bluuebunny/crossref_metadata_2025 huggingface dataset:
The APOE ∍4 allele Is Associated with Decline on Delayed Recall Performance in Community‐Dwelling Older Adults
Authors: O'Hara Ruth , Yesavage Jerome A. , Kraemer Helena C. , Mauricio Maritess , Friedman Leah F. , Murphy Greer M.
Published: April 2015

OBJECTIVE: This study investigated whether the Apolipoprotein (APOE) ∍4 allele was associated with cognitive decline in community‐dwelling older adults.

DESIGN: Longitudinal cognitive performance of older adults with the ∍3/∍4 genotype was compared with that of older adults with the ∍3/∍3 genotype.

SETTING: Aging Clinical Research Center, Stanford University.

PARTICIPANTS: One hundred community‐dwelling older adults were recruited from a pool of 531 individuals who had participated in a memory training study 4 to 5 years earlier. These individuals were concerned about their memory functioning and were recruited through newspaper advertisements and contacts with local senior centers. The 100 individuals who agreed to participate in the follow‐up investigation were between 59 and 95 years of age.

MEASUREMENTS: At both baseline and follow‐up, subjects were administered a battery of seven cognitive tests that examined verbal and spatial memory, attention, speed‐of‐processing, and language abilities. APOE genotype was determined at follow‐up.

RESULTS: Individuals with the ∍3/∍4 APOE genotype were significantly younger than individuals with the APOE ∍3/∍3 genotype. No significant differences were observed between the two groups on measures of attention, speed‐of‐processing, vocabulary, immediate verbal memory, and immediate spatial memory. However, those older adults with the ∍3/∍4 genotype exhibited significantly greater decline in performance on delayed recall of verbal material than did those with the ∍3/∍3 APOE genotype.

CONCLUSION: These findings are consistent with previous studies, which suggest that the APOE ∍4 allele predicts decline on measures of delayed recall.
Psychiatric Diagnosis and Intervention in Older and Younger Patients in a Primary Care Clinic: Effect of a Screening and Diagnostic Instrument
Authors: Valenstein Marcia , Kales Helen , Mellow Alan , Dalack Gregory , Figueroa Sara , Barry Kristen Lawton , Blow Frederic C.
Published: April 2015

OBJECTIVES: To determine whether patient age is associated with psychiatric diagnosis or provider intervention in a busy primary care clinic, and, if so, whether a screening and diagnostic tool, the PRIME‐MD, modifies age‐related differences.

DESIGN, SETTING, AND PARTICIPANTS: PRIME‐MD use, psychiatric diagnosis, and provider interventions for psychiatric conditions were recorded for eligible patients attending a Veterans Affairs Medical Center primary care clinic. Data from 952 younger (< 65 years) and 1135 older patients (>65 years) were analyzed to determine whether there were age‐related differences in diagnosis/intervention and if use of the PRIME‐MD modified these differences.

INTERVENTION: Implementation of the PRIME‐MD, a two‐step instrument consisting of a self‐administered patient questionnaire and a provider‐administered structured diagnostic interview.

MEASUREMENTS: Outcome measures were rates of (1) PRIME‐MD use, (2) overall psychiatric diagnosis, (3) new psychiatric diagnosis, and (4) provider intervention for psychiatric conditions.

RESULTS: There was no association between patient age and PRIME‐MD use. Older patients were less likely to receive a psychiatric diagnosis in analyses that adjusted for “highly positive” screening questionnaires (OR =. 45; P < .001). Older patients were also less likely to receive an intervention for a psychiatric condition in analyses that adjusted for whether a psychiatric diagnosis (OR = .62, P = .015) or a new psychiatric diagnosis (OR = .36, P < .001) was made during the study visit. The PRIME‐MD increased rates of diagnosis and intervention but did not alter age‐related disparities.

CONCLUSIONS: Decreased rates of psychiatric diagnosis and intervention in older primary care patients are of concern. Implementing the PRIME‐MD will likely increase rates of diagnosis and intervention but will need to be accompanied by additional measures to eliminate age‐related disparities. J Am Geriatr Soc 46:1499–1505, 1998.
Validation and Application of the Pneumonia Prognosis Index to Nursing Home Residents with Pneumonia
Authors: Mylotte Joseph M. , Naughton Bruce , Saludades Charito , Maszarovics Zoltan
Published: April 2015

OBJECTIVES: To evaluate the predictability of a pneumonia prognosis index in nursing home residents with pneumonia and to use the index to account for acute severity of pneumonia before comparing the short‐term outcome of residents with pneumonia treated with intravenous antibiotic therapy in two different settings: an inpatient geriatrics unit and a nursing home

DESIGN: A retrospective chart review of 158 episodes of nursing home‐acquired pneumonia treated initially with intravenous antibiotics; 100 episodes were treated in an inpatient acute geriatrics service (AGS), and 58 were treated completely in a nursing home (Nursing Home group)

SETTING: The AGS is a 20‐bed unit within a 400‐bed, public, university‐affiliated hospital. The Nursing Home group consisted of residents of two nonproprietary nursing homes.

PARTICIPANTS: Nursing home residents with radiographically proven pneumonia who had at least one of the following signs/symptoms: cough, fever, purulent sputum, respiratory rate ≥ 25 per minute, localized auscultatory findings, or pleuritic pain.

MEASUREMENTS: The pneumonia prognosis index was calculated for each resident at the time of diagnosis of pneumonia; the index has been validated as a predictor of hospital outcome in patients with community‐acquired pneumonia and is also considered a measure of acute severity of pneumonia. Status (alive or dead) of each resident at 30 days after diagnosis was the major dependent variable

RESULTS: Mean (± SD) duration of antibiotic therapy for the Nursing Home group (10.7 ± 4.5 days) was not significantly different from that of the AGS group (9.6 ± 3.4 days; P = .26). The pneumonia prognosis index stratified the 158 episodes of pneumonia into low‐ and high‐risk groups for 30‐day mortality; the mortality rates in each risk strata were not significantly different from those reported in the original derivation and validation studies of the index. In addition, the distribution of episodes among the risk strata of the index was not significantly different for the two study groups, which was an indication that the two groups were similar in terms of acute severity of pneumonia. Thirty‐day mortality was not significantly different between the two groups: AGS, 21% and Nursing Home, 24.1% (P = .66).

CONCLUSION: The pneumonia prognosis index seems to have the same capability for predicting the outcome in nursing home residents with pneumonia as in residents with community‐acquired pneumonia. The index is also a measure of acute pneumonia severity. Nursing home residents with pneumonia, even those who are most acutely ill, can be treated successfully with intravenous therapy in the nursing home; their 30‐day mortality was no different than that of those with the same acute severity of illness who were admitted to a hospital for treatment.
Venous Thrombosis in Older People: Prevalence of the Factor V Gene Mutation Q506
Authors: André E. , Siguret V. , Alhenc‐Gelas M. , Saint‐Jean O. , Gaussem P.
Published: April 2015

OBJECTIVES: Old age is usually considered to be a risk factor for venous thromboembolism, in conjunction with other factors such as heart failure, major surgery, cancer, long‐term immobilization, and antiphospholipid antibodies. Genetic risk factors, especially inherited deficiencies in coagulation inhibitors, also play a role in the pathogenesis of thrombosis, but these are usually diagnosed in thrombophilic patients before the age of 50. The factor V Q506 mutation, responsible for activated protein C resistance, was recently linked to thromboembolic disease. We therefore investigated the prevalence of biological risk factors in older hospital patients with venous thromboembolism.

DESIGN: A 2‐year study period.

SETTING: Ivry sur Seine (Paris), France.

PARTICIPANTS: Seventy‐nine geriatric patients (60 women and 19 men, mean age 83 ± 6.8 years, range 70–102 years) who had had at least one proven episode of venous thromboembolism were enrolled over a 2‐year period.

MEASUREMENTS: Lupus anticoagulant and antithrombin (AT), protein C (PC), and protein S (PS) levels were determined in plasma. The factor V Q506 mutation was detected on genomic DNA.

RESULTS: Lupus anticoagulant was detected in two women, one of whom also had a high level of anticardiolipin IgG, leading to the diagnosis of an antiphospholipid syndrome. No hereditary deficiency in AT, PC, or PS was found, but one patient had an acquired AT deficiency. Interestingly, nine of the 79 patients (11.4%, six women and three men) were heterozygous for the factor V Q506 mutation, although none were homozygous. The only major risk factor for thrombosis identified in these patients was prolonged immobilization in four cases. Four of the nine patients who were heterozygous for the factor V Q506 mutation had recurrent thromboembolism, and two of these patients had been immobilized for long periods.

CONCLUSIONS: This study confirms that hereditary deficiencies in coagulation inhibitors, and the lupus anticoagulant, are rarely involved in the pathogenesis of venous thromboembolism in older subjects. In contrast, the factor V Q506 mutation was frequently associated with thrombosis (11.4% of our patients) and should, therefore, be considered an important risk factor in the older people.
Gastroesophageal Reflux Disease
Authors: Katz Philip O.
Published: April 2015

Gastroesophageal reflux disease (GERD) is a spectrum of disease that can best be defined as the symptoms and/or signs of esophageal or adjacent organ injury secondary to the reflux of gastric contents into the esophagus or, beyond, into the oral cavity or airways. Injury is defined based on symptoms or organ damage resulting in esophagitis, laryngeal inflammation, or acute and/or chronic pulmonary injury.

Though specific studies are lacking, GERD seems to occur more frequently in older people. In general, because it has been present for a longer period of time, older patients will often present with more complicated GERD, including severe erosive esophagitis, peptic stricture, and Barrett's esophagus, a premalignant condition, making treatment of older patients with GERD potentially more difficult and complex. Though it is not usually life‐threatening, GERD can have a major effect on patients' well‐being and quality of life. This article reviews the presentation, pathophysiology, diagnosis, and treatment of GERD as it relates to the older patient. J Am Geriatr Soc 46:1558–1565, 1998.
Current Status of Antioxidant Therapy for Alzheimer's Disease
Authors: Pitchumoni Suresh S. , Doraiswamy P. Murali
Published: April 2015

Accumulating evidence from preclinical and clinical studies supports the hypothesis that oxidative stress may be associated with the onset and progression of Alzheimer's Disease (AD). Antioxidant therapies are being promoted in the lay press to enhance mental functions and delay cognitive losses with aging. An increasing number of physicians are also recommending antioxidant therapies, such as high dose vitamin E, for subjects with AD and other neurodegenerative disorders. High dose vitamin E, ginkgo biloba, and selegiline are three putative antioxidants that have been tested in randomized multicenter trial conditions in the US. This paper summarizes the oxidative stress hypothesis of AD and reviews the strengths and limitations of published antioxidant studies in AD in relation to the role of such therapies in practice. J Am Geriatr Soc 46:1566–1572, 1998.
Lower‐Extremity Functioning in Older Mexican Americans and Its Association with Medical Problems
Authors: Perkowski Linda C. , Stroup‐Benham Christine A. , Markides Kyriakos S. , Lichtenstein Michael J. , Angel Ronald J. , Guralnik Jack M. , Goodwin James S.
Published: April 2015

OBJECTIVE: To describe lower‐extremity functioning in community‐dwelling older Mexican Americans and to examine its relationship with medical problems.

DESIGN: Cross‐sectional analyses of survey and performance‐based data obtained in a population‐based study employing area probability sampling.

SETTING: Households within selected census tracts of five Southwestern states: Arizona, California, Colorado, New Mexico, and Texas.

PARTICIPANTS: A total of 2873 Mexican Americans aged 65 years and older.

MEASUREMENTS: A multidimensional questionnaire assessing demographic, sociocultural, and health variables. Standardized tests of lower‐extremity physical functioning included measures of standing balance, repeated chair stands, walking, and an overall summary measure.

RESULTS: Regression analyses revealed that being more than age 75 and female, having arthritis diabetes, visual impairments, or being obese or underweight were all significantly associated with performance on both individual and summary tests of lower‐extremity functioning. In separate regression analyses, the total number of medical conditions was also associated with performance.

CONCLUSIONS: The likelihood of predicting performance or inability to complete tests of lower‐extremity functioning was greatest for those aged 80 and older, those with arthritis or diabetes, and those with three or more medical conditions. Because of the high prevalence of diabetes in Mexican Americans, documentation of the association of diabetes with performance‐based tests of lower‐extremity functioning may help guide early interventions targeted to prevent progression to more severe limitations or disability.
Urinary Incontinence in a Community‐Based Cohort: Prevalence and Healthcare‐Seeking
Authors: Roberts Rosebud O. , Jacobsen Steven J. , Rhodes Thomas , Reilly W. Terence , Girman Cynthia J. , Talley Nicholas J. , Lieber Michael M.
Published: April 2015

OBJECTIVE: To estimate the prevalence of urinary incontinence and to assess care‐seeking behavior for urinary symptoms among community‐dwelling people.

DESIGN: A community‐based cross‐sectional study.

SETTING: Randomly selected men and women from Olmsted County, Minnesota.

PARTICIPANTS: Two cohorts, one comprised of both men (n = 778) and women (n = 762) 50 years of age or older and a second comprised of men aged 40 years or older (n = 2150).

MEASUREMENTS: Participants completed questionnaires assessing urinary incontinence in the previous 12 months, the number of days leaked, the amount leaked, and healthcare‐seeking measures for urinary symptoms.

RESULTS: In the first cohort, the prevalence of incontinence was 24% in men and 49% in women; 29% of men and 13% of women with incontinence had sought care for urinary symptoms. Urinary incontinence was more strongly associated with care‐seeking measures for urinary symptoms in men (Odds Ratio (OR) = 4.3, 95% Confidence Interval (CI) = 2.4, 8.0) than in women (OR = 2.1, 95% CI = 1.2, 3.9). Moderate or severe urinary incontinence was associated significantly with care‐seeking for urinary symptoms (OR = 10.5, 95% CI = 5.6, 19.8). In the second cohort, the prevalence of urinary incontinence was 17.3%; 8.5% of men with incontinence had sought care for urinary symptoms. Men with incontinence were 1.2 times (95% CI = .8, 1.9) as likely to seek care for urinary symptoms as men without incontinence.

CONCLUSION: Our findings indicate that although urinary incontinence is relatively common in the community, care‐seeking for urinary symptoms among persons with urinary incontinence is low, particularly among women, for whom the prevalence exceeds 40% between the ages of 50 and 70 years. These findings suggest that strategies to promote care‐seeking for incontinence need to be investigated and employed in the community.
Prevalence of Coronary Artery Disease, Atherothrombotic Brain Infarction, and Peripheral Arterial Disease: Associated Risk Factors in Older Hispanics in an Academic Hospital‐Based Geriatrics Practice
Authors: Mendelson Gad , Aronow Wilbert S. , Ahn Chul
Published: April 2015

OBJECTIVE: To investigate the prevalence of coronary artery disease (CAD), atherothrombotic brain infarction (ABI), and peripheral arterial disease (PAD) in older Hispanics and the association with risk factors in this population.

DESIGN: A retrospective analysis of charts from all Hispanics seen during January 1996 through July 1997 at an academic hospital‐based geriatrics practice.

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

PATIENTS: One hundred sixty women and 53 men, mean age 80 ± 8 years (range 64 to 100), were included in the study.

MEASUREMENTS AND MAIN RESULTS: Of 213 Hispanics in the study, 59 (28%) had documented CAD, 43 (20%) had ABI, 34 (16%) had PAD, and 90 (42%) had either CAD, ABI, or PAD. Serum total cholesterol and triglycerides were measured in 202 of 213 subjects (95%). Serum high‐density lipoprotein cholesterol was measured in 137 of 213 patients (64%). Other risk factor data were documented in all patients. Multiple logistic regression analysis performed in 202 patients using the variables age, gender, cigarette smoking, hypertension, diabetes mellitus, obesity, serum total cholesterol, and serum triglycerides showed statistically significant associations between prevalent CAD, ABI, or PAD and age (P = .002, odds ratio (OR) = 1.083), cigarette smoking (P = .002, (OR) = 3.865), hypertension (P = .007, (OR) = 2.749), diabetes mellitus (P = .028, (OR) = 2.386), obesity (P = .014, (OR) = 2.608), serum total cholesterol (P < 0.001, (OR) = 1.025), and serum triglycerides (P = .017, (OR) = .993).

CONCLUSIONS: Either CAD, ABI, or PAD was present in 42% of 213 older Hispanics. There were statistically significant associations between prevalent CAD, ABI, or PAD in older Hispanics and risk factors, including age, cigarette smoking, hypertension, diabetes mellitus, obesity, and serum total cholesterol.
ADVANCING GERIATRIC NURSING PRACTICE: Geriatric Nurse Practitioners in Long‐Term Care: Demonstration of Effectiveness in Managed Care
Authors: Burl Jeffrey B. , Bonner Alice , Rao Maithili , Khan Anwer M.
Published: April 2015

OBJECTIVE: This study was undertaken to review the impact of utilizing geriatric nurse practitioner/physician (GNP/MD) teams on cost and utilization for a cohort of Medicare HMO enrollees residing in long‐term care facilities. The results would be used by the organization for further development of the GNP Program.

DESIGN: A 1‐year retrospective data analysis on revenues and cost for 1077 HMO enrollees residing in 45 long termcare facilities.

SETTING: Proprietary and not‐for‐profit, licensed long term care facilities in the HMO's service area of central Massachusetts. Facilities in the study had both skilled (Medicare‐certified) and custodial beds.

MEASUREMENTS: Data were collected retrospectively on overall cost, revenues, emergency department (ED) transfers, hospital, and subacute days.

RESULTS: Of 1077 residents, 414 were cared for by GNP/MD teams compared with 663 by physicians alone. Acute care and ED costs were significantly lower for the GNP/MD‐covered patients. There was a gain of $72 per resident per month (PRPM) with the GNP/MD‐covered patients compared with a loss of $197 PRPM for physicians alone. There were no significant differences in ancillary services or prescriptions.

CONCLUSION: The use of GNPs in collaboration with physicians reduced ED and acute care utilization costs as well as overall costs for a cohort of HMO enrollees in long‐term care. This encouraged the HMO to support the concept that all long‐term care HMO residents should be covered by GNP/MD teams.
Prescribing Exercise Intensity for Older Women
Authors: Kohrt Wendy M. , Spina Robert J. , Holloszy John O. , Ehsani Ali A.
Published: April 2015

OBJECTIVE: For the purpose of prescribing exercise intensity, the American College of Sports Medicine (ACSM) provides guidelines for relating the perceived level of exertion and the heart rate (HR) response during exercise, expressed either as a percentage of maximal HR or of HR reserve, to a percentage of maximal aerobic power (VO2max). However, because maximal HR and V̇O2max decline with age, it is possible that these guidelines are not appropriate for an older population. The purpose of this study was to evaluate in 60‐to 72‐year‐old women the relationships among the common methods of prescribing exercise intensity.

DESIGN: Participants were 112 healthy but sedentary women, aged 66 ± 4 years, who performed treadmill walking at four speeds.

SETTING: Subjects were recruited from the community, and exercise tests were performed at a university laboratory facility.

MEASUREMENTS: V̇O2max and maximal HR were determined during treadmill walking. The HR and V̇O2 responses to walking 6 minutes at each of four speeds ranging from 67 to 107 m/min, along with ratings of perceived exertion (RPE) and plasma lactate levels, were determined on a separate day.

RESULTS: The exercise bouts required an average of 55 ± 10%, 64 ± 12%, 77 ± 12%, and 91 ± 9% of V̇O2max. Corresponding HR values were 64 ± 8%, 70 ± 9%, 81 ± 10%, and 92 ± 7% of maximal HR, and they were within the expected ranges based on ACSM guidelines. HR values as a percentage of HR reserve were much lower than expected based on the guidelines. RPE values were lower than expected at a given %V̇O2max, and plasma lactate levels were also relatively low, suggesting that older women are able to exercise at a higher percentage of V̇O2max than levels currently recommended.

CONCLUSIONS: The results indicate that HR expressed as a percentage of maximal HR is an appropriate method of prescribing exercise intensity in healthy, sedentary 60‐ to 72‐year‐old women. The HR reserve method is not recommended in this population because it will likely result in the exercise being performed at a higher than expected percentage of V̇O2max.
Coronary Heart Disease Risk Factors of Vigorously Active Sexagenarians and Septuagenarians
Authors: Williams Paul T.
Published: April 2015

OBJECTIVE: To examine the dose‐response relationship between coronary heart disease risk factors and vigorous exercise in older men.

DESIGN: Physician‐supplied medical data were compared with running distance and performance in a national cross‐sectional survey of 175 septuagenarian, 935 sexagenarians, and 8672 younger male runners.

RESULTS: Older runners ran significantly more slowly than younger runners. Nevertheless, men 60 years of age and older who ran further had significantly higher plasma high‐density lipoprotein (HDL)‐cholesterol concentrations (regression slope ± SE: 0.16 ± 0.02 mg/dL per km/week, P < .001), and significantly lower ratios of total cholesterol to HDL‐cholesterol (−0.009 ± 0.002 per km/week, P < .001), plasma triglyceride concentrations (−0.309 ± 0.107 mg/dL per km/week, P ≤ .004), systolic and diastolic blood pressures (−0.066 ± 0.028, and −0.042 ± 0.016 mm Hg per km/week, respectively, P ≤ .02), body mass indices (−0.039 ± 0.004 kg/m2 per km/week, P < .001), and waist circumferences (−0.107 ± 0.010 cm per km/week, P < .001). Better 10‐kilometer race performance times were also associated (P ≤ .001) with higher HDL‐cholesterol levels and lower adiposity, blood pressure, triglycerides, and ratios of total cholesterol to HDL‐cholesterol levels. Septuagenarians who ran faster and further also had significantly (P ≤ .03) higher HDL‐cholesterol, lower ratios of total cholesterol to HDL‐cholesterol, and slimmer waists. Compared with those less than age sixty, older runners had significantly greater calculated reductions in waist (P = .039) and chest circumferences (P = .009) but significantly less reduction in low‐density lipoprotein (LDL) cholesterol (P = .020) per kilometer run per week.

CONCLUSIONS: Age does not limit the potential for vigorous activity to increase HDL‐cholesterol or to reduce blood pressure, adiposity, or triglycerides, but it may attenuate improvements in LDL‐cholesterol. Sexagenarians and septuagenarians are expected to have reduced heart disease risk in proportion to their vigorous activity.
Characteristics of Acquired Immunodeficiency Syndrome in Older Adults
Authors: Chen Helen X. , Ryan Patricia A. , Ferguson Robert P. , Yataco Albert , Markowitz Jan A. , Raksis Karen
Published: April 2015

OBJECTIVE: To examine demographic and clinical features of older AIDS patients in comparison with younger individuals.

DESIGN: Data base review.

SETTING: Maryland AIDS Registry from 1981 through the end of 1994.

PARTICIPANTS: All registered Maryland AIDS cases greater than or equal to 60 years of age at diagnosis and all Maryland AIDS cases aged 20 to 39.

MAIN OUTCOME MEASURES: Demographic features, mode of transmission and change in mode over time, clinical presentations, CD4+ counts, and survival time.

RESULTS: A total of 321 (2.7%) AIDS cases diagnosed in Maryland were people 60 years of age or older compared with 7511 cases (63.9%) in people aged 20 to 39 years. The proportion of whites was higher in the older group, but the gender distribution was similar to younger counterparts. Transfusion was the primary cause of exposure of 32% of the older people with AIDS; however, during the last few years, sexual transmission and drug abuse have been implicated more frequently. Twelve percent of older patients had no reported risk factors compared with 4% of younger AIDS patients. The most common presenting AIDS indicator disease in older cases was Pneumocystis carinii pneumonia. Wasting syndrome, candidiasis, and HIV encephalopathy also occurred frequently. Median life span was 9 months compared with 22 months in the young.

CONCLUSION: Our study demonstrates that transfusion is no longer the leading cause of AIDS in older people in Maryland. The relatively increased prominence of transmission by other modes in this age group raises the importance of preventive and educational measures. Older patients generally have a shorter survival than younger individuals.
Sleep Complaints in Community‐Dwelling Older Persons: Prevalence, Associated Factors, and Reported Causes
Authors: Maggi Stefania , Langlois Jean A. , Minicuci Nadia , Grigoletto Francesco , Pavan Mara , Foley Daniel J. , Enzi Giuliano
Published: April 2015

OBJECTIVES: To determine the prevalence rates of self‐reported sleep complaints and their association with health‐related factors.

DESIGN: A cross‐sectional study.

SETTING: People living in the community.

PARTICIPANTS: A total of 2398 noninstitutionalized individuals, aged 65 years and older, residing in the Veneto region, northeast Italy.

MEASUREMENTS: Odds ratios for the association of sleep complaints with potential risk factors.

RESULTS: The prevalence of insomnia was 36% in men and 54% in women, with increased risks for women (odds ratio (OR) = 1.69, 95% CI: 1.3–2.1), depression (OR = 1.93, 95% CI, 1.5–2.5), and regular users of sleep medications (OR = 5.58, 95% CI, 4.3–7.3). About 26% of men and 21% of women reported no sleep complaints. Night awakening, reported by about two‐thirds of the participants, was the most common sleep disturbance. Women and regular users of sleep medications had significantly increased odds for insomnia and for not feeling rested upon awakening in the morning. Depressive symptomatology was more strongly associated with insomnia and night awakening than with awakening not rested, whereas physical disability was more strongly associated with awakening not rested than with the other two sleep disturbances.

CONCLUSION: Our findings show that sleep complaints, highly common among older Italians, are associated with a wide range of medical conditions and with the use of sleep medications. Further longitudinal studies are needed to investigate the causes and the negative health consequences of sleep disturbances to improve both the diagnosis and treatment.
Provider Practice Patterns in Nursing Home‐Acquired Pneumonia
Authors: Medina‐Walpole Annette M. , McCormick Wayne C.
Published: April 2015

OBJECTIVE: To describe provider practice patterns in the diagnosis and treatment of Nursing Home‐Acquired Pneumonia (NHAP) and to document associations with cure, mortality, and transfer.

DESIGN: A retrospective cohort.

SETTING: Six nursing homes in Seattle, Washington.

PARTICIPANTS: A total of 94 patients, 65 years of age or older (mean 83 ± SD 9), in whom the diagnosis of pneumonia was documented in the nursing home medical record between July 1, 1994, and June 6, 1995.

MEASUREMENTS: Multivariate logistic regression was used to assess the relationship between descriptive, diagnostic, or therapeutic measures and three outcomes, cure, 30‐day mortality, and hospital transfer.

RESULTS: Ninety‐four episodes of pneumonia were identified. Allowing for more than one outcome per patient, there were 71 (75.5%) cures, 16 (17%) deaths, and nine (9.6%) transfers. Eighty‐five percent of patients identified as having NHAP by their providers had chest X‐rays (CXRs), and 69% had physical examinations. Sputum examination was ordered in 5%, blood cultures in 6%, and white blood cell counts in 33% of patients. In multivariate analysis, patients with functional decline were more likely to die (Odds Ratio (OR) 36.5 (95% CI 6.1, 220)). Cognitive decline was a risk factor for mortality (OR 6.8 1 (CI 1.8, 26)) and transfer (OR 7.5 (CI 1.2, 46)). Those patients receiving only oral antibiotics (OR 3.2 (CI 1.1, 9.7)) were more likely to be cured. Length of therapy >1 week was also associated with cure (OR 2.9 (CI 1.0, 8.6)). Providers with Certificate of Added Qualifications (CAQ) in Geriatric Medicine were more likely to achieve cure (OR 3.1 (CI 1.0, 9.0)).

CONCLUSIONS: Most patients with NHAP had diagnostic CXRs and physical examinations. In multivariate analysis, death was more likely to occur in patients with cognitive or functional decline. Cure was associated with the use of oral antibiotics alone and with care by providers with CAQ in Geriatric Medicine.
Newer Psychotropic Medication Use in Nursing Home Residents
Authors: Lasser Robert A. , Sunderland Trey
Published: April 2015

OBJECTIVE: To evaluate the use of newer psychotropic agents in nursing home residents in the era of new Health Care Financing Administration (HCFA) guidelines.

DESIGN: Retrospective chart review of referrals to an on‐site geriatric psychiatry service in seven Eastern Massachusetts facilities during 1995–1996.

SUBJECTS: The 298 patients examined included 226 women and 72 men with a mean (SD) age of 81.9 (9.4) years.

MEASUREMENTS: Patient demographics, psychiatric history and medical diagnoses, prescribed medication information, and mental status examination results were recorded systematically. Descriptive statistics of demographics, medication use, and dosing were generated, and comparative analyses were performed by chi‐square, ANOVA, and Tukey's tests.

RESULTS: Overall, 69% of subjects were taking at least one psychotropic medication. Although benzodiazepines (32%) and antipsychotics (42%) were used by a large portion of subjects, antidepressants (61%) were the most commonly prescribed psychotropic, with 53% taking serotonin reuptake inhibitors. The atypical antipsychotic, risperidone, accounted for more than 30% of antipsychotic prescriptions. Low rates of anticholinergic use and low doses and rates of tricyclic antidepressant use were found in Alzheimer's disease patients. Mean dosing of the psychotropic agents fell within HCFA guidelines.

CONCLUSIONS: Newer‐generation psychotropics have had a significant impact on the prescribing practices of primary physicians in treating nursing home residents. Of clinical importance is the high rate of antidepressant use in a population that has traditionally received inadequate pharmacotherapy for depression. More studies are needed to examine a shift to the use of other psychotropic drugs in this population in the post‐HCFA area.
Emotional Vitality Among Disabled Older Women: The Women's Health and Aging Study
Authors: Penninx Brenda W.J.H. , Guralnik Jack M. , Simonsick Eleanor M. , Kasper Judith D. , Ferrucci Luigi , Fried Linda P.
Published: April 2015

OBJECTIVE: To examine correlates of high overall level of emotional functioning (emotional vitality) in disabled older women.

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

POPULATION: A total of 1002 moderately to severely disabled women aged 65 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. Correlations with demographics, health status, and social context were examined.

RESULTS: Despite their physical disabilities, 35% of the 1002 disabled older women were emotionally vital. The percent of emotionally vital women declined with increasing severity of disability. After adjustment for disability status, a significantly increased likelihood for being emotionally vital was found for black race (OR = 1.69) and for having higher income (OR = 1.77), better cognition (OR = 2.36), no vision problems (OR = 1.61), adequate emotional support (OR = 2.54), and many face‐to‐face contacts (OR = 1.64). Having more than one negative life event reduced the likelihood of emotional vitality (OR = 0.57).

CONCLUSION: A substantial proportion of even the most disabled older women can be described as emotionally vital. Findings also suggest that emotional vitality is not solely a function of stable, enduring individual characteristics but that health status, disability, and sociodemographic context also have an influence on emotional vitality.
Can We Afford Comprehensive, Supportive Care for the Very Old?
Authors: Wasson John H. , Bubolz Thomas A. , Lynn Joanne , Teno Joan
Published: April 2015

OBJECTIVE: To address the question, “Is there enough overuse of Medicare reimbursement to hospitals that reallocation of excess could provide sufficient funds to enhance home care and community services?”

DESIGN: Simulation using data from the Medicare Current Beneficiary Survey (MCBS) to estimate dollars that might be reallocated from hospital reimbursement.

PARTICIPANTS: A total of 3577 persons aged 80 and older in a stratified sample of Medicare beneficiaries interviewed in September 1992 in the MCBS.

MEASUREMENTS: We ranked the United States hospital service areas' (HSAs) Medicare hospital discharge rates. We assigned the beneficiaries in the MCBS to the HSAs based on their residence zip codes. The hospitalization expenditures and mortality rates of MCBS respondents living in HSAs in each quartile were compared.

RESULTS: By reducing hospital utilization to the mean level now used by the lowest quartile of HSAs, $560 would be saved per Medicare beneficiary aged 80 or older (P =.004) with no difference in mortality rates. These savings could purchase 40 visiting nurse visits per year for those in need. Potential savings would be $152 per Medicare beneficiary if hospital utilization were reduced from that used by the highest quartile to the level of the lower three quartiles of HSAs, enough to purchase about 11 additional visiting nurse visits.

CONCLUSION: This simulation suggests that the very old might safely receive less hospital care. Because relatively few older people need home and community services in a year, these per capita savings could be reallocated to purchase many services for those having the greatest need.
Do Older Drivers with Visual and Cognitive Impairments Drive Less?
Authors: Stutts Jane C.
Published: April 2015

OBJECTIVE: To determine whether older drivers with poorer cognitive and/or visual function drive fewer miles or avoid driving in situations that pose higher crash risks, such as at nighttime, in rush hour traffic, or when weather conditions are bad.

DESIGN: A cross‐sectional data analysis conducted as part of a larger prospective study.

SUBJECTS: A total of 3238 drivers aged 65 and older applying for renewal of their driver's license at one of eight participating North Carolina driver's license offices.

MEASUREMENTS: Subjects were administered a battery of brief tests of cognitive and visual function, which included the Trail Making Test Parts A and B, the Short Blessed Orientation‐Memory‐Concentration test, and measures of high and low contrast visual acuity, contrast sensitivity, and peripheral vision. Participants were also asked to complete a brief driving survey containing questions about the number of miles they drove and whether they avoided driving under certain conditions, such as after dark or on busy, multi‐lane roadways. Driver age and gender were covariates in the analyses.

RESULTS: Results of multivariate logistic regression models show a clear pattern of reduced driving exposure — lower annual miles and greater avoidance of high‐risk driving situations — associated with lower levels of cognitive and visual function. In general, the prevalence odds of reduced driving exposure were higher for the cognitive function variables than for the visual function variables, and higher for males than for females. Men who scored in the lowest quartile of performance on one of the cognitive tests were six to seven times more likely to report driving fewer than 3000 miles a year than were men scoring in the highest quartile, and women with low scores were one‐and‐one‐half to two times more likely to report driving less than 3000 miles than women with higher scores.

CONCLUSIONS: While the findings of this study are reassuring, they do not guarantee that all drivers with cognitive and visual impairments are limiting their driving exposure appropriately, and geriatricians and other health professionals should be encouraged to evaluate their patients' cognitive and visual fitness for driving and provide counsel where indicated.
A Pelvic Muscle Precontraction Can Reduce Cough‐Related Urine Loss in Selected Women with Mild SUI
Authors: Miller Janis M. , Ashton‐Miller James A. , DeLancey John O. L.
Published: April 2015

OBJECTIVES: To test the hypothesis that selected older women with mild‐to‐moderate stress urinary incontinence (SUI) can learn to demonstrate significantly reduced urine loss in 1 week by intentionally contracting the pelvic floor muscles before and during a cough (a skill we have termed “The Knack”).

DESIGN: A prospective, randomized, single‐blind interventional study.

SETTING: The Older American Independence Center, a federally sponsored research program affiliated with the University of Michigan in Ann Arbor, Michigan.

PARTICIPANTS: Twenty‐seven women with a mean (SD) age of 68.0 (5.5) years, self‐reported SUI, and demonstrable urine loss during a deep cough.

INTERVENTION: Women were randomized to an immediate intervention group (Group I: n = 13) who were taught the Knack after their first clinic visit, or a wait‐listed control group (Group II: n = 14) who were taught the Knack after 1 month.

MEASUREMENTS: At 1 week after instruction, we tested the efficacy of the Knack in a standing stress test by (1) comparing the volumes of cough‐related urine loss leaked by all subjects, with and without use of the Knack, and (2) comparing the volumes of cough‐related urine loss leaked by Group I, using the Knack, with Group II, which had not yet been taught the Knack.

RESULTS: Intra‐individual results showed that at 1‐week follow‐up, the Knack was used to reduce urine loss resulting from a medium cough by an average of 98.2%, compared with that of a similar cough performed 1 minute before without the Knack (P =.009); likewise urine loss was reduced by an average of 73.3% (P =.003) in a deep cough. Reduction in urine loss was not significantly correlated with a digital measure of pelvic floor muscle strength.

CONCLUSION: Within 1 week, selected older women with mild‐to‐moderate SUI can acquire the skill of using a properly‐timed pelvic floor muscle contraction to significantly reduce urine leakage during a cough.
Moderate‐Intensity Aerobic Training Improves Glucose Tolerance in Aging Independent of Abdominal Adiposity
Authors: DiPietro Loretta , Seeman Teresa E. , Stachenfeld Nina S. , Katz Lee D. , Nadel Ethan R.
Published: April 2015

OBJECTIVE: To test the hypothesis that training‐related improvements in glucose and insulin responses to an oral glucose tolerance test (OGTT) are independent of changes in abdominal adiposity.

DESIGN: Adiposity and responses to an OGTT were measured before and after a 4‐month randomized, controlled aerobic training program.

SETTING: An academic medical institution.

PARTICIPANTS: Sixteen healthy older (73 ± 1 year) men and women.

INTERVENTION: Both the training (T) (n = 9) and control (C) (n = 7) groups exercised 4 times a week for 60‐minute sessions. T exercised on mini‐trampolines at 55 to 65% of HRmax (determined from a graded treadmill test) for 1 month and then at 75% for 3 months; C engaged in supervised stretching and yoga.

MEASUREMENTS: At baseline and follow‐up, we estimated abdominal fat (from computed tomography and anthropometry), plasma glucose, and serum insulin responses to the OGTT and fasting concentrations of free fatty acids (FFA).

RESULTS: Aerobic training resulted in a 16% increase in V̇2 peak and a 24% decrease in FFA in the T group (P <.05), but training had no effect on abdominal fat. In the T group, the glucose response curve shifted to the left, and the incremental area under the glucose curve decreased by 25% (P <.05). This improvement in glucose response occurred, however, only in those with impaired glucose tolerance at baseline and without any observed change in insulin response. No change in any variables occurred in the C group.

CONCLUSIONS: Our data suggest that moderate‐intensity aerobic training has a favorable effect on glucose tolerance in older people, independent of changes in abdominal adiposity.
Corticotropin‐Dependent Cushing's Syndrome in Older People: Presentation of Five Cases and Therapeutical Use of Ketoconazole
Authors: Berwaerts Joris J. , Verhelst Johan A. , Verhaert Griet C. , Verhaegen Ann A. , Abs Roger E.
Published: April 2015

BACKGROUND: Cushing's syndrome is a rare disorder. The corticotropin (ACTH)‐dependent form of this syndrome generally results either from excessive ACTH secretion by a pituitary adenoma or ectopic secretion by a malignant tumor. Theoretically, the latter type can be assumed to occur more frequently in old age as the incidence of malignancy increases.

METHODS: Diagnostic procedures for these five cases of Cushing's syndrome consisted of 24‐hour urinary cortisol excretion, plasma ACTH and serum cortisol levels, oCRH stimulatory test, low‐dose and high‐dose dexamethasone suppression tests, CT scan or MR imaging of the pituitary region, and bilateral inferior petrosal sinus sampling. Patients were treated with ketoconazole, if possible, and evaluated according to clinical response and 24‐hour urinary cortisol excretion.

PATIENTS: The five cases presented were selected on the basis of age—75 years or older – from a total of about 100 patients presenting with Cushing's syndrome. In only three cases were signs of hypercorticism found on clinical examination. The other two patients were evaluated for adrenocortical excess because of severe hypokalemia and the fortuitous finding of enlarged adrenal glands on CT scan, respectively.

RESULTS: As a result of endocrine testing, pituitary‐dependent Cushing's disease was suspected in three patients and ectopic Cushing's syndrome in two patients. Imaging techniques demonstrated only one pituitary adenoma in the first three patients and a lung tumor in one of the latter two patients. Inferior petrosal sinus sampling confirmed the suspected origin of the Cushing's syndrome in the three patients in which this procedure was performed. All three patients with pituitary‐dependent Cushing's disease underwent successful clinical and biochemical treatment with ketoconazole.

CONCLUSION: Pituitary‐dependent Cushing's disease may occur more frequently in patients older than 75 years of age than has previously been assumed. Because surgical treatment is not always easily tolerated by older patients, the steroidogenesis inhibitor, ketoconazole, can be a valuable alternative for the control of hypercorticism.
Effect of Tamoxifen on Bone Fractures in Older Nursing Home Residents
Authors: Breuer Brenda , Wallenstein Sylvan , Anderson Richard
Published: April 2015

OBJECTIVES: To evaluate the association between tamoxifen (TAM) treatment and rate of bone fractures in older, nursing home residents.

PARTICIPANTS: A total of 93,031 women, aged 65 years and older, whose data were part of the 1993 New York State MDS and for whom there was documentation of treatment with at least one medication.

SETTING: New York State long‐term care facilities.

DESIGN: Cross‐sectional study via secondary analysis of 1385 matched sets of residents. Each set included one resident who was receiving TAM treatment and up to four residents who were not.

MEASUREMENTS: Measurements included age, ethnicity, TAM treatment, hormone replacement therapy, vision impairment, any bone fractures, and, specifically, hip fractures.

RESULTS: During the 1.5‐year period for which bone fractures are documented in the 1993 MDS, the fracture rates were: 7.62% in women not treated with TAM, 3.20% in women receiving 10 mg TAM daily, and 6.73% in women receiving 20 mg TAM daily. The odds ratio (OR) for bone fractures among women receiving 20 mg TAM daily compared with nontreated women was 0.916 (95% confidence interval (CI): 0.720–1.164; P =.472), and was 0.312 (95% CI: 0.112–0.865; P =.025) for those receiving 10 mg daily. The rates of hip fracture were 4.98%, 2.40%, and 4.57% for controls and women receiving 10 mg and 20 mg TAM daily, respectively. Whereas the hip fracture rate for women receiving 20 mg daily was statistically similar to that of the controls (OR =.963; 95% CI: 0.718–1.291; P =.800), the difference between the controls and those receiving 10 mg daily approached significance (OR: 0.313; 95% CI: 0.096–1.018; P =.054).

CONCLUSION: Although standard treatment of 20 mg TAM daily offers no apparent protection against bone fracture in older nursing home residents, a daily 10 mg dose seems to be protective. J Am Geriatr Soc 46:968–972, 1998.
Hearing Loss in Community‐Dwelling Older Persons: National Prevalence Data and Identification Using Simple Questions
Authors: Reuben David B. , Walsh Kathleen , Moore Alison A. , Damesyn Mark , Greendale Gail A.
Published: April 2015

OBJECTIVE: To estimate the prevalence of hearing loss among community‐dwelling older persons according to clinical criteria and to develop a brief self‐report screening instrument to detect hearing loss

DESIGN: Survey

SETTING: National probability sample of noninstitutionalized older persons

PARTICIPANTS: A total of 2506 persons aged 55 to 74 who participated in the National Health and Nutrition Examination Survey

MAIN OUTCOME MEASURES: Hearing loss as defined by Ventry and Weinstein (VW) criteria and by the High Frequency Pure‐Tone Average (HFPTA) scale

RESULTS: Hearing loss by VW criteria was present in 14.2% and by HFPTA criteria in 35.1% of those surveyed. The prevalence increased with advancing age and was higher among men and those with less education. A logistic regression model identified six independent factors for hearing loss by VW criteria: age ≥ 70 years (adjusted odds‐ratio (AOR) 2.7, 95% confidence interval (95% CI) 1.6, 4.4), male gender (AOR 3.0, 95% CI 1.9, 4,8), ≤ 12th grade education (AOR 3.8, 95% CI 1.8, 7.7), having seen a doctor for deafness or hearing loss (AOR 8.9, 95% CI 5.3, 14.9), unable to hear a whisper across a room (AOR 3.2, 95% CI 2.0, 5.1), and unable to hear a normal voice across a room (AOR 6.2, 95% CI 2.6, 14.9). A clinical scale based on the logistic model had 80% sensitivity and 80% specificity in predicting hearing loss using VW criteria and 59% sensitivity and 88% specificity in predicting hearing loss using HFPTA criteria.

CONCLUSIONS: Hearing loss, as defined by two clinical criteria, is common and can be screened for accurately using simple questions that assess sociodemographic and hearing‐related characteristics. J Am Geriatr Soc 46:1008–1011, 1998.