bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of Recombinant Interferon Alfa‐2b in Elderly Patients with Anti‐HCV‐Positive Chronic Active Hepatitis
Authors: Bresci Giampaolo , Del Corso Laura , Romanelli Anna Maria , Giuliano Gabriella , Pentimone Ferdinando
Published: April 2015

Objective: To compare efficacy and tolerance of recombinant interferon alfa‐2b in the treatment of anti‐HCV‐positive chronic active hepatitis (CAH) in subjects aged 65 years and above with those less than 65.

Design: A randomized controlled trial.

Setting: Outpatients in two hospitals.

Patients: 65 consecutive outpatients with anti‐HCV‐positive CAH for 1 to 30 years, having basal aminotransferase levels at least twice the normal value. Those 65 and over were randomized to an interferon group (A, n = 22) or a no‐treatment group (B, n = 22). All those under 65 received interferon (group C, n = 21).

Intervention: Interferon at a dose of 3 mU 3 times a week for a 6‐month period. A normalization of serum aminotransferase levels was considered a positive response to therapy.

Results: Response to therapy was positive in 62% of the treated elderly compared to 57% of the adults (P = 0.85). The two groups of responders showed a common highly significant reduction of aminostransferase (P < 0.001). Side effects were similar in elderly and young. Two untreated elderly showed spontaneous normalization of aminotransferase.

Conclusion: Interferon in anti‐HCV‐positive CAH is useful in the elderly, allowing normalization of aminotransferase, improvement of the histology and remission of the disease in 62% of the cases. Side effects seem to be independent of age. Further studies are required to assess both duration of remission and usefulness of cyclic therapy in previous responders.
Calcium Homeostasis of an Elderly Population upon Admission to a Nursing Home
Authors: Komar Lindsay. , Nieves J. , Cosman F. , Rubin A. , Shen V. , Lindsay R.
Published: April 2015

Objective: To evaluate the skeletal health, calcium, and vitamin D homeostasis of patients upon their entry to a long‐term‐care facility. Factors that could contribute to the risk of future osteoporotic fractures were also evaluated.

Design: Cross‐sectional study.

Patients: Two hundred eighty‐seven consecutive admissions were invited to participate; 109 patients were recruited into the study.

Measurements: A high prevalence of low to low‐normal circulating levels of 25(OH)D was found in nursing home residents upon their admission to the nursing home, with 86% of the patients having circulating 25(OH)D levels of less than 50 nmol/L and 41% having levels below 25 nmol/L. Frankly elevated parathyroid hormone levels were found in 16% of the patients. Additionally, alkaline phosphatase and osteocalcin levels were elevated in 23% and 13% of the patients, respectively. Bone mineral measurements were in the osteoporotic range for 85% of the nursing home residents. Bone density results for females with a history of any classic osteoporotic fracture were significantly lower than for those with no fracture history (68.5 arbitrary units (AU) for those with no fracture history, 58.8 AU in those with history of hip fracture; P < 0.05). The bone mineral measurements were higher in women with adequate 25(OH)D compared with women with deficient or borderline 25(OH)D with and without fracture history. Levels of 25(OH)D were positively correlated with urine calcium/creatinine (r = .24; P = 0.03) and 1,25(OH)2D (r = .28; P = 0.01) and were negatively correlated with 1–84 PTH (r = ‐.24; P = 0.02).

Conclusion: Hypovitaminosis D is prevalent among elderly patients entering a nursing home with secondary hyperparathyroidism and apparently increased bone turnover present in patients with circulating 25(OH)D levels below 50 nmol/L. Bone density measurements showed that a majority of the individuals entering a nursing home are osteoporotic. There is a positive association between 25(OH)D levels and bone mass and a negative association between 25(OH)D levels and a history of fracture.
Serum Fructosamine as a Screening Test for Diabetes in the Elderly: A Pilot Study
Authors: Cefalu William T. , Ettinger Walter H. , Bell‐Farrow Audrey D. , Rushing Julia T.
Published: April 2015

Objective: To determine the value of serum glycated protein, measured as serum fructosamine, as a screening test for diabetes in the elderly.

Design: Cross‐sectional pilot study.

Setting: Ambulatory research clinic in university setting.

Patients: One hundred fifty‐seven consecutive community‐dwelling participants in the Cardiovascular Health Study, average age 71.8 + 5 (mean ± SD, range 65–88 years).

Measurements: Serum fructosamine levels (first and second generation assay) were obtained. All subjects who did not have a diagnosis of diabetes were given a 75‐g glucose tolerance test (GTT).

Results: Twenty‐six subjects (17%) (10 previously diagnosed, 16 undiagnosed and asymptomatic) had diabetes mellitus, and 38 subjects (24%) had impaired glucose tolerance by history or by the GTT (WHO criteria). Only the 16 asymptomatic diabetics were included in the analysis for the pilot study. There was a significant difference in the fasting fructosamine level between non‐diabetics and asymptomatic diabetics for the first generation (2.06 ± .21 vs 2.53 ± .49 mMol/L, P < 0.0015) and second generation assay (221 ± 27 vs 269 ± 48 μMol/L, P < 0.0012). Receiver operator curves were constructed to evaluate the test characteristics of serum fructosamine. Using a point of ≥2.3 mMol/L for the first‐generation assay, the sensitivity to detect asymptomatic diabetes was 75%, specificity 83%, and positive predictive value 35%. To detect both diabetes and impaired glucose tolerance using a cutpoint of ≥2.3 mMol/L, the sensitivity was 24%, specificity 95%, and positive predictive value 68%. Employing a cut point of 250 μMol/L for the second generation assay, the sensitivity to detect diabetes was 81%, specificity 87%, and positive predictive value 43%. However, to detect diabetes and glucose intolerance using the second generation assay, the sensitivity was 39% and specificity was 86%.

Conclusion: This study demonstrated that a single measurement of either first or second generation fructosamine showed promise as a screening test for diabetes, but not impaired glucose tolerance, in older people.
Serum Erythropoietin Levels in Elderly Inpatients with Anemia of Chronic Disorders and Iron Deficiency Anemia
Authors: Joosten E. , Van Hove L. , Lesaffre E. , Goossens W. , Dereymaeker L. , Van Goethem G. , Pelemans W.
Published: April 2015

Objective: To analyze the relationship between serum erythropoietin levels and hemoglobin levels in elderly patients with anemia of chronic disorders related to cancer or acute infection when compared with anemic patients with iron deficiency.

Design: Prospective survey with comparison groups.

Setting: Tertiary care center.

Patients: An elderly group aged 70 and above (mean 84, range 70–96) was divided into subgroups of 45 with anemia of chronic disorders (23 with cancer and 22 with acute infection), 24 with iron‐deficiency anemia, and 27 with no anemia. Thirty non‐anemic younger adults were also studied.

Measurements: Serum erythropoietin (radioimmunoassay), complete blood count, serum iron, B12, folate and ferritin, liver and kidney function tests, blood gas analyses, and bacteriological and radiological tests.

Results: The serum erythropoietin levels were significantly lower in the elderly non‐anemic hospitalized group than in the healthy younger group. A significant negative relationship between the log serum erythropoietin and hemoglobin levels was found in patients with iron deficiency, but not in the other groups. For any given hemoglobin level, the response of erythropoietin was significantly higher in anemic patients with iron deficiency when compared with the neoplastic and infectious group.

Conclusion: Erythropoietin response to anemia is blunted in elderly patients with anemia of chronic disorders related to cancer or acute infection. Erythropoietin level is lower in non‐anemic elderly inpatients than in healthy younger persons.
Depression and Smoking Cessation in Older Adults: A Longitudinal Study
Authors: Salive Marcel E. , Blazer Dan G.
Published: April 2015

Objective: To explore the relationship of smoking cessation and depression.

Design: Cohort study with 3 years of follow‐up.

Setting: North Carolina community of the Established Populations for the Epidemiologic Studies of the Elderly.

Participants: Stratified cluster sample of adults age 65 years and older, with an oversampling of African Americans.

Main Measures: Depressive symptoms using a modified Center for Epidemiologic Studies Depression (CES‐D) scale; smoking cessation using change in self‐reported smoking.

Results: Current smokers had the highest prevalence of clinically significant CES‐D scores (11.2%), followed by never smokers (9.6%) and former smokers (7.1%). After 3 years, 128 (25%) of 511 baseline current smokers had quit. Among women with a clinically significant CES‐D score, 55% quit smoking, compared with only 25% among those with a normal score (P < 0.05). Depressive symptoms were significantly associated with nearly fourfold increased odds of smoking cessation among women (relative odds [RO] 3.7, 95% confidence interval [CI] 1.2, 11.0; P < 0.05), but not among men (RO 0.6, 95% CI 0.2, 2.0, not significant), after adjusting for potential confounding.

Conclusions: Depressive symptoms may directly increase the likelihood of smoking cessation among older women. When predicting smoking cessation, depression and gender should be considered in combination since to consider them separately may be misleading. This challenges prior reports that depressed smokers are less likely to quit smoking than non‐depressed smokers.
Adverse Events Related to Drugs and Drug Withdrawal in Nursing Home Residents
Authors: Cerety Meghan B. , Cornell John E. , Plichta Denise T. , Eimer Michelle
Published: April 2015

Objective: To (1) develop and standardize explicit criteria to link clinical adverse events to drug withdrawal, (2) determine the incidence and severity of Adverse Drug Events (ADEs) and Adverse Drug Withdrawal Events (ADWEs) in a nursing home population, and (3) establish the contribution of demographic, clinical, and functional characteristics to ADEs and ADWEs.

Design: Retrospective record review of an admission cohort.

Setting and Subjects: Consecutive admissions of residents of an academic Veterans Affairs nursing home with available records and lengths of stay >30 days (n = 175). Subjects were 96% men, aged 70 ± 12 years, and took 7.0 ± 3.4 medications.

Methods: We applied standardized algorithms to determine incidence, probability, and severity of ADEs and ADWEs. Multiple regression techniques were used to identify factors associated with frequency and risk of events.

Results: Ninety five residents experienced 201 ADEs. Twelve required hospitalization or prolonged hospitalization, and one resident died. Sixty two persons had 94 ADWEs. None were associated with death and one with hospitalization. The four most commonly prescribed drug classes accounted for 72% of ADEs and 80% of ADWEs. Results of multivariate analyses showed common risk factors for both ADEs and ADWEs: number of diagnoses, number of medications, and hospitalization during the nursing home stay.

Conclusions: ADEs and ADWEs were common in nursing home residents in this Veteran's Affairs setting. Explicit criteria developed and applied in this study should be applied prospectively in other settings, both to further define risk of drug discontinuation and to assist in development of specific drug discontinuation guidelines.
Why Men Are Interested in an Evaluation for a Sexual Problem
Authors: Perez E. David , Mulligan Thomas , Wan Tom
Published: April 2015

Objective: To understand why men were interested in an evaluation of a perceived sexual problem.

Design: Survey.

Setting: Tertiary‐referral VA Medical Center in Southeast Atlantic Region.

Participants: Respondents from a 3% random sample of male veterans age 30–99 registered at a VA medical center with completed survey data (n = 427).

Measurements: A cross‐sectional mailed survey. Independent variables included survey data related to emotional state, physical state, and/or demographic characteristics (marital status, race, and age). The dependent variable was interest in evaluation of a sexual problem.

Main Results: Measures of erectile function, libido, and orgasm, when entered sequentially as separate functional sets in a logistic regression analysis, have a statistically significant (P < 0.05) influence on interest in an evaluation of a sexual problem. After controlling for sexual function and emotional state, physical state did not add to predicting interest in an evaluation for a sexual problem. After controlling for all other covariates, those who were never married, non‐white, and elderly were less interested in an evaluation for a sexual problem (P < 0.05).

Conclusion: Age, race, and marital status, in addition to sexual function, influence male veterans' interest in seeking clinical assessment for a sexual problem.
Characteristic Features of Long‐Living Patients with Familial Hypercholesterolemia in Japan
Authors: Murano Shunichi , Shinomiya Masaki , Shirai Kohji , Saito Yasushi , Yoshida Sho
Published: April 2015

Objective: To assess characteristics of long‐living familial hypercholesterolemics (FHs) in comparison with younger patients.

Design: Cross‐sectional study.

Setting: Lipid clinics of a university hospital and 14 related medical institutions.

Patients: A total of 335 heterozygous FHs including 17 patients over 70 years old. The average ages of the aged (≥70 years old) and the younger groups were 73.5 ± 3.7 and 46.5 ± 15.0 years, respectively.

Measurements: Medical history, serum lipids and apolipoproteins, and radiographic measurement of Achilles tendon xanthomas.

Main Results: Age distribution of FHs suggests shorter life of FHs compared with the general population. The age distribution of FH females was shifted to older age compared with that of FH males (P < 0.01). No significant differences were found between the levels of serum lipids and apolipoproteins in the aged and the younger groups. The thickness of the Achilles tendon was positively correlated with the product of excess total serum cholesterol and age in the patients (P < 0.01). Progression of Achilles tendon thickening was less in females than in males. A few cases of longevity could not be explained by any of the anti‐atherogenic factors including female gender, a relatively low concentration of serum total cholesterol, a high concentration of HDL‐cholesterol, a non‐smoking habit, and a familial predisposition for longevity.

Conclusion: The female gender was found to be one of the most important factors for long survival of FHs. The different progression of Achilles tendon thickening in females and males may be related to the slower development of atherosclerosis and higher survival rate of the female patients.
Yale Ficsit: Risk Factor Abatement Strategy for Fall Prevention
Authors: Tinetti M. E. , Baker D. I. , Garrett P. A. , Gottschalk M. , Koch M. L. , Horwitz R. I.
Published: April 2015

Based on finding a strong association between number of impairments and risk of falling in earlier studies, Yale FICSIT investigators are conducting an intervention trial comparing the effectiveness of usual care plus social visits (SV) and a targeted risk abatement intervention (TI) strategy in reducing falls among at risk community elderly persons. Subjects include members of a participating HMO who are ≥70 years of age, cognitively intact, not terminally ill, not too physically active, and possess at least one fall risk factor. The targeted risk factors include postural hypotension; sedative use; at least four targeted medications; upper and lower extremity strength and range of motion impairments; foot problems; and balance, gait, and transfer dysfunctions. The interventions include medication adjustments, behavioral change recommendations, education and training, and home‐based exercise regimens targeting the identified risk factors. The interventions are carried out by the study nurse practitioner and physical therapist in TI subjects' homes. The SV subjects receive a comparable number of home visits as the TI subjects during which a structured life review is performed by social work students. The primary outcome is occurrence of falls during the 12‐month followup. Secondary outcomes include change in mobility performance and fall‐related efficacy.
The Boston FICSIT Study: The Effects of Resistance Training and Nutritional Supplementation on Physical Frailty in the Oldest Old
Authors: Fiatarone Maria A. , O'Neill Evelyn F. , Doyle Nancy , Clements Karen M. , Roberts Susan B. , Kehayias Joseph J. , MD Lewis A. Lipsitz , Evans William J.
Published: April 2015

Research indicates that lower extremity muscle weakness in the elderly is consistently related to impaired mobility and fall risk. Reversible components of the muscle weakness of aging include underuse syndromes and undernutrition, both of which are prevalent in nursing home populations. The Boston FICSIT study is a nursing home‐based intervention to improve muscle strength through progressive resistance training of the lower extremities and/or multi‐nutrient supplementation in chronically institutionalized subjects aged 70–100. Baseline measurements of falls, medical status, psychological variables, functional status, nutritional intake and status, body composition, muscle mass and morphology, muscle function, and gait and balance are taken. The nursing home residents are then randomly assigned to one of four treatment groups for 10 weeks: (1) high intensity progressive resistance training of the hip and knee extensors 3 days per week; (2) multi‐nutrient supplementation with a 360‐kcal high carbohydrate, low fat liquid supplement every day; (3) a combination of groups (1) and (2); and (4) a control group. Both non‐supplemented groups receive a liquid placebo every day, and both non‐exercising groups attend three sessions of “leisure activities” every week in order to control for the attentional aspects of the exercise and nutritional interventions. At the end of the 10‐week period, all baseline measurements are re‐assessed.
Flexible Bronchoscopy as a Diagnostic Tool in the Evaluation of Pulmonary Tuberculosis in an Elderly Population
Authors: Patel Yogesh R. , Mehta Jay B. , Harvill Leo , Gateley Kerry
Published: April 2015

Objective: This study intends to determine what role fiberoptic bronchoscopy (FOB) plays in the diagnosis of tuberculosis (TB), particularly in a geriatric population.

Design: Cases of tuberculosis reported to the Tennessee Department of Health during the years 1989 and 1990 were divided into two age groups: Group A (<65 years) and Group B (≥65 years). Natural sputum smears and cultures positive for M, tuberculosis (M. TB) in each group were compared with FOB specimens, acid‐fast bacilli (AFB) smears and cultures. Data were analyzed by chi‐square tests of independence for each year, then compared to determine statistical significance.

Setting and Patients: Of the 601 TB cases reported to the State of Tennessee in 1989, 285 patients were in Group A and 316 in Group B. For 1990, 525 cases were reported, 269 in Group A and 256 in Group B. All cases met CDC‐approved criteria for diagnosis of tuberculosis.

Measurements: The number of positive AFB smears and M. TB cultures were compared in each group. In cases with sputum negative but FOB specimens positive for TB, identification was made by FOB only.

Main Results: In Group A, 26 (9.1%) were diagnosed by FOB; only eight of these had positive sputum cultures. In Group B, 77 (24.4%) were diagnosed by FOB. Of these, 23 had positive sputum cultures; the remaining 54 patients (17.1%) had diagnoses based on FOB alone. In 1990, 269 cases of TB were reported in Group A. Of these, 38 (14.1%) were diagnosed by FOB. There were 256 TB cases reported among Group B, 83 (32.4%) of which were diagnosed by FOB. Of these 83 cases, 60 (23.4%) were diagnosed by FOB only. While no statistically significant difference was seen between the 1989 and 1990 rates of TB diagnosis by FOB for those in Group A (age <65), the difference in rates for those in Group B (age ≥65) was statistically significant (P < 0.05).

Conclusions: A steady increase in the use of FOB as a diagnostic tool was noted, suggesting that a significant number (19.9%) of geriatric TB cases might have been missed without the aid of FOB. While the exact reason for its increased utilization is not known, this study indicates that FOB has become a more important source of diagnosis in pulmonary TB, particularly among the elderly.
Urinary Retention in the Elderly: A Study of 100 Hospitalized Patients
Authors: Grosshans Cl. , Passadori Y. , Peter B.
Published: April 2015

Objective: To estimate the prevalence of incomplete bladder emptying by the elderly and to determine its significance and its relationship to overflow incontinence.

Design: Survey comparing groups with and without incomplete bladder emptying.

Setting: A geriatric hospital ward.

Patients: One hundred patients who were consecutively admitted, with an average age of 82.6 years.

Measurements: A physical examination, perineal examination, micturition assessment, and evaluation of the postvoiding residual urine volume (PRUV) by ultrasonography at day 1 and day 8 following admission. One‐channel cystometry and urine cultures were also done. Between‐group comparison was performed between groups R (ie, PRUV greater than 50 mL) and C (ie, PRUV less than 50 mL).

Main Results: The prevalence of PRUV greater than 50 mL was 34%. Group R patients presented with greater dependency; death was the final outcome of hospitalization in 36% of these cases (vs only 9% in group C). A high PRUV was not correlated with urinary tract infection or renal failure, but there was a strong, almost significant trend toward incontinence being more prevalent in R (57%) than in C (38%) (P = 0.06). Group R presented a hypotonic bladder in 45% of cases, evidenced by cystometry, versus 6% in group C.

Conclusions: In cases with a high PRUV, the utmost caution is necessary both in the diagnosis of overflow incontinence and in establishing a therapeutic approach. Incomplete bladder emptying is associated with a poor prognosis.
Falls: An Examination of Three Reporting Methods in Nursing Homes
Authors: Kanten Deanna N. , Mulrow Cynthia D. , Gerety Meghan B. , Lichtenstein Michael J. , Aguilar Christine , Cornell John E.
Published: April 2015

Objective: To examine the concordance of various fall reporting methods and to use the results to recommend a preferred method of ascertaining fall frequency for residents of nursing homes, both for research and in the collection of federally mandated nursing home data.

Design: A cohort study followed for 858 patient months, with a mean individual follow‐up of 6.6 months.

Measurements: Falls were independently ascertained monthly by three methods: review of administrative incident reports, nursing home chart abstraction, and structured interview of subjects. Concordance of events was assessed using measures of simple agreement and Kendall's Tau‐b. Simple correlation and multiple regression were used to evaluate the relation of age, sex, gender, depression, mental status, and functional status with degree of concordance between self‐reported falls and chart‐recorded falls.

Setting: One academic and six community nursing homes in San Antonio, Texas.

Participants: 131 long‐stay nursing home residents, greater than 60 years of age, dependent in at least two activities of daily living, and mildly cognitively impaired.

Results: Falls were ascertained in 74 of the 131 individuals; 53 subjects fell 124 times by incident report, 58 had 140 falls according to chart review, and 66 subjects self‐reported 232 falls. Greatest agreement between reporting methods was shown for incident report and chart review, with a Kendall's Tau‐b of 0.88; self‐report and chart‐review agreement was 0.56; and self‐report and incident agreement was 0.53. Estimated total fall events were more often (P = 0.001) identified by chart review (92%) than incident report (82%). Although concordance was higher for non‐fallers, no significant relationships were observed between concordance and age, sex, race, depression, mental status, and functional status. Also, there was no systematic relationship between length of follow‐up and degree of concordance.

Conclusions: Fall frequency varies by ascertainment method, with chart review reflecting a greater number of fall events than the traditionally counted incident reports.
Nighttime Sleep and Bed Mobility among Incontinent Nursing Home Residents
Authors: Schnelle John F. , Ouslander Joseph G. , Simmons Sandra F. , Alessi Cathy A. , Gravel Michele D.
Published: April 2015

Objective: To describe sleep and body movement patterns in incontinent nursing home residents for the purpose of determining if the residents require nighttime changing and body repositioning on a 2‐hour schedule.

Design: Cross‐sectional survey.

Setting: Four nursing homes.

Participants: 118 nursing home residents.

Measurements: Over two nights, bedside monitoring equipment recorded wrist activity (as a proxy measure for sleep) and body movements of both the shoulder and hip areas in consecutive 2‐minute intervals. Specific outcome measures were: (1) Average duration of a sleep episode, peak duration of a sleep episode, and percent of time in bed asleep. (2) The number of 2‐minute intervals in which a large movement (45 degree turn) at the shoulder and hip was noted per hour of recording for each resident. (3) The number of resident‐initiated, rather than staff‐initiated, large movements at the shoulder and hip that occurred within the same 2‐minute intervals.

Results: There was large variability in all sleep measures; however, on average, residents slept 66% of the time they were in bed. The distribution of these measures suggests that sleep was punctuated with frequent mighttime awakenings. Thirty‐three percent of the incontinent residents demonstrated very low levels of resident‐initiated movement at the shoulder and hip. Sixty‐six percent demonstrated at least one large movement at the shoulder and hip per hour during periods of sleep as well as during periods of wake.

Conclusion: The majority of incontinent nursing home residents self‐initiate sufficiently frequent movements at both the shoulder and hip so as not to be in need of frequent repositioning by nursing staff. Since the sleep of many of these residents is also characterized by frequent awakenings, incontinent nursing home residents may benefit from a schedule of nursing care at night that considers sleep of equal importance to incontinence care and body repositioning.
The Nighttime Environment, Incontinence Care, and Sleep Disruption in Nursing Homes
Authors: Schnelle John F. , Ouslander Joseph G. , Simmons Sandra F. , Alessi Cathy A. , Gravel Michele D.
Published: April 2015

Objective: To evaluate the association between noise, light, nursing care practices, and nighttime awakenings in incontinent nursing home residents.

Design: Cross‐sectional survey.

Setting: Four long‐term care nursing facilities.

Participants: One hundred eighteen incontinent nursing home residents.

Measurements: Over two nights, bedside monitoring equipment recorded wrist activity, resident bed movements, and environmental noise and light changes in consecutive 2‐minute intervals. Changes in sleep and bed movement were compared with changes in noise and light that occurred within the same or proximal 2‐minute intervals. Noise and light changes in combination with large resident movement at the hip and shoulder were interpreted as related to incontinence care based on observational measures. Specific outcome measures were: (1) the number of noise and light changes as well as staff care practices that did not wake the resident during periods of consecutive sleep, ie, sleep lasting a minimum of 10 minutes; (2) the number of noise and light changes as well as staff care practices that occurred immediately before or during the 2‐minute intervals during which a resident woke from a period of consecutive sleep; and (3) the number of such staff care practices that were related to incontinence care.

Results: Noise and light changes associated with both general environmental events and more specific nurse care practices were associated with 50% of all waking episodes of 4 minutes or longer and 35% of all waking episodes of 2 minutes or shorter. The major sources of all noise were traced to nursing staff. Eighty‐seven percent of all incontinence care practices were associated with episodes of waking.

Conclusion: The data reported in this paper document that general environmental noise and incidents of nursing care practices, particularly those related to incontinence care, are responsible for a substantial amount of the sleep fragmentation that is common among nursing home residents.
A Practical Equation to Predict Resting Metabolic Rate in Older Females
Authors: Arciero Paul J. , Goran Michael I. , Gardner Andrew M. , Ades Philip A. , Tyzbir Robert S. , Poehlman Eric T.
Published: April 2015

Objective: To develop a practical and accurate age‐specific equation for predicting resting metabolic rate (RMR) in older women and, thereafter, to cross‐validate existing equations for predicting RMR in older females.

Design: Cross‐sectional validation study.

Setting: General Clinical Research Center.

Participants: A convenience sample of 75 healthy older women (age 50–81) free of significant cardiovascular or any other non‐cardiac disease that may affect cardiovascular function or metabolic rate.

Measurements: All 75 volunteers were characterized for resting metabolic rate (RMR), body composition, anthropometrics, physical activity, and energy intake.

Results: A practical equation for predicting RMR in older women using easily measured variables was: [RMR (kcal/d) = 7.8 (weight, kg) + 4.7 (standing height, cm) − 39.5 (menopausal status; 1–3) + 143.5]. These variables accounted for 59% (R2) of the variation in RMR and predicted RMR within ±66 kcal/d. When five previously published equations were applied to our sample of older women to predict RMR, individual predicted values deviated by −31% to 20% from the measured value.

Conclusion: We offer a practical equation to predict RMR in healthy older women based on a measure of body weight, standing height, and menopausal status.
Drug Use Patterns of Persons with Alzheimer's Disease and Related Disorders Living in the Community
Authors: Semla Todd P. , Cohen Donna , Paveza Gregory , Eisdorfer Carl , Gorelick Philip , Luchins Daniel , Hirschman Robert , Freels Sally , Levy Paul , Ashford J. Wesson , Shaw Helen
Published: April 2015

Objective: To describe drug use patterns by persons with Alzheimer's disease, multi‐infarct dementia, and mixed Alzheimer's disease and multi‐infarct dementia.

Design: Multicenter, patient registry.

Setting: Community‐living persons evaluated in primary care, geriatric, and Alzheimer ambulatory settings.

Participants: Of the 930 persons in three diagnostic categories, there were 671 with probable or possible Alzheimer's disease by NINCDS/ADRDA criteria or Alzheimer's disease by DSM‐III‐R criteria, 162 multi‐infarct cases by DSM‐III‐R criteria, and 97 mixed cases by DSM‐III‐R criteria. In each diagnostic category, 65% were women, and the majority were 70 years or older.

Measurements: The average number of all prescription and non‐prescription drugs and selected therapeutic categories by age, sex, diagnosis, and mini‐mental status score at the time of diagnosis or evaluation.

Results: Alzheimer patients average 2.3 drugs compared with multi‐infarct (4.3; P < 0.0001) and mixed (3.7; P = 0.002) patients, and their pattern of drug use was different when stratified by therapeutic categories and drug classes. Drug use increased with age, and women used significantly more drugs than men in all three diagnostic categories. Women with Alzheimer's disease used significantly more cardiovascular drugs than men with Alzheimer's disease (P < 0.05). The lower the mini‐mental status score in patients with any dementia, the greater the mean number of central nervous system agents used. The higher the mini‐mental status score in a patient with multi‐infarct or mixed dementia, the greater the use of cardiovascular drugs.

Conclusion: Drug use by Alzheimer patients was lower than in multi‐infarct and mixed patients, primarily due to a lower prevalence of cardiovascular drugs.
How Many Physicians Will Be Needed to Provide Medical Care for Older Persons? Physician Manpower Needs for the Twenty‐First Century
Authors: Reuben David B. , Zwanziger Jack , Bradley Thomas B. , Fink Arlene , Hirsch Susan H. , Williams Albert P. , Solomon David H. , Beck John C.
Published: April 2015

To estimate the number of full‐time‐equivalent (FTE) physicians and geriatricians needed to provide medical care in the years 2000 to 2030, we developed utilization‐based models of need for non‐surgical physicians and need for geriatricians.

Based on projected utilization, the number of FTE physicians required to care for the elderly will increase two‐ or threefold over the next 40 years. Alternate economic scenarios have very little effect on estimates of FTE physicians needed but exert large effects on the projected number of FTE geriatricians needed.

We conclude that during the years 2000 to 2030, population growth will be the major factor determining the number of physicians needed to provide medicare care; economic forces will have a greater influence on the number of geriatricians needed.
Type of Fall and Risk of Hip and Wrist Fractures: The Study of Osteoporotic Fractures
Authors: Nevitt Michael C. , Cummings Steven R. ,   Study of Osteoporotic Fractures Research Group
Published: April 2015

Objective: To determine the causes of hip or wrist fractures.

Design: Case‐control analysis nested in a prospective cohort study.

Setting: Four clinical centers in Baltimore, Maryland, Minneapolis Minnesota, Portland, Oregon, and Monessen, Pennsylvania.

Participants: Non‐black women age 65 and older living in the community.

Measurements: We measured bone density, arm strength, and anthropometric characteristics at a baseline examination. Those who subsequently suffered hip (n = 130) or wrist (n = 294) fractures as a result of a fall and a consecutive sample of those who fell without a fracture (n = 467) were interviewed about their falls.

Results: In multivariate analyses, those who suffered hip fractures were more likely to have fallen sideways or straight down (odds ratio 3.3; 95% confidence interval 2.0 to 5.6) and to have landed on or near the hip (32.5; 9.9, 107.1) than women who fell without a fracture. Among women who fell on the hip, those with hip fractures were taller (1.5; 1.2, 2.2 per SD increase), less likely to have landed on a hand (0.3; 0.1 to 0.6) or to break the fall by grabbing or hitting an object (0.4; 0.2, 0.9), had weaker triceps (1.7; 1.2, 2.5 per SD decrease), and were more likely to land on a hard surface (2.8; 1.4, 5.5) than those without fractures. Women with wrist fractures were more likely to have fallen backward (2.2; 1.3, 3.8) and to have landed on a hand (20.4; 11.5, 36.0) than those who fell without a fracture. Among women who fell on the hand, those with wrist fractures were taller (1.4; 1.1, 1.8 per SD increase) and less likely to break the fall by grabbing or hitting an object (0.4; 0.2, 0.7). Among women who fell on their hip or hand, the risk of fracturing that site more than doubled for each standard deviation decrease in bone density at the site of fracture.

Conclusions: The nature of the fall determines the type of fracture, while bone density and factors that increase or attenuate the force of impact of the fall determine whether a fracture will occur when a faller lands on a particular bone. These findings have important implications for prevention of fractures in older women.
The Relationship Between Aging and Disease: Geriatric Ideology and Myths of Senility
Authors: Forbes William F. , Hirdes John P.
Published: April 2015

An ongoing debate in gerontology concerns the relationship between aging and disease. Goodwin, as part of a discussion on the importance of geriatric ideology, argues that age‐related disorders like senile dementia of the Alzheimer's type (SDAT) should be regarded as an aging process, while others suggest it is more appropriate to consider it as a disease. This paper comments on the arguments presented by Goodwin and develops these by providing a review of the underlying assumptions concerning aging and disease. The policy relevance and implications for future research are also outlined.
Medical Decision‐Making in the Last Six Months of Life: Choices about Limitation of Care
Authors: Fried Terri R. , Gillick Muriel R.
Published: April 2015

Objective

To characterize the limitation of care in routine geriatric practice in advance of and at the time of a patient's final episode of illness.

Design

A descriptive study performed by retrospective chart review.

Setting

An outpatient geriatric practice affiliated with a community teaching hospital.

Patients

Fifty‐nine recipients of primary care who were community‐dwelling and older than 65, died in the years 1988–1991, and were enrolled in the practice for at least 6 months prior to death.

Measurements

We recorded the type(s) of care patients (or, in the case of incompetence, their families) and their physicians chose to limit during the last episode of illness preceding death and during previous episodes of illness by examining those instances when therapy other than that considered “standard” was given. We also examined whether the presence of dementia, functional impairment, chronic disease, terminal illness, site of routine care (home vs hospital), and location of death were associated with the limitation of care.

Results

A choice to limit diagnostic tests or treatment was made by the patient or surrogate in 40% of the 59 patients during the 6 months before the patient's final episode of illness. Most frequently limited were diagnostic tests, surgery, and hospitalization for purposes other than surgery. Terminal illness and location of death were associated with the limitation of care, but dementia, functional impairment, chronic illness, and location of care were not. By comparison, 89% of the patients had limitation of care during the final episode of illness, and more aggressive therapies such as cardiopulmonary resuscitation and intubation constituted the majority of therapies withheld.

Conclusions

In one geriatric practice, care is frequently limited before a patient's final illness in the course of routine practice. In contrast to recent discussion focusing on limitation of end‐of‐life interventions or interventions in the severely impaired, these results suggest that there are multiple points in the course of a community‐dwelling elderly patient's illness at which choices about level of care can be made. Given this opportunity, a significant number of elderly patients or their surrogates will choose less intensive therapy.
Individualized Care Alternatives Used in the Process of Removing Physical Restraints in the Nursing Home
Authors: Werner Perla , Koroknay Vivian , Braun Judith , Cohen‐Mansfield Jiska
Published: April 2015

Objective

To describe the individualized care alternatives used during the process of removing physical restraints in a nursing home.

Design

Descriptive survey.

Setting

A non‐profit geriatric long‐term care facility

Subjects

Sixty‐three physically restrained residents (mean age = 85.3 years).

Measures

Information regarding the different care alternatives used to replace physical restraints was obtained from the Gerontological Clinical Nurse Specialist implementing the process of removing restraints.

Results

The physical restraints of six of the 63 participants were removed without implementing any care alternative. With the remaining 57 participants, an average of 3.3 different care alternatives were used (range 1–7 care alternatives). Environmental alternatives (such as wheelchair adaptations and alternative seating) were used with 86% of the restrained residents; alterations in nursing care (such as additional supervision and toileting schedules) were used with 77% of the participants. Psychosocial and physiological alternatives, as well as the use of structured activities, were used less frequently. At the end of the study period, five residents remained restrained.

Conclusions

This papers shows the complexity of the process of removing physical restraints in the nursing home. The need of an individualized approach is stressed.
Book Reviews
Authors: Katz Paul R. , Baum John
Published: April 2015

Aging in Good Health. By MH Beers, MD and SK Urice, PhD, JD. New York, Pocket Books, Division of Simon and Schuster, Inc., 1992. 351 pages. $10.00.
Book Reviews
Authors: Neufeld Richard R.
Published: April 2015

Toward a Restraint‐Free Environment. Reducing the Use of Physical and Chemical Restraints in Long‐Term and Acute Care Settings. By Judith V. Braun and Steven Lipson. Baltimore, Health Professions Press, 1993. 305 pages. $28.00 (Paperback).
Book Reviews
Authors: Stotts Nancy A.
Published: April 2015

Acute and Chronic Wounds: Nursing Management. By Ruth Bryant. St. Louis, Mosby Year Book, Inc., 1992. 350 pages. $37.95.
Depression, Cognition, and Functional Ability in Patients with Alzheimer's Disease
Authors: Fitz Allan G. , Teri Linda
Published: April 2015

Objective: To investigate the relationship of depression to functional and cognitive impairment in patients with Alzheimer's disease (AD).

Design: Clinic‐based study comparing AD patients with and without depression.

Setting: Geriatric outpatient clinic at the University of Washington Medical Center, Seattle, WA.

Participants: Ninety‐one AD patients, 46 with major depression and 45 without.

Measurements: The relationship of the Mattis Dementia Rating Scale (mDRS), DSM‐III‐R diagnosis of depression, and Hamilton Depression Rating Scale (HDRS) to daily functioning as measured by the Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), and Communication subscales of the Record of Independent Living (RIL) was examined.

Main Results: Both depression and mDRS related significantly to functional impairment, but the amount of variance contributed differed by level of cognitive impairment and functional area investigated. In mildly cognitively impaired subjects, diagnosis and severity of depression (combined) was significantly related to IADL and Communication subscales, after controlling for age and mDRS. No predictor was significantly related to ADL functioning. In contrast, for moderately cognitively impaired subjects, depression diagnosis was significantly related to ADL and Communication performance, but not to IADL functioning. mDRS also significantly predicted ADL, IADL, and Communication subscales. Severity of depression was not significant.

Conclusions: These findings, that the presence (diagnosis) and severity (HDRS score) of depression significantly predicted functional status, but that the degree of association varied by level of cognitive severity, has important diagnostic and treatment implications. In particular, the importance of examining whether functional impairment in depressed AD patients can be modified by depression treatment is discussed.
The Utility of an Admission Assessment to Predict In‐Hospital Nutrient Intake
Authors: Sullivan Dennis H.
Published: April 2015

Objective: To determine if pre‐complication nutrient intake can be predicted based on an admission assessment.

Design: Survey (cross‐sectional study).

Setting: Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital.

Patients: Three‐hundred‐twelve randomly selected admissions to the GRU.

Measurements: At admission, each patient completed a comprehensive medical, neuropsychological, functional, and nutritional assessment. While remaining hospitalized, each subject was monitored on a daily basis for the development of complications. Complete calorie counts were obtained at least every other day, and the average pre‐complication daily volitional nutrient intake was expressed as a percent of predicted requirements as determined using the Harris‐Benedict equation.

Results: Based on a stepwise linear regression analysis, the strongest predictor of pre‐complication volitional intake was the first day calorie count, followed by waist circumference, the percent of weight lost in the 6 months prior to admission, supra‐iliac skinfold thickness, and admission Katz ADL score. The model R2 = 0.66.

Conclusions: It is possible to predict pre‐complication nutrient intake with a fair degree of accuracy based on an admission assessment, which includes a 1‐day calorie count.
Correlates of Impaired Function in Older Women
Authors: Ensrud Kristine E. , Nevitt Michael C. , Yunis Carla , Cauley Jane A. , Seeley Dana G. , Fox Kathleen M. , Cummings Steven R.
Published: April 2015

Objective: To determine the factors associated with impaired function in older women.

Design: Cross‐sectional analysis of baseline data collected for a multicenter, prospective study of risk factors for osteoporotic fractures.

Setting: Four clinical centers in Portland, Oregon, Minneapolis, Minnesota, Baltimore, Maryland, and the Monongahela Valley, Pennsylvania.

Participants: A total of 9,704 ambulatory, non‐black women, aged 65 years and older, recruited from population‐based listings.

Measurements: Independent variables, including demographic and historical information (medical conditions, health habits, and medications) and physiologic measures (anthropometry, blood pressure, mental status, vision, and neuromuscular performance) were obtained from a baseline questionnaire, interview, and examination. Measurement of function was assessed by self‐reported ability to perform six physical and instrumental activities of daily living (ADL) and impaired function (dependent variable) was defined as difficulty performing three or more physical and instrumental ADLs.

Results: In order of decreasing strength of association, hip fracture, osteoarthritis, parkinsonism, slower walking speed, lower hip abduction force, back pain, greater Quetelet index, osteoporosis, former alcohol use, stroke, never drinking alcohol, lower mental status, use of anxiolytics and/or sleeping medications, inability to hold the tandem position, postural dizziness, cataracts, greater waist to hip ratio, lower physical activity in the past year, greater lifetime cigarette consumption, and lower grip strength were independently associated with impaired function in multivariate analyses. Age, low educational level, diabetes, current heavy alcohol use, postural hypotension, depth perception, and contrast sensitivity were not independent predictors. A combination of neuromuscular performance measures, including decreased muscle strength and impaired balance and gait, appeared to account for the effect of age on disability.

Conclusion: A combination of many factors, including medical conditions, health habits such as obesity, smoking, alcohol abstinence, and physical inactivity, and direct measures of neuromuscular performance are associated with impaired function in older women.