWs). A per‐protocol rather than intention‐to‐treat analysis was performed.

METHODS: A randomized trial with 3‐months follow‐up. A total of 190 patients aged 70 years and older were randomized to an acute geriatrics‐based ward, and 223 patients were randomized to general medical wards.

RESULTS: The two groups were comparable at inclusion. However, after care in the AGW, 71% of patients could be discharged directly home compared with 64% of those treated in MWs (relative risk 1.17; 95% CI, 0.93–1.49). The length of stay was shorter in the AGW (mean 5.9 vs 7.3 days; P = .002). The proportion of patients in geriatric or other hospital wards or in nursing homes did not differ, but the proportion of AGW patients in sheltered living tended to be lower (P = .085). At the follow‐up, case fatality, ADL function, psychological well‐being, need for daily personal assistance, drug consumption, need for readmission to hospital, and total health care costs after discharge did not differ between the two groups. Poor global outcome was observed in 37% of AGW and 34% of MW patients.

CONCLUSIONS: A geriatric approach with greater emphasis on early rehabilitation and discharge planning in the AGW shortened the length of hospital stay and may have reduced the need for long‐term institutional living. This occurred despite patients in an acute geriatric ward not having better medical or functional outcome than older acute patients treated in general medical wards.
Outcomes of Older Persons Receiving Rehabilitation for Medical and Surgical Conditions Compared with Hip Fracture and Stroke
Authors: Johnson Marie F. , Kramer Andrew M. , Lin Michael K. , Kowalsky Jacqueline C. , Steiner John F.
Published: April 2015

OBJECTIVE: Older persons with general medical and surgical conditions increasingly receive posthospital rehabilitation care in nursing homes and rehabilitation hospitals. This study describes the characteristics of such patients, contrasted with patients with traditional rehabilitation diagnoses of hip fracture and stroke.

DESIGN: Prospective cohort study.

SETTING: Seventeen skilled nursing facilities and six rehabilitation hospitals in seven states.

PARTICIPANTS: Medicare patients age 65 or older receiving posthospital rehabilitation.

METHODS: A total of 290 medical/surgical patients were compared with 336 hip fracture and 429 stroke patients. Data were collected prospectively from charts, nursing assessments, and patient interviews. Patient characteristics associated with functional recovery and mortality were estimated using multivariate regression.

RESULTS: Medical/surgical patients had greater premorbid activities of daily living (ADL) (P < .001) and instrumental activities of daily living (IADL) (P < .01) disability, but suffered less decline with the acute event than hip fracture or stroke patients (P < .001). Medical/surgical patients were more likely to recover premorbid ADL function (P < .05) but 1‐year mortality was significantly greater (30% vs. 14% hip fracture; 18% stroke; P < .001). Predictors of functional recovery and mortality differed between the three groups. Among medical/surgical patients, premorbid ADL difficulty, cognitive impairment, a pressure ulcer at rehabilitation admission, and depression were associated with failure to recover premorbid function whereas increasing comorbidity and incontinence were associated with mortality.

CONCLUSIONS: Medical/surgical patients represent a unique rehabilitation population. They experienced greater premorbid functional disability, less acute decline, but greater mortality than patients with traditional rehabilitation diagnoses. Further study of this distinct rehabilitation population may help identify patients most likely to benefit from rehabilitation.
Stepping Performance During Obstacle Clearance in Women: Age Differences and the Association with Lower Extremity Strength in Older Women
Authors: Berg William P. , Blast Eileen R.
Published: April 2015

OBJECTIVE: To compare stepping performance during obstacle clearance in younger and older women, and to examine the relationship between lower extremity strength and stepping performance during obstacle clearance in older women.

DESIGN: Correlational study.

SETTING: A small community.

PARTICIPANTS: Twenty‐four older women (mean age = 74.4), and 16 younger women (mean age = 20.7). The older participants lived independently in the community and were able to walk unaided.

MEASUREMENTS: Lower extremity muscle strength, measures of stepping performance including reaction time, movement time, extent of obstacle clearance, time to clear obstacle, among others.

MAIN RESULTS: The older women were far slower in stepping than the younger women. Toe trajectories differed between older and younger women during the initial portion of the step. The younger women tended to lift the toe straight up, whereas the older women tended to move the toe backward, away from the obstacle, passing farther from the obstacle when the toe cleared the obstacle height. There was little, if any, association between relative lower extremity strength and stepping performance during obstacle clearance in older women.

CONCLUSIONS: Dramatic differences in the speed of volitional stepping performance were found between younger and older women. Among the older women, lower extremity strength was not related to volitional stepping performance.
Memory Complaint in a Community Sample Aged 70 and Older
Authors: Turvey Carolyn L. , Schultz Susan , Arndt Stephan , Wallace Robert B. , Herzog Regula
Published: April 2015

OBJECTIVES: The ability of older people to estimate their own memory, often referred to as “metamemory,” has been evaluated in previous studies with conflicting reports regarding accuracy. Some studies have suggested that an older person's metamemory is mostly accurate, whereas others have demonstrated little relationship between memory complaint and actual impairment. This study examines memory complaint in a large national sample of older people aged ≥70.

DESIGN: A longitudinal cohort study with two waves of data collection spaced 2 years apart.

SETTING: A nationwide random sample of community‐dwelling older persons.

PARTICIPANTS: A total of 5444 community‐dwelling persons aged ≥70 and their spouses.

MEASUREMENTS: Participants were asked if they believed their memory was excellent, very good, good, fair, or poor. They were then administered a cognitive assessment derived from the Mini‐Mental Status Exam.

RESULTS: In general, people's assessment of their memory corresponded with their actual performance on cognitive measures. However, large portions of the sample inaccurately assessed their memory skills. People who reported depressive symptoms and had impairment in activities of daily living were more likely to state that their memory was impaired, although they performed very well on cognitive measures.

CONCLUSIONS: The conditions that skew people's self‐assessment are the ones most likely to bring them into contact with healthcare professionals. This may give clinicians the general impression that older people cannot assess their own cognitive skills. However, poor metamemory appears to be a characteristic of a specific subgroup of older persons, not necessarily characteristic of the general population.
Clinical Characteristics and Prognosis of Myasthenia Gravis in Older People
Authors: Evoli Amelia , Batocchi Anna Paola , Minisci Cristiana , Di Schino Chiara , Tonali Pietro
Published: April 2015

OBJECTIVES: To investigate the characteristics of myasthenia gravis (MG) in older people and to evaluate the benefits of immunosuppressive treatments at this age.

BACKGROUND: Myasthenia gravis in older adults has not been extensively studied. In patients with disease onset after the age of 60, treatment mainly relies on medical therapy because thymectomy is generally not performed unless a thymoma is present.

METHODS: Of 837 myasthenic patients followed since 1978, we identified 172 cases with onset after age 60. All patients were treated with anticholinesterases. In the decade from 1978 to 1988, immunosuppressive therapy was performed mainly with corticosteroids (prednisone); since 1989, azathioprine alone or, more often, associated with prednisone, has been increasingly used in MG patients. Long‐term outcome was evaluated in 149 cases with follow‐up longer than 1 year. Remission, pharmacological remission, and marked improvement with reduction in drug dosage were considered good results.

RESULTS: Patients older than age 60 at onset of the disease were 20.5% of our series, male/female ratio was 1.9, age at onset ranged from 61 to 86 years, 87.2% patients had generalized disease, thymoma was detected in 37 patients (21.5%). Of 149 cases with sufficient follow‐up data, 9 were in remission, 111 achieved good results, 3 died of MG, and 120 required immunosuppressive therapy at some time. Sixty‐seven patients had been treated with prednisone for 0.5–16 years (mean, 5 years); good results were recorded in 51 patients (76.1%) and severe side effects in 12 (17.9%). Forty‐six patients had received combined therapy with prednisone and azathioprine for 1 to 12 years (mean, 3.9 years); good results were recorded in 41 patients (89.1%) and severe side effects in six (19.5%). Seven patients had been treated with azathioprine alone for 1 to 4 years (mean, 2.3 years) with good results in five and with no side effects.

CONCLUSIONS: The prognosis of MG in older people seems to be favorable, although full remission is rare and MG weakness, treatment side effects, and associated thymoma can contribute to mortality rate. In our experience, the combined therapy with prednisone and azathioprine was more effective than prednisone alone, and steroid‐related side effects were more frequent than those related to azathioprine.
What's the Basis for Treating Infections Your Way? Quality Assessment of Review Articles on the Treatment of Urinary and Respiratory Tract Infections in Older People
Authors: Lutters Monika , Vogt Nicole
Published: April 2015

OBJECTIVE: To assess the quality of readily available review articles on urinary and respiratory tract infections in older people.

METHODS: Data sources were articles identified by MEDLINE search (1988–1998), review of the bibliographies of identified publications, textbooks from the library of a geriatric university hospital, and booklets with general guidelines on antibiotic therapy. Selection was made of review articles or book chapters about urinary and/or respiratory tract infections in older people that were readily available, ie, in Swiss medical libraries. Quality was assessed according to clinical applicability of the recommendations, methodology of the review, type of literature cited in the bibliography, and age of the population included in these reference articles.

RESULTS: Only 13 of 29 (45%) review articles about urinary tract infections and seven of 29 (24%) articles about respiratory tract infections satisfied our criteria of applicability. Specifically, dosage, route of administration, and treatment duration were often not described. The overall methodological quality was low (mean score 1.9 ± 1.0 on a scale of 9). No review specified the methods used to identify, select, and validate included information. Authors of the review articles quoted an important number of other review articles and only a small number of clinical trials. Less than one‐quarter of these clinical trials actually comprised primarily an older population.

CONCLUSIONS: Review articles on treatment of common infectious diseases in older people are often neither clinically applicable nor of good methodological quality. Therefore, more systematic review articles regarding treatment of older patients, as well as evidence‐based practice guidelines, are needed.
Morbidity and Comorbidity in Relation to Functional Status: A Community‐Based Study of the Oldest Old (90+ Years)
Authors: von Strauss Eva , Fratiglioni Laura , Viitanen Matti , Forsell Yvonne , Winblad Bengt
Published: April 2015

OBJECTIVES: To describe health and functional status in the oldest old; to explore the relationships of morbidity and functional status; and to verify whether this relationship was modified by gender.

DESIGN AND SETTING: A community‐based survey including all inhabitants aged ≥90 living in central Stockholm, Sweden. All participants were clinically examined by physicians, cognitively assessed by psychologists, and interviewed by nurses. Diagnoses were made according to the International Classification of Diseases‐Ninth Revision (ICD‐9), the DSM‐III‐R criteria for dementia, and Katz index of activities of daily living.

PARTICIPANTS: Of the 698 subjects in the study population, 99 (14%) had died and 29 (4%) moved before examination. Of the remaining subjects, 502 (88.1%) were examined, and the refusal rate was 11.9%.

MEASUREMENTS: Age‐ and gender‐specific prevalence figures, and age‐, gender‐ and education‐adjusted odds ratios (OR) were used.

RESULTS: Of 502 examined subjects, 19% had no disease and 73% were functionally independent. Dementia was the most prevalent disease among women (42.2%), and cardio‐and cerebrovascular diseases were the most frequent among men (42.4%). Women had higher prevalences of dementia (adjusted OR = 2.1, 95% confidence interval (CI) 1.2–3.7) and fractures and musculoskeletal diseases (adjusted OR = 2.8, 95% CI 1.1–7.3), whereas men had a higher prevalence of malignancy (OR = 0.2, 95% CI 0.1–0.7). Women were more disabled than men independent of age, education, and number of diseases (adjusted OR = 2.2, 95% CI 1.1–4.3).

CONCLUSIONS: A great proportion of nonagenarians were functionally independent despite their advanced age. Further studies are needed to clarify the excess of disability among very old women.
Mortality and Institutionalization Following Hip Fracture
Authors: Cree Marilyn , Soskolne Colin L. , Belseck Elaine , Hornig Joshua , McElhaney Janet E. , Brant Rollin , Suarez‐Almazor Maria
Published: April 2015

OBJECTIVES: To identify determinants of mortality and institutionalization after hip fracture and to identify those older hip fracture patients at high risk of death or institutionalization after hip fracture.

DESIGN: Population‐based prospective inception cohort study of hip fracture patients; patients were assessed in the hospital and at 3 months following the hip fracture.

SETTING: Edmonton area hip fracture patients admitted to one of two Edmonton, Alberta, Canada, acute care centers between July 10, 1996, and August 31, 1997.

PARTICIPANTS: Patients were residents of the Edmonton area and over the age of 64. Those who had previously fractured the same hip within the past 5 years or had some pathological condition underlying the hip fracture were excluded. Of 610 eligible patients, 558 contributed some, baseline information and were included in the mortality analysis; the institutionalization analysis was restricted to the 338 patients who lived in the community before fracture, survived the 3‐month period postfracture, and had completed a 3‐month follow‐up interview.

MEASUREMENTS: The baseline interview was done in the hospital to assess mental status, prefracture physical function, prefracture health perception, and prefracture social support. The 3‐month follow‐up interview was done by phone to assess physical function, health perception, and social support 3 months postfracture. Demographic and comorbidity information was collected from medical records.

RESULTS: Low mental status in hospital was found to increase the chances of mortality and institutionalization, and male gender was found to increase mortality risk fourfold. Each additional 10 years of age increased the risk of institutionalization approximately 2.5 times. Patients with lower postfracture physical function had at least five times the risk of institutionalization compared to patients with high postfracture physical function.

CONCLUSIONS: Cognitive impairment, older age, and gender were associated with increased risk of poor outcome following hip fracture. The socioeconomic variables — social support and health perception — did not contribute significant additional information in explaining mortality or institutionalization risk. While demographic factors cannot be modified, physical function 3 months postfracture may be amenable to intervention and may reduce the risk of institutionalization. Intervening to increase postfracture physical function may be particularly beneficial to older patients, or to those who are cognitively impaired. J Am Geriatr Soc 48: 283–288, 2000.
Extent and Determinants of Hospitalization in a Cohort of Older Disabled People
Authors: Kliebsch Ulrike , Siebert Harald , Brenner Hermann
Published: April 2015

OBJECTIVES: The purpose of this prospective cohort study was to determine the extent and determinants of hospitalization in a population sample of older disabled people.

DESIGN: A longitudinal cohort study.

SETTING: Noninstitutionalized disabled people in the region of Augsburg, South Germany.

PARTICIPANTS: The study population included 2427 persons, aged 60 years and older, who, between 1991 and 1993, applied for benefits from the statutory health insurance system provided to the most severely handicapped noninstitutionalized persons.

MEASUREMENTS: Baseline variables were derived from a standardized medical examination. Information about hospitalization and mortality until June 30, 1996, was extracted from records of the pertinent health insurance plan. Rate ratios (RRs) of hospitalization were derived from a multivariable Poisson regression model corrected for the correlation of multiple hospitalizations for each person.

RESULTS: The overall absolute hospitalization rate was 6.7 hospitalizations per 10 person‐years at risk, with a mean length of stay per hospitalization of 19.2 days. Multivariable analysis showed an inverse association of age and hospitalization. Persons cared for primarily by their children had a lower rate of hospitalization (RR = 0.83) than persons relying mainly on professional home care. Medical causes of disability and dependency with respect to activities of daily living were unrelated to the hospitalization rate. A total of 1415 persons (58.3%) died during follow‐up. The rate of hospitalization was twice as high among these subjects compared with others. The hospitalization rate increased rapidly during the last year of life, with a peak increase in the last 3 months.

CONCLUSIONS: This study expands the current inadequate database on hospitalization in Europe. Further expansion is necessary for the efficient allocation of medical resources to older people, a group steadily increasing in numbers. J Am Geriatr Soc 48: 289–294, 2000.
Risk Factors for Symptomatic Peripheral Arterial Disease in Older Persons in an Academic Hospital‐Based Geriatrics Practice
Authors: Ness Jose , Aronow Wilbert S. , Ahn Chul
Published: April 2015

OBJECTIVE: To investigate risk factors for symptomatic peripheral arterial disease (PAD) in older persons.

DESIGN: A retrospective analysis of charts from all older persons seen from January 1, 1998, through June 15, 1999, at an academic, hospital‐based geriatrics practice.

SETTING: An academic, hospital‐based geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.

PATIENTS: A total of 467 men, mean age 80 ± 8 years, and 1444 women, mean age 81 ± 8 years, were included in the study.

MEASUREMENTS AND MAIN RESULTS: Symptomatic PAD was present in 93 of 467 men (20%) and in 191 of 1444 women (13%) (P = .001). Significant risk factors for symptomatic PAD by univariate analysis were: age (P = .021 in women); cigarette smoking, hypertension, diabetes mellitus, serum total cholesterol, serum high‐density lipoprotein (HDL) cholesterol (inverse association), and serum low‐density lipoprotein (LDL) cholesterol (P < .001 in men and women); obesity (P = .013 in men and .002 in women); and serum triglycerides (P = .027 in women). Significant independent risk factors for symptomatic PAD by stepwise logistic regression analysis were: age (odds ratio = 1.052 in men and 1.025 in women); cigarette smoking (odds ratio = 2.552 in men and 4.634 in women); hypertension (odds ratio = 2.196 in men and 2.777 in women); diabetes mellitus (odds ratio = 6.054 in men and 3.594 in women); serum HDL cholesterol (odds ratio = .948 in men and .965 in women); and serum LDL cholesterol (odds ratio = 1.019 in men and women).

CONCLUSIONS: Significant independent risk factors for symptomatic PAD in older men and women were age, cigarette smoking, hypertension, diabetes mellitus, serum HDL cholesterol (inverse association), and serum LDL cholesterol. J Am Geriatr Soc 48: 312–314, 2000.
The Effect of a Multifaceted Physician Office‐Based Intervention on Older Women's Mammography Use
Authors: Preston Jeanette A. , Scinto Jeanne D. , Grady Jacqueline N. , Schulz Allyson F. , Petrillo Marcia K.
Published: April 2015

BACKGROUND: In response to identified low mammography use among older women in three geographic areas in Connecticut, a physician office‐based mammography intervention was initiated under the Health Care Financing Administration's Health Care Quality Improvement Program.

OBJECTIVE: To evaluate the intervention's impact on older women's mammography use.

DESIGN: A quasi‐experimental design comparing mammography rates for women in the intervention program with a randomly selected control sample.

SETTING: Community‐based physician offices.

PATIENTS: Female Medicare beneficiaries aged 65 to 74 years seen by participating and control physicians for at least one primary care visit in 1995 (baseline) and 1996 (follow‐up). In the baseline period, 1720 women in the intervention sample and 2761 women in the control sample were included in the study.

INTERVENTION: The recruitment strategies included the use of physician opinion leaders and modified academic detailing. The multifaceted intervention incorporated patient education, physician reminders, and audit‐with‐feedback

MEASUREMENTS: Biennial mammography rates. Patient adherence to physician mammography referral was evaluated in a restricted cohort of women selected from the intervention sample.

RESULTS: The mammography rate for the intervention sample increased from 62.7% (baseline) to 73.1% (follow‐up), (P < .001), whereas the control sample's rate remained essentially unchanged (68.3 to 69.5%), (P = .34). The intervention patients were 48% more likely than controls to experience an increase in biennial mammography use (OR = 1.48; 95% CI, 1.22–1.79) after adjustment for patient race and income and physician gender, specialty, and age. The proportion of women who adhered to their physicians' mammography referral was 70.6%.

CONCLUSIONS: These data demonstrate the effectiveness of a multifaceted intervention program administered in the setting of community physician practices. The relatively low rate of patients' acceptance of their physicians' mammography recommendations has identified the need to address more effectively older women's concerns about mammography screening. J Am Geriatr Soc 48: 1–7, 2000.
Characteristics of Motor Vehicle Crashes of Drivers with Dementia of the Alzheimer Type
Authors: Carr David. B. , Duchek J. , Morris J. C.
Published: April 2015

OBJECTIVE: To determine whether there is a difference in crash rates and characteristics between drivers with dementia of the Alzheimer type (DAT) and nondemented older persons who were controls.

DESIGN: A pilot study using a 5‐year retrospective analysis of state‐recorded crash data and crash characteristics followed by patient enrollment into a study on road test skills.

SETTING: Alzheimer's Disease Research Center at Washington University in St. Louis, Missouri. Subjects were enrolled as volunteers in a longitudinal study of aging and DAT.

PARTICIPANTS: One hundred twenty‐one subjects (58 nondemented, older drivers and 63 drivers with DAT) with a mean age of 11 years met the inclusion criteria for this study. DAT was diagnosed using validated clinical diagnostic criteria and was staged by the Clinical Dementia Rating (CDR) Scale. All subjects with DAT were in the very mild (CDR = 0.5) or mild (CDR = 1) stages.

MAIN OUTCOME MEASURE: State‐recorded traffic crashes. Also, a daily driving diary was completed by each subject and used to estimate miles traveled per year.

RESULTS: Subjects diagnosed with mild DAT (CDR = 1) reported less roadway exposure (average number of miles driven per year) than did drivers with very mild DAT (CDR = 0.5) or controls. Crashes in both groups were infrequent, with 0.07 state‐recorded crashes per driver per year in the nondemented group (CDR = 0), 0.06 in the very mild DAT group (CDR = 0.5), and 0.04 in the mild DAT group (CDR = 1). There was no statistical difference in the crash frequency between groups, even when adjusting for exposure. Drivers with DAT had trends toward more at‐fault crashes, crashes with injuries, and crashes in which the officer on the scene cited failure to yield.

CONCLUSIONS: In our sample, individuals with very mild or mild DAT who continued to drive seemed to have crash rates similar to those of the controls. There may be significant differences between the causes and the consequences of crashes involving drivers with DAT when compared with cognitively intact age‐matched controls, but none were found in this pilot study. Further research on crash characteristics is needed in larger samples of community‐based drivers with DAT across wider ranges of dementia severity to address issues such as driving competency and public safety. J Am Geriatr Soc 48: 18–22, 2000.
Completed Suicide Among Older Patients in Primary Care Practices: A Controlled Study
Authors: Conwell Yeates , Lyness Jeffrey M. , Duberstein Paul , Cox Christopher , Seidlitz Larry , DiGiorgio Andrea , Caine Eric D.
Published: April 2015

OBJECTIVE: To determine whether physical and psychiatric illness, functional status, and treatment history distinguish older primary care patients who committed suicide from those who did not.

DESIGN: A case‐control study using data collected by psychological autopsies of suicides and prospective patient interviews for controls.

SETTING: Primary care practices in Monroe County, NY.

PARTICIPANTS: Forty‐two suicides aged 60 years and older who visited a primary care provider within 30 days of death and 196 patients aged 60 years and older from a group practice of general internal medicine (n = 115) or family medicine (n = 81).

MEASUREMENTS: Psychiatric diagnosis; depressive symptom severity; physical health and function; psychiatric treatment history.

RESULTS: Completed suicides had more depressive illness (P = .001), physical illness burden (P = .0002), and functional limitations (P = .0001) than controls and were more likely to be prescribed antidepressants (P = .004), anxiolytic agents (P = .0001), and narcotic analgesics (P = .022). Among depressed subjects, affective symptom severity (P < .0001) and emotional dysfunction (P < .0001) distinguished suicide completers. However, physical health, overall function, and treatments received did not differ between groups.

CONCLUSIONS: The primary care setting is an important venue for late life suicide prevention. Primary care providers should be well prepared to diagnose and treat depression in their older patients. Additional research is needed concerning the interactions of physical health, functional status, and depressive symptoms in determining suicide risk. J Am Geriatr Soc 48: 23–29, 2000.