bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Hearing Impairment and the Quality of Life of Elderly Individuals
Authors: Mulrow Cynthia D. , Aguilar Christine , Endicott James E. , Velez Ramon , Tuley Michael R. , Charlip Walter S. , Hill Judith A.
Published: April 2015

Hearing impairment is one of the most common chronic health problems of elderly Americans. Although adverse effects on quality of life are thought to be considerable, they have not been rigorously evaluated. This study was designed to identify the types and extent of dysfunction experienced by elderly individuals with hearing loss, and to define the most appropriate measures for assessing this dysfunction. Elderly male veterans attending a primary care clinic were screened for hearing loss and had their quality of life assessed with a comprehensive battery of disease‐specific and generic measures. Of 472 people who had their hearing tested, 106 had hearing loss. Hearing loss was associated with significant emotional (P = .0001), social (P = .0001), and communication (P = .02) dysfunction. Most individuals (66%) perceived these dysfunctions as severe handicaps even though audiologic loss revealed only mild to moderate impairment (pure tone average loss, 27–55 dB). Adverse effects were best detected with disease‐specific rather than generic functional status measures. We conclude that hearing impairment is associated with important adverse effects on the quality of life of elderly individuals, and that these effects are perceived as severe handicaps even by individuals with only mild to moderate degrees of hearing loss.
The Elderly Amputee with Severe Chronic Obstructive Pulmonary Disease
Authors: Sioson Eulogio R.
Published: April 2015

The case reports describe three elderly amputees with coexisting severe COPD. All three successfully mastered their prostheses and were discharged home able to walk functional distances. This demonstrates that these patients deserve a trial period of rehabilitation in a situation where close medical supervision and optimal medical management are available. Two of our cases died within 5 years, indicating the fragility and poor long‐term prognosis of these patients; the third was lost to follow‐up.
The Dieulafoy Gastric Erosion
Authors: Polit Stanley A.
Published: April 2015

Definitive treatment of the Dieulafoy erosion—once recognized—has generally been surgery. Numerous surgical approaches have been suggested, including: simple oversewing of the lesion,11 wedge restriction,12 and gastrectomy with and without vagotomy and pyloroplasty.8,12 Attempts at endoscopic electrocoagulation and angiographic embolization have generally been disappointing; however, Pointer el al have recently reported satisfactory control of hemorrhage from Dieulafoy lesions with bipolar electrocoagulation and endoscopic injection sclerotherapy, either independently or in combination.13

These case reports describe two elderly patients with massive upper gastrointestinal tract bleeding from Dieulafoy's gastric erosion; it is hoped the geriatrician will be alerted to an often unrecognized source of hemorrhage.
The Mental Efficiency of the Elderly Person with Type II Diabetes Mellitus
Authors: U'Ren Richard C. , Riddle Matthew C. , Lezak Muriel D. , Bennington‐Davis Margaret
Published: April 2015

Cognitive function is often impaired in type I diabetes mellitus, especially when onset is in early childhood. Limited evidence suggests similar impairment in the much larger population of older persons with type II diabetes. We report here the results of 13 measures of mental efficiency in persons between 65 and 77 years of age without gross mental impairment. Nineteen persons with type II diabetes were compared with 19 controls with normal glycosylated hemoglobin values and to seven persons not previously known to have diabetes but who had elevated glycosylated hemoglobin. Significant differences (P < .05) between the nondiabetic control and diabetic groups were noted on eight of the 13 tests. The group of subjects with elevated glycosylated hemoglobins showed levels of cognitive performance intermediate between the normal and known diabetic groups on the majority of tests. These findings confirm that mental efficiency is frequently impaired in older persons with diabetes. Given the high prevalence of diabetes in the aging population we suggest that diabetes may be another important factor contributing to premature loss of cognitive abilities in older people.
Survival in Acute Leukemia in Elderly Patients
Authors: Whitely Randolph , Hannah Phyllis , Holmes Frederick
Published: April 2015

Acute leukemia is more common in older people than in the young or middle‐aged. However, the possibilities of achieving remission or prolonging survival are both inversely correlated with increasing age. We studied survival in 118 acute leukemia patients over the age of 64 seen at a university hospital from 1970 to 1987. Seventy percent had myeloid morphology. Median survival times were 106 days in those diagnosed in the 1970s and 71 days for those diagnosed in the 1980s. This was little changed from an earlier series from the same hospital extending back to the 1940s in which median survival was 69 days.

Considering the two decades separately, age at diagnosis, sex, race, type of leukemia, and whether or not disease‐specific treatment was applied had no significant effect on survival duration. Acute leukemia in the older patient demands difficult medical and ethical choices. Supportive therapy provides immediate comfort and relatively limited morbidity with certainty of death within a few months. Disease‐specific therapy causes immediate morbidity for all, shortened life for the majority, and extended life for the minority.
The Nursing Home Life‐Space Diameter
Authors: Tinetti Mary E. , Ginter Sandra F.
Published: April 2015

We developed the Nursing Home Life‐Space Diameter (NHLSD) as a measure of the extent and frequency of mobility among skilled nursing facility (SNF) residents. Intrarater and interrater reliability was assessed in a small sample of SNF residents. The means and ranges of NHLSD scores, the characteristics associated with NHLSD score, and the association between NHLSD score and other functional characteristics were then determined among 398 residents of 12 SNFs. NHLSD scores ranged from 0, signifying bed‐ or chair‐bound to 50, signifying leaving the facility daily. The correlation between NHLSD scores by two nurses was 0.951; the correlation between scores at two points of time was 0.922. Mean score among the 398 subjects was 27.05. Decreased vision, presence of a neurologic disease, and arthritis were all associated with lower NHLSD score. Mobility (NHLSD) score was moderately correlated with other functional characteristics such as participation in social activities (Spearman's correlation = +0.565). The NHLSD, which represents a simple and reliable assessment of mobility among SNF residents, could be used to assess the effect of interventions and to monitor changes among SNF residents.
After Reaching Retirement Age Physical Activity Sustains Cerebral Perfusion and Cognition
Authors: Rogers Robert L. , Meyer John S. , Mortel Karl F.
Published: April 2015

Among neurologically normal volunteers approaching age 65 with an option for retirement, a four‐year prospective longitudinal study was designed to examine effects of different levels of physical activity on cerebral perfusion by between‐group comparisons. After the fourth year, cognitive performance was also tested. Three groups were compared, each composed of 30 elderly volunteers, assigned as follows: Group 1, who continued to work; Group 2, who retired but participated in regular physical activities; and Group 3, who retired but did not participate in regular, planned physical activities. Retirees who elected to become physically inactive exhibited significant declines in cerebral blood flow (CBF) throughout four years of follow‐up. Those who continued to work or retirees who elected to participate in regular activities sustained more constant CBF levels. Active retirees and those who continued to work also scored better on cognitive testing after the fourth year of follow‐up compared to inactive retirees.
Use of a Vacuum Tumescence Device in the Management of Impotence
Authors: Korenman Stanley G. , Viosca Sharon P. , Kaiser Fran E. , Mooradian Arshag D. , Morley John E.
Published: April 2015

This study evaluated the use of a vacuum tumescence device in the treatment of impotence in older men. Twenty couples with sexual dysfunction due to erectile impotence and who were interested in restoration of sexual function were treated by providing them with both a vacuum tumescence device to engorge the penis and an obstructing band to impede venous return. Nineteen patients established firm to hard erections lasting an average of 16 minutes and were able to have satisfactory coitus with vaginal ejaculation an average of three times per month. The penile – brachial pressure index, supine and after exercise (a measure of the adequacy of penile arterial flow), exhibited a significant increase following six months' use of the vacuum tumescence device. The only significant complications were mild, self‐limited hematomas on three occasions of use. Thus in this limited series the vacuum tumescence device provided a well‐accepted, relatively inexpensive therapeutic approach to impotence.
Psychotropic Drug Use among Caregivers of Patients with Dementia
Authors: Clipp Elizabeth C. , George Linda K.
Published: April 2015

The majority of research on “caregiver burden” focuses on mental health consequences. These stresses are associated with psychotropic drug use among some caregivers. The purposes of this paper are to identify the correlates of psychotropic drug use among caregivers of demented older adults and to determine whether or not certain types of psychotropics (ie, antianxiety, antidepressant, and sedative/hypnotic agents) have common or unique correlates. The prevalence of psychotropic drug use among caregivers in the sample (n = 510) is substantially higher than previously reported prevalence rates in the general population and among community‐dwelling elderly. Using logistic regression techniques, caregiver characteristics (eg, gender, health, relationship to the patient) rather than severity of the patient's condition emerge as predictors of antianxiety, antidepressant, and sedative/hypnotic use. The caregiver's perception of how well he or she is supported in the caregiving role emerges as an important correlate of psychotropic drug use in general and especially of antidepressant consumption. Results suggest that caregivers are a high‐risk group for the development of emotional symptoms such as nervousness, exhaustion, decreased appetite, and difficulty sleeping, symptoms that may or may not constitute a psychiatric disorder. Characteristics of the caregiver, especially aspects of the support system, should be important considerations in decisions to prescribe psychotropic drugs.
Early Natural Menopause and the Duration of Postmenopausal Life
Authors: Snowdon David A.
Published: April 2015

Menopause marks the beginning of a stage of life characterized by an increased susceptibility to diseases such as coronary heart disease and osteoporosis. It was therefore hypothesized that early age at natural menopause would lengthen the duration of the postmenopausal stage of life and thereby result in an earlier age at death. This study investigated the relations between age at natural menopause, duration of postmenopausal life (ie, life expectancy at menopause), and age at death (ie, age at menopause plus life expectancy at menopause). Data were derived from a study of 5,287 naturally postmenopausal Seventh‐day Adventists observed during 1976–1982. Life expectancy was estimated by a mathematical model that used mortality ratios from the study and mortality rates from the US general population. For natural menopause before the age of 47 years, each one‐year decrease in age at menopause was associated with a 0.53‐year increase in postmenopausal life(P =.04) and a 0.47‐year decrease in the age at death(P =.04). For natural menopause at the age of 47 years and older, however, each one‐year decrease in age at menopause was associated with a 0.99‐year increase in postmenopausal life(P =.03) and only a 0.01‐year decrease in the age at death(P =.85). Overall, these findings argue against the possibility that the association between age at menopause and age at death in this study was due to the relation of age at menopause to the duration of postmenopausal life.
Occurrence of Adverse Effects and High Amantadine Concentrations With Influenza Prophylaxis in the Nursing Home
Authors: Degelau John , Somani Salma , Cooper Susan L. , Irvine Patrick W.
Published: April 2015

Amantadine, in a dose of 100 mg/day, is recommended for influenza prevention in older nursing home residents. We studied an influenza prevention protocol in a 98‐bed community nursing home (96% female; mean age = 87.4 years). Fifty‐five residents received amantadine when influenza A was confirmed. Although no further influenza cases were diagnosed, 22% experienced adverse events. Dose in mg/kg/day was significantly higher in the group experiencing adverse events (2.24 ± 0.98 vs 1.76 ± 0.35; P < .01). Amantadine concentrations in 32 residents ranged from 128–5,810 ng/mL. Six residents had amantadine concentrations greater than 1,000 ng/mL. Seventy‐eight percent would have qualified for further dose reduction on the basis of estimated creatinine clearance. The results suggest that adverse events may be an important problem with the 100 mg/day dose, and this dose may be excessive for influenza prophylaxis in many nursing home residents.
Profile of Urinary Incontinent Elderly in Long‐Term Care Institutions
Authors: Yu Lucy C. , Rohner Thomas J. , Kaltreider D. Lynne , Hu Teh‐wei , Igou Jessie F. , Dennis Patrick J.
Published: April 2015

This article presents a profile of incontinent elderly in long‐term care institutions. One hundred thirty‐three frail elderly women were recruited from seven nursing homes in central Pennsylvania for a three‐year clinical trial to test the effectiveness of a behavioral therapy on urinary incontinence. All of the patients had more than one medical diagnosis. Eighty percent had cardiorespiratory conditions; the most prevalent diagnoses were cardiovascular diseases. Eighty percent had one or more neurological diseases, including “organic brain syndrome”(47%) and senile dementia (30%); 44% had arthritis/rheumatism. Half of the patients showed severe cognitive impairment; only 12% showed no cognitive impairment. Sixty‐three percent were totally dependent; 68% used wheelchairs, 61% were chairbound; 50% had impairments in vision, one‐third in hearing, and 14% in speech. Normal bladder capacity, absence of detrusor instability, and satisfactory bladder emptying, as evidenced by low residual urines, was found in 41% of the patients, suggesting that incontinence in this elderly group may not be a primary bladder problem, but rather that mental and physical disabilities may be a more important underlying cause of incontinence in these patients. An important finding in this study is that 34% of the patients had detrusor instability. It is theoretically possible that pharmacologic therapy with anticholinergic agents or imipramine could improve incontinence in this group. Five percent were found to have large residual urine volumes in association with high‐capacity bladders suggesting overflow incontinence as the cause of their daily leakage. Pelvic relaxation and stress leakage was far less common in this elderly group of nursing home patients than in young and middle‐aged women.
Incontinence Among Elderly Community‐Dwelling Dementia Patients
Authors: Ouslander Joseph G. , Zarit Steven H. , Orr Nancy K. , Muira Shari A.
Published: April 2015

Incontinence was identified by 36% of 184 caregivers as a problem in their care of older community‐dwelling patients with dementia. Incontinent dementia patients had greater impairment of cognitive function and more frequent behavioral problems than did patients without incontinence. Burden scores were higher among caregivers of incontinent patients, but multiple regression analyses indicated that factors other than incontinence contributed more to perceived burden. Follow‐up interviews revealed that incontinence had played an important role in most decisions to institutionalize among caregivers of patients who were placed in a nursing home between interviews; it rarely, however, was the primary reason. The majority of incontinent patients still residing in the community were being managed by nonspecific techniques such as diapers and toileting schedules. These data emphasize the need to educate community caregivers of dementia patients in the appropriate management of incontinence and the need for further research on methods of effectively targeting assessment and treatment strategies to this patient population.
Procainamide – Cimetidine Drug Interaction in Elderly Male Patients
Authors: Bauer Larry A. , Black Doug , Gensler Ann
Published: April 2015

Thirty‐six hospitalized male patients receiving oral sustained‐release procainamide every six hours for the treatment of ventricular arrhythmias were studied at steady‐state before and after oral cimetidine 300 mg every six hours for three days. Average age and weight were 73 ± 12 (SD) years and 76 ± 10 kg. Patients did not have a myocardial infarction within the last two years or congestive heart failure and had calculated creatinine clearances (CrCl) between 35 and 75 mL/min/70 kg. Ten patients had urine collections that permitted computation of the ratio between the renal clearance of procainamide and CrCl (PA/CrCl) and the renal clearance of n‐acetylprocainamide (NAPA) and CrCl (NAPA/CrCl). The average steady‐state procainamide and NAPA concentrations increased 55% and 36%, respectively, during cimetidine treatment (P < .01). Twelve patients experienced mild to severe symptoms of what may have been procainamide toxicity. Apparent procainamide oral clearance decreased 41% while patients received cimetidine (P < .01). PA/CrCl and NAPA/CrCl ratios decreased by 33% and 21%, respectively, during cimetidine therapy (P < .05). Cimetidine therapy given to older male patients taking procainamide can cause steady‐state concentrations of procainamide to rise to toxic levels. Patients prescribed this combination should be monitored carefully for adverse side effects.
Candidates for the Certificate of Added Qualifications in Geriatric Medicine; Who, Why, and When?
Authors: Reuben David B. , Bradley Thomas B. , Zwanziger Jack , Hirsch Susan H. , Beck John C.
Published: April 2015

We surveyed physicians who took the examination for certification for Added Qualifications in Geriatric Medicine, physicians who only inquired about the examination, and physicians who expressed no interest in the examination to learn about practice characteristics of those who took the examination and their reasons for taking it. Based on a 72% response rate, we were able to demonstrate that those who took the examination took care of an older population of patients and disproportionately more of the oldest‐old. These physicians were more likely to report the care of older people to be a professional focus and, in internal medicine, were more likely to have had formal training in geriatrics. Their reasons for taking the examination were primarily to obtain credentials but also frequently to improve their ability to care for older people. Nearly two‐thirds of those who had inquired about the exam but did not take it in 1988 plan to do so at a later date.
Do‐Not‐Resuscitate Orders in an Extended‐Care Study Group
Authors: Meyers Roberta M. , Lurie Nicole , Breitenbucher Robert B. , Waring Christine J.
Published: April 2015

We examined the charts of 911 nursing home patients in Hennepin County, Minnesota, to determine the prevalence of written do‐not‐resuscitate (DNR) orders. Information regarding demographic characteristics, and whether a surrogate decisionmaker was available and participated in the decision, was also collected.

Twenty‐seven percent of patients had DNR orders. Ninety percent of all patients had potentially available surrogate decisionmakers. However, for 31% of patients with DNR orders, there was no documentation of patient or surrogate participation in the DNR decision. Univariate analysis identified female sex, increased age, level of care (skilled versus intermediate), presence of a potential surrogate decisionmaker, and increasing length of time since nursing home admission as factors associated with presence of DNR orders. When a logistic regression model was used, increased age, increased length of time since nursing home admission, skilled versus intermediate level of care, and presence of a surrogate decisionmaker were independently associated with presence of DNR status.

Several variables are independently associated with written DNR orders; their relationship to the factors physicians use in decision making requires further study.
The Effect of Recombinant Human Growth Hormone on Malnourished Older Individuals
Authors: Kaiser Fran E. , Silver Andrew J. , Morley John E.
Published: April 2015

Malnutrition in the elderly is often unrecognized and untreated. Reduced secretion of growth hormone (GH) has been suggested as a cause of decreased muscle and bone mass with aging. This pilot study characterized the nutritional response of elderly malnourished subjects to recombinant human GH (rhGH). Subjects were included if they were over 60 years of age, if weight was more than 20% below average body weight (ABW), and if serum albumin concentration was less than 3.8 g/dL. Subjects were divided into two groups: one received 100 Hg/kg rhGH (Protropin®, Genentech) intramuscularly (IM) daily for 21 days; the other received a daily control injection of normal saline (Controls ‐ C) (0.1 mL/kg IM) for the same period of time.

During the 3‐week period, mid‐arm muscle circumference (MAMC) increased an average of 0.6 cm in GH patients but fell in C subjects. There was a non‐significant trend to a decreased caloric intake in the control group. Weight increased an average of 4.95 lbs (2.2 kg) in the GH treated group, and decreased an average of 4.9 lbs (2.2 kg) in C subjects (P < 0.05). Urinary nitrogen retention occurred only in the growth hormone treated subjects (P < 0.05). Somatomedin C (IGF‐1) rose significantly in those treated with GH (P < 0.05), while there was no change in the control group. There was a significant assocition between weight change and IGF 1 concentration (r = 0.837, P < 0.05). Neither clinical edema nor hyperglycemia was noted. These findings suggest that GH may be an effective way of maintaining and enhancing weight in malnourished older individuals.
Dementia in Institutionalized Elderly: Relation to Sleep Apnea
Authors: Ancoli‐Israel Sonia , Klauber Melville R. , Butters Nelson , Parker Linda , Kripke Daniel F.
Published: April 2015

Sleep apnea is characterized by transient hypoxemias which are thought to affect mental functioning. Accordingly, speculation and research have focussed on relationships between sleep apnea and dementia. We studied 235 nursing home (ie institutionalized) patients (152 women with a median age of 83.5; 83 men with a median age of 79.7) with portable sleep recording equipment. The Mattis Dementia Rating Scale and the Geriatric Depression Scale were given to each. Seventy percent of the patients had five or more respiratory disturbances per hour of sleep and 96 percent showed some dementia. Sleep apnea was significantly correlated with all sub‐scales on the dementia rating scale. There were trivial differences in dementia ratings between those with mild‐moderate apnea and those with no apnea. There were significant differences, however, between the latter two groups and those with severe apnea. In particular, items reflecting attention, initiation and perseveration, conceptualization, and memory tasks on the DRS distinguished between those with and without severe sleep apnea. Among those patients with no depression, all patients with severe sleep apnea were also severely demented. Our data suggest that there is a strong relationship between dementia and sleep apnea when the sleep apnea and dementia are severe. Although causality cannot be inferred from associations, our hypothesis for study is that sleep apnea causes deficits in brain function, possibly due to global effects rather than any particular cortical or subcortical structure.
Abnormal Eating Attitudes and Body Image in Older Undernourished Individuals
Authors: Miller Douglas K. , Morley John E. , Rubenstein Laurence Z. , Pietruszka Fern M.
Published: April 2015

An anorexia nervosa‐like syndrome has been reported in older persons. To gain additional insight into this condition, a questionnaire designed to assess the severity of eating disorders (the EAT‐26) was administered to 183 male outpatients. Thirty‐four subjects were found to be undernourished by midarm circumference measurement and 21 by weight adjusted for age‐sex‐height. Approximately 60% of malnourished subjects acknowledged inappropriate self‐control around food, up to 26% described other unsuitable eating attitudes, and 3% to 52% evidenced various forms of distorted body image. They scored high on EAT‐26 Oral Control subscale but low to normal on Dieting and Bulimia and Food Preoccupation subscales.

These results indicate that abnormal eating attitudes and body image occur in an important minority of undernourished elderly males, but the pattern of abnormalities differs from that seen in classical anorexia nervosa. This association deserves additional investigation, with special attention to the psychopathology producing high Oral Control responses and to females as well as males. In the meantime, clinicians need to consider anorexialike attitudes when caring for malnourished seniors.
Do‐Not‐Resuscitate Orders at a Chronic Care Hospital
Authors: Berlowitz Dan R. , Wilking Spencer V. B. , Moskowitz Mark A.
Published: April 2015

Do‐not‐resuscitate (DNR) orders have become an accepted part of medical practice. While these orders have been extensively evaluated in acute care hospitals, little is known about their use in the long‐term care setting. We reviewed the medical records of all admissions to a chronic care hospital over a 13‐month period, collecting data on selected patient characteristics, use of DNR orders, and patient outcomes during the 6‐week period following admission. Fifty‐eight of the 301 patients (19.3%) had a DNR order written. Patients' families were involved predominantly in the DNR decision in 73% of the cases while patients themselves were involved in only 18%. Physicians made the decision unilaterally in 6% of the cases. Patients' functional status rather than specific diagnoses predicted the use of DNR orders. Patients with DNR orders were twice as likely to receive new intravenous therapies than patients without those orders (71% vs 33%, P < 0.01) and four times as likely to die (38% vs 9%, P < 0.01). They were no more likely to be transferred emergently to an acute care hospital (5% vs 9%, P > 0.2). We conclude that DNR orders are not infrequently used, and physicians rarely make the decision unilaterally. Patients with DNR orders have a high likelihood of dying and are infrequently transferred to acute care facilities.
Are There Clinical and Epidemiological Differences between Familial and Non‐familial Alzheimer's Disease?
Authors: Edwards Jeffrey K. , Larson Eric B. , Hughes James P. , Kukull Walter A.
Published: April 2015

To determine whether there are clinical and epidemiological differences between familial and non‐familial Alzheimer's disease, we studied 151 patients with the clinical diagnosis of Dementia of the Alzheimer Type (DAT).

Eighty‐four index patients (56%) had at least one relative with reported DAT‐type memory loss; the remaining 67 did not. For comparison, patients with a positive family history were grouped into a suspected familial DAT (FDAT), and those with a negative family history were grouped into a suspected non‐familial DAT (NFDAT). There were no significant differences between FDAT and NFDAT patients with respect to age of symptom onset, survival time, rate of cognitive decline, motor function, behavioral signs or symptoms, head trauma, thyroid dysfunction, maternal age, or birth order. There were no significant differences between pedigrees of FDAT and NFDAT patients in respect to the prevalence of Down's syndrome or age of mortality.

To examine a more “familial” set of FDAT patients, an FDAT subgroup (F2DAT) consisting of 33 index patients with two or more affected relatives with DAT‐type memory loss was compared to the 67 NFDAT patients in a similar analysis. No significant differences were found. However, NFDAT index patients had a higher reported prevalence of head trauma than those patients in the F2DAT subgroup (NFDAT 22%, F2DAT 7%, OR = 4.2, CI = 0.9–20.0, P = 0.08). Thus severe head trauma may be a more important etiological factor in the non‐familial form of DAT. To better examine this tendency, future studies should be conducted utilizing a larger number of pedigrees and familial criteria which account for the number of persons at risk and the age at onset of disease.
Rationale for a Primary Prevention Study Using Low‐Dose Aspirin To Prevent Coronary and Cerebrovascular Disease in the Elderly
Authors: Silagy Christopher A. , McNeil John J. , Bulpitt Christopher J. , Donnan Geoffrey A. , Tonkin Andrew M. , Worsam Bernard
Published: April 2015

The benefits of prophylactic aspirin therapy to prevent cardiovascular and cerebrovascular disease in asymptomatic individuals remains unclear. The rationale for developing a multicentered, double‐blind, placebo‐controlled clinical trial to determine whether low‐dose aspirin (100 mg daily) prevents cardiovascular and cerebrovascular morbidity and mortality in persons aged 70 years and over with no evidence of pre‐existing cardiovascular or cerebrovascular disease is described.

Sample size calculations have indicated that 15,000 subjects would be required over a 4‐year follow‐up period in order to demonstrate a 20% reduction in overall cardiovascular mortality at the 0.01 level with a power of 0.8. Such a large‐scale community‐based clinical trial has never been conducted in Australia in this age group. Therefore the PACE (prevention by low‐dose aspirin of cardiovascular disease in the elderly) pilot study has been developed to test recruitment strategies and methods and ascertaining disease end‐points.
A Controlled Study of Disruptive Vocalizations among Geriatric Residents in Nursing Homes
Authors: Cariaga José , Burgio Louis , Flynn William , Martin David
Published: April 2015

This paper reports the results of a controlled study comparing geriatric residents in nursing homes who displayed disruptive vocalizations with residents in a comparison group. Two 350‐bed nursing homes were surveyed, and it was found that 11% of the residents engaged in disruptive vocalizations, at least once per week, of sufficient severity to require consideration in the resident's care plan. Results show that disruptive vocalizers were more functionally impaired and were more likely to receive a diagnosis of dementia. They were also more likely to display a higher activity level and to experience sleep disturbance and to be prescribed neuroleptic medications. Descriptive data are presented on typology of disruptive vocalizations, likely situations for their occurrence, and the utilization and perceived efficacy of common interventions. Suggestions are made regarding behavioral treatments for this vexing problem.
BOOK REVIEWS
Authors: Kleiman Michael B.
Published: April 2015

Shared Housing for the Elderly. Edited by Jaffe DJ Westport, CT, Greenwood Press Inc., 1989. 204 pages. $39.95.
Use of Life‐Sustaining Care for the Elderly
Authors: Hanson Laura C. , Danis Marion
Published: April 2015

Advanced age has been proposed as one criterion for limiting the use of life‐sustaining medical treatment, but very little is known about current practices. We retrospectively studied utilization rates of intensive care (IC) and cardiopulmonary resuscitation (CPR) in admissions to a university hospital over 1 year (n = 9,998), to test whether these treatments are used more selectively for elderly patients. Overall utilization rates did not vary by age. However, among 524 terminal admissions, IC was used for 63% of patients age 35–74 but for only 50% of patients 75 and older (P < 0.01). Among elderly patients, nursing home residence, diagnosis of advanced malignancy, severe chronic illness, and older age were independent predictors of withholding IC prior to death. Despite more selective use, survival rates were lower for elderly than for younger patients receiving IC (88% vs 78%, P < 0.001). CPR showed similar but non‐significant trends. Intensive care is being used less frequently prior to death for elderly patients, based on diagnosis and functional status as well as chronologic age.
Screening for Frailty: Criteria and Predictors of Outcomes
Authors: Winograd Carol Hutner , Gerety Meghan B. , Chung Maria , Goldstein Mary K. , Dominguez Frank , Vallone Robert
Published: April 2015

Objective

To determine the reliability of rapid screening by clinically derived geriatric criteria in predicting outcomes of elderly hospitalized patients.

Design

Prospective cohort study of 985 patients screened at the time of hospital admission and followed for 1 year with respect to the outcomes of mortality, hospital readmission, and nursing home utilization.

Setting

Palo Alto Veterans Affairs Medical Center, a tertiary care teaching hospital.

Subjects

Male patients 65 years of age and older admitted to the Medical and Surgical services during the period from October 1, 1985 through September 30, 1986.

Results

Patients were grouped by specific screening criteria into three groups of increasing frailty: Independent, Frail, and Severely Impaired. Each criterion focused on a geriatric condition and was designed to serve as a marker for frailty. Increasing frailty was significantly correlated with increasing length of hospital stay (P < 0.0001), nursing home utilization (P < 0.0001), and mortality (P < 0.0001). Multivariate analyses revealed that the clinical groups were more predictive of mortality and nursing home utilization than were age or Diagnosis‐Related Groups (DRGs). Rehospitalization was unrelated to age, clinical group, or DRG, suggesting that utilization may not be driven by the clinical factors measured in this study.

Conclusions

Rapid clinical screening using specific geriatric criteria is effective in identifying frail older subjects at risk for mortality and nursing home utilization. Our findings suggest that geriatric syndromes are more predictive of adverse outcomes than diagnosis per se. This well operationalized screening process is inexpensive as well as effective and could easily be introduced into other hospital settings.
BOOK REVIEWS
Authors: Barzel Uriel S. , Healy Patricia C.
Published: April 2015

Successful Models of Community Long Term Care Services for the Elderly. Edited by Killeffer EHP, and Bennett R. Binghamton, NY, The Haworth Press, Inc., 1990. 174 pages. $24.95.
BOOK REVIEWS
Authors: Gordon Michael
Published: April 2015

Textbook of Medical Ethics. By Loewy EH. New York, Plenum Medical Book Company, 1989. 252 pages. $35.00.
BOOK REVIEWS
Authors: Groth‐Juncker Annemarie
Published: April 2015

Infections in Nursing Homes and Long‐Term Care Facilities. Edited by Verghese A and Berk SL, Basel, Switzerland, Karger, 1990. 248 pages. $98.00.
Comparing Sources of Drug Data about the Elderly
Authors: Johnson Richard E. , Vollmer William M.
Published: April 2015

Objective: This project assessed the extent of agreement between drug‐taking data obtained from an in‐home assessment and that obtained from an automated outpatient pharmacy system and from a mail questionnaire.

Design: The underlying assumption is that an in‐home assessment provides the most complete information (criterion standard) about the prescription medications being taken. The drug data from the mail questionnaire and automated outpatient pharmacies were compared with that from the in‐home assessment by use of t tests and measures of sensitivity, specificity, and positive predictive value.

Setting: Kaiser Permanente, Northwest Region, a prepaid group practice HMO.

Participants: All elderly HMO members enrolled in the Social HMO demonstration project who had a comprehensive assessment within 30 days of returning a mail questionnaire between March 1986 and March 1988 (n = 83 frail elderly).

Main Outcome Measures: The number of medications currently being taken and the number of different therapeutic classes of drugs being taken per elderly HMO member.

Main Results: The in‐home assessment and the automated prescription system closely agreed on the number of different medications and the different therapeutic classes of prescription drugs being taken. The in‐home assessment and mail questionnaire were in less agreement. Agreement was less for non‐prescription drugs.

Conclusions: An automated prescription system is an adequate source of information about the prescription drugs currently being taken by frail elderly HMO enrollees with a prepaid prescription drug benefit.
Refusal of Tube Feeding as Seen from a Patient Advocacy Organization: A Comparison with Landmark Court Cases
Authors: Ahronheim Judith C. , Mulvihill Michael
Published: April 2015

Objective: To determine how closely high court decisions regarding tube feeding are a reflection of the situations that occur in the general population.

Design: A retrospective review was conducted of memos recording inquiries made to the Society for the Right to Die (SRD), a patient advocacy organization. Characteristics of clients were compared to characteristics of individuals considered in landmark “right‐to‐die” tube feeding cases during the same period of time.

Results: Information from 116 memos of inquiries made from 1985 through mid‐1990 was compared to 20 court cases, and significant differences were identified. The average age of the SRD clients was 77.6 (±18.4) years compared to 55.1 (±22.8) years for the court cases (P < 0.001). Of the clients, 79% were 70 years of age or older and 28% were 90 or older; in contrast, 7 (35%) of subjects in the court cases were 70 years of age or older, and none was over 90 (P < 0.001). In addition, whereas 14 (70%) of the court cases dealt with individuals in a persistent vegetative state, only 17 (15%) of SRD clients carried that diagnosis (P < 0.001), with the remainder suffering from dementia, various stages of coma, or a variety of other debilitating disorders. The sex distribution, year of inquiry or year of court decision, and geographic distribution were similar. Some states were overrepresented in both groups.

Conclusion: High court cases may inadequately reflect the majority of situations that arise on a day‐to‐day basis. Elderly individuals, in particular those who are not in a persistent vegetative state, are significantly underrepresented.
The Financial Impact of a Nursing Home Practice on an Academic Medical Center
Authors: Zweig Steven , Lawhorne Larry W. , Colwill Jack M.
Published: April 2015

This study reports the economic contributions of nursing home practice to an academic department of family practice as well as the fiscal impact of referrals from nursing home practice on an academic medical center. Payment to primary physician faculty for nursing home service did not fully compensate for faculty effort. Nevertheless, these services did result in significant revenues to consulting physicians and the University Hospital. In aggregate, an average nursing home visit was associated with $33 in charges for the visit by the primary physician, $15 for additional primary care services in the clinic and hospital, $72 for services by consulting physicians, and $307 in charges by the University Hospital. The average nursing home patient provided $3,744 in charges and $2,403 in income to the academic medical center per year, with $1,813 going to the hospital and $331 to consulting physicians. Even though primary care is not well reimbursed, a relatively small number of patients have the capacity to create substantial income for consulting physicians and the hospital. The study does not address whether these nursing home referrals to the hospital utilized disproportionately high hospital resources.
The Quality of Life in Women with Urinary Incontinence as Measured by the Sickness Impact Profile
Authors: Hunskaar Steinar , Vinsnes Anne
Published: April 2015

The objectives of this paper were to assess the quality of life of community‐living women with urinary incontinence according to age, symptom group, amount of leakage, and duration, by use of the Sickness Impact Profile (SIP). Thirty‐six women aged between 40 and 60 years and 40 women aged 70 years or more were randomly selected from the clients attending an incontinence clinic and interviewed using the SIP questionnaire. Urge and stress incontinence subgroups were defined by means of a symptom questionnaire. Total, psychosocial, and physical dysfunctions were moderate (8%, 7%, and 8% respectively) in general, but major differences were found when age and symptom groups were analysed. Urge symptoms were associated with more impairment than symptoms of stress incontinence. The elderly women with symptoms of stress incontinence were relatively little affected, while their younger counterparts were severely affected, especially in the categories of emotional behavior and recreation and pastimes. We conclude that urinary incontinence in women adversely affects quality of life to a significant degree; the extent depends on the nature of incontinence and the age of the person.
Appropriateness of Patient Transfer from a Nursing Home to an Acute‐Care Hospital: A Study of Emergency Room Visits and Hospital Admissions
Authors: Bergman Howard , Carfield A. Mark
Published: April 2015

Objective: To determine the appropriateness of transfers to acute care hospitals from a nursing home.

Design: Nursing home and hospital records of all the nursing home residents during the 3‐year study period were reviewed retrospectively to determine: number and type of transfers; problems identified in the nursing home justifying the transfers; diagnoses made at the hospitals; length of hospital stays; outcome of hospital visits.

Setting: An 80‐bed public nursing home.

Subjects: 112 residents in the nursing home over the 3‐year study period.

Main Outcome Measures: Based on the decision of the hospital physician, those transfers resulting in hospital admissions were considered appropriate. As well, transfers to the emergency room with return to the nursing home without hospital admission were also judged to be appropriate if the problems required diagnostic and therapeutic procedures not available in the nursing home.

Results: During the 3‐year study period, 55 residents (49%) were transferred a total of 102 times. An average of 26% of patients were transferred each year. Direct admissions to acute hospitals accounted for 17% of the transfers, transfers to the emergency room with subsequent admission for 34%, and transfers to the emergency room with subsequent return to the nursing home without admission for 45%. Four percent of patients transferred died in the emergency room. On the basis of the outcome measure, 7% of all transfers could have been diagnosed and treated in the nursing home and were considered inappropriate.

Conclusions: The majority of transfers from this nursing home to acute‐care hospitals were appropriate.
The Relationship between Muscle Mass and Muscle Strength in the Elderly
Authors: Reed Richard L. , Pearlmutter Lori , Yochum Kathleen , Meredith Keith E. , Mooradian Arshag D.
Published: April 2015

To determine the extent that muscle mass is predictive of muscle strength in the elderly, anthropomorphic estimates of muscle area and impedance measurements of muscle mass and peak isometric muscle strength were obtained in a relatively healthy older population over 65 years of age (mean age = 71.7; n = 218). Midarm muscle area correlated strongly with upper arm strength (r = 0.68, P < 0.0001) while midthigh muscle area had a much lower correlation with thigh muscle strength (r = 0.29, P < 0.0001). These muscle area calculations also include bone area. Lean body mass calculated by bioelectric impedance correlated highly with cumulative muscle strength measured by summing all muscle groups (r = 0.79, P < 0.0001). To determine whether aging alters muscle strength per unit of muscle mass, additional middle‐aged subjects were included, and three groups, middle‐aged (55–64) (n = 78), young‐old (65–74) (n = 161), and old‐old (75+) (n = 57), were compared. A significant age‐related trend of decreasing muscle strength per unit of lean body mass was noted. It is concluded that although muscle mass correlates with muscle strength in a healthy older population, use of simple age‐independent clinical measurements of body mass should not be used to predict muscle strength.
Mania in the Elderly: A 5–7 Year Follow‐Up
Authors: Dhingra Upma , Rabins Peter V.
Published: April 2015

A 5–7 year follow‐up study of elderly individuals hospitalized on an acute psychiatric inpatient service for bipolar disorder, manic phase, demonstrates that the prognosis of mania has improved in the past 30 years. A majority of those hospitalized for mania are alive and living independently 5 years after hospitalization. However, eight of 25 (32%) patients have experienced a decline in Mini‐Mental State Exam score to below 24, suggesting a clinically significant cognitive disorder. Mortality rates were higher in the manic group than expected from population norms. Compared to a group of similarly aged individuals hospitalized for unipolar depression, patients with bipolar disorder had an earlier age of onset and a lesser likelihood of being rehospitalized.
The Epidemiology of Skin Tears in the Institutionalized Elderly
Authors: Malone Michael L. , Rozario Nirmala , Gavinski Mary , Goodwin James
Published: April 2015

While skin tears are a common occurrence in the institutionalized elderly population, nothing has been written about this problem. We retrospectively studied all incident reports during a 1‐year period at a large, urban, long‐term‐care facility to identify residents with skin tears. The overall incidence of skin tears was 0.92 per patient per year. The incidence rate for females, but not for males, increased significantly with age (P = 0.012). The mean length of the skin tear was 1.9 cm ± 1.4 (mean ± SD). Eighty percent occurred in the upper extremities, with the most frequent location being the forearm. Almost half of the skin tears reported had an unknown cause. Wheelchairs and accidentally bumping into an object each accounted for a quarter of the skin tears where the cause was known. Transfers and falls contributed to a lesser extent. Impaired mental status was no more likely to be present in residents experiencing a skin tear than in all nursing home residents. Twenty‐four of the 147 residents with skin tears had four or more tears, accounting for 40% of all skin tears reported. Ninety‐seven percent of the episodes resulted in no attending physicians' orders other than the standing orders. Future studies should be designed to determine if there are adverse consequences of skin tears and to suggest programs to reduce their occurrence.