bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Self‐Monitoring of Blood Glucose on Quality of Life in Elderly Diabetic Patients
Authors: Gilden Janice L. , Casia Carla , Hendryx Michael , Singh Sant P.
Published: April 2015

Self‐monitoring of blood glucose (SMBG) has been associated with improvement in diabetes knowledge and glycemic control in young and middle‐aged diabetic patients. This study investigated the influences of SMBG on the quality of life in 20 older diabetic individuals, aged 60 to 79 years with duration of diabetes 15.6 ± 2.3 (SD) years. Questionnaires (Cronbach's alpha reliability = .93) were administered regarding the impact of four aspects of diabetic self‐care—general factors, diet, medications, and monitoring blood or urine—on quality of life. Each category was scored separately. Data were analyzed comparing individuals using SMBG with those monitoring glycosuria. Older patients showed acceptance of SMBG with respect to performance, lack of time consumption, ease of record keeping, and less embarrassment. Individuals performing SMBG reported better medication compliance than those monitoring glycosuria. No differences were observed between the two groups for general factors, diet, or the overall perception of quality of life. Both groups of patients reported that diabetes and performing self‐care techniques did not significantly interfere with their lifestyle. In conclusion, this study demonstrates that self‐care techniques, such as SMBG, do not negatively influence the perception of quality of life in older people.
Improving Medication Prescribing and Utilization in the Nursing Home
Authors: Gurwitz Jerry H. , Soumerai Stephen B. , Avorn Jerry
Published: April 2015

There is ample and compelling evidence to suggest that medications are frequently used inappropriately in the nursing home. The occurrence of avoidable adverse drug reactions is the most serious consequence of inappropriate prescribing; economic implications are also of interest. With increasing concern over the quality of care in nursing homes, and with the revision of regulations governing such care by the Health Care Financing Administration, it is important to consider the experience thus far in monitoring and improving drug use in nursing homes. A number of studies have investigated approaches designed to reduce inappropriate prescribing and drug utilization in this setting. In contrast to the wide range of approaches that have been evaluated and implemented in the hospital setting, interventions in the nursing home have centered primarily around consultant‐pharmacist activities. Although these activities are now federally mandated in all nursing homes, there is little evidence from adequately controlled studies to document their impact or cost‐effectiveness. By contrast, face‐to‐face educational interventions directed at physicians (“academic detailing”) have been shown to be effective in improving prescribing for some medications. The prominent role played by the nursing staff in the utilization of many medications in the nursing home implies that an educational intervention excluding nursing staff would be insufficient to influence drug utilization positively in many situations (eg, psychoactive medications and laxatives). Future research efforts must pay greater attention to adequate study design considerations as well as to the clinical outcomes of such interventions and their cost‐effectiveness.
The Natural History of Functional Morbidity in Hospitalized Older Patients
Authors: Hirsch Calvin H. , Sommers Lucia , Olsen Anna , Mullen Lisa , Winograd Carol Hutner
Published: April 2015

This study provides data on changes in the functional status of older patients that are associated with acute hospitalization. Seventy‐one patients over the age of 74 admitted to the medical service of Stanford University Hospital between February and May 1987 received functional assessments covering seven domains: mobility, transfer, toileting, incontinence, feeding, grooming, and mental status. Assessments were obtained by report from the patient's caregiver (or the patient when he or she lived alone) for 2 weeks before admission; from the patient's nurse on day 2 of hospitalization and on the day before discharge; and again from the caregiver (or patient) 1 week after discharge. The sample had a mean age of 84, covered 37 Diagnostic Related Groups, and had a median length of stay of 8 days. Between baseline and day 2, statistically significant deteriorations occurred for the overall functional score and for the individual scores for mobility, transfer, toileting, feeding, and grooming. None of these scores improved significantly by discharge. In the case of mobility, 65% of the patients experienced a decline in score between baseline and day 2. Between day 2 and discharge, 67°/o showed no improvement, and another 10% deteriorated further. These data suggest that older patients may experience a burden of new and worsened functional impairment during hospitalization that improves at a much slower rate than the acute illness. An awareness of delayed functional recovery should influence discharge planning for older patients. Greater efforts to prevent functional decline in the hospitalized older patient may be warranted.
Biological and Neuropsychological Characterization of Physostigmine Responders and Nonresponders in Alzheimer's Disease
Authors: Harrell Lindy E. , Jope Richard S. , Falgout Janet , Callaway Ross , Avery Carol , Spiers Mary , Leli Dano , Morere Donna , Halsey James H.
Published: April 2015

To assess the efficacy of oral physostigmine for the treatment of Alzheimer's disease, 20 patients were entered into a clinical trial. All patients underwent a dose‐finding phase (two weeks), followed by an open trial (two weeks), and a double‐blind crossover phase (two weeks drug, two weeks placebo). Extensive neuropsychological testing (Buschke Selective Reminding procedure, category generation, picture recognition, finger tapping) and measurement of systemic cholinergic parameters were measured during each of these phases. Patients were classified as physostigmine responders and nonresponders based on a priori established criteria. Using these, nine patients were found to respond to physostigmine, while 11 were classified as nonresponders. During baseline conditions, responders when compared to nonresponders were found to have higher concentrations of red blood cell (RBC) choline (Ch) and higher ratios of RBC Ch to plasma Ch. Neuropsychological tests were found to fall into one of three categories. The first group of tests were sensitive to drug effects and differentiated physostigmine responders from nonresponders; the second group was found to predict responsiveness; and the third group was neither predictive nor sensitive to drug effects.
The Concept of “Reversible” Dementia
Authors: Maletta Gabe J.
Published: April 2015

Although good clinical and research information continually appears in the dementia literature, there is the disconcerting sense that, in some areas, a lack of clarity and rigor exists regarding terminology. Although definitions in the field of dementia initially seem reasonably straightforward, specific problem areas exist. This multidisciplinary field encompasses a variety of physician specialists, as well as other diverse professionals and brings not only the benefit of a rich mix of backgrounds, but also provides a medium for potential misunderstanding due to miscommunication. The variety of definitions of dementia, and especially the label, “reversible dementia,” exemplifies this problem. Disease‐specific dementias, pseudodementia, and delirium are three clinical situations that may or may not be classified as “reversible dementias,” depending on individual training, custom, and jargon. Use of the term “reversible dementia” may cause misunderstanding and inefficiency and benefits neither patient nor caregiver. It is suggested that the term be replaced. Further, all diagnostic labels should be clearly understood and explained. Emphasis must be placed on promoting the fact that all patients with cognitive/functional decline, no matter how defined or what the cause, are eminently treatable individuals.
Autopsies and Death Certificates in the Chronic Care Setting
Authors: Gloth F. Michael , Burton John R.
Published: April 2015

All autopsies (n = 34) performed over a period from July 1, 1981 to June 30, 1988 in a teaching nursing home were reviewed to determine the autopsy rate, to evaluate premortem versus postmortem diagnostic discrepancies, and to see if educational efforts could improve each. The autopsy rate was 3.5%. Major discrepancies appeared in 47.1% of cases. Pneumonia was the most frequent and most frequently missed diagnosis. Only 23 of 34 death certificates reflected the cause of death as documented in the chart, and only 12 had concordant diagnoses with those from autopsy. After a collective educational effort, the autopsy rate increased from a rate (average of initial six years) of 2.4% to 10.8% in the last year. The autopsy rate is low, but can be improved with educational efforts. Death certificates, in this population, may be misleading when used for general statistical purposes.
Lack of an Association Between the Presence of Tumor Necrosis Factor or Interleukin‐1 Alpha in the Blood and Weight Loss Among Elderly Patients
Authors: Mooradian Arshag D. , Reed Richard L. , Osterweil Dan , Clements Neil , Scuderi Philip
Published: April 2015

To determine the association between blood cytokine levels and body weight loss in elderly patients, serum levels of cachectin/tumor necrosis factor alpha (TNF) and interleukin‐1 alpha (IL‐1) were measured with specific and sensitive ELISA systems. Of the 19 healthy young subjects, two (10.5%) had detectable levels of serum TNF and one (5.3%) was positive for IL‐1. In the healthy elderly group, two of the 12 subjects (16.7%) had measurable TNF levels and four (33.3%) had elevated IL‐1 levels. Of the 61 ambulatory elderly patients, 31.1% had serum that contained TNF and 22.9% had IL‐1. Similar proportions were found in 127 nursing home patients. None of the common diseases examined in this study nor any commonly used medications were associated with increased serum cytokine levels. Patients with weight loss of more than 5 lbs were less likely to have elevated serum TNF and IL‐1 levels compared to the rest of the group. It is concluded that although elevated levels of TNF or IL‐1 may occur more frequently in older groups, there is no evidence for a causal relationship between these circulating cytokines and clinically significant weight loss in the elderly.
Short‐Term Variability of Measures of Physical Function in Older People
Authors: Smith Laurel A. , Branch Laurence G. , Scherr Paul A. , Wetle Terrie , Evans Denis A. , Hebert Liesi , Taylor James O.
Published: April 2015

Self reported physical function was assessed in telephone interviews approximately 3 weeks apart for a sample of 193 persons aged 69 or older. Three measures of physical function were used: a modified Activities of Daily Living scale, three items proposed by Rosow and Breslau, and five items from among those used by Nagi. Agreement between first and second interviews was very good; most subjects reported no impairment in function at either interview. Among those who reported some impairment, the degree of limitation within the specific activities reported as limited and the total number of activities with any degree of limitation agreed exactly for most and within one level for almost all subjects. There was no evidence to suggest that age or cognitive impairment affected the variability of the responses, and reported declines and improvements in function were about equally common.
Leisure Time Exercise and Lipid and Lipoprotein Levels in an Older Population
Authors: Reaven Peter D. , McPhillips Janice B. , Barrett‐Connor Elizabeth L. , Criqui Michael H.
Published: April 2015

Plasma lipid and lipoprotein levels were measured in 1,019 men and 1,273 women, aged 50 to 89, who were classified according to whether they reported participation in regular strenuous exercise. In men and women, strenuous exercisers had significantly (P < .01) higher age‐adjusted high‐density lipoprotein (HDL) cholesterol levels than nonstrenuous exercisers, and male strenuous exercisers also had lower plasma triglyceride levels. Adjusting for differences in cigarette smoking, alcohol consumption, or obesity did not alter these results. A subgroup of 498 consecutive men and 615 consecutive women that completed a more detailed exercise questionnaire were classified into categories of light, moderate, heavy, or no exercise. In men, age‐adjusted HDL cholesterol levels were higher and triglyceride levels lower with higher exercise‐intensity categories (P for trend < .001). In the heavy exercise category, HDL cholesterol levels were 15% higher and plasma triglyceride levels were 41% lower than in the sedentary group. In women, HDL cholesterol levels were significantly higher and triglyceride levels lower at the more moderate levels of exercise. In both genders results among exercise‐intensity groups did not change after adjusting for age, cigarette smoking, and alcohol consumption. In men, adjusting for obesity did not significantly alter the intergroup differences, whereas in women adjusting for body mass index or waist‐to‐hip ratio reduced differences in HDL cholesterol levels between exercising and sedentary participants to nonsignificance. We conclude that exercise levels attainable by older adults may significantly improve HDL cholesterol levels and could theoretically reduce the risk of ischemic heart disease.
Diagnosis of Illness Presentation in the Elderly
Authors: Fried Linda P. , Storer Dean J. , King Deborah E. , Lodder Frances
Published: April 2015

In the standard medical model of diagnosis, there is a 1:1 correspondence between clinical symptoms and signs and a pathological disease process. However, it is believed that this model does not accurately define many illness presentations in elderly patients. The frequency with which the medical model is diagnostically accurate, and the other models that might more effectively diagnose geriatric illness, are unknown. This study was designed to ascertain the frequency with which the medical model of diagnosis pertains in a clinical population of older adults and to develop and validate alternative models for diagnosis of illness presentation in this population. Using a retrospective chart review (n = 86) and a prospective validation in a second sample (n = 56) of geriatric assessment clinic patients, it was found that the medical model of illness fit less than half of the patients. To describe the illness presentations of the remaining patients, four new diagnostic models of illness presentation were identified which incorporate comorbidity, functional, and psychosocial factors. Use of these new models along with the medical model of illness diagnosis may assist in more accurate and complete diagnosis in elderly patients and enhance teaching of effective diagnosis in geriatric medicine.
Is the Recommended Daily Allowance for Vitamin D Too Low for the Homebound Elderly?
Authors: Gloth F. Michael , Tobin Jordan D. , Sherman Sheryl S. , Hollis Bruce W.
Published: April 2015

A population of sunlight‐deprived elderly was studied to determine the daily intake of vitamin D and whether dietary intake was sufficient to maintain a normal vitamin D status. Twenty‐two subjects over 65 years old with serum creatinine <180 μmol/L and confined indoors for more than 6 months were chosen from the community and a nursing home in Southeast Baltimore. Three‐day food records were obtained along with serum levels of 25‐hydroxyvitamin D (25‐OHD), 1,25‐dihydroxyvitamin D (1,25‐(OH)2 D), and intact parathyroid hormone (PTH). The mean daily vitamin D intake was over twofold greater than the adult Recommended Daily Allowance (RDA) of 200 IU. The mean 25‐OHD level was 40 nmol/L (normal 25–138 nmol/L) with seven patients less than 25 nmol/L. Of those participants with 25‐OHD values less than 25 nmol/L, the mean vitamin D intake was 467 IU (range 36–1096 IU). We conclude that the current RDA seems inadequate for many older individuals who do not get sun exposure. This particular population of elderly is at risk to develop vitamin D deficiency and the associated complications.
The Progression of Mild Idiopathic Dementia in a Community Population
Authors: O'Connor DW , Pollitt PA , Hyde JB , Fellowes JL , Miller ND , Roth M
Published: April 2015

Thirty‐one subjects aged 75 years and over who were identified as suffering from mild, idiopathic dementia in a large community survey were reviewed at annual intervals for 2 years. Diagnoses and severity ratings were based on defined criteria following a mental state examination, a medical and psychiatric history, detailed cognitive testing, and an interview with relatives or other key informants. Fourteen subjects became more severely demented within 2 years. The initial cognitive test battery failed to reveal any differences between respondents whose dementia advanced and those whose condition remained unchanged, but, in the former group, subjects' symptoms had been present for longer, and a greater proportion had been recognised as demented, or possibly demented, by their general practitioners. We suggest that subjects whose dementia progressed had actually been more severely disabled at the time of identification.
B Complex Vitamin Patterns in Geriatric and Young Adult Inpatients with Major Depression
Authors: Bell Iris R. , Edman Joel S. , Morrow Frank D. , Marby David W. , Mirages Stephanie , Perrone Gayle , Kayne Herbert L. , Cole Jonathan O.
Published: April 2015

This study compared the B complex vitamin status at time of admission of 20 geriatric and 16 young adult non‐alcoholic inpatients with major depression. Twenty‐eight percent of all subjects were deficient in B2 (riboflavin), B6 (pyridoxine), and/or B12 (cobalamin), but none in B1 (thiamine) or folate. The geriatric sample had significantly higher serum folate levels. Psychotic depressives had lower B12 than did non‐psychotic depressives. Poorer blood vitamin status was not associated with higher scores on the Hamilton Depression Rating Scale or lower scores on the Mini‐Mental State Examination in either age group. The data support the hypothesis that poorer status in certain B vitamins is present in major depression, but blood measures may not reflect central nervous system vitamin function or severity of affective syndromes as measured by the assays and scales in the present study.
Follow‐up of Mild Hypothyroidism in a Nursing Home
Authors: Drinka Paul J. , Nolten Wolfram E. , Voeks Susan K. , Langer Elizabeth H.
Published: April 2015

The course of untreated mild hypothyroidism was followed in 67 nursing home residents (mean age 78 years). The diagnosis was based on a normal free thyroxine index (FTI) and elevated thyrotropin concentration (TSH 4.6 to 15.0 μIU/mL, nl ≤ 4.5 μIU/mL). FTI and TSH were measured in follow‐up> 42–378 (mean 161) days after the diagnosis of mild hypothyroidism had been made. In 45 patients initial TSH was <6.8 μIU/mL; in 23 of these subjects TSH returned to normal during the observation period, whereas in 22 TSH remained elevated. In all 22 residents whose initial TSH was >6.8 μIU/mL, TSH remained elevated at follow‐up. In 4 subjects whose initial TSH concentrations ranged from 5.0 to 9.6 μIU/ml, FTI fell below normal 91–141 days after the diagnosis of mild hypothyroidism was made. Clinical progression of the signs or symptoms of hypothyroidism was not detected in the 4 patients who developed hypothyroxinemia. Three demonstrated positive thyroid antibody titers, and 1 had myasthenia gravis. These observations suggest a need for replacement therapy in debilitated patients with mild hypothyroidism and evidence of thyroid autoimmunity.
Unexplained Weight Loss in the Ambulatory Elderly
Authors: Thompson Mason P. , Morris L. Kyle
Published: April 2015

Significant unexplained and unintentional weight loss was found in 45 elderly patients who were identified by computer search of the diagnostic files of seven family practice centers. We performed a case series chart review study which revealed that 24% of the 45 cases had no definitive etiology for the weight loss after two years of extensive clinical investigation. Depression was found to be the most common diagnosis made (18%) followed by cancer (16%). Only four patients died during the study period and all had cancer. The most prevalent diagnosis in this group of ambulatory elderly patients did not prove to be cancer, as often thought, but rather “unexplained weight loss.” CT scans were not found to be helpful as screening tests in the evaluation of weight loss. Using the data from this study, the diagnostic evaluations of elderly patients with unexplained weight loss may be more efficiently directed.
BOOK REVIEWS
Authors: Barzel Uriel S. , Rhymes Jill A.
Published: April 2015

Geriatric Orthopaedics: Rehabilitative Management of Common Problems. By Goldstein TS. Gaithersburg, MD, Aspen Publishers, Inc., 1991. 252 pages, PNS.
Pelvic Muscle Exercise for Stress Urinary Incontinence in Elderly Women
Authors: Wells Thelma J. , Brink Carol A. , Diokno Ananias C. , PhD Robert Wolfe , Gillis Grace L.
Published: April 2015

Purpose

To compare pelvic muscle exercise to pharmacologic treatment of stress urinary incontinence, the most common cause of urine leakage reported by community‐living elderly women.

Subjects

Convenience sample of 157 community‐living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation.

Methods

Eighty‐two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to 50 mg twice a day.

Main results

Treatment outcomes (subjective improvement, self recorded frequency of wetting) were equally satisfactory in both groups. The response to exercises was as good in 5 months as in 6. It was also as good when the minimum recommended number of exercises per day was 80 as when it was 125.

Conclusions

Among those completing the protocol, pelvic exercises were beneficial in reducing stress incontinence, and the benefit was comparable to that produced by phenylpropanolamine.
Is Age an Independent Risk Factor of Adverse Drug Reactions in Hospitalized Medical Patients?*
Authors: Carbonin Pierugo , Bernabei Roberto , Sgadari Antonio
Published: April 2015

Objective: To study the incidence and the risk factors of adverse drug reactions.

Design: Multicenter survey.

Setting: Hospitalized care: 22 internal medicine and 19 geriatric wards.

Patients: All patients (n = 9,148) consecutively admitted during two observation periods of 2 months.

Main Outcome Measure: Incidence of adverse drug reactions.

Results: The mean age was 67.1 ± 0.17 years (median 72); the mean duration of hospital stay was 18.1 ± 0.19 days (median 14). Each patient was administered 5.1 ± 0.03 (median 5) drug prescriptions. The incidence of probable or definite adverse drug reactions was 5.8% (532/9,148). In univariate analysis, the incidence of adverse drug reactions increased from 3.3% at under age 50 to 6.5% at age 70–79 and decreased over age 80 (5.8%). In multivariate logistic regression, taking more than four drugs (OR = 2.94, CI = 2.38–3.62), staying in hospital more than 14 days (OR = 2.82, CI = 2.26–3.52), having more than 4 active medical problems (OR = 1.78, CI = 1.29–2.45), staying in a medical ward instead of geriatric ward (OR = 1.33, CI = 1.09–1.63), and drinking alcohol (OR = 1.28, CI = 1.03–1.58) were positively correlated with adverse drug reactions occurrence (P < 0.05). Age, gender, and smoking cigarettes were not significant predictors of adverse drug reactions.

Conclusion: Age is not an independent risk factor of adverse drug reactions, and good geriatric care can reduce the incidence of adverse drug reactions.
The Home Care Practice and Attitudes of Minnesota Family Physicians
Authors: Keenan Joseph M. , Bland Carole J. , Webster Linda , Myers Shepherd
Published: April 2015

Objective: Assess home care practice and attitudes of Minnesota family physicians (FPs).

Design: Mailed survey.

Setting: State of Minnesota.

Participants: Members of the Minnesota Academy of Family Physicians, 80% of the FPs practicing in the state.

Intervention: A 55‐item mailed, self‐complete questionnaire regarding general practice and personal physician characteristics (18 questions), specific questions regarding geriatric and home care practice and related attitudes (37 questions); up to four reminder or follow‐up surveys were sent.

Main Outcome Measures: Descriptive summary of FP home care practice and attitudes.

Results: Eighty percent of surveys were completed, 76% of responding physicians made at least one home visit in the previous year, and 92% of home visits were to geriatric patients. Discriminant function analysis identified six significant (P < 0.001) variables that explained 52% of the variance (r2 = 0.52, Wilks Lambda = 0.48) in home visiting behavior between frequent home visiting FPs (greater than 24 visits/year) and non‐visiting FPs. FPs most likely to do home visiting were older and tended to have small group or solo practices in rural settings.

Conclusion: The survey documented continued decline (from previously published surveys) of physician home visiting behavior and widespread dissatisfaction with reimbursement. However, attitudes regarding home care provided by other professionals were highly positive.
The Effects of Aging on the Secretion of the Common Alpha‐Subunit of the Glycoprotein Hormones in Men
Authors: Ceda Gian Paolo , Denti Licia , Ceresini Graziano , Torsiglieri W. , Hoffman Andrew R. , Valenti G.
Published: April 2015

To investigate the effects of aging on the secretion of the common alpha‐subunit of the glycoprotein hormones, we measured basal levels of luteinizing hormone (LH), testosterone (T) and alpha‐subunit in 176 normal men aged 19 to 89 years. In addition, in two groups of young (<65 years; n = 25) and old (>65 years; n = 15) subjects, the effects of luteinizing hormone‐releasing hormone (LHRH) on LH and alpha‐subunit secretion were determined. Age‐related increases in serum alpha‐subunit and LH were noted only in the oldest men while T levels decreased progressively with advancing age. LHRH stimulation resulted in significantly greater secretion of alpha‐subunit in the old subjects while no difference in LH release between young and old men was observed. Moreover, there was a delay to peak LH and alpha‐subunit levels after LHRH in the old subjects. These data suggest that the aging process in males involves deficits in both testicular and gonadotroph functions as demonstrated by (1) the relative hypogonadotropic hypogonadism seen until the ninth decade; (2) the hypergonadotropic hypogonadism apparent in men >80 years; (3) the delay in the timing of peak responses of LH and alpha‐subunit after LHRH administration; and (4) the disproportionate increase in the secretion of alpha subunit relative to intact LH.
Epidemiology of Asymptomatic Bacteriuria in Elderly Women
Authors: Abrutyn Elias , Mossey Jana , Levison Matthew , Boscia Jerome , Pitsakis Peter , Kaye Donald
Published: April 2015

We studied asymptomatic bacteriuria in elderly ambulatory women residents without indwelling catheters in self‐contained apartment houses at the Philadelphia Geriatric Center (PGC), in the nursing home at PGC, and in several life‐care communities (LCC). Subjects were studied every 6 months from January 1983 through January 1989, and since enrollment was continuous some participated in more surveys than others. PGC residents were middle class and lived either in a self care apartment house (CL) or nursing home (NH); LCC residents were middle or upper class. Antimicrobial therapy for asymptomatic bacteriuria was not given by the study team.

The ages of the 865 women studied averaged 80.3, 82.8, and 83.3 years in LCC, CL, and NH, respectively. On each survey about 11% at LCC, 18% at CL, and 25% at NH sites had positive cultures. Turnover was high. The conversion rate from a negative to a positive culture was 5% at LCC, 11% at CL, and 8% at NH. The reversion rate from a positive to a negative culture was 33% at LCC, 34% at CL and 31% at NH (P > 0.05). Persistent infection with the same organism was uncommon. Infection risk was associated with residence, which was partially explained by a factor evaluating mobility, but was unrelated to age or scores evaluating activities of daily living or mental status. Besides mobility, other more complex factors play a role in the acquisition of infection.
The Interrelationship between Physical Exercise, Muscle Strength and Body Adiposity in a Healthy Elderly Population
Authors: Reed Richard L. , Yochum Kathleen , Pearlmutter Lori , Meredith Keith E. , Mooradian Arshag D.
Published: April 2015

Objective: To determine the relationship between habitual physical exercise and body adiposity in a healthy elderly population.

Research Design and Methods: Physical exercise was measured by a questionnaire previously adapted for use with the healthy elderly. The level of exercise was converted into calories expended over the previous 14 days and was divided into tertiles. Body adiposity was measured at six sites by anthropometry, and overall percent body fat was measured by bioelectric impedence.

Participants and Setting: Two hundred and thirteen healthy ambulatory subjects over the age of 60 (116 females and 97 males) were recruited from a large retirement community in Southern Arizona. The mean age of the subjects was 70.0 years.

Results: Percent body fat was similar in men with different levels of physical activity (27.9% for lowest fertile of activity, 28.1% for middle tertile of activity, and 28.5% for highest tertile of activity). The corresponding values of percent fat in women was 38.0%, 36.0%, and 37%, respectively. There was a statistically significant increase in muscle strength measured in five muscle groups with a hand‐held dynamometer with increasing levels of activity.

Conclusions: These data indicate that level of physical exercise, over the range of 0 to 1,528 Kcal/day, does not predict body adiposity in the healthy elderly population. To decrease body fat without a change in dietary habits would require a more intensive exercise regimen than currently being undertaken by most healthy elderly people.
The Dubbo Study of the Health of Elderly: Correlates of Coronary Heart Disease at Study Entry
Authors: Simons Leon A. , Friedlander Yechiel , McCallum John , Simons Judith , Powell Idona , Heller Richard , Berry Geoffrey
Published: April 2015

A prospective study of the health of elderly Australians recently commenced in Dubbo, NSW, the study population comprising 1,237 males and 1,568 females 60 years and older. The prevalence rates of coronary heart disease (CHD) and its associated risk factors have been examined in the baseline data. The age‐standardized rate of CHD was 23.8/100 in males and 18.1/100 in females. The prevalence rate increased with age until 79 years in males, thereafter declining. The rate increased steadily with age in females. In a multiple logistic model, the following possible predictors of CHD were included: age, cigarette smoking, use of alcohol, exercise, religiosity, years of education, hypertension, diabetes, family history of CHD, body mass index, lipid and lipoprotein variables. The presence of CHD in males was significantly predicted by age, hypertension (odds ratio, OR = 1.40), family history (OR = 2.05), and high density lipoprotein (HDL) cholesterol (OR = 0.78). The significant predictors in females were age, years of education (OR = 0.82), hypertension (OR = 1.45), family history (OR = 1.77), serum triglycerides (OR = 1.30), and HDL cholesterol (OR = 0.73). Hypertension was found to be a stronger predictor of CHD in the younger age group (60–69 years), while diabetes was a predictor of CHD in older males (70–79 years). Our findings require confirmation in the prospective study now in progress.
Cognitive Function after Spinal or General Anesthesia for Transurethral Prostatectomy in Elderly Men
Authors: Haan Joost , van Kleef Jack W. , Bloem Bastiaan R. , Zwartendijk Jaap , Lanser Jan BK , Brand Ronald , van der Does Iris GF , Krul Evelien JT , Elshove Hester M. , Moll Annet C. , Buruma Onno JS , Roos Raymund AC
Published: April 2015

Cognitive functions in 53 elderly men who underwent a transurethral prostatectomy were assessed pre‐operatively and 4 days and 3 months post‐operatively. Thirteen patients had a preference for one particular type of anesthesia, and the remaining 40 were randomly allocated to receive either spinal or general anesthesia. Cognitive function was not different between the groups receiving different types of anesthesia at either time point and did not decrease post‐operatively. No pre‐ or perioperative variable could distinguish the subgroup of patients who had a post‐operative decrease of 2 points or more on the Mini‐Mental State Examination. No difference in post‐operative performance was found in the patient groups with pre‐operative Mini‐Mental State Examination scores above or under their age‐specific norm. It is concluded that neither hospitalization nor the two forms of anesthesia investigated cause a decrease in cognitive function in elderly men.
The Effect of Planned Walking on Communication in Alzheimer's Disease
Authors: Friedman Rita , Tappen Ruth M.
Published: April 2015

One of the effects of Alzheimer's disease is a diminution in the ability to communicate. A randomized, non‐blinded two‐group experimental study was undertaken to determine if planned walking has the capacity to improve the communication performance of patients with moderate to severe Alzheimer's disease. Thirty subjects meeting NINCDS‐ADRDA diagnostic criteria for probable Alzheimer's disease, selected from two nursing homes, participated in the study. Intervention and comparison groups were each made up of subjects from both nursing homes. Subjects in one group were walked individually for 30 minutes three times a week for 10 weeks. Subjects in the comparison group were engaged in conversation for the same amount of time for 10 weeks.

A multivariate analysis of variance (MANOVA) was performed on the communication data. Analysis of the data at post‐testing indicated that communication performance improved significantly in the planned walking group over the conversation‐only group (f = 4.29; df = 2.28; P = 0.024). The results suggest that a planned walking program has the capacity to improve the communication performance of patients with Alzheimer's disease.
Osteoporosis in Late Life: Does Health Locus of Control Affect Psychosocial Adaptation?
Authors: Gold Deborah T. , Smith Sandra D. , Bales Connie W. , Lyles Kenneth W. , Westlund Ronald E. , Drezner Marc K.
Published: April 2015

Osteoporosis, a metabolic bone disease most prevalent in older adults, is a major public health problem. Although management of osteoporosis through diet, exercise, and medication has improved, little is known about the psychosocial consequences of this disabling disease. In an attempt to identify patient characteristics that would provide physicians with insight into appropriate management styles for older osteoporotics, we assessed 103 patients with osteoporosis for their health locus of control (HLOC) orientation. We examined the relationship between HLOC and patient outcomes after participation in the Duke University Preventive and Therapeutic Program for Osteoporosis (DUPATPO) to determine whether HLOC was associated with functioning after program participation. More specifically, we asked whether internal or external HLOC was associated with decreases in depression, psychiatric symptoms, and stress symptoms, or with increases in self‐esteem, exercise, and disease knowledge. We have shown in our earlier work (Gold et al, J Am Geriatr Soc 1989; 37:417) that program participation is associated with improved functioning in older adults. We now asked whether knowledge of a patient's HLOC would help predict these improvements. A comparison group (ie, older osteoporotics who did not participate in DUPATPO) was also assessed for HLOC to examine the possible association between HLOC and health behaviors regardless of the DUPATPO intervention. Our findings indicate that HLOC provided little useful information regarding patient outcomes. Although improvements were seen in the mental health of program participants, no association between these improvements and HLOC could be found.
Self Report and Performance‐Based Hand Function Tests as Correlates of Dependency in the Elderly
Authors: Falconer Judith , Hughes Susan L. , Naughton Bruce J. , Singer Ruth , Chang Rowland W. , Sinacore James M.
Published: April 2015

Preventing or minimizing functional dependency in older adults rests, in part, upon the ability to predict who is at risk. The purpose of this study was to compare the ability of five tests of hand function to discriminate the degree of dependency in older adults. Seven hundred sixty four subjects were assessed for hand function on performance‐based (Williams Test of Hand Function, a test of Williams Board items only, Jebsen Test of Hand Function, grip strength), and self‐reported (Dexterity Scale of the Geriatrics‐Arthritis Impact Measurement Scale (GERI‐AIMS)) measures of hand function, and self‐reported multidimensional functional status (GERI‐AIMS). A trichotomous variable representing a continuum of dependency based upon living site (independent living, home‐bound, institutional) was used as the measure of dependency. Sixty‐two cases were dropped for incomplete data. Discriminant function analyses of the 702 subjects (age = 76.78 years, SD = 8.79) showed that basic demographic variables explain 40.8% of the variance in dependency; all hand function tests significantly correlated with dependency; the Williams Board correlated best (additional 12.5% variance explained). However, a multidimensional functional status measure explains substantially more variance in dependency (16.9%) after controlling for demographic variables and performance on the Williams Board. This comparison of methods and tests available for measuring hand function was made to provide criteria for selecting an instrument for a given setting.
Thyroid Stimulating Hormone Elevation without Antithyroid Antibody Elevation in Nursing Home Patients
Authors: Drinka Paul J. , Nolten Wolfram E. , Voeks Susan , Hanger Elizabeth
Published: April 2015

Objectives: To investigate the relationship between antithyroid antibody elevation and thyrotropin (TSH) elevation.

Setting: Large state veterans home.

Methods: Seven hundred seventy‐six residents were screened for TSH elevation. Seventy‐two residents with TSH elevation and no history of thyroid disease or recent iodine exposure later had determinations of antithyroglobulin and antimicrosomal antibodies. The relationship between TSH levels and antibody titers was explored.

Results: Eleven percent of the residents had TSH elevation. Thirty‐two percent of men and 64% of women with TSH elevation had elevation of antithyroid antibodies. Those residents with the highest antithyroid antibody titers had significantly greater TSH elevation.

Conclusion: Previous investigators have found similar percentages of individuals with TSH elevation who lack antithyroid antibody elevation. We hypothesize that TSH elevation without elevated antibody titers may be the result of a previously described involutional histologic lesion of the thyroid.
The Relation of Dizziness to Functional Decline
Authors: Boult Chad , Murphy John , Sloane Philip , Mor Vincent , Drone Corby
Published: April 2015

Objective: to assess the effect of dizziness on the probability that an older person will die or become functionally disabled within 2 years. Dizziness is a common symptom for which the prognosis is uncertain. This report compares the prognoses for dizzy and not‐dizzy older people in order to assist clinicians who diagnose and treat these patients.

Design: a prospective study of a representative sample of elderly (70+) non‐institutionalized Americans. Elderly subjects (n = 3,798) in the Longitudinal Study of Aging (LSOA) were asked questions about the presence of dizziness, medical conditions, and functional disability in 1984. The cohort was reinterviewed about functional disability in 1986.

Outcome Measure: transition from functional ability to disability after 2 years.

Results: Bivariate analyses showed that dizziness predicts functional decline but not mortality. Multivariate models revealed that age, race, sensory impairment, vascular disease, and other morbidity are independent predictors of becoming disabled. Controlling for these potential confounders, dizziness does not predict an increased probability of becoming disabled.

Conclusion: Elderly people who are dizzy should be evaluated for the presence of these related conditions.
Effect of Education on the Mini‐Mental State Examination as a Screening Test for Dementia
Authors: Uhlmann Richard F , Larson Eric B
Published: April 2015

We studied whether Mini‐Mental State Examination (MMSE) norms for detecting dementia in elderly outpatients vary according to educational attainment. Subjects were 109 elderly outpatients with Alzheimer's dementia and 100 non‐demented outpatient controls. Receiver operating characteristics (ROC) of the MMSE were examined among three strata of educational attainment: middle school, high school, and college/graduate school. MMSE ROC curve areas were .95–.96 in the three educational strata. Assuming a dementia prevalence of 10%–30%, the most accurate lower limits of normal for MMSE scores and their attendent sensitivities and specificities were 21 for middle school (.82/.94), 23 for high school (.79/.97), and 24 for college/graduate school (83/1.00) attainment. These norms accurately classified over 90% of subjects in all three educational strata. We conclude that education‐specific norms optimize performance of the MMSE as a screening test for Alzheimer's dementia in elderly outpatients.
The Ethics of Pressure Sore Prevention and Treatment In The Elderly: A Practical Approach
Authors: Moss Robert J. , La Puma John
Published: April 2015

The management of pressure sores in elderly patients raises a number of ethical dilemmas for health care professionals. Aggressive treatment of advanced pressure sores is often inconsistent with the overall goals of therapy. Private and public funding for effective prevention and early treatment are restricted and constrained. Little information is available that proves treatment efficacy. Health care professionals and their institutions are often stigmatized by the occurrence of a pressure sore even though accountabilities may lie in the natural history of the disease. We use case analysis to identify ethical dilemmas in pressure sore prevention and management and suggest a framework for ethical decisionmaking so that health care professionals and public policy analysts can make informed judgments about patients and standards of quality care.
Oral Cancer Screening in the Elderly
Authors: Fedele Denise J. , Jones Judith A. , Niessen Linda C.
Published: April 2015

Oral cancers represent approximately 3% of all cancers diagnosed in the United States. Oral cancer is one‐fifth as common as cancer of the breast, colon, and lung but more than twice as common as cervical cancer. Incidence rates for oral cancer are highest among older men. Epidemiologic data identify alcohol and tobacco as major risk factors associated with the disease. Screening for oral cancer is a simple, non‐invasive procedure which can be easily incorporated into the comprehensive assessment of older patients. Oral cancer screening can detect early, localized lesions which are associated with an improved prognosis. Five‐year survival rates are more than four times greater in individuals with localized lesions than those with distant metastases. Since older Americans visit their physician more often than their dentist, the physician's medical examination provides an excellent opportunity to screen for oral cancers.
Is Routine Preoperative Hemodynamic Evaluation of Nonagenarians Necessary?
Authors: Schrader Lydia L. , McMillen Marvin A. , Watson Charles B. , MacArthur John D.
Published: April 2015

An Incidence of co‐morbid cardiac disease in the elderly surgical patient as high as 66% has been previously reported.1 Even in the absence of clinically significant cardiac disease, advanced age alone is often considered sufficient indication for Swan‐Ganz placement, hemodynamic evaluation, adjustment of fluid states, and inotropic support. Yet data clearly documenting the need for this evaluation and therapy are difficult to obtain. All major general surgical and orthopedic operations in nonagenarians were reviewed in our institution from July 1, 1987 through December 31, 1988. Fifty‐one procedures were performed on 46 patients. None of these patients had preoperative Swan‐Ganz catheterization or hemodynamic evaluation. Eighteen general surgical, 30 orthopedic, 2 neurosurgical, and 1 gynecological procedures were performed. Forty‐three were performed under general anesthesia, 7 under spinal anesthesia, and 1 with local anesthesia. Seven out of 51 patients (14%) experienced major complications, and 16 out of 51 (31%) experienced minor complications. Thirty‐day mortality was 0%, and 6‐month survival was 92%. Only one complication occurred within 48 hours of surgery that might possibly have been prevented with hemodynamic evaluation, adjustment of fluid status, inotropic support, and intensive care unit monitoring.
Erythropoietin Response to Anemia as a Function of Age
Authors: Powers James S. , Krantz Sanford B. , Collins Jerry C. , Meurer Karen , Failinger Ann , Buchholz Terry , Blank Michael , Spivak Jerry L. , Hochberg Mark , Baer Alan , Cotes P. Mary , Goldwasser Eugene
Published: April 2015

The erythropoietin (EPO) response to anemia was assessed for 244 subjects aged 1–64 years (mean 45.2 years) and 121 subjects aged 65–94 years (mean 68.3 years). Subjects included non‐anemic individuals as well as those with anemia of various etiologies, excluding renal disease and pregnancy. Significant inverse correlations between serum immunoreactive EPO and hematocrit were noted for both groups. Regression lines failed to show a significantly lower slope or y‐intercept for older compared to younger subjects. EPO levels were not significantly lower for older compared to younger subjects when controlled for hematocrit level. These results suggest that the EPO response to anemia in older subjects is similar to that of younger subjects.
Falls and Injuries in Frail and Vigorous Community Elderly Persons
Authors: Speechley Mark , Tinetti Mary
Published: April 2015

Identification of different types of falls and fallers among elderly persons might aid in the targeting of preventive efforts. In a representative sample of 336 community elderly, subjects were assigned to Frail, Vigorous, or Transition groups based on observed patterns of clustering among demographic, physical, and psychological variables. The frequency and circumstances of falls in these three groups were then ascertained. As expected, the observed incidence of falling in one year of follow‐up was highest in the Frail group (52%) and lowest in the Vigorous group (17%). However, 22% (5/23) of falls by vigorous subjects, but only 6% (5/89) of falls by frail subjects, resulted in a serious injury. Compared with frail subjects, vigorous fallers were somewhat more likely to fall during displacing activity (53% vs 31%), with an environmental hazard present (53% vs 29%), and on stairs (27% vs 6%). These findings suggest that fall‐related injuries can be a serious health problem for vigorous as well as frail elderly persons. Injury prevention, therefore, should be directed at all elderly persons but tailored to expected differences in fall circumstances.