bluuebunny/crossref_metadata_2025 huggingface dataset:
The Yale Geriatric Care Program: A Model of Care To Prevent Functional Decline in Hospitalized Elderly Patients
Authors: Inouye Sharon K. , Acampora Denise , Miller Ronald L. , Fulmer Terry , Hurst Leslie D. , Cooney Leo M.
Published: April 2015

Objective: To describe the structure and implementation of the Yale Geriatric Care Program, an innovative, nursing‐centered model for developing geriatric nursing expertise throughout an acute‐care hospital.

Design: Descriptive study of an intervention in a prospective cohort of patients.

Setting: University teaching hospital.

Patients: Two hundred forty four patients aged 70 years and older on four non‐intensive care intervention units during the study period (July 9, 1990 to July 31, 1991).

Intervention: The Geriatric Care Program involved an integrated model of primary nurses, specially trained unit‐based geriatric resource nurses, gerontological nurse specialists, and geriatric physicians. The intervention included surveillance and identification of frail older patients, unit‐based geriatric educational programs for all nurses, special education and support for the geriatric resource nurses, and twice‐weekly rounds of the Geriatric Care Team.

Results: The Geriatric Care Program has been successfully implemented on four units. The interventions ranged from general clarification of goals in 226 (92%) to specific recommendations for management of immobility in 100 (41%), bladder/bowel problems in 99 (41%), pressure ulcer treatment or prevention in 61 (25%), confusion evaluation or management in 62 (25%), and adjustment of medications in 43 (18%). Overall, 68% of the specific recommendations were documented to have been implemented. Barriers to implementation of the program have included initial difficulties with recruitment and retainment of geriatric resource nurses (due to high nursing turnover and the increased time commitment required), breakdown in communication and carryover of recommendations between nursing shifts, and obstacles to communication between the nursing and medical staff.

Conclusions: An innovative model of care, in which geriatric nursing was integrated as part of standard nursing care on selected medical and surgical units, has been designed and implemented. Evaluation of the effectiveness and costs of this intervention are currently underway.
A Controlled Trial of a Nursing‐Centered Intervention in Hospitalized Elderly Medical Patients: The Yale Geriatric Care Program
Authors: Inouye Sharon K. , Wagner D. Raye , Acampora Denise , Horwitz Ralph I. , Cooney Leo M. , Tinetii Mary E.
Published: April 2015

Objective: To test the effectiveness of a nursing‐centered intervention to prevent functional decline among hospitalized elderly medical patients.

Design: Prospective cohort study with stratified and matched cohort analyses.

Setting: General medicine wards of a university teaching hospital.

Patients: Two hundred sixteen patients aged ≥70 years (85 intervention and 131 control patients).

Intervention: The intervention included identification and surveillance of frail older patients, twice‐weekly rounds of the Geriatric Care Team, and a nursing‐centered educational program.

Main Outcome Measure: Functional decline, defined as a net decline in five activities of daily living (ADLs).

Results: In stratified analyses, the intervention resulted in a beneficial effect with a relative risk of 0.82 (95% confidence interval [CI] 0.54 to 1.24) in patients (n = 106) with one of four geriatric target conditions at baseline (eg, delirium, functional impairment, incontinence, and pressure sores). The intervention had no effect in patients without target conditions at baseline (n = 110); thus, this subgroup was excluded from further analyses.

When patients were matched on number of target conditions and risk for functional decline at baseline (n = 66), the intervention resulted in a significant beneficial effect, with a reduction in functional decline from 64% in controls to 41% in the intervention group, for a relative risk of 0.64 (95% CI, 0.43 to 0.96). The intervention group had significantly less decline in ADL score and in individual ADLs than control subjects. Specific interventions aimed at maximizing function, such as physical therapy, were received more often by intervention patients; however, the beneficial effects of the intervention were achieved without increasing per‐day hospital costs.

Conclusions: The intervention appears effective to decrease functional decline in targeted elderly hospitalized medical patients.
Efficacy of Heavy‐Resistance Training for Active Women over Sixty: Muscular Strength, Body Composition, and Program Adherence
Authors: Nichols Jeanne F. , Omizo Debra K. , Peterson Katrina K. , Nelson Karen P.
Published: April 2015

Objective: To determine the effects of resistance training on muscular strength, body composition (percent fat and lean tissue mass), and program adherence in active women over 60 years of age.

Design: This study was designed as a stratified, randomized, non‐blinded trial. Subjects were stratified into rank‐ordered pairs by level of physical activity according to the Blair Seven‐Day Recall, then randomly assigned into either a weight‐training (WT, n = 18) or control (CON, n = 18) group.

Participants and Setting: Thirty‐six women over the age of 60 (67.1 ± 1.5, x ± SE) were recruited from the San Diego community. All subjects had to be engaging in some form of aerobic exercise at least 3 days each week for a minimum of 6 months.

Measurements and Intervention: Subjects engaged in isotonic training 3 days/week on Polaris machines at a target intensity of 80% of the 1 repetition maximum (1 RM) for three sets of seven exercises selected to train major muscle groups of the trunk and upper and lower body. The 1 RM was re‐tested every 6 weeks in WT and the workload adjusted to maintain target intensity. The 1 RM was tested at 0, 12, and 24 weeks in CON. Body fatness and lean tissue mass, excluding skeletal mass, were assessed at 0 and 24 weeks by dual energy radiography using a total body scan.

Results: Increases in muscle strength of the weight trainers were significant for all seven exercises (5%–65%), with the greatest gains in the shoulder and trunk muscles. Percent body fat of weight trainers decreased significantly (from 38.8% to 37.9%, P < 0.05), while lean tissue mass increased by 1.5 kg (P < 0.01). No changes in body composition were observed in control subjects. Overall program adherence was 83% (15 weight trainers and 15 control women completed the study). Monthly attendance averaged 86.8 ± 3.3%, with no incidence of injury during the training sessions.

Conclusions: These data indicate that heavy‐resistance weight training is safe and enjoyable for older women and that meaningful gains in muscular strength and body composition can be made even in women who are already highly active.
Survival of Elderly Patients with Transfusion‐Related Acquired Immunodeficiency Syndrome
Authors: Sutin David G. , Rose David N. , Mulvihill Michael , Taylor Brian
Published: April 2015

Objective: To determine the influences of age and risk group on the survival of AIDS patients. We concentrated on transfusion because it is the commonest risk factor for AIDS in patients over 70 years of age.

Design: Survival curve regression analysis.

Participants: Patients aged 13 years and over with AIDS acquired through transfusion, and patients 65 years or older with AIDS as a result of intravenous drug use (IVDU). Data were obtained from the New York City Department of Health.

Main Outcome: The patients were divided into four groups, ages 13–40 years, 41–64 years, and 65 years and over with AIDS as a result of transfusion, and 65 years and older with AIDS as a result of IVDU. The survivals of the three transfusion‐related AIDS groups were compared, as were the 65 years‐and‐over groups with AIDS as a result of transfusion or IVDU. AIDS‐defining diagnoses between those over and under 65 years with AIDS as a result of transfusion were also compared.

Results: The median survival for the three transfusion‐related AIDS groups were 273 days, 58 days, and 60 days, respectively. There was a significant association between shorter survival and increasing age. This was largely due to the longer survival of the patients aged 13–40 years. There was no difference in AIDS‐defining diagnosis between those over and under 65 years with transfusion‐related AIDS. The survival curves of the elderly with AIDS as a result of transfusion or IVDU were not different.

Conclusion: Age over 40 years is an independent risk factor for poor survival among transfusion‐related AIDS patients. Among the elderly, patients with transfusion‐related AIDS have similar survivals to patients with IVDU‐related AIDS.
Surface Area Measurement of Pressure Sores Using Wound Molds and Computerized Imaging
Authors: Hayward Peter G. , Hillman Gilbert R. , Quast Michael J. , Robson Martin C.
Published: April 2015

Objective: To develop a method to measure wound surface area.

Design: Validity study.

Setting: Inpatient service.

Participants: Four patients with decubitus ulcers.

Measurements: A new imaging process estimating wound surface area and volume by NMR spectroscopy of a mold of the pressure ulcer and a comparison measurement of volume of the mold by water displacement. Measurements made serially totalled 17.

Results: Measurement of the volume of the mold by the computer system correlated strongly with measurement of the volume by water displacement. Surface area of the pressure sore mold correlated strongly with volume of the mold raised to the two‐thirds power.

Conclusions: It is possible for the first time to measure surface area of decubitus ulcers. This may provide a way of determining accurately the dose of newly proposed topical treatments.
Responsiveness of Health Status Measures to Change among Older Adults
Authors: Wagner Edward H. , LaCroix Andrea Z. , Grothaus Louis C. , Hecht Julia A.
Published: April 2015

Objective: This study examines the ability of commonly used self‐reported health status measures to detect important changes in health (responsiveness) in older adults.

Design: We compared changes in health status measures over the year among subgroups of a cohort of seniors: those who experienced an intervening illness, hospitalization or increase in drug regimen, and those who didn't. Differences between the two groups in changes in the measures were quantitated using Guyatt's responsiveness statistic and receiver operating characteristic curves (ROC).

Setting: Staff model HMO.

Participants: 1379 senior HMO enrollees who were participants in a health promotion trial and provided complete information at baseline and one year later.

Measurements: The following self‐reported health status measures were evaluated: restricted activity days, bed disability days, the Medical Outcomes Study physical function scale, self‐evaluated health, and a positive affect scale.

Main Results: All measures except the positive affect scale were able to discriminate significantly between seniors who were or were not hospitalized and/or reported a major illness in the intervening year. The two disability days measures showed the best responsiveness for all indicators of worsening health and included 70%‐80% of the area under the ROC curves for major illness defined by hospitalization or self‐report.

Conclusions: Commonly used, brief self‐reported physical health status measures are responsive to intervening illness among relatively healthy seniors supporting their use in longitudinal geriatric research.
Effect of Education on the Clock‐Drawing Dementia Screen in Non‐Demented Elderly Persons
Authors: Ainslie Nina K. , Murden Robert A.
Published: April 2015

Objective: To examine the effect of education on clock‐drawing ability in non‐demented elderly persons.

Design, Setting, Participants: Descriptive study of 187 elderly persons, 77 demented, 110 non‐demented, 54 with 9+ years of education, 133 with 8 or fewer years of education, from three university medical center geriatric divisions.

Measurements: Subjects took the Folstein Mini‐Mental State Exam and were asked to draw a clock showing a time of 3 o'clock. Clocks were scored using three previously described scoring scales (Shulman, Sunderland, and Wolf‐Klein). Mean scores and proportions of normal and abnormal clocks were compared for well and poorly educated non‐demented subjects. Sensitivities and specificities for detecting dementia were calculated.

Results: Mean scores of the well educated non‐demented subjects were significantly better than mean scores of the poorly educated non‐demented subjects on all three scales. However, proportions of abnormal clocks were not significantly different between well and poorly educated on the Wolf‐Klein scale. For the poorly educated subgroup, sensitivity and specificity for detecting dementia by clock drawing were 90% and 42% by the Shulman scale, 74% and 44% by the Sunderland scale, and 48% and 90% by the Wolf‐Klein scale.

Conclusions: Clock‐drawing ability is affected by education in non‐demented elderly persons. The scoring method of Wolf‐Klein is least educationally affected and maximizes specificity for detecting dementia but has low sensitivity. Educational effects make clock drawing a poor single screening test for dementia in a poorly educated population.
Iowa FICSIT Trial: The Feasibility of Elderly Wearing a Hip Joint Protective Garment to Reduce Hip Fractures
Authors: Wallace Robert B. , Ross Jo Ellen , Huston Jeffrey C. , Kundel Carolyn , Woodworth George
Published: April 2015

Hip fractures exact a heavy toll in the elderly population. While intervention strategies are being investigated to reduce the numbers of geriatric falls and to improve the body's resiliency, the geriatric population remains at risk for the mortality and morbidity associated with fractures.

The Iowa FICSIT site is investigating the feasibility of passive protection of the proximal femur through the use of hip pads. The pad is designed to disperse throughout the pad the energy created in a fall. The focus of the Iowa trial is to determine if elderly will wear hip pads for the majority of their waking hours. Thirty subjects are being recruited from each of six elderly populations who are at high risk to fall and at increased risk of injury.

To facilitate compliance, the following strategies are utilized: run‐in period, graduated implementation, tailoring of wearing times, and self‐report of compliance. Outcome measures include compliance rates and injuries sustained during falls.
Dissociation between the Wishes of Terminally Ill Parents and Decisions by Their Offspring
Authors: Sonnenblick Moshe , Friedlander Yechiel , Steinberg Avraham
Published: April 2015

Objective: To assess the attitude and factors affecting decision‐making by offspring for life‐sustaining measures toward their elderly terminally ill parents.

Design: Survey

Setting: Acute geriatric department of a university‐affiliated teaching hospital.

Patients and Participants: 108 offspring of 48 terminally ill elderly patients were interviewed.

Measurements: The attitude of offspring regarding life‐sustaining measures based on a comprehensive questionnaire, administered by face‐to‐face interview, that included clinical, social, and religious information for each patient and social, religious, demographic, and educational information for each family member.

Results: A significant majority requested the continuation of fluid, nutrition, and medication (78%, 66%, 73%, respectively). A minority of 25%–29% requested the initiation of resuscitation, mechanical ventilation, and dialysis. Active euthanasia was requested by seven offspring. Factors that significantly affected offspring's decisions were the degree of religious observance and close relationship. Approximately 50% of offspring believed they knew their parents' wishes, but most of them did not comply with the parents' wishes. The offspring's preferences for themselves differed in important aspects from the requests for their parents. The great majority stated that a family member and/or the responsible physician should be involved in the decision‐making process (76% and 79%, respectively). Only 2.0% suggested the participation of an ethics committee, and the court was rejected by all.

Conclusions: Basic life‐sustaining measures are requested for the terminally ill parents by most of the offspring. A significant minority even requested aggressive life‐sustaining measures. The degree of religiosity and closeness of relationship influenced offspring's request most strongly.
A Preliminary Report of Vitamin D and Calcium Metabolism in Older African Americans
Authors: Perry Horace M. , Miller Douglas K. , Morley John E. , Horowitz Michael , Kaiser Fran E. , Perry H. Mitchell , Jensen Judy , Boyd Sheila , Kraenzle Dale , Bentley Judy
Published: April 2015

Objective: To determine normal serum bone‐related biochemical variables in older African‐Americans.

Design: A convenience sample of older African‐Americans who had a health screening and blood testing for calciotropic hormones was compared with white Americans who were recruited at the end of the Systolic Hypertension in the Elderly Program (SHEP) study and were not on a thiazide diuretic.

Setting: Community‐dwelling African‐Americans who participated in SHEP or who attended one of two mass health screenings.

Participants: Thirty‐two African‐Americans aged 68–93 years and 43 white Americans aged 70–89 years.

Measurements: Twenty‐five hydroxyvitamin D (250HD), parathyroid hormone, osteocalcin, and calcitonin.

Results: Serum 250HD levels in 38% of the African‐American men and 38% of African‐American women were less than 8 ng/mL compared with 22% of Caucasian men and 40% of Caucasian women. Serum parathyroid hormone (PTH) was above the normal range in 25% of men and 33% of women of African‐American descent and 14% of Caucasian men and 30% of Caucasian women. Serum 25OHD was lower (P < 0.05) in individuals with a previous history of fracture. Serum albumin (P < 0.05), calcitonin (P < 0.05), and osteocalcin (P < 0.05), but not 25OHD, were lower in African‐Americans (men and women) when compared with Caucasians (P < 0.05). Serum calcium corrected for albumin was higher in the African‐Americans than in the Caucasians (P < 0.05). As previously reported in Caucasians, PTH was inversely related to log 25OHD in African‐Americans. Serum osteocalcin was positively correlated to PTH in African‐Americans, as previously reported in Caucasians. Log 25OHD correlated inversely with osteocalcin in African‐Americans, but this was not seen in Caucasians.

Conclusions: In this limited sample, hypovitaminosis D (as assessed by 25OHD level) with secondary hyperparathyroidism occurred frequently in elderly African‐Americans. Osteocalcin, a measure of osteoblast activity, correlated with 25OHD and parathyroid hormone. Osteocalcin serum levels were lower in African‐Americans than Caucasians, but serum calcium corrected for albumin was higher in the former compared to the latter.
The Methodology of Studying Decline in Alzheimer's Disease
Authors: Brooks John O. , Kraemer Helena Chmura , Tanke Elizabeth Decker , Yesavage Jerome A.
Published: April 2015

Objective: To present a new model for analyzing longitudinal data. The trilinear model is superior to the commonly used linear model that includes the flawed assumption that decline is uniform throughout the course of disease—an assumption that does not correspond to clinical observations.

Design: A longitudinal cohort sample was used to compare the linear and trilinear models. Simulated longitudinal data were generated to assess classification errors with the trilinear model.

Subjects and Setting: The subjects were 80 patients with Alzheimer's disease tested in a hospital out‐patient clinic.

Methods: The trilinear model describes Alzheimer's disease as proceeding through three periods: An initial period of stability before detectable decline, a period of decline, and a final period of stability during which there is no further detectable decline. A program for the Apple Macintosh computer is available at no charge to apply the model to data.

Findings: The analyses indicated that the trilinear model provides a better reflection of decline in Alzheimer's disease than does the linear model. This advantage is present whether the periods of stability reflect a “true” lack of decline or insensitivity of a measurement instrument.

Conclusions: The trilinear model provides not only a more accurate estimate of the average rate of change, but also (when possible) estimates of the point at which decline begins and ends. Also, more detailed comparisons of tests could be made by using the trilinear parameters. The trilinear model would benefit researchers engaged in longitudinal research of progressive disorders.
Comparison of One‐Day and Three‐Day Calorie Counts in Hospitalized Patients: A Pilot Study
Authors: Breslow Rosalind A. , Sorkin John D.
Published: April 2015

Objective: To determine whether a 1‐day calorie count can replace the labor‐intensive 3‐day calorie count commonly performed in hospitalized patients when estimates of caloric and protein intake are required.

Design: Pilot study using prospective, non‐concurrent review of medical records.

Setting: Hospital.

Participants: Thirty patients (mean age 67 years).

Results: Mean 3‐day intake (952 ± 91 calories, 41 ± 4 g protein) was about half of calculated requirements; first‐day intake was similar (918 ± 116 calories, 40 ± 5 g protein). The first day had high sensitivity (calories 96%; protein 93%) and positive predictive value (calories 100%; protein 96%). Malnutrition was evident; three‐fourths of patients had weights below recommended ranges, and 83% were hypoalbuminemic.

Conclusions: Three‐day calorie counts are frequently performed in patients suspected of eating poorly. Results of this pilot study suggest that 1‐day calorie counts may be a valid alternative. However, readily available anthropometric and biochemical data may be as good an indicator of inadequate dietary intake.
Improving Neglected Influenza Vaccination Among Healthcare Workers in Long‐Term Care
Authors: Thomas David R. , Winsted Beverly , Koontz Carol
Published: April 2015

Objective: To increase utilization of influenza vaccination among long‐term‐care health workers.

Design: Before‐after intervention study.

Setting: A 300‐bed life‐care community served by 195 staff employees.

Intervention: An educational intervention followed by a Vaccination Fair.

Measurements: Percent receiving vaccination. A post‐intervention survey was used to define staff attitudes towards vaccination.

Results: Use of influenza vaccination among staff increased from 8% the previous year to 46% during a Vaccination Fair and to 54% during a similar Fair the next year.

Conclusions: Organized institutional efforts to promote immunization among health‐care workers, such as a Vaccination Fair, improves compliance among health‐care workers.
Cross‐Cultural Cognitive Examination: Validation of a Dementia Screening Instrument for Neuroepidemiological Research
Authors: Glosser Guila , Wolfe Nicola , Albert Martin L. , Lavine Lawrence , Steele John C. , Calne Donald B. , Schoenberg Bruce S.
Published: April 2015

Objective: Validation of a new instrument for screening dementia, the Cross Cultural Cognitive Examination (CCCE), is described.

Design: Criterion and concurrent validation and cross‐cultural comparison of a new instrument.

Participants: All individuals over the age of 40 in a village in southern Guam participated in a door‐to‐door survey. Alzheimer's and Parkinson's Disease patients and healthy controls aged 40–90 participated in the US mainland study.

Measurements: The CCCE was administered to all subjects. Effects of age, language, education, and gender on test performances and social‐cultural differences were assessed. Concurrent validation of the test with respect to other well accepted screening instruments was determined.

Results: High specificity (>94%) and sensitivity (>99%) for detecting dementia were found in Guam and US mainland samples, and these were not biased by differences in gender, linguistic preference, education, or cultural background. Sensitivity and specificity of the CCCE matched or exceeded that of already accepted dementia screening instruments.

Conclusions: These validation studies support the usefulness of the CCCE for identifying patients with generalized dementia, rather than focal types of cognitive impairment, quickly and reliably in cross‐cultural neuroepidemiological research.
Clostridium difficile Colonization in Residents of Long‐Term Care Facilities: Prevalence and Risk Factors
Authors: Walker Karla J. , Gilliland Susan S. , Vance‐Bryan Kyle , Moody Julia A. , Larsson Alison J. , Rotschafer John C. , Guay David R. P.
Published: April 2015

Objective: To determine the period prevalence of Clostridium difficile disease and asymptomatic carriage in the residents of long‐term care facilities (LTCF) and to characterize the risk factors for colonization or associated disease.

Design: Period prevalence survey.

Setting: Two long‐term care facilities in St. Paul, MN.

Participants: Specimens were collected from 225 LTCF residents.

Measurements: The dependent variable was the culture result for C. difficile, which was isolated and identified using selective culture media and a commercial anaerobe identification kit. Tissue culture assay was used to detect the ability of each C. difficile isolate to produce toxin. Independent variables (including gender, age, race, current medical diagnoses, severity of underlying disease, case mix, current clinical symptoms, current medications, antibiotic use within 4 weeks prior to specimen procurement, and other pertinent history) were obtained from the current medical record of each participant.

Results: Of 225 stool cultures that were obtained, 16 (7.1%) were positive for C. difficile. None of the residents with a positive culture was symptomatic. History of nosocomial infection and the use of antibiotics in general, cephalosporins, trimethoprim/sulfamethoxazole (TMP/SMX), and histamine‐2 blockers were significantly associated with positive C. difficile culture (P ≤ 0.05) by univariate analyses. Trends towards significance (0.05 < P < 0.10) were noted for narcotic use, previous hospitalization, LTCF, and non‐insulin‐dependent diabetes mellitus. Logistic regression analysis revealed significant, independent predictors of positive culture: antibiotic use in general (P = 0.028; relative risk = 3.31), histamine‐2 antagonist use (P = 0.038; relative risk = 3.27), cephalosporin use (P = 0.038; relative risk = 4.66), and TMP/SMX use (P = 0.007; relative risk = 8.45).

Conclusions: The use of antibiotics, particularly cephalosporins and TMP/SMX, is a significant risk factor for asymptomatic carriage of C. difficile in long‐term care facilities. The use of H‐2 blockers was also a significant risk factor for carriage; however, this finding has not been reported previously and should be confirmed by independent studies. These medications should be used judiciously in the LTCF population. When diarrheal diseases are encountered in LTCF residents, a high index of suspicion for C. difficile infection should be maintained and the appropriate diagnostic and therapeutic measures taken.
Oral Nutritional Supplement Use in Elderly Nursing Home Patients
Authors: Johnson Larry E. , Dooley Pamela A. , Gleick Jeffrey B.
Published: April 2015

Objectives: To determine why elderly nursing home patients receive liquid oral protein supplements, what nutritional assessment is utilized, and whether there is evidence of effectiveness.

Design: Retrospective, case control study comparing patients over 65 years of age, at two nursing homes, who were served oral supplements (OS) at least twice daily (n = 56), with a random sample of non‐supplemented, non‐tube fed patients (n = 53). Comparisons included medical diagnoses, medications, morbidity and mortality, weight changes, laboratory test results, and functional and behavioral status.

Results: Nursing home patients were begun on OS (median time after admission = 2 months, range = 0–72 months) primarily because of weight loss (71%) and poor appetite (16%). Supplemented patients were below an age‐adjusted body weight on admission, unlike controls, and continued to lose weight until OS were started. On OS, weight was slowly regained over 9–10 months in a majority of patients to approximate admission weight. Some patients on OS showed improvement in albumin, total lymphocyte count, cholesterol, or hemoglobin, but too few patients had sufficient lab tests to verify any consistent effect. Mortality was higher in OS patients (8 vs 2, P = 0.057), who were also somewhat older (87.9 vs 84.5 years), but there was no statistical difference in infection or hospitalization rate.

Measurements: Nutritional assessment in these nursing homes consisted almost exclusively of (1) serial measurement of weight, (2) comparison of weight to (a) “ideal body weight” and (b) previous weight, and (3) a subjective evaluation of food consumption. No other anthropometric evaluations or laboratory tests were conducted for nutritional assessment.

Conclusions: The diagnosis of and intervention in undernutrition in nursing home patients is frequently disorganized. In addition, nutritional assessment, either for screening or for following intervention, is hampered by the lack of convenient and unambiguous assessment tools. OS use is associated with weight gain in many nursing home patients and also improves other nutritional parameters in selected individuals.
Medical Treatment Preferences of Nursing Home Residents: Relationship to Function and Concordance with Surrogate Decision‐Makers
Authors: Gerety Meghan B. , Chiodo Laura K. , Kanten Deanna N. , Tuley Michael R. , Cornell John E.
Published: April 2015

Objective: To describe treatment preferences of nursing home residents, concordance with decisions by self‐selected proxies and to establish the relationship of sociodemographic and functional measures to decisions.

Setting and Subjects: 52 patient‐proxy pairs at a Veterans Affairs nursing home.

Methods: Treatment preferences were elicited from residents and proxies regarding cardiopulmonary resuscitation, mechanical ventilation, and intensive care unit care. Hospitalization, intravenous antibiotics, intravenous fluid administration, and tube feeding were presented in three separate health scenarios. Concordance was determined for the entire interview and separately for each scenario. Treatment‐seeking intensity and decision‐making consistency were scored and used to explore associations with sociodemographic variables and function.

Results: Subjects were predominantly male (97%) and non‐Hispanic white (74%); average age was 70 ± 12 years, with 4 ± 2.9 diagnoses. Residents accepted 70% of all treatments. The proportion of subjects accepting interventions declined parallel to health status in each scenario. Only 7/52 (13%) subjects made inconsistent decisions. Resident treatment acceptance was inversely associated with GDS scores but not associated with any other sociodemographic or functional measure. Concordance with proxies was no greater than chance. Proxies' decisions were not systematically biased against resident preferences or influenced by patient characteristics.

Conclusions: Veterans desired most treatments, but adjusted preferences according to health status and were not inconsistent. Depressive symptoms should be addressed prior to advance directive selection. The patient remains the best source of information, but proxies' decisions exhibit no bias and are not affected by patient status.
The Physics of Frailty
Authors: II Walter M. Bortz
Published: April 2015

The contribution of frailty to human morbidity and mortality is immense. Yet it lacks a conceptual framework. By borrowing from the hypotheses provided by the thermophysicists, frailty can be understood in a way that both interrelates the relationship between form and function and provides medical science with an operational insight that yields clinical benefit.

Frailty results where the organism is uncoupled from its environment yielding a break in the forward feedback cycle of stimulus to reaction to growth to increased functional competence to improved response to stimulus. Recognition of the centrality of this interrelatedness to health becomes a key theme for illness prevention and therapy.
Treatment of Vasculogenic Sexual Dysfunction with Pentoxifylline
Authors: Korenman Stanley G. , Viosca Sharon P.
Published: April 2015

Objective: To evaluate the use of pentoxifylline to treat impotence in men with mild to moderate penile vascular insufficiency.

Design: Double‐blind randomized clinical trial.

Setting: Sexual Dysfunction Clinic at VA Medical Center, Sepulveda, CA.

Participants: Convenience sample of couples.

Intervention: Twelve weeks of treatment with placebo or 400 mg tid of pentoxifylline.

Measurements: (1) Report of patient verified by partner as to number of coital episodes per month; (2) penile‐brachial pressure index determinations.

Results: Pentoxifylline therapy regularly increased the PBPI in impotent men in comparison with the placebo, frequently into the normal range. Pentoxifylline therapy was particularly useful in restoring the PBPI in men with the pelvic steal syndrome; six of seven such subjects improved into the normal range. During the pentoxifylline treatment period, in contrast with the control period, nine men were able to reestablish coital function and three had no improvement. Six couples did not attempt intercourse despite a professed interest in sexual activity; however five out of the six men experienced erections during episodes of fantasy or attempts at masturbation during treatment. There were no complications of therapy.

Conclusions: These promising preliminary results suggest a well tolerated alternative therapy for erectile dysfunction in patients with mild to moderate penile vascular disease.
The Dark Side of Incontinence: Nighttime Incontinence in Nursing Home Residents
Authors: Ouslander Joseph , Schnelle John , Simmons Sandra , Bates‐Jensen Barbara , Zeitlin Michael
Published: April 2015

Objective: To describe the characteristics of nighttime urinary incontinence in a sample of nursing home (NH) residents.

Design: Prospective descriptive study of a convenience sample of incontinent NH residents.

Setting: Four NHs.

Participants: 136 incontinent NH residents.

Measurements: Frequency and volume of incontinent and continent voids for three 10‐hour daytime and three 10‐hour nighttime data collection periods.

Results: The frequency of nighttime incontinence was the same as during the day, but the volume of nighttime incontinent voids and total nighttime volume were higher than during the day. There was substantial between‐ and within‐subject variability in volumes, but the distribution of ratios of night/total volumes approximated a normal curve. Diuretic use was associated with relatively low nighttime volumes.

Conclusion: About one‐quarter of the NH residents we studied produced substantially more urine at night than during the day. Several medical, behavioral, and environmental approaches should be considered for reducing the frequency and volume of nighttime incontinence in this population.
Influence of Age on Measurement of Health Status in Patients Undergoing Elective Surgery
Authors: Mangione Carol M. , Marcantonio Edward R. , Goldman Lee , Cook E. Francis , Donaldson Magruder C. , Sugarbaker David J. , Poss Robert , Lee Thomas H.
Published: April 2015

Purpose: To assess the influence of age on the relationships between global measures of health and specific health dimensions.

Design: Cross‐sectional cohort study.

Setting: University tertiary care hospital.

Patients: Patients older than 50 years admitted for major elective non‐cardiac surgery.

Measurements: Consenting patients underwent preoperative evaluations including a medical history, physical examination, and administration of health status assessment instruments. Global health status was measured with the Medical Outcomes Study Short Form (SF‐36) and with a 0 to 100 verbal measure of global health. Specific health dimensions (physical function, role function, social function, mental health, energy and fatigue, and pain) were measured using the SF‐36. Subjects also completed a second validated measure of physical functioning, the Specific Activity Scale (SAS).

Results: Although patients aged >70 years (n = 276) had poorer role function, energy, and fatigue scores and poorer physical function on both the SF‐36 and SAS than younger patients (n = 469) (P < 0.05), they had similar overall health perception. In the entire population, global health status as measured with the SF‐36 health perception scale had the greatest correlation with the energy and fatigue scale (r = .45), correlated moderately with mental health (r = .35), social function (r = .32), and physical function (r = .33), and correlated less well with the surgically remediable dimension of pain (r = .23). However, correlations of global health perception with pain and global health perception with role functioning were significantly (P ≤ 0.05) lower in older patients when compared with subjects 70 years or younger (r = .13 vs .28 and r = .19 vs .33, respectively).

Conclusion: Despite poorer role function, poorer energy and fatigue scores, and poorer physical function, elderly persons have similar global health perception when compared with younger individuals. These data indicate that global health perception may be determined by different factors in the elderly or that the elderly have fundamentally different expectations of what their global health status should be. Our findings emphasize the importance of multidimensional scales when evaluating quality of life because, particularly in the elderly, the use of global measures alone may not reflect critically important dimension‐specific impairments in health.
Utilization of Cardiopulmonary Resuscitation in Nursing Homes in One Community: Rates and Nursing Home Characteristics
Authors: Duthie E. , Mark D. , Tresch D. , Kartes S. , Neahring J. , Aufderheide T.
Published: April 2015

Objective: To determine the rate of cardiopulmonary resuscitation use among all nursing homes in a large urban area, to examine CPR use over time, to discover whether CPR use varies among nursing homes, and to describe characteristics of patients undergoing CPR.

Design: Retrospective survey.

Setting: Nursing homes in a large urban area.

Participants: One hundred ninety‐six nursing home residents of 68 nursing homes underwent cardiopulmonary resuscitation over a 4‐year period (1986–1989). Over this time there were 9,486 deaths in these homes, which comprised 10,252 beds.

Measurements: The CPR:death ratio was determined for each facility. The ratio was analyzed over time and by type of facility (eg, proprietary, non‐profit, size of facility). The ratio was also examined among facilities with variable death rates. Patients undergoing CPR are described.

Results: The ratio of CPR:death over the 4‐year period was 0.02. CPR:death ratio was higher (0.03) for the proprietary homes compared with the non‐profit homes (0.01) P < 0.0001. A significant downward trend of CPR:death was noted over the study period for the non‐profit homes; no such trend was noted in the proprietary homes. Size of nursing home did not influence the rate of CPR use. Homes with greater numbers of deaths per bed had a lower utilization of CPR. Patients undergoing CPR were old, frail, and had multiple medical problems. CPR attempts were frequent around the time of nursing home admission.

Conclusion: The utilization of CPR in nursing homes is quite low. Non‐profit homes utilize CPR less than proprietary homes. Nursing homes with the highest numbers of deaths per bed utilize CPR less than homes with lower numbers of deaths per bed. Nursing home residents receiving CPR are quite old, have multiple illnesses, and are impaired.
Exogenous Calciferol (Vitamin D) and Vitamin D Endocrine Status among Elderly Nursing Home Residents in the New York City Area
Authors: O'Dowd Kenneth J. , Clemens Thomas L. , Kelsey Jennifer L. , Lindsay Robert
Published: April 2015

Objective: To determine the role and relative importance of sources of exogenous calciferol (vitamin D) in maintaining vitamin D endocrine status in the mid‐winter and early spring in a representative sample of institutionalized elderly persons in the New York City area.

Design: Cross‐sectional survey.

Setting: A privately‐run urban nursing home and the long‐term care unit of a suburban public hospital.

Participants: Residents aged 60 years and older scheduled for a routine annual physical examination and an additional group of individuals ascertained by random sampling. Those with a history of anti‐convulsant or glucocorticoid use, liver disease, chronic renal disease (or serum creatinine > 1.5 mg/dL), parathyroid disease, Paget's disease, gastric surgery, or pharmacological vitamin D use were excluded. Of 301 sampled individuals, 221 were found eligible to participate, and 109 were successfully enrolled.

Results: The average vitamin D intake was 379 IU/day (range 55–1006 IU/day) and total vitamin D intake was below the Recommended Dietary Allowance in 16% of subjects. Fifty percent of total vitamin D intake came from fortified milk, and 26% came from vitamin supplements. Vitamin supplement use was not associated with low dietary intake. Among subjects taking a supplement containing 400 IU/day, none had serum calcidiol levels below 15 ng/mL, while among subjects with vitamin D intake between 200 and 400 IU/day, 46% had serum calcidiol levels below 15 ng/mL and 14% had calcidiol levels below 10 ng/mL. Vitamin D intake from non‐supplement sources (but not from supplements) appeared to have a negative association with serum calcitriol levels.

Conclusions: Many nursing home residents may require vitamin supplements in order to achieve optimal levels of calciferol replacement. The choice of a vehicle for calciferol replacement may affect calcitriol levels.
The Effects of Age and Diabetes Mellitus on Nerve Function
Authors: Maser Raelene E. , Laudadio Charles , DeCherney G. Stephen
Published: April 2015

Objective: This project evaluated the association of age and vibratory thresholds (assessment modality of large sensory nerve fibers) in subjects with and without diabetes mellitus.

Design: Cross‐sectional study.

Setting: Medical Research Institute of Delaware.

Participants: Individuals with non‐insulin‐dependent diabetes mellitus and non‐diabetic control subjects.

Measurements: Vibratory thresholds were examined in four age groups (ie, <45 yrs, 45–54 yrs, 55–64 yrs, ≥65 yrs). The independent association of age, duration of diabetes, height, gender, glycemic control, and smoking history were analyzed in terms of their relationship to vibratory thresholds.

Main Results: Vibratory thresholds increased with age for both control and diabetic subjects. Comparing controls with diabetic subjects in the same age categorizes revealed significant differences for vibratory thresholds only in the ≥65 year old age group. Modeling with vibratory thresholds as the dependent variable showed that age and male gender were independently associated with vibratory thresholds for the controls and explained the majority of the variability (R2 = 0.79). Age, duration of diabetes, and height were independently associated with vibratory thresholds for the diabetic subjects but explained much less of the variability (R2 = 0.39).

Conclusion: The results suggest an acceleration of the natural aging process for large sensory nerve fiber function in diabetic subjects. Thus, young diabetic subjects may be at a risk of lower extremity complications as a result of injuries similar to that of older non‐diabetic individuals.
Clock Completion: An Objective Screening Test for Dementia
Authors: Watson Yasmira I. , Arfken Cynthia L. , Birge Stanley J.
Published: April 2015

Objective To develop a simple, readily administered and scored screening test for dementia utilizing the clock‐drawing task.

Design Retrospective analysis of clock‐drawing errors and prospective validations.

Setting Hospital‐based outpatient geriatric assessment clinic, rehabilitation service, apartment building for older adults, and long‐term care facility.

Participants Convenience sample of patients attending the geriatric assessment clinic, patients on the rehabilitation service, or residents of the above sites.

Measurements Sensitivity and specificity of a clock‐scoring system in identifying patients with dementia and the comparison of this system with the Short Blessed Test (SBT) in the diagnosis of dementia and in the prospective validation of the test.

Results Of the 10 clock‐drawing errors evaluated, placement of digits in a pre‐drawn circle had the greatest sensitivity and specificity in distinguishing patients with irreversible dementia from patients with other disorders who did not meet NINCDS‐ADRDA criteria for probable dementia. The derived scoring system had a sensitivity of 87% and a specificity of 82%, compared with a sensitivity of 82% and a specificity of 88% for the SBT in identifying dementia. Test‐retest reliability for the distinction between demented and non‐demented was 82%, with a Kappa of 0.63 for the clock completion, and 82%, with a Kappa of 0.62 for the SBT. Inter‐rater reliability for clock completion was 0.90 to 0.93.

Conclusion A simple, completely objective scoring system for a clock completion test has been developed which involves only the number of digits placed in the fourth quadrant of a pre‐drawn circle. This readily administered test is as effective in screening for dementia as the longer six‐item SBT.
Comparison of Cyclic Guanosine Monophosphate Response to Infusion of Atrial Natriuretic Peptide in Young and Elderly Subjects
Authors: Tan Adriaan C.I.T.L. , Jansen Tim L. Th. A. , Thien Theo , Kloppenborg Peter W.C. , Benraad Theo J.
Published: April 2015

Objective: To compare the sensitivity to atrial natriuretic peptide (ANP) in young and elderly subjects.

Design: Double‐blind, random‐order, placebo‐controlled study using two different rates of ANP infusion.

Subjects: Eight healthy young (23 ± 3 years, mean ± SD) and eight healthy elderly (76 ± 4 years) subjects recruited from the general population.

Measurement: Plasma cyclic guanosine monophosphate (cGMP, the second messenger of ANP) levels reflecting the sensitivity of biologically active ANP receptors.

Results: Baseline ANP levels were higher and rose to a greater extent in the elderly both during low‐ (0.25 μg/min) and high‐dose (2.0 μg/min) infusion of ANP. Plasma levels of cGMP rose in proportion to the increase in ANP. When the rise in cGMP levels was related to the increase in ANP levels (expressed as nmol/L per 100 pg/mL ANP increase), no difference was found between young and elderly subjects.

Conclusion: The ability of elderly subjects to increase cGMP in response to exogenous ANP is similar to that of young subjects. This may reflect a similar sensitivity of the target organs towards ANP. However, because of lower clearance in the elderly, a similar dose of ANP results in a greater elevation of ANP and cGMP levels and hence induces a greater effect.
The Aging‐Disease Dichotomy Is Alive, but Is It Well?
Authors: Blumenthal Herman T.
Published: April 2015

“To draw a distinction between disease and normal aging is to separate the undefined from the undefineable.”