bluuebunny/crossref_metadata_2025 huggingface dataset:
Reported Home Health Agency Referrals by Internists and Family Physicians
Authors: Boling Peter A. , Keenan Joseph M. , Schwartzberg Joanne , Retchin Sheldon M. , Olson Lorayn , Schneiderman Mindy
Published: April 2015

Objective: To evaluate the frequency of home health agency referrals (HHRs) by internists and family physicians.

Objective: Telephone survey of a randomly selected, nationally representative, stratified physician sample.

Participants and Setting: One thousand one hundred sixty‐one interviews with 576 family physicians and 585 internists selected from the American Medical Association Physician Masterfile.

Main Results: Most respondents (88%) reported making HHRs (mean for those making HHRs = 43/year). Physicians with ≥ 48 annual HHRs (n = 315) reported a mean of 2.6 hours/week in home care telephone management and 2.1 hours/week on related paperwork. Rural internists and family physicians (n = 230) reported less availability of several types of non‐physician home health services than non‐rural respondents (n = 931), yet rural physicians were more likely to refer patients to home health agencies. Using multivariate linear regression, the reported frequency of HHRs was significantly related to rural practice location, number of home‐bound patients, proportion of geriatric patients, number of house calls, graduation from a U.S. or Canadian medical school, physician knowledge of community resources, and physician experience either as a medical director, a member of the board of directors, or a consultant for a home health agency.

Conclusions: Internists and family physicians who work at least 10 hours per week in ambulatory care report making approximately three home health agency referrals per month and spending substantial amounts of time coordinating home health agency care. Despite reporting less availability of many home health agency services, rural physicians report greater involvement than non‐rural physicians in the delivery of home care. J Am Geriatr Soc 40:1241–1249, 1992
A Comparison of Patient Risk for Pressure Ulcer Development with Nursing Use of Preventive Interventions
Authors: Xakellis George C. , Frantz Rita A. , Arteaga Manuel , Nguyen Man , Lewis Anne
Published: April 2015

Objective: (1) Determine if the Braden scale or Norton scale predicted the same patients to be at risk for pressure ulcer development as were receiving preventive nursing interventions. (2) Identify the items on the Braden and Norton risk assessment scales that the nurses used intuitively to determine a patient's need for a preventive intervention.

Objective: Cross‐sectional study.

Setting: Six hundred‐bed, state‐supported, long‐term care facility.

Patients: War veterans who were 82% male and 97% Caucasian, mean age 73.

Measurements: (1) Patients were categorized as at‐risk or not‐at‐risk by the Norton and Braden scales. (2) The presence of a preventive nursing intervention was noted. Agreement in assignment of at‐risk status among the two assessments and presence of a preventive intervention was analyzed using Cohen's Kappa. (3) The staff nurses' use of preventive interventions was modeled using stepwise logistic regression. The items from the Braden and Norton risk assessment scales were used as independent variables with staff nurse implementation of a preventive intervention as the dependant variable.

Results: Nurse preventive interventions were found on 45% of patients. The Norton scale identified 38% and the Braden scale identified 27% of patients as at‐risk. Agreement among the three methods was 0.53. Agreement between the Braden and Norton scales was 0.73. Agreement between use of a preventive intervention and a classification as at‐risk by the Braden or Norton scale was 0.41 and 0.43, respectively. Stepwise logistic regression revealed that low Braden mobility scores (Odds Ratio: 2.74) and low Braden friction/shear scores (Odds Ratio: 3.29) were associated with an increased likelihood of a patient receiving a preventive nursing intervention.

Conclusions: The overall level of agreement among the two scales predicting risk and the presence of a preventive intervention was not high. Agreement, however, between the two risk assessment scales was close. The staff nurses apparently relied on a patients' mobility, their exposure to friction/shear, and additional unidentified factors to guide implementation of a preventive intervention. Further study is needed to define the cost, efficacy, and related cost effectiveness of routine pressure ulcer risk assessment. J Am Geriatr Soc 40:1250–1254, 1992
Depression in the Elderly: Effect on Patient Attitudes toward Life‐Sustaining Therapy
Authors: Lee Melinda A. , Ganzini Linda
Published: April 2015

Objective: To determine the effect of depression on preferences for life‐sustaining therapy in older persons.

Design: A survey comparing depressed, older veterans and a similar, but non‐depressed, control group.

Setting: A 490‐bed Veterans Affairs teaching hospital.

Patients: Medical inpatients over 65 years of age were potential subjects. Patients who were in intensive care, cognitively impaired, unable to communicate, abusing alcohol or drugs, or unable to return for outpatient care were excluded. Ninety‐five eligible subjects (29%) refused to participate. Depressed subjects scored >14 on the Geriatric Depression Scale (GDS) and were diagnosed as depressed by a psychiatrist who was blind to the GDS results. Complete data were collected on 50 depressed and 50 control subjects.

Main Outcome Measures: A self‐administered questionnaire quantified patients' preferences regarding life‐saving interventions in their current state of health and in four hypothetical scenarios of serious illness.

Results: Depressed subjects desired fewer interventions than control subjects in their current health and in hypothetical scenarios with a good prognosis (P < 0.05). There were no differences between groups in poor prognosis scenarios. However, depression did not explain more than 5% of the variance in decision‐making in any situation. In good prognosis scenarios, subjects' assessment of quality of life was the most powerful predictor of desire for life‐saving interventions, accounting for 9%–17% of the variance (P < 0.01).

Conclusions: These results suggest that depression is associated with treatment refusal in situations with a good medical prognosis. Depression, however, is only a weak predictor of treatment refusal. Further research is needed to define which patients would accept medical treatment if effectively treated for depression. J Am Geriatr Soc 40:983–988, 1992
Exporting a Successful Influenza Vaccination Program from a Teaching Hospital to a Community Outpatient Setting
Authors: Margolis Karen L. , Nichol Kristin L. , Wuorenma Jan , Von Sternberg Thomas L.
Published: April 2015

Purpose: To assess whether we could export a successful multifaceted influenza vaccination program from an academic medical center to a community setting.

Design: Pre/post study using concurrent control groups.

Setting: Clinics in a staff model Health Maintenance Organization (HMO). One urban and one suburban clinic were chosen as intervention clinics, while two similar clinics were selected as control clinics.

Patients: All patients aged 65 and over enrolled in the four clinics.

Interventions: An informational mailing to patients, a standing‐order policy allowing nurses to administer vaccine, a vaccination reminder on daily appointment lists, and availability of walk‐in visits for vaccination. Patients in the control clinics received usual care.

Measurements: Vaccination rates were determined using a validated postcard survey of 150 randomly selected patients at each clinic both at baseline (1988–89) and after the intervention (1989–90).

Results: The baseline vaccination rates ranged from 51.4% to 74.6%, with nearly all vaccinations taking place at the HMO. In one intervention clinic, the vaccination rate improved from 56.4% to 72.3%, P = 0.01. In the other, the baseline rate was 74.6% and did not change significantly after the intervention. There was no change in the vaccination rate in the control clinics after the intervention period.

Conclusions: An influenza vaccination program that combines several organizational interventions may be successfully exported from an academic to a community setting and may serve as a useful model for others. J Am Geriatr Soc 40:1021–1023, 1992
Are Activity‐Based Assessments of Balance and Gait in the Elderly Predictive of Risk of Falling and/or Type of Fall?
Authors: Topper A. K. , Maki B. E. , Holliday P. J.
Published: April 2015

Objective

To determine whether an activity‐based test of balance and gait is predictive of the risk of: (1) falling in situations that are related to specific tasks evaluated as part of the test, (2) experiencing falls precipitated by different classes of biomechanical events, or (3) falling in general; and to compare the predictive ability of the activity‐based test for the falls described in (2) and (3) to that of a posturography test that has been found previously to be predictive of falling risk.

Design

Cohort study.

Setting

Baseline tests performed in balance laboratory; subsequent history of falling monitored prospectively for 1 year in two residential‐care facilities.

Participants

Seventeen male and 83 female consecutive volunteers (mean age = 83, SD = 6) who were independent in activities of daily living and able to stand unaided.

Measurements

Independent variables were derived from an activity‐based balance‐and‐gait test and a posturography test. Dependent variables were the numbers of subjects with one or more: (1) falls in specific situations related to activity‐based test items, (2) falls related to general classes of biomechanical precipitant, and (3) falls in general.

Main Results

Subjects who were rated as “abnormal” in activity‐based test items related to transfers, turning or reaching were more likely to experience one or more falls in related situations in everyday life. Activity‐based scores were predictive of risk of experiencing falls with no obvious biomechanical precipitant and falls precipitated by center‐of‐mass perturbation, but not falls precipitated by base‐of‐support perturbation. In comparison, a posturographic measure of spontaneous medial‐lateral postural sway (blindfolded conditions) failed to predict falls having no biomechanical precipitant, but provided the best predictions of both center‐of‐mass and base‐of‐support falls, as well as risk of falling in general.

Conclusions

Activity‐based testing of certain tasks (transfer, turning, reaching) may be useful in indicating a specific need for intervention to reduce the risk of falling during related everyday activities. In terms of predicting falling risk, a static posturography test may provide better prediction overall of the different classes of falls and may be useful as a quick and simple screening tool to help identify high‐risk individuals.
Hypouricemia, Abnormal Renal Tubular Urate Transport, and Plasma Natriuretic Factor(s) in Patients with Alzheimer's Disease
Authors: Maesaka John K. , Wolf‐Klein Gisele , Piccione Joanne M. , Ma Chan M.
Published: April 2015

Objective

To study tubular urate transport in Alzheimer's disease (AD) and measure sodium and lithium transport rates in rats exposed to AD plasma.

Design

Cross‐sectional study in three comparison groups.

Setting

Referral private institution involving outpatient and hospitalized patients.

Patients

AD, multi‐infarct dementia (MID) and non‐demented controls (C) were selected and evaluated by a geriatrician and a psychiatrist according to availability and willingness to participate in the study. Demented patients had brain imaging, categorized according to NINCDS‐DSM III criteria, and had Mini‐mental status examination (MMSE) scores determined.

Interventions

Injection of 0.5 mL of plasma I.P. followed 120 minutes later by an IV plasma injection of 0.2 mL priming dose and infusion of 1.8 mL of plasma at 0.01 mL/min in Sprague Dawley rats.

Measurements

Renal clearance studies were performed in subjects and in rats exposed to the plasma of study subjects. We measured serum urate concentration and fractional excretion (FE) of urate in subjects and FE sodium and FE lithium in rats.

Results

Serum urate was lower and FE urate higher in 18 AD patients compared with six patients with MID, P < 0.05 and P < 0.005, and 11 C, P < 0.02 and P < 0.005, respectively. Higher FE sodium and FE lithium were noted in rats given plasma from 19 AD patients compared with 12 with MID, P < 0.005 and P < 0.0025, and 14 C, P < 0.0025 and P < 0.0005, respectively. FE sodium and FE lithium decreased progressively after serial dilutions of three AD plasmas and FE lithium was negatively correlated with MMSE scores only in AD, r = ‐0.71 and P < 0.0005.

Conclusions

In AD there is defective tubular urate transport and a plasma natriuretic factor(s). FE sodium and/or FE lithium in rats exposed to plasma of demented patients may differentiate AD from MID and estimate the severity of AD.
Dementia, Agitation, and Care in the Nursing Home
Authors: Aronson Miriam K. , Post Donna Cox , Guastadisegni Paul
Published: April 2015

Objective

To examine the behavioral and functional problems of the cognitively impaired.

Design

A survey of a cohort of residents from six nursing homes.

Participants

Subjects were randomly selected based on a minimum age of 70 years and a Resource Utilization Group (RUG) classification of the Physical or Behavioral type. Of those eligible, 44% (n = 366) agreed to participate. The participants and non‐participants had similar demographics except for a higher incidence of mental illness in the non‐participant group, which did not have a significant impact on agitation.

Setting

Six nursing homes in New York City, three voluntary non‐profit and three proprietary.

Measurement

The study used chart review, assessment of residents' cognitive and functional abilities, nursing assistants' ratings of residents' functional abilities, behavioral problems, and the amount of effort required in care, and time‐motion observations of staff‐resident interactions.

Results

Residents' level of cognitive impairment had a significant impact on problem behaviors during ADL tasks, along with supervision required in patient care (P < 0.05). These results were validated by time‐motion analysis. Regression analysis revealed that for non‐demented subjects, the best indicator of care needs was health status, while for demented residents the best indicator was cognitive status (P < 0.0003).

Conclusions

The care needs of residents with dementia are better estimated by a mental status test for cognitive impairment then by ADL assessment alone. Greater agitation is associated with increasing cognitive impairment. Further, agitation and behavioral problems associated with care result in a need for increased staff supervision.
Predicting Short‐Term Survival for Patients with Advanced Alzheimer's Disease
Authors: Volicer Beverly J. , Hurley Ann , Fabiszewski Kathy J. , Montgomery Paul , Volicer Ladislav
Published: April 2015

Objective

The purpose of this study was to develop a statistical model for predicting short term survival in patients with dementia of the Alzheimer type (DAT).

Design

A prospective cohort study.

Setting

Three 25‐bed intermediate medical care units using a structured approach to patient care management including palliative care options and patients from a second, traditional long‐term care setting.

Participants

Of 104 patients with advanced DAT monitored for 34 months, 68 patients (97% white male) who had at least one fever episode were included in the model development phase. Data from 71 additional DAT patients with at least one fever episode were used to test the statistical model.

Main Outcome Measures

Six‐month survival following a fever episode.

Results

Older age and higher severity of DAT at the time of the fever episode, palliative care, and hospital admission for long‐term care within 6 months prior to the fever were found to be positively associated with likelihood of mortality within 6 months of the fever onset. Adjusted odds ratios for each of these variables were statistically significant. The model performed well in subsequent testing on an independent sample of patients.

Conclusion

Results provide a formula which can be used to predict likelihood of dying within 6 months following onset of a fever in DAT patients. This statistical prediction is recommended for use in combination with clinical judgment to certify DAT patients for Medicare hospice coverage.
BOOK REVIEWS
Authors: Hoyer William J. , Kotary Lisa
Published: April 2015

Annual Review of Gerontology and Geriatrics, Vol. 11. Edited by K. Warner Schaie and M. Powell Lawton. New York, Springer Publishing Co., 1991. 365 pages including author and subject indexes. $46.00.
Adverse Clinical Events in Dependent Long‐Term Nursing Home Residents
Authors: Bernardini Bruno , Meinecke Claudia , Zaccarini Cinzia , Bongiorni Nadia , Fabbrini Stefano , Gilardi Camilla , Bonaccorso Orazio , Guaita Antonio
Published: April 2015

Objective

To assess the occurrence, type, and burden of adverse clinical events (ACE) among residents of chronic facilities. An ACE is any acute or subacute change in health status suggesting acute or subacute illness.

Design

Survey with face‐to‐face functional assessment and 3‐month retrospective chart review.

Study Population

One hundred six continuing‐care residents with a minimum length of stay of 4 months at an Italian chronic care facility.

Measurements

Functional assessment and chart review‐based classification of ACE burden on care management according to a clinical‐functional Severity Rating Scale.

Main Results

Functional dependence, dementia and concurrent clinical problems were common. Two hundred seventy‐three ACEs were detected. Eighty‐nine percent of residents experienced at least one ACE. Only 21% of ACEs could be managed by simple medical intervention and monitoring within 1 day; in 23% there was need for more complex care management; 7% of the latter ACEs resulted in residual (new) functional impairment. Cardiovascular and gastrointestinal systems were most commonly involved in ACEs. Neurological ACEs were the most frequent category leading to new functional impairment (22%). ACE occurrence/burden was higher in male residents (P < 0.01) and strongly associated with the number of concurrent medical problems (P < 0.001). Neither cognitive nor functional dependence levels were related to ACE occurrence.

Conclusions

This description of the burden on care management resulting from acute and subacute changes in clinical and functional status of chronic patients emphasizes the continuing and unpredictable nature of medical attention required in a nursing home or chronic care facility. ACEs occur far more frequently among the elderly than is generally recognized. Thus a high level of medical and nursing skill is necessary in chronic care facilities.
Clinical Presentation of Meningioma in the Elderly
Authors: Wofford James L. , Moran William P. , Wilson Thomas A. S. , Velez Ramon
Published: April 2015

Objective

To compare presenting manifestations of meningioma in elderly patients with those in younger patients.

Design

Retrospective survey.

Setting

Tertiary care center.

Patients

All hospitalized adult patients with the primary diagnosis of meningioma over a 5‐year period (n = 116). Nine patients with recurrence of a previously resected meningioma were excluded. Fifty‐two percent (56/107) of patients were ≥65 years of age.

Measurements

Presenting symptoms were classified as asymptomatic, focal, non‐specific, or both focal and non‐specific. Presenting neurologic signs on physical examination were classified as focal, non‐focal, or normal. Duration of symptoms was classified as ≤1 week, 1 week to 1 month, 1 to 6 months, and >6 months.

Results

Older patients presented more commonly with confusion (32% vs 4%) and dystaxia (28% vs 10%) than younger patients and presented less commonly with headache (23% vs 49%) and visual changes (21% vs 43%). While 2% of patients were asymptomatic at presentation, the remainder had symptoms categorized as focal (38%), non‐specific (26%), or both (34%). There was no significant difference between older and younger age groups in the proportions of patients having focal symptoms. Duration of symptoms for all patients was categorized as ≤1 week (15%), 1 week to 1 month (16%), 1 to 6 months (23%), and >6 months (44%). In general, older patients were diagnosed earlier than younger patients. The presence of focal neurologic signs was not significantly different between older and younger patients.

Conclusions

Presenting manifestations of meningioma differ between older and younger adult patients, but focality of symptoms and signs is similar. In this case series, the duration of symptoms prior to diagnosis was shorter in older than in younger patients.
Selenium and Oxygen‐Metabolizing Enzymes in Elderly Community Residents: A Pilot Epidemiological Study
Authors: Berr Claudine , Nicole Annie , Godin Jean , Ceballos‐Picot Irene , Thevenin Marc , Dartigues Jean‐François , Alperovitch Annick
Published: April 2015

Objective

To investigate the relationship of selenium and oxygen‐deactivating enzymes with age in the elderly.

Sample

The study sample consisted of volunteers recruited from the PAQUID study. This study is conducted in a representative sample of non‐institutionalized individuals aged ≥65 years living in Southwestern France; its main objective is to study longitudinally the incidence and risk factors of dementia.

Methods

Plasma and erythrocyte selenium and activities of oxygen metabolizing enzymes in erythrocytes (GSH‐Px, CuZn‐SOD, and GSSG‐RD) were measured in 239 volunteers (108 males and 131 females; mean age 73.7 years).

Results

Plasma selenium (PSe) decreased significantly with age; a similar but non‐significant trend was found for erythrocyte selenium (ESe). None of the enzyme activities showed a clear relationship with age. Women had significantly higher GSH‐Px activities than men. For PSe levels lower than 77 ng/mL, there was a strong correlation between PSe and GSH‐Px; above this value, the correlation decreased, suggesting that the selenium requirement for GSH‐Px production had been satisfied. In this sample, CuZn‐SOD was correlated negatively with GSH‐Px (r = −0.18; P ≤ 0.01) and positively with GSSG‐RD (r = +0.20; P ≤ 0.01).

Conclusions

In individuals aged ≥65 years, we found that blood selenium levels were negatively correlated with age. Our analysis of the relationship between selenium and GSH‐Px activity suggests that low selenium values are associated with decreased GSH‐Px activity.
Interleukin‐6: A Cytokine for Gerontolgists
Authors: Ershler William B.
Published: April 2015

Interleukin‐6 (IL‐6) is a multifunctional cytokine that presumably plays its major role as a mediator of several of the acute phase inflammatory responses. These include inflammatory cell and lymphocyte activation and hepatocellular stimulation of acute phase protein synthesis. IL‐6 expression is normally low, and serum levels are usually non‐detectable in the absence of inflammation. However, with advancing age, serum levels become detectable, and it is proposed that this reflects an age‐associated loss in the normal regulation of gene expression for this molecule. The cause of this is most likely multi‐factorial, but there is evidence that it relates to an age‐associated loss of T cell immunoregulatory functions as well as menopausal loss of estrogen. In any event, the “inappropriate” presence of IL‐6 results in many changes typical of chronic inflammation. There is also speculation that IL‐6 may contribute to the pathogenesis of several diseases of late‐life including lymphoma, osteoporosis, and Alzheimer's disease. In this review the biology of this important cytokine is presented and its relevance to gerontology is highlighted.
A Comparative Study of Monoclonal Gammopathies and Immunoglobulin Levels in Japanese and United States Elderly
Authors: Bowden Mark , Crawford Jeffrey , Cohen Harvey Jay , Noyama Osamu
Published: April 2015

Objective: To define the prevalence of monoclonal immunoglobulin (Ig) proteins and quantitative serum immunoglobulin levels in elderly Japanese in comparison with elderly Caucasians as possible factors related to the reported lower incidence of multiple myeloma in elderly Japanese than in elderly Caucasians.

Design: Survey study

Setting: Community Center in Yokohama, Japan and Retirement Community in the United States.

Participants: Convenience sample of community‐dwelling elderly subjects (age 63–95) presenting for health screening examinations in each setting. Frozen serum samples were obtained from routine screening from 146 consecutive Japanese subjects and 111 US subjects.

Intervention: None

Measurements: Presence of monoclonal immunoglobulin protein determined by serum protein electrophoresis and immunofixation and quantitative Ig by laser nephelometry.

Results: Four (2.7%) of the Japanese cohort had monoclonal gammopathies compared with 11 (10%) of the American cohort. Two of the monoclonal gammopathies were IgG Kappa and two were IgG Lambda. No cases of multiple monoclonal gammopathy were identified in the Japanese group, compared with 25% of the monoclonal gammopathies in the American group. The mean quantitative serum IgG level for the Japanese group was 1,685 ± 520 mg/dL versus 1,118 ± 402 mg/dL for the American group; mean quantitative IgA levels were 283 ± 116 mg/dL versus 226 ± 116 mg/ dL (P < 0.001). Albumin levels were normal in both populations, suggesting that there was not an increase in occult inflammatory disorders in the Japanese population.

Conclusion: The low prevalence of monoclonal gammopathy in elderly Japanese is consistent with the reported lower frequency of multiple myeloma. The reason for the higher quantitative immunoglobulin levels in this population is unclear. Further cross‐cultural investigation is warranted to explore the genetic influences on altered immune regulation with aging.
A Brief Agitation Rating Scale (BARS) for Nursing Home Elderly
Authors: Finkel Sanford I. , Lyons John S. , Anderson Rachel L.
Published: April 2015

Objective: To determine the effectiveness of a brief agitation rating scale (BARS) derived from the Cohen‐Mansfield Agitation Inventory (CMAI).

Design: Test of reliability and validity of a new test.

Setting: The Lieberman Geriatric Health Centre, a skilled nursing facility.

Participants: Forty members of the Lieberman Geriatric Health Centre nursing staff, 232 residents, and a sample of 40 randomly selected residents.

Measurements: Observational agitation ratings by registered nurses and certified nurses' assistants; item to total correlations for the CMAI on each of the three shifts; Pearson correlations between the 10‐item BARS and the BEHAVE‐AD and the BSSAD scales.

Results: Internal consistency reliability for the BARS was .74 (for the day shift), .82 (evening shift), and .80 (night shift), compared with .86, .91, and .87 for the full CMAI. Each of the 232 residents' scores on the BARS was correlated with a total score from the CMAI separately on each shift. Correlations were of .95, .94, and .95. Thus, across all shifts, the BARS accounted for approximately 90 percent of the variance of the total score of the CMAI. Concurrent validity of the BARS was supported by significant correlation with BEHAVE‐AD and BSSD.

Conclusions: The BARS represents a brief and effective mechanism to assess the presence and severity of physically aggressive, physically non‐aggressive, and verbally agitated behaviors in elderly nursing home residents.
Decisions about Enteral Tube Feeding among the Elderly
Authors: Ouslander Joseph G. , Tymchuk Alexander J. , Krynski Michele D.
Published: April 2015

Objective: To determine choices about enteral tube feeding and factors associated with deciding to accept or forego this intervention in a group of ambulatory non‐demented older individuals.

Design: Descriptive survey.

Setting and Participants: Thirty four volunteers from a senior adult day center and 34 volunteers from the residential care section of a multilevel long‐term care institution, mean age 77.8.

Intervention: Structured interview using a hypothetical clinical vignette in simplified language, story‐book format depicting an irreversibly and severely impaired state of health.

Measurement: Choice of whether to accept or forego enteral tube feeding based on the clinical vignette.

Results: Thirty four (50%) decided to accept and 34 (50%) chose to forego enteral tube feeding in the situation presented in the vignette. No demographic, cognitive, or affective factors were associated with the decision. Presentation of the vignette and associated questions were not anxiety‐provoking or upsetting to the vast majority of participants.

Conclusion: A hypothetical clinical vignette depicting a state of severely impaired health resulted in 34 (50%) of 68 ambulatory non‐demented older individuals deciding to accept enteral tube feeding. No factors we examined were strongly associated with the decision. The vignette and discussion were not anxiety‐provoking when presented in the format used in this study. Advance‐directive discussions about enteral tube feeding and other health care decisions, using understandable hypothetical clinical vignettes that describe risks and benefits that might influence decisions, should be encouraged in the practice of geriatric medicine.
Comparison of Adaptations and Compliance to Exercise Training between Middle‐Aged and Older Men
Authors: Sheldahl Lois M. , Tristani Felix E. , Hastings James E. , Wenzler Richard B. , Levandoski Scot G.
Published: April 2015

Objective: To compare the rate and magnitude of physiologic and psychologic adaptations to aerobic training between middle‐age and older men, to assess their interest in continued participation (>6 months) in a supervised high‐intensity training program, and to evaluate the safety of high‐intensity training for older people.

Design: Before‐after intervention trial.

Setting: Medical center in a Midwestern metropolitan city.

Participants: Thirteen middle‐age (35–50 years) and 14 older (60–71 years) normal men.

Intervention: Subjects trained on treadmills and leg cycle ergometers for 40 minutes 3 times per week. The intensity was increased to 85% of peak heart rate (HR) within the first 3 weeks of training.

Measurement: Peak oxygen consumption, HR at submaximal work rates, three psychological tests, and election to continue in the supervised program.

Results: At 6 months of training, peak oxygen consumption had increased by 12% and 11% in the middle‐aged and older groups, respectively, with 86% and 100% of this increase occurring within the first 3 months. Both groups showed comparable decreases in HR at submaximal work rates after 3 months of training with no further significant change from 3 to 6 months. None of the psychologic parameters evaluated changed significantly with 3 or 6 months of training in either group. More of the older (71%) than middle‐aged (45%) men elected to continue in the supervised program after 6 months.

Conclusions: The results of this study involving small groups of carefully screened middle‐aged and older men suggest that the time course and magnitude of physiologic adaptations to aerobic training are similar between age groups when the training regimen is the same. Neither age group showed alterations in psychologic parameters nor experienced orthopedic injuries with training. The older group showed greater interest in continued participation in a supervised exercise program.
Screening Elders for Risk of Hospital Admission
Authors: Boult Chad , Dowd Bryan , McCaffrey David , Boult Lisa , Hernandez Rafael , Krulewitch Harry
Published: April 2015

Objective: To define a set of screening criteria that identifies elders who are at high risk for repeated hospital admission in the future.

Design: Longitudinal cohort study. Logistic regression analysis of data from half of the subjects was used to identify risk factors for repeated hospital admission. The ability of these risk factors to identify elders who are at high risk for repeated hospitalization in the future was then tested using data from the other half of the subjects.

Setting: United States.

Participants: A subsample (n = 5876) of a multistage probability sample of all non‐institutionalized U.S. civilians who were 70 years or older in 1984.

Measurements: At baseline (1984), elderly subjects were asked about their demographic, socioeconomic, medical, and functional characteristics and about their recent use of health services. Their subsequent hospital admissions and mortality were then monitored through the records of the Medicare program and the National Death Index (1985–88).

Results: Among the subjects in the first half of the sample, eight factors emerged as risk factors for repeated admission: older age, male sex, poor self‐rated general health, availability of an informal caregiver, having ever had coronary artery disease, and having had, during the previous year, a hospital admission, more than six doctor visits, or diabetes. Based on the presence or absence of these factors in 1984, 7.2% of the subjects in the second half of the sample were estimated to have a high probability of repeated admission (Pra ≥ 0.5) during 1985–1988. In comparison with subjects estimated to have a low risk (Pra < 0.5), this high‐risk group's actual experiences during 1985–1988 included a higher cumulative incidence of repeated admission (41.8% vs 26.2%, P < 0.0001), a higher cumulative rate of mortality (44.2% vs 19.0%, P < 0.0001), more hospital days per person‐year survived (5.2 vs 2.6), and higher hospital charges per person‐year survived ($3731 vs $1841).

Conclusion: Eight easily ascertained risk factors affect elders' probability of being hospitalized repeatedly within four years. In the future, brief surveys about the presence of these factors could be used to estimate elders' risk of future hospitalization and, thereby, to identify some of those who may derive the greatest benefit from interventions designed to avert the need for hospitalization.
Nocturnal Activity and Immobility across Aging (50–98 Years) in Healthy Persons
Authors: van Hilten J. J. , Middelkoop H. A. M. , Braat E. A. M. , van der Velde E. A. , Kerkhof G. A. , Ligthart G. J. , Wauquier A. , Kamphuisen H. A. C.
Published: April 2015

Objective: To measure the influence of age on measures of nocturnal activity and immobility in 100 healthy subjects aged 50 to 98 years.

Design: Cross‐sectional study.

Setting: Urban population in Leiden. Recordings were performed at home while the subjects maintained their habitual 24‐hour pattern of activities.

Participants: 100 subjects without a history of major medical disorders and a normal neurological examination and performance‐oriented assessment of gait (Tinetti).

Measurements: Motor activity was recorded during six successive nights with a wrist‐worn activity monitor. The occurrence of supra‐threshold motor activity was recorded over 15‐second epochs. A questionnaire was used to evaluate sleep habits and the occurrence of sleep disturbances. Four mean measures reflecting activity or immobility during the nocturnal period were calculated for each subject.

Results: Only one out of four measures, (ie, the nocturnal proportion of time with movement, increased with age for females. For males, no age effects emerged. The mean duration of nocturnal immobility periods was higher in females than in males. Also, for females, the use of hypnotics increased with successive decades. Sex and the use of hypnotics were significantly related to the mean duration of immobility periods.

Conclusion: If care is taken not to confound aging with illness, measures of nocturnal activity and immobility reveal only marginal effects of aging.
A Longitudinal Study of Cognitive Function in Elderly Persons with Subjective Memory Complaints
Authors: Flicker Charles , Ferris Steven H. , Reisberg Barry
Published: April 2015

Objective: To assess change in cognitive function in elderly individuals with subjective memory loss over a follow‐up interval of more than 3 years.

Design: Prospective cohort study.

Setting: An outpatient research clinic in aging and dementia at a university hospital.

Participants: A convenience sample of 59 healthy, elderly individuals (mean age 68.7 years) with memory complaints but no clinically apparent cognitive dysfunction.

Measurements: Participants were given a full diagnostic evaluation and were administered a neuropsychological test battery at baseline and follow‐up. The cognitive assessment battery included 12 tests of recent memory, immediate memory, language function, visuospatial praxis, and psychomotor speed. Most of the tests had been established to be sensitive to cross‐sectional age differences.

Results: Of 59 subjects, 54 (91.5%) were successfully followed up an average of 3.4 years later. Between baseline and follow‐up, two tests exhibited significant improvement, two tests exhibited significant decline, and the other eight were unaffected.

Conclusion: Elderly individuals with subjective perceptions of cognitive decrements who fail to provide clear evidence of cognitive impairment upon clinical interview are not at high risk for progressive cognitive deterioration over the subsequent 3‐ to 4‐year interval.
Predictors of Family Caregivers' Physical and Psychological Health following Hospitalization of Their Elders
Authors: Silliman Rebecca A.
Published: April 2015

Objective: To identify characteristics present at the time of elders' (≥75 years of age) hospitalization that predicted caregivers' self‐reported physical and psychological health 1 year later.

Design: A prospective observational cohort study of 104 family caregivers followed for 1 year from the time of their elders' hospitalization.

Setting: Urban community hospital with academic affiliation.

Subjects: Caregivers of patients enrolled in an evaluation of inpatient interdisciplinary geriatric assessment who provided care for the entire year of follow‐up and who participated in all interviews.

Main Outcomes: Self‐reported physical and psychological health.

Results: Caregivers' baseline self‐reported physical health (AOR = 21.8; 95% CI = 4.65–102), the impact of caregiving on their social and leisure time activities (AOR = 9.93; 95% CI = 1.71–57.8), and their relationship to their elders (AOR = 6.50; 95% CI = 1.20–35.2) were all significantly associated with self‐reported physical health at follow‐up. Caregivers' baseline self‐reported health (AOR = 3.70; 95% CI = 1.11–12.5), whether or not they had additional current caregiving responsibilities (AOR = 6.67; 95% CI = 1.89–25.0), and the interaction of perceptions of caregiving and the adequacy of family help were significant predictors of psychological health at follow‐up, adjusted for baseline psychological health.

Conclusion: Information available at the time of elderly patients' admission to the hospital can help to differentiate those caregivers at risk for future physical and psychological distress from those who are likely to continue doing well.
The Use of Intramuscular Cefoperazone versus Intramuscular Ceftriaxone in Patients with Nursing Home‐Acquired Pneumonia
Authors: Phillips Steven L. , Branaman‐Phillips Joann
Published: April 2015

Objective: To compare the efficacy and safety of intramuscular cefoperazone and intramuscular ceftriaxone in the treatment of nursing home‐acquired pneumonia in the nursing home setting.

Design: A randomized clinical trial.

Setting: Skilled nursing wards at the Veterans Home of California.

Patients: 104 residents of skilled nursing wards, aged 65 years or older.

Interventions: Intramuscular administration of either cefoperazone or ceftriaxone.

Measurements: The variables analyzed for baseline comparability were demographics (age, sex), clinical variables (duration in nursing home; presence of sputum, fever, cough, or leukocyte count), and clinical symptoms and signs. Efficacy was assessed by days of therapy, final maximum temperature, and clinical and bacteriological response.

Results: Fifty residents received cefoperazone, 1 gm every 12 hours, intramuscularly. Fifty‐four residents received ceftriaxone, 1 gm every 24 hours, intramuscularly. The total duration of treatment was scheduled for 10 days. Clinical cure was seen in 45 (90%) of the cefoperazone treatment group and 51 (94%) of the ceftriaxone treatment group, with a mean duration of therapy of 10.30 and 9.90 days, respectively. Satisfactory sputum specimens were collected in 71% of the treated residents; the most common isolate was Streptococcus pneumoniae, followed by Haemophilus influenzae and Staphylococcus aureus, respectively. The overall mortality was 4.5% at long‐term follow‐up. Both agents were well tolerated and no therapy was discontinued due to intramuscular pain or abnormal laboratory values.

Conclusions: Intramuscular cefoperazone and intramuscular ceftriaxone are safe and effective in the treatment of nursing home‐acquired pneumonia. The clinical outcomes in both treatment groups support their use within this select population without the need for transferring the patient to an acute care hospital. Clinical studies are needed to evaluate the impact of such therapy on the control of health care expenditures within the nursing home facility.
Urinary Incontinence in Nursing Homes: Incidence, Remission and Associated Factors
Authors: Ouslander Joseph G. , Palmer Mary H. , Rovner Barry W. , German Pearl S.
Published: April 2015

Objective: To determine the incidence and remission rates of daytime urinary incontinence (UI) in a cohort of newly admitted nursing home (NH) residents.

Design: Prospective cohort study.

Setting: Eight proprietary NHs in Maryland.

Subjects: Four hundred thirty new admissions age 65 or older who were participants in a larger prospective study of mental morbidity and adjustment to the NH.

Measures: Nurses aides' reports of continence status, psychiatric examinations, and nursing staff assessments of mobility at 2 weeks, 2 months, and 1 year after NH admission.

Results: The prevalence of daytime UI at admission was 39% in both females and males. Among the 293 members (68%) of the admission cohort remaining in the NHs 2 months after admission, the incidence of daytime UI was 27% (21% in females, 51% in males); daytime UI resolved in 23% (24% in females, 20% in males). Among the 178 members (41%) of the admission cohort remaining in the NHs 1 year after admission, the incidence of daytime UI between 2 months and 1 year after admission was 19% (16% in females, 46% in males); daytime UI resolved in 22% (23% in females, 14% in males). The continence status of about two‐thirds of residents remaining in the NH at 1 year after admission was stable over time: 22% had daytime UI, and 42% were continent at all three data collection points. The development of daytime UI was associated with male sex, the diagnosis of dementia, fecal incontinence, and the inability to ambulate or transfer independently. Resolution of daytime UI was associated with the absence of these characteristics.

Conclusions: Despite limitations attributable to the method of defining UI and potential biases related to the attrition of the admission cohort over time, this is the first large prospective study to examine the incidence and remission patterns of daytime UI among NH residents. The strong association between UI and dementia was validated for the first time by direct psychiatric examinations. Sex and mobility are also closely associated with the development and remission of UI in this setting. This study provides some valuable data that can be used to assess the impacts of the recently developed Resident Assessment Protocol for UI and Agency for Health Care Policy and Research Clinical Practice Guidelines.
How Different are VA Nursing Home Residents?
Authors: Mehr David R. , Fries Brant E. , Williams Brent C.
Published: April 2015

Objective: To identify similarities and differences between VA nursing home residents and other nursing home residents.

Design: Comparison of cross‐sectional data from three sources.

Participants: Residents of VA nursing homes nationwide in early October 1986 (n = 10,117); participants in the 1985 National Nursing Home Survey (NNHS) (n = 5,243); residents assessed in New York State nursing homes in 1988 (n = 94,840).

Measures: Age‐stratified comparisons were made between the VA and the NNHS for gender, marital status, race, ethnicity, length of stay, activities of daily living (ADL) status, and selected diagnoses and conditions. Additionally, case‐mix data were compared between the VA and the New York State populations.

Main Results: The population of VA nursing homes is over‐whelmingly men (96.1% versus 28.4% in the NNHS), and 31.2% of the VA population is under 65 years of age compared with 11.6% in the NNHS. Young (<65) VA residents are considerably more impaired in ADL than young residents in the NNHS; differences are less pronounced in those over 65 years old. VA case mix is slightly higher than the overall New York State population though the distribution of residents into categories in the Resource Utilization Groups, Version II system is somewhat different.

Conclusions: VA nursing homes contain a substantial distinctive population of seriously impaired residents under 65 years of age. Though differences exist, older VA residents have many similarities to residents of non‐VA nursing homes and constitute a functionally impaired population that can provide insights into the status of nursing home residents generally.
Physical Performance Test and Activities of Daily Living Scales in the Assessment of Health Status in Elderly People
Authors: Rozzini Renzo , Frisoni Giovanni B. , Bianchetti Angelo , Zanetti Orazio , Trabucchi Marco
Published: April 2015

Objective: To compare the ability of Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), and the Physical Performance Test (PPT) to detect health status impairments.

Patients: Five hundred forty nine community‐dwelling elders (89.8% of the eligible elderly population) aged 70 and over; mean age [was] 76.8 ± 6.1; 179 were males and 370 females.

Setting: City of Ospitaletto, Brescia, Northern Italy.

Measurements: A multidimensional questionnaire assessing demographic variables, indicators of social activities, psychological function, and somatic health and functional status (BADL and IADL). Also, the PPT was administered.

Results: Cognitive and affective status were independently associated with BADL, IADL function, and age; number of drugs were also associated with IADL function. Other health variables (number of diseases, number of symptoms, and global health score) did not independently contribute to explaining the BADL and IADL variance. Cognitive status, number of symptoms, number of diseases, number of drugs, and global health were independently associated with PPT.

Conclusions: Chronic diseases may affect functional status in a manner that is insensitive to traditional self‐report ADL and IADL measures. Performance‐based measures may capture this impairment before more severe functional loss emerges.