bluuebunny/crossref_metadata_2025 huggingface dataset:
Rising from the Floor in Older Adults
Authors: Alexander Neil B. , Ulbrich Jessica , Raheja Aarti , Channer Dwigbt
Published: April 2015

OBJECTIVE: The primary goal was to determine the ability of older adults to rise from the floor. A secondary goal was to explore how rise ability might differ based on initial body positions and with or without the use of an assistive device.

DESIGN: Cross‐sectional analysis of young, healthy older, and congregate housing older adults.

SETTING: University‐based laboratory and congregate housing facility.

PARTICIPANTS: Young adult controls (12 men and 12 women, mean age 23 years), healthy older adults (12 men and 12 women, mean age 73 years), and congregate housing older adults (32 women and 6 men, mean age 80 years). The healthy older adult women (n = 12, mean age 75 years) and a subset of the congregate housing women (n = 27, mean age 81 years) were identified for further analyses.

INTERVENTION: Videotaping and timing of rising from the floor from controlled initial body positions (supine, on side, prone, all fours, and sitting) and with or without the use of a furniture support.

MAIN OUTCOME MEASURES: Whether subjects were successful in rising, and if they were, the time taken to rise. Subjects also rated their perceived difficulty of the task as compared to the reference task, rising from a supine position.

RESULTS: Older adults have more difficulty rising from the floor than younger adults. The healthy old took twice as long as the young to rise, whereas the congregate old took two to three times as long as the healthy old to rise. Although all young and healthy old rose from every position, a subset of the congregate housing residents was unable to rise from any position, 24% when attempting to rise without a support and 13% when attempting to rise with a support. Congregate old were most likely to be successful when rising from a side‐lying position while using the furniture for support. The more able congregate old, as well as the young and healthy old, rose more quickly and admitted to the least difficulty when rising from the all fours position.

CONCLUSIONS: The inability to rise from the floor is relatively common in congregate housing older adults. Based on the differences between groups in time to complete the rise, determining the differences in rise strategies, and the underlying biomechanical requirements of rising from different positions with or without a support would appear to be useful. These data may serve as the foundation for future interventions to improve the ability to rise from the floor.
Does Aging Mean A Better Life for Women?
Authors: Eronen Minna K. , Rankinen Tuomo , Rauramaa Rainer , Sulkava Raimo , Nissinen Aulikki
Published: April 2015

OBJECTIVE: To study 10‐year changes in selected quality of life dimensions in a cohort of aging Eastern Finnish women.

DESIGN: Ten‐year follow‐up of a representative population sample.

SETTING: The county of Kuopio in Eastern Finland.

PARTICIPANTS: In 1982, a representative sample (n = 296) of 50 to 60‐year‐old women was examined in the FIN‐MONICA study. Ten years later, 241 of the participants were re‐examined.

MEASUREMENTS: Self‐administered questionnaires were used to collect the data. Self‐rated health, self‐rated physical fitness, frequency of leisure time physical activity, functional capacity, reported symptoms, occurrence of diseases, and satisfaction with family life and economic situation were measured. In 1992, total life satisfaction at that moment and 5 years earlier were also assessed.

RESULTS: The self‐rated health assessment remained unchanged. During the 10 years from 1982 to 1992, the proportion of women who reported diagnosed cardiopulmonary diseases increased; angina pectoris, in particular, increased from 6% to 20%. However, even though their running ability had decreased, the number of women rating their physical fitness as good or fairly good increased from 23% to 32%. The participants reported significantly less headache and feelings of exhaustion than they had 10 years earlier. Average satisfaction with their economic situation increased, and satisfaction with family life remained the same. Thirty‐seven percent of the women rated their current life situation as better than 5 years previously, 29% felt that it had remained the same, and 34% indicated that it had become worse during the past 5 years.

CONCLUSION: These data suggest that some quality of life dimensions may improve during aging in postmenopausal women.
Seasonal Prevalence of Vitamin D Deficiency in Institutionalized Older Adults
Authors: Liu Barbara A. , Gordon Michael , Labranche Jean M. , Murray Tim M. , Vieth Reinhold , Shear Neil H.
Published: April 2015

OBJECTIVE: To determine the prevalence and seasonal variation of vitamin D deficiency among older residents of long‐term care facilities.

DESIGN: Cross‐sectional survey with 6‐month follow‐up.

SETTING: Three long‐term care facilities in Toronto.

PATIENTS: Persons more than 65 years old, medically stable, who had resided in the facility for at least 6 months and had no conditions known to interfere with vitamin D metabolism.

MEASUREMENTS: Information regarding demographics, past health, and medication use was collected. Mental and functional status were assessed by questionnaire. Venous blood samples were analyzed for alkaline phosphatase, calcium profile, albumin, intact parathyroid hormone, 25 hydroxyvitamin D (25OHD), and vitamin D binding protein in September 1994 and March 1995. In a subgroup of patients, bone specific alkaline phosphatase was measured, and dietary intake of vitamin D was assessed.

RESULTS: A total of 155 subjects completed the study. The mean age of the subjects was 83.2 years (SD 7.1), and 47% were female. The mean 25OHD level in the March sample (39.9 nmol/L, SD 19.7) was significantly lower than the mean 25OHD level in the September sample (44.9 nmol/L, SD 16.9) (P = .001). The prevalence of vitamin D deficiency in the osteomalacic range (25OHD < 25 nmol/L) increased from 9% in the fall sample to 18% after the winter (χ2 = 4.65, P = .03). The prevalence of borderline deficiency or hypovitaminosis D (25OHD < 40 nmol/L) increased from 38% in the fall sample to 60% in the spring sample (χ2 = 14.9, P < .001).

Dependence in transfers was associated with an increased risk of hypovitaminosis D, odds ratio 2.08 (95% confidence interval 1.08–4.01), dependence in ambulation 2.57 (1.26–5.23), and regular use of a wheelchair 2.17 (1.09–4.31). When entered into a forward conditional logistic regression model, only dependence in ambulation remained significant, with an adjusted odds ratio of 2.57 (95% CI: 1.26–5.18).

CONCLUSIONS: Vitamin D deficiency and borderline vitamin D status are common among older residents of long‐term care facilities in Canada. Even though this population has limited outdoor exposure, seasonal variation in the prevalence of deficiency remains significant. Evaluation of interventions to improve the status of vitamin D nutrition in this population is needed.
The Effect of Specific Medical Conditions on Functional Decline
Authors: Kiely Dan K. , Morris John N. , Morris Shirley A. , Cupples L. Adrienne , Ooi Wee Lock , Sherwood Sylvia
Published: April 2015

OBJECTIVES: To examine how functional status among older community‐dwelling residents differs over time between those with and those without specific medical conditions.

DESIGN: Prospective cohort study.

PARTICIPANTS: A total of 1060 community‐dwelling Massachusetts residents aged 65 or older who were not totally functionally dependent at baseline assessment.

MEASUREMENTS: Functional status, five medical conditions (heart problem, arthritis, diabetes, cancer, and stroke), and the total number of these five medical conditions. Assessments were done at baseline and at two annual follow‐ups. RESULTS: Adjusted repeated measures analysis of covariance revealed a time difference (P < .001) for all five medical conditions and group differences for diabetes (P = .006) and stroke (P < .001). Functional abilities declined over time and those with specific medical conditions were more impaired initially, but the rate of decline did not significantly differ from those free of the condition. The presence of each additional medical condition resulted in additional impairment (P < .001), but the rate of decline over time did not differ by number of medical conditions.

CONCLUSIONS: Efforts to reduce or prevent the development of specific medical conditions are essential to maintaining functional independence of older people as well as to reducing use of supportive services and admission rates to nursing homes. Particular attention should be directed toward preventing stroke since its consequences are the most functionally disabling. J Am Geriatr Soc 45:1459–1463, 1997.
Mortality over Four Years in SHEP Participants with a Low Ankle‐Arm Index
Authors: Newman Anne B. , Tyrrell Kim Sutton , Kuller Lewis H.
Published: April 2015

OBJECTIVES: To assess the risk of total and cardiovascular mortality in older adults with systolic hypertension and with a low ankle‐arm index (AAI) as a marker of subclinical peripheral arterial disease (PAD).

DESIGN: Prospective observational study

PARTICIPANTS: A subgroup of 1537 participants in the Systolic Hypertension in the Elderly Program (SHEP) were screened for lower extremity arterial disease using the AAI. Participants were evaluated at 4 years to determine vital status and cause of death. Total and cardiovascular disease (CVD) mortality rates were assessed in relationship to clinical CVD at baseline, cardiovascular risk factors and the presence of a low AAI (subclinical PAD).

RESULTS: Total mortality rates increased as the AAI decreased in those with and without clinical CVD at baseline. In those without clinical CVD at baseline, the presence of an AAI ≤ .9 was associated with an age‐adjusted relative risk (RR) of 3.00 for total mortality in men and 2.67 in women. Results were similar for CVD mortality and persisted after adjustment for cardiovascular risk factors including the presence of an abnormal electrocardiogram.

CONCLUSIONS: A low ankle arm‐index predicted a two to three‐fold increase in total and cardiovascular mortality in older adults with systolic hypertension of risk for incident cardiovascular disease. In this study of older adults with systolic hypertension, 19.7% of the participants had subclinical PAD. Risk factor modification could be targeted to older adults based on markers of asymptomatic atherosclerosis. J Am Geriatr Soc 45:1472–1478, 1997.
The Impact of Kyphosis on Daily Functioning
Authors: Ryan Stephen D. , Fried Linda P.
Published: April 2015

OBJECTIVES: To determine whether moderate or severe kyphosis is associated with decrements in physical function, especially mobility.

DESIGN: Cross‐sectional analysis of a cohort study.

SETTING: The Johns Hopkins Functional Status Laboratory, a multidisciplinary, standardized, quantitative assessment center.

PARTICIPANTS: A total of 231 community‐dwelling volunteers aged 59 and older who participated in a 1‐day evaluation.

MEASUREMENTS: Age, gender, self report of physical function, standardized measurement of: kyphosis (both qualitatively clinical criteria and quantitative assessment), time to walk 5 meters (0.1 seconds), and time to climb a flight of stairs (0.1 seconds) at usual pace.

RESULTS: Using multivariate step‐wise regression analysis, the presence and severity of kyphosis, measured qualitatively, was independently associated with time to walk 5 meters and to climb a flight of stairs (P = .015, P < .001, respectively), adjusting for moderate‐severe scoliosis, heart rate response to exercise, arthritis, vertigo, age, and gender. Similarly, quantitative kyphosis was associated independently with stair climb time (P = .005). Qualitative kyphosis was also associated with difficulty reaching (OR = 2.21 (95%CI: 1.14 to 4.29)) and difficulty performing heavy housework (OR = 1.64 (95%CI: 1.03 to 2.61)), adjusting for prior diagnosis of moderate‐severe scoliosis, prior diagnosis of arthritis, age, and gender.

CONCLUSION: Kyphosis, by both clinical and quantitative assessment, is associated with diminished function, especially performance of mobility tasks. This association should be verified prospectively. If predictive, the impact of kyphosis on physical function should be considered in osteoporosis prevention and treatment counseling. J Am Geriatr Soc 45:1479–1486, 1997.
Antidepressant Use Over Time in a Rural Older Adult Population: The MoVIES Project
Authors: Ganguli Mary , Mulsant Benoit , Richards Stephanie , Stoehr Gary , Mendelsohn Aaron
Published: April 2015

OBJECTIVE: To examine the use of antidepressant drugs over time among community‐based older persons.

DESIGN: A longitudinal community study with four approximately biennial data collection waves (1987 ‐ 1996).

SETTING: A low‐socioeconomic status rural older community‐based population in Southwestern Pennsylvania.

PARTICIPANTS: A total of 1681 individuals with a mean age of 72.9 years at study entry,

MEASUREMENTS: Antidepressant drug use, demographics, and health services utilization by self‐report.

RESULTS: Antidepressant use was reported by less than 5% of the population during all four waves. It was associated with female gender, use of mental health services, presence of five or more depressive symptoms, and use of five or more prescription drugs, but not with age. During the four waves, tricyclics accounted for 84.6%, 85.3%, 78.4%, and 45.5% of total antidepressants used, whereas selective serotonin reuptake inhibitors (SSRIs) accounted for 2.6%, 11.8%, 8.1%, and 36.4%.

CONCLUSIONS: Overall, our data on antidepressant use in this rural older population mirror national trends away from tricyclics and towards SSRIs. Our findings also suggest underutilization of mental health services and antidepressant drugs in this population. J Am Geriatr Soc 45:1501–1503, 1997.
Preserved Antilipolytic Insulin Action Is Associated with a Less Atherogenic Plasma Lipid Profile in Healthy Centenarians
Authors: Paolisso Giuseppe , Gambardella Antonio , Ammendola Stefania , Tagliamonte Maria Rosaria , Rizzo Maria Rosaria , Capurso Antonio , Varricchio Michele
Published: April 2015

OBJECTIVE: Recent studies have demonstrated that centenarians have a preserved glucose tolerance and insulin action and a more favorable body composition and fat distribution than aged subjects. The strong relationship among glucose tolerance, insulin action, plasma lipid concentration, and lipoprotein metabolism would lead to the hypothesis that healthy centenarians may also have a less atherogenic profile than aged subjects less than 100 years old.

DESIGN: Investigation of the relationship between insulin action and lipid metabolism in healthy centenarians.

PARTICIPANTS: Fifty‐six subjects were categorized into three groups: Adults (≤ 50 years old; n = 20); Aged (≥ 75 years old; n = 22); Centenarians (≥100 years old; n = 14). The latter represented a select group of individuals free of major age‐related diseases.

MEASUREMENTS: Anthropometric measurements were made in all subjects, fasting blood samples were drawn for metabolite determinations, and an euglycemic glucose clamp was performed.

RESULTS: Compared with aged subjects, healthy centenarians appeared to have a less atherogenic plasma lipid profile. Fasting plasma LDL cholesterol (2.4 ± 0.6 vs 3.7 ± .6 mmol/L P < .010) was significantly higher in aged subjects than in centenarians, whereas fasting plasma HDL cholesterol (1.0 ± 0.4 vs 1.7 ± .4 mmol/L P < .005) had an opposite trend. In centenarians, insulin‐mediated glucose uptake was greater (34.6 ± 0.5 vs 23.3 ± .05 μmol/Kg FFM × min P < .010) than in aged subjects and correlated with fasting plasma triglycerides, FFA, LDL, and HDL cholesterol, Apo B, and Apo A1 concentrations. Finally, insulin infusion suppressed plasma FFA concentration in similar ways in adults and centenarians.

CONCLUSION: Our study demonstrates that centenarians have a less atherogenic plasma lipid and lipoprotein profile than aged subjects J Am Geriatr Soc 45:1504–1509, 1997.
Development and Validation of a Clinical Prediction Rule for Prolonged Nursing Home Residence After Hip Fracture
Authors: Steiner John F. , Kramer Andrew M. , Eilensen Theresa B. , Kowalsky Jacqueline C.
Published: April 2015

OBJECTIVES: To develop and validate a clinical prediction rule for nursing home residence 6 months after a hip fracture.

DESIGN: Two prospective cohort studies, a development study (DS) and a validation study (VS).

SETTING: The DS included hip fracture patients admitted to 92 rehabilitation units or skilled nursing facilities; the VS included hip fracture patients from 11 integrated healthcare systems.

PARTICIPANTS: A total of 344 community‐dwelling hip fracture patients aged 65 and older participated in the DS; 239 similar patients were enrolled in the VS.

INTERVENTION: None.

MEASUREMENTS: The acute hospital record, nursing evaluations, and patient questionnaires provided information about demographics, physical and neuropsychological function, and comorbidity. Residence 6 months after fracture was determined by phone interview. Multivariate analysis identified predictors for a risk score to assess the likelihood of nursing home residence.

RESULTS: 18.7% of patients in the DS resided in nursing homes 6 months after hip fracture. The four independent risk factors for institutionalization were (1) being unmarried (OR = 6.7 [95% CI 2.4 to 19]), (2) incontinence (OR = 2.3 [CI 1.2 to 4.7]), (3) dependence in ambulation (OR = 5.0 [CI 2.1 to 12.3]), and (4) cognitive impairment (OR = 6.6 [CI 3.3 to 13.2]). Of patients with all four risk factors, 73.2% were institutionalized at 6 months, compared with 0% of patients with no risk factors. In the VS, 6.1% of patients resided in nursing homes after 6 months, with a range from 50.0% of patients with four risk factors to 0% of those with no risk factors. Areas under receiver‐operating characteristic curves for the prediction rule were 0.84 ± .03 in the DS, and 0.81 ± .06 in the VS.

CONCLUSION: A clinical prediction rule using four easily measurable characteristics can identify individuals at high or low risk of nursing home residence 6 months after hip fracture. J Am Geriatr Soc 45:1510–1514, 1997.
Longitudinal Weight Changes, Length of Survival, and Energy Requirements of Long Term Care Residents with Dementia
Authors: Wang San Y. , Fukagawa Naomi , Hossain Monir , Ooi Wee L.
Published: April 2015

OBJECTIVE: We hypothesized that institutionalized patients with dementia, who frequently have feeding problems and require supervised and assisted feeding, would lose more weight during their residency than nondemented, independently functioning residents and have compromised survival. To test this hypothesis, we examined the survival and longitudinal changes in weight of two cohorts of institutionalized residents with dementia and compared these cohorts with a cohort of nondemented residents. We also measured the resting energy expenditures of a subset of the subjects with dementia as an indicator of their energy needs.

DESIGN: A longitudinal cohort study with retrospective baseline chart review and subsequent follow‐up of monthly weights and mortality over 4 years.

SETTING: A 725‐bed long‐term care institution with specified levels of care.

SUBJECTS: Two cohorts of residents with dementia, one consisting of subjects who required total care throughout their institutional stay (n = 31) and another group who did not initially require total care (n = 48); these were compared with a cohort with normal mentation who were functionally independent in their daily activities (n = 26). The total number of subjects was 105.

MEASUREMENTS: Demographics, medical problems, and medications by chart review; functional and mental status evaluations; longitudinal monthly weights and mortality for the 48‐month study period; and resting energy expenditures by indirect calorimetry.

MAIN RESULTS: Residents with dementia had lower weights on admission and throughout their stay than nondemented, independently functioning residents, and they were more likely to have a weight loss of 10 lbs or more at some point during the 4‐year study period. However, their mean weights did not change during the study period. The mean survival from admission of those demented residents who died was more than 3 years. Resting energy expenditures of women residents with advanced dementia were 12% lower than predicted from the Harris Benedict equations.

CONCLUSION: Dementia is not necessarily associated with unremitting weight loss during institutionalization despite the frequent occurrence of feeding difficulties and temporary weight loss. This may be caused partly by the lower than expected resting energy expenditures and, hence, energy needs of affected residents as their dementia progresses. Demented residents weighed significantly less than nondemented, independently functioning residents throughout their institutional stay. Nevertheless, nursing staff are able to maintain weight and survival for extended periods even in very impaired residents. J Am Geriatr Soc 45:1189–1195, 1997.
Active Voluntary Euthanasia or Physician‐Assisted Suicide?
Authors: Onwuteaka‐Philipsen Bregje D. , Muller Martien T. , van der Wal Gerrit , van Eijk Jacques Th. M. , Ribbe Miel W.
Published: April 2015

OBJECTIVE: To find out why Dutch general practitioners (GPs) and nursing home physicians (NHPs), and patients (according to their physician) opt for active voluntary euthanasia rather than for physician‐assisted suicide, or vice‐versa.

DEFINITIONS: The following definitions were used in the study: Euthanasia is the intentional termination of life, by someone other than the patient, at the patient's request; physician‐assisted suicide is intentionally helping a patient to terminate his or her life at his or her request.

DESIGN: Two descriptive, retrospective studies.

SETTING: The Netherlands.

METHOD: Data were collected by means of anonymous questionnaires sent to a random sample of 521 GPs from the province of North Holland, 521 GPs from the rest of the Netherlands, and all 713 NHPs who were members of the Dutch Association of Nursing Home Physicians. Data were collected over the period 1986–1989 (inclusive) for GPs and the period 1986‐June 1990 (inclusive) for NHPs.

RESULTS: Forty‐eight percent of the Gps, 78% of the NHPs, and about half of the patients who opted for euthanasia did so because of the physical condition of the patient. The reason GPs, NHPs, and patients gave most often for opting for physician‐assisted suicide was that they wanted ‘as far as possible to let the patient bear the responsibility.’

CONCLUSION: In 38% of all cases for GPs and 57% of all cases for NHPs, only active voluntary euthanasia could be performed because of the patient's condition. In the other cases, where there was a choice, most GPs performed euthanasia, while most NHPs assisted in suicide. Active voluntary euthanasia was chosen primarily for medico‐technical reasons, whereas physician‐assisted suicide was selected primarily for moral reasons.
Driving Patterns and Medical Conditions in Older Women
Authors: Forrest Kimberly Y.‐Z. , Bunker Clareann H. , Songer Thomas J. , Coben Jeffrey H. , Cauley Jane A.
Published: April 2015

OBJECTIVES: To describe driving patterns (e.g., driving frequency) in older women drivers and to evaluate the impact of medical conditions and comorbidity on driving patterns.

DESIGN: Cross‐sectional examination of the association between medical conditions and driving patterns.

SETTING: Population‐based cohort from the Pittsburgh Center of the Study of Osteoporotic Fractures (SOF).

PARTICIPANTS: A total of 1768 women aged 71 years or older.

MAIN MEASUREMENTS: Driving information was obtained through a driving questionnaire, including driving status, weekly mileage, longest trip in the past year, etc. Data for demographics, lifestyle behavior, and medical conditions were collected through the SOF study.

RESULTS: Among the participants, 1103 (62.3%) were current drivers, 337 (19.1%) had stopped driving, and 329 (18.6%) had never driven in their lifetime. The proportion reporting driving cessation and decline in driving amount increased with age. The prevalence of most medical conditions was higher among former drivers than in current or never drivers. Even after controlling for age and other demographic variables, fractures, heart disease, diabetes, self‐ reported poor vision or hearing, as well as comorbidity were found to be associated independently with decreased driving amount, including driving cessation, decline in mileage, and avoiding long trips.

CONCLUSION: Both individual medical conditions and comorbidity influence driving patterns in older drivers. Because it is common for older people to have several medical conditions simultaneously, comorbidity might be a more comprehensive measure of medical impact on driving.
Association of Insulin‐Like Growth Factor‐I with Body Composition, Weight History, and Past Health Behaviors in the Very Old: The Framingham Heart Study
Authors: Harris Tamara B. , Kiel Douglas , Roubenoff Ronenn , Langlois Jean , Hannan Marian , Havlik Richard , Wilson Peter
Published: April 2015

OBJECTIVES: We examined correlates of insulin‐like growth factor‐I (IGF‐I), an indicator of growth hormone levels, to identify factors associated with higher levels of IGF‐I in old age.

DESIGN: Nested study of cross‐sectional correlates and early‐life predictors of IGF‐I level.

SETTING: A longitudinal cohort study, the Framingham Heart Study.

PARTICIPANTS: A total of 790 men and women (mean age 78.5, range 72–94), who had weight, waist and hip circumferences measured at the time of IGF‐I measurement.

MEASUREMENTS: Association of IGF‐I with weight, fat distribution, functional status, nutritional indicators, and past health behaviors was assessed. We also examined IGF‐I in relation to body composition derived from dual energy X‐ray absorptiometry.

RESULTS: IGF‐I levels declined with age in both men and women. However, low IGF‐I did not show expected associations with low lean mass and increased body fat. Current functional status and grip strength were not associated with IGF‐I. Low IGF‐I was associated with weight loss in men; the strongest associations were with indicators of poorer nutritional status in both men and women. Levels of IGF‐I in old age did not vary by past health behaviors.

CONCLUSION: Although IGF‐I declined with age, these data from the Framingham Heart Study did not show expected cross‐sectional associations of weight, body fat, and lean mass. The strongest associations were between IGF‐I and nutritional indicators. These results suggest caution may be warranted with regard to use of IGF‐I as an indicator of growth hormone.
Financial Performance Among Adult Day Centers: Results of a National Demonstration Program
Authors: Reifler Burton V. , Henry Rona Smyth , Rushing Julia , Yates Kim , Cox Nancy J. , Bradham Douglas D. , McFarlane Mary
Published: April 2015

OBJECTIVES: This paper describes the financial performance (defined as percent of total expenses covered by net operating revenue) of 16 adult day centers participating in a national demonstration program on day services for people with dementia, including examination of possible predictors of financial performance.

METHODS: Participating sites submitted quarterly financial and utilization reports to the National Program Office. Descriptive statistics summarize the factors believed to influence financial performance.

RESULTS: Sites averaged meeting 35% of expenses from self‐pay and 29% from government (mainly Medicaid) revenue, totaling 64% of all (cash plus in‐kind) expenses met by operating revenue. Examination of center characteristics suggests that factors related to meeting consumer needs, such as being open a full day (i.e., 7:30 am to 6:00 pm) rather than shorter hours, and providing transportation, may be related to improved utilization and, thus, improved financial performance. Higher fees were not related to lower enrollment, census, or revenue.

CONCLUSIONS: Adult day centers are able to achieve financial viability through a combination of operating (i.e., fee‐for‐service) and non‐operating revenue. Operating revenue is enhanced by placing emphasis on consumer responsiveness, such as being open a full day. Because higher fees were not related to lower utilization, centers should set fees to reflect actual costs. The figure of 64% of expenses met by operating revenue is conservative inasmuch as sites included in‐kind revenue as expenses in their budgeting calculations, and percent of cash expenses met by operating revenue would be higher (approximately 75% for this group of centers).
Health Status Gender Differences of Newly Admitted Black Nursing Home Residents
Authors: Martin Judy C. , Engle Veronica F. , Graney Marshall J.
Published: April 2015

OBJECTIVES: To investigate gender differences in health status of newly admitted black nursing home residents on the day following admission.

DESIGN: Descriptive and comparative cross‐sectional study of black residents drawn from a larger prospective longitudinal study on health and functional status of new nursing home residents interviewed on the first full day after admission.

SETTING: Eight southern nursing homes: three not‐for‐profit, three for‐profit, one county government‐operated, and one federal government‐operated. Homes ranged in size from 110 to 575 beds and were licensed for skilled and intermediate care.

PARTICIPANTS: Black nursing home residents (N = 224) aged 60 years and older as admitted sequentially to nursing homes.

MEASUREMENTS: Health status was assessed by the Short Portable Mental Status Questionnaire, as a measure of mental status, and the Scaled Outcome Criteria, as a measure of ability to perform activities of daily living (ADLs). Morbidity was assessed by the number of medical diagnoses, number of prescribed medications, and the medical diagnoses of hip fracture, dementia, and cancer. Resident classification data assessed the source of entry to the nursing home, payer source, and level of care required. Demographic data assessed included age, education, marital status, and number of living children.

RESULTS: Both black men (n = 126) and women (n = 98) newly admitted to the nursing home had health and social deficits. Moreover, women, although not significantly different from men in average age, were more impaired in six of eight ADLs, including grooming, dressing, feeding, ambulating, transferring, and defecating. Women were also less likely to be married. No gender differences were found for five other health status variables, four other demographic variables, five resident classification variables, or five measures of morbidity.

CONCLUSION: These data on southern black nursing home residents provide evidence that among older black nursing home residents, women have greater care needs than men. Findings illustrate the need to consider gender in planning nursing home care of black older residents. black women may be at greater risk for health status alterations and require more frequent health status monitoring and intervention.
The Prognostic Significance of Delirium in Older Hospital Patients
Authors: O'Keeffe Shaun , Lavan John
Published: April 2015

OBJECTIVES: To determine whether delirium is an independent predictor of adverse outcomes of hospitalization in older patients.

DESIGN: Cohort study

PATIENTS: A total of 225 people admitted as an emergency to an acute geriatric unit in a university teaching hospital

METHODS: Subjects were screened for delirium, defined by Diagnostic and Statistical Manual, 3rd Edition criteria, every 48 hours. Outcome measures included mortality, duration of hospital stay, hospital‐acquired complications, and institutional placement. The influence of delirium on these outcomes was calculated after adjusting for age, illness severity on admission, burden of comorbidity, prior cognitive impairment, and level of disability.

RESULTS: Delirium was present on admission in 41 patients (18%) and developed after admission in a further 53 patients (24%). Patients with delirium were more likely than non‐delirious patients to have chronic cognitive impairment, severe acute illness, multiple comorbid conditions, and functional disability. Nevertheless, in multivariate analyses adjusting for these factors, delirium was independently associated with prolonged hospital stay, functional decline during hospitalization, increased risk of developing a hospital‐acquired complication, and with increased admission to long‐term care.

CONCLUSION: Delirium is an independent predictor of adverse outcomes in older hospital patients.
Recruitment in the Trial of Nonpharmacologic Intervention in the Elderly (TONE)
Authors: Whelton Paul K. , Bahnson Judy , Appel Lawrence J. , Charleston Jeanne , Cosgrove Nora , Espeland Mark A. , Folmar Steve , Hoagland Donna , Krieger Susan , Lacy Clifton , Lichtermann Lynne , Oates‐Williams Floria , Tayback Matthew , Wilson Alan C.
Published: April 2015

OBJECTIVE: To compare the effectiveness of different approaches to participant enrollment in a behavior modification trial.

DESIGN: Concurrent, prospective evaluation performed in context of recruitment for a randomized, controlled trial.

SETTING: Four study centers located in Baltimore, Maryland, Memphis, Tennessee New Brunswick, New Jersey, and Winston‐Salem, North Carolina.

PARTICIPANTS: Men and women aged 60 to 80 years who were being treated with a prescription medication for control of hypertension.

MAIN OUTCOME MEASURES: Visit counts and percent yields were assessed at each stage of the screening and randomization process. Logistic regression was used to contrast the randomization yields for different recruitment strategies and to explore the impact of sociodemographic characteristics and geographic location on recruitment yields

RESULTS: The overall randomization yields from a pre‐screen contact and a first screening visit to enrollment in the trial were 11% and 31%, respectively. Randomization yields varied significantly by participant age, education, and marital status.

CONCLUSIONS: Our results demonstrate the feasibility of recruitment for trials of nonpharmacologic interventions in older people and suggest that mass mailing and mass media advertising campaigns provide an effective means of enrolling in such studies participants with a broad range of personal characteristics.
Driving Cessation and Increased Depressive Symptoms: Prospective Evidence from the New Haven EPESE
Authors: Marottoli Richard A. , de Leon Carlos F. Mendes , Glass Thomas A. , Williams Christianna S. , Cooney Leo M. , Berkman Lisa F. , Tinetti Mary E.
Published: April 2015

OBJECTIVES: The purpose of this study was to determine the association between driving cessation and depressive symptoms among older drivers. Previous efforts in this area have focused on the factors associated with cessation, not the consequences of having stopped.

DESIGN: Cohort study

SETTING: Urban community

PARTICIPANTS: A driving survey was administered in 1989 to surviving noninstitutionalized members of the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) cohort. Of 1316 respondents, 502 were active drivers as of 1988, 92 had stopped driving between 1982 and 1987, and the remainder had either never driven or had stopped before 1982.

MEASUREMENTS: Information about independent and dependent variables other than driving status came from the in‐person EPESE interviews in 1982, 1985, and 1988, except for medical conditions, which were updated yearly. Depressive symptoms were assessed by the Centers for Epidemiologic Studies ‐ Depression (CES‐D) scale. Analyses focused on the changes in depressive symptoms before and after driving cessation. Repeated measures multivariable analysis accounted for the effect of cessation on the outcome adjusting for the potential confounding due to sociodemographic and health‐related factors.

RESULTS: Individuals who stopped driving exhibited substantial increases in depressive symptoms during the 6‐year interval. Driving cessation was among the strongest predictors of increased depressive symptoms (Coefficient 2.464, SE 0.758, P = .001) even when adjusting for sociodemographic and health‐related factors.

CONCLUSIONS: Driving cessation was associated with an increase in depressive symptoms even when accounting for sociodemographic and health‐related factors. These consequences need to be taken into account when advising older drivers and when developing alternative transportation strategies.
Predictors of Antipsychotic Withdrawal or Dose Reduction in a Randomized Controlled Trial of Provider Education
Authors: Meador Keith G. , Taylor Jo A. , Thapa Purushottam B. , Fought Randy L. , Ray Wayne A.
Published: April 2015

OBJECTIVES: To evaluate the effects of an educational program to reduce antipsychotic use in nursing homes that had high use rates post‐OBRA‐87 and to identify factors that predicted antipsychotic withdrawal or 50% or greater dose reduction.

DESIGN/SETTING: A randomized controlled trial (RCT) of the educational program (nursing home the unit of randomization and analysis) was conducted in 12 Tennessee nursing homes (6 education/6 control). Cohort analysis in baseline antipsychotic users identified factors predicting withdrawal or dose reduction.

SUBJECTS: The RCT analysis included 1152 patients in the homes at baseline and 6 months. The cohort analysis included 133 baseline antipsychotic users in the five education homes able to implement the recommendations of the educational program.

OUTCOME MEASURES: Change in days of antipsychotic use per 100 days of nursing home residence, withdrawal from antipsychotics, reduction in antipsychotic dose by 50% or more.

RESULTS: Following the educational intervention, use of antipsychotics in the six education homes decreased from 25.3 days per 100 at baseline to 19.7 days per 100 by month 6, a 23% reduction relative to control homes (P = .014). In the withdrawal analysis, 44 (33%) of 133 baseline antipsychotic users were withdrawn. Factors at baseline predicting successful withdrawal were low antipsychotic dose, no use of benzodiazepines or antidepressants, and behavioral symptoms score below the median. However, although an additional 22 patients had dose reductions 50%, none of the predictors of withdrawal were associated with dose reductions.

CONCLUSION: Focused provider education programs may facilitate antipsychotic reduction above and beyond that attributable to regulatory changes. Patients who are poor candidates for total antipsychotic withdrawal may tolerate substantial dose reductions, which should reduce their risk of adverse antipsychotic effects.
The Benefits of In‐Home Pharmacy Evaluation for Older Persons
Authors: Der Elaine Hsia , Rubenstein Laurence Z. , Choy Gavin S.
Published: April 2015

OBJECTIVE: To assess the potential benefit of a pharmacist performing in‐home medication evaluations on frail older people.

DESIGN: Prospective analysis with pre‐post comparison.

SETTING: A hospital‐based home care program at the Sepulveda Veterans Affairs Medical Center.

PARTICIPANTS: Male veterans in a home care program who live within 15 miles of the medical center and take three or more prescription medications (N = 20, mean age: 75.1 years).

MEASURES: Prescribed medications were documented from the medical records and compared with regimens actually being followed in the home. In addition, the home was inspected, patients were educated, and recommendations were made to the prescribing physicians when necessary.

RESULTS: At first visit, patients had a mean of 6.0 prescribed daily medications but were only taking 4.7 of these regularly. Also noted were many potentially unnecessary medications (70% of subjects) and multiple problems with the medication regimen (e.g., incorrect drug frequency or dosage, expired medications, medication omission). Follow‐up visit revealed a significant decrease in medication discrepancies and problems (P ≤ .05).

CONCLUSION: An in‐home pharmacy assessment reveals many problems with drug administration not otherwise detected easily. These assessments can lead to potentially useful interventions that can improve medication regimens and compliance. Determination of long‐term effects must await controlled trials.
The Doctor's Role in Discussing Advance Preferences for End‐of‐Life Care: Perceptions of Physicians Practicing in the VA
Authors: Markson Lawrence , Clark Jack , Glantz Leonard , Lamberton Victoria , Kern Donald , Stollerman Gene
Published: April 2015

OBJECTIVES: Although previous studies have shown physicians support advance directives, little is known about how they actually participate in decision‐making. This study investigates (1) how much experience physicians have had discussing and following advance preferences and (2) how physicians perceive their role in the advance decision‐making process.

DESIGN: Mail survey conducted in 1993.

SETTING: The Department of Veterans Affairs.

PARTICIPANTS: A national probability sample of 1050 VA internists, family physicians, and generalists.

MEASUREMENTS AND MAIN RESULTS: Questionnaires were returned by 67% of participants. In the last year, 79% stated they had discussed advance preferences with at least one patient, and 19% had talked to more than 25. Seventy‐three percent had used a written directive to make decisions for at least one incompetent patient. Younger age, board certification, spending less time in the outpatient setting, and personal experience with advance decision‐making, were all associated independently with having advance preference discussions. Among physicians who had discussions, 59% said they often initiated the discussion, 55% said discussions often occurred in inpatient settings, and 31% said discussions often occurred in outpatient settings.

Eighty‐two percent of those responding thought physicians should be responsible for initiating discussions. Most would try to persuade a patient to change a decision that was not well informed (91%), not medically reasonable (88%), or not in the patient's best interest (88%); few would attempt to change decisions that conflicted with their own moral beliefs (14%).

CONCLUSIONS: Physicians report that they are actively involved with their patients in making decisions about end‐of‐life care. Most say they have had recent discussions with at least some of their patients and feel that as physicians they should play a large and important role in soliciting and shaping patient preferences.
Managing Geriatric Syndromes: What Geriatric Assessment Teams Recommend, What Primary Care Physicians Implement, What Patients Adhere To
Authors: Shah P. Nina , Maly Rose C. , Frank Janet C. , Hirsch Susan H. , Reuben David B.
Published: April 2015

OBJECTIVES: To evaluate the responses of primary care physicians and patients to recommendations from a commmunity‐based comprehensive geriatric assessment (CGA) program for management of four target conditions: falls, depression, urinary incontinence, and functional impairment.

DESIGN: Case series.

SETTING: Senior centers, meal sites, senior housing, and other community sites as screening locations; and a community‐based academic practice as the location for CGA.

PARTICIPANTS: A total of 150 older patients living in the community who have one or more of the four target conditions and who received CGA
MEASUREMENTS: Physician implementation and patient adherence rates were ascertained during a face‐to‐face structured interview with the patient 3 months after CGA.

RESULTS: Two hundred twelve of 528 (40%) CGA recommendations were clearly or possibly related to the target or target‐related conditions. Of these 212 recommendations, 59% required a physician's order for implementation. The remaining 41% were patient self‐care recommendations. Overall physician implementation across conditions was 70%; implementation rates were highest for falls and lowest for functional impairment. Overall patient adherence rate was 85% for physician‐implemented recommendations and 46% for self‐care recommendations. Patient adherence to recommendations for counseling or support groups and exercise programs was particularly low.

CONCLUSIONS: When examining the process of care of community‐based CGA, patient as well as physician adherence must be considered. Although patient adherence to physician‐initiated recommendations was high for all conditions, it varied substantially across target conditions and types of recommendations for self‐care recommendations.
The Relationship Between Endothelin‐1, Event‐Related P300 Potentials, and Prognosis in Cerebral Arteriosclerosis
Authors: Kügler Christian F.A. , Funk H. , Vlajic P. , Platt D.
Published: April 2015

OBJECTIVES: To search for a potential role of endothelin‐1 (ET‐1), a potent vasoconstrictor and presumably neurotoxic 21‐amino acid peptide, for dysfunction of brain signal processing and cerebrovascular morbidity in nondemented patients with cerebral arteriosclerosis.

DESIGN: Cross‐sectional study with longitudinal follow‐up.

SETTING: University‐affiliated teaching hospital.

PARTICIPANTS: A total of 106 nondemented patients with significant stenosis of either the internal carotid (cAD, cases; n = 63, mean age ± SD, 62 ± 7 years) or peripheral arteries (pAD, disease controls; n = 43, 60 ± 11 years) were investigated before carotid endarterectomy and bypass surgery, respectively. After a mean follow‐up of about 19 months, cerebrovascular morbidity of the cAD and pAD patients was evaluated by phone.

MEASUREMENTS: Brain signal processing functions by event‐related visual P300 potentials; cerebrovascular events by a structured telephone interview; the extent of arteriosclerosis by venous ET‐1 concentration.

RESULTS: Venous ET‐1 levels were elevated in both cAD and pAD patient groups, but to the same degree. In these patients, ET‐1 concentration was correlated slightly with diastolic blood pressure (r = .334, P = .0326, stepwise regression). Only in cAD patients with ET‐1 levels above the 75th percentile were P300 latencies markedly prolonged compared with their lower ET‐1 level counterparts. Furthermore, the P300 latencies of the cAD patients, but not of the pAD patients, correlated positively with venous ET‐1 concentration and inversely with pack years of smoking (r = .728, P = .0002; stepwise regression). In contrast to base‐line P300 abnormalities and classical risk factors (e.g., hypertension), high ET‐1 levels predicted an increased cerebrovascular morbidity of cAD, but not of pAD, patients (P = .0044; Mantel‐Cox test).

CONCLUSIONS: In nondemented patients with cerebral arteriosclerosis, endothelin‐1 is associated with P300 abnormalities reflecting subclinical dysfunction of brain signal processing. In the long‐term, high venous ET‐1 levels also appear to predict a higher cerebrovascular morbidity of cAD patients even after carotid endarterectomy.