bluuebunny/crossref_metadata_2025 huggingface dataset:
Availability of Knowledgeable Informants for a Psychological Autopsy Study of Suicides Committed by Elderly People
Authors: Younger Susan C , Clark David C. , Oehmig‐Lindroth Ruth , Stein Robert J.
Published: April 2015

Psychological autopsy methodology has not been applied in studies of elderly suicides, despite the fact that the elderly are associated with a higher rate of suicide than any other age group. One school of thought argues that older adults who die by suicide are socially isolated and/or estranged for a long period of time before death, so that knowledgeable informants are difficult or impossible to obtain. In the present retrospective study we examine the number and availability of knowledgeable informants for 145 older people who committed suicide. We believe that the ability to access several motivated informants per case is essential to any psychological autopsy study by modern standards.

The stereotype of the “average expectable” elderly suicide victim as socially isolated and living alone or in an institutional setting was not supported by our findings; an unexpectedly high percentage of subjects were married at the time of their death. There was at least one knowledgeable informant in 90% of cases and two or more in almost 50%. In 46%, the subject had expressed despondency over illness. In a prospective study involving interviews with informants for eight subjects, all eight had at least two knowledgeable and willing informants. Two cases of the eight are presented to illustrate the role of delirium and an ominous diagnosis (cancer) as causes of suicide. We conclude that it is feasible to do a psychological autopsy study of elderly suicides.
Disturbance in Daily Sleep/Wake Patterns in Patients With Cognitive Impairment and Decreased Daily Activity
Authors: Meguro K. , Ueda M. , Yamaguchi T. , Sekita Y. , Yamazaki H. , Oikawa Y. , Kikuchi Y. , Matsuzawa and T.
Published: April 2015

The sleep/wake patterns of 121 chronically ill, mentally and physically handicapped patients were visually monitored hourly for 14 consecutive days. Four types of sleep/ wake patterns were found. In order to investigate how cognitive and physical functions correlated with sleep disorders, patients were classified based on a scale of mental function and the grading of daily activity. The percent of total sleep hours and the sleep rating, showing disturbances in sleep/wake pattern, were evaluated. We found a high degree of individuality in sleep/wake patterns. Sleep disturbance was associated with daily activity as well as with cognitive impairment. This monitoring system provides medical personnel with valuable information for clinical management.
What Practicing Physicians in North Carolina Rate as Their Most Challenging Geriatric Medicine Concerns
Authors: Williams Mark E. , Connolly Nancy K.
Published: April 2015

We recently surveyed a random sample of 500 physicians in family practice, general practice, and internal medicine in North Carolina, to discover their most challenging geriatric concerns. Using a three‐stage survey technique, respondents were asked to answer two open‐ended questions about the most challenging geriatric problems they face and what specific geriatric content areas would attract their participation in an educational program. They were then asked to rank 34 topics on which they would like more information.

A total of 242 responses were received for a 55% response rate (63 of the 500 were undeliverable). Responses indicated that physicians are more concerned with management than diagnosis and revealed considerable evidence of empathy and concern. The top three topics had to do with the management of dementia, multiple problems, and depression. Approximately 25% of physicians consider problems of financing health care as among the most challenging problems.
Reducing Polypharmacy in the Elderly
Authors: Kroenke LTC Kurt , Pinholt Ellen M.
Published: April 2015

A prospective, controlled trial to reduce polypharmacy in patients 65 years or older was carried out in the residents' clinic of a teaching hospital. Of 272 elderly patients surveyed, 89 (33%) were taking five or more prescription drugs. Recommendations to discontinue medications or to simplify regimens were formulated for 79 polypharmacy patients. Compared to 41 controls, the 38 patients whose physicians were informed of the recommended changes demonstrated a small but significant reduction in the mean number of drugs, the complexity, and the cost of their regimens. Physicians complied with eight (100%) of eight recommendations to simplify a dosage schedule, eight (62%) of 13 recommendations to substitute a new drug for the old one, and only eight (40%) of 20 recommendations to stop a medication (P = .04). Noncompliance usually resulted from patient refusal or from medications being prescribed by another provider. Whereas feedback to the primary physician is beneficial, more substantial reductions in outpatient polypharmacy may require overcoming patient barriers and limiting the number of prescribing physicians.
Informed Consent for Neuroleptics with Elderly Patients in Two Settings
Authors: Gurian Bennett S. , Baker Errol H. , Jacobson Susan , Lagerbom Barbara , Watts Patricia
Published: April 2015

This paper presents the results of four studies that evaluated the use of neuroleptics in an aging population both in nursing homes and in a psychiatric teaching hospital. The purpose was to determine the degree to which prescribing practices were in compliance with recent court rulings respecting the right of patients to informed consent to “exceptional” medication. The results indicate that physicians in nursing homes do not inform their patients of the risks of neuroleptics, do not seek consent, and do not consider competency to be even an issue. Elderly patients in the acute academic setting were informed of risks and benefits. However, both consent to medication and the competency to give this consent were presumed until or unless the patient failed to acquiesce. The degree to which these practices might be in potential conflict with state law, ignore the benefits of a negotiated doctor/patient partnership, and demonstrate one aspect of poor quality of care are discussed, and policy recommendations are made.
Salmonella Outbreak in a Nursing Home
Authors: Choi M. , Yoshikawa T. T. , Bridge J. , Schlaifer A. , Osterweil D. , Reid D. , Norman D. C.
Published: April 2015

We performed a retrospective review of an outbreak of Salmonella gastroenteritis that occurred in a community nursing home in 1987. Forty‐four of 199 residents had a diarrheal illness; Salmonella heidelberg was isolated from the stool in 19 cases. Although the distribution of cases suggested a common source for the outbreak, no common source of infection could be demonstrated, despite extensive investigation. The clinical presentation of symptomatic individuals ranged from mild diarrhea to a severe gastrointestinal illness, and 26% of symptomatic, culture‐positive patients required hospitalization. The median duration of pathogen excretion during convalescence in untreated residents was six weeks, but six patients who were treated with antibiotics shed S. heidelberg for a median duration of 14.5 weeks. We conclude that (1) the clinical spectrum of Salmonella gastroenteritis in nursing‐home patients is variable, ranging from mild to severe illness; and (2) nursing‐home Salmonella outbreaks impose a high economic burden because of expense of epidemiologic investigation, prolonged isolation measures, hospitalization for severely ill residents, and potential institutional closure.
A Questionnaire Investigation of Anxiety and Depression in Early Dementia
Authors: Wands Kim , Merskey Harold , Hachinski Vladimir C. , Fisman Michael , Fox Hannah , Boniferro Mary
Published: April 2015

We report findings on a study of anxiety and depression by questionnaire in 50 patients with mild dementia and 134 control subjects using the Hospital Anxiety and Depression Scale. Thirty‐eight percent of patients and 9% of controls had a possible or probable diagnosis of an anxiety disorder. Possible or probable depression was found in 28% of the patients and 3% of the controls. These rates for the patients were above those in normal populations.

All patients and control subjects were tested with the Extended Scale for Dementia (ESD). Neither group showed a significant relationship between depression and ESD scores. In the control subjects there was a negative correlation (P < .006) between anxiety and cognitive scores, one that was not found in the patients.
A Metaanalysis of Controlled Trials of Neuroleptic Treatment in Dementia
Authors: Schneider Lon S. , Pollock Vicki E. , Lyness Scott A.
Published: April 2015

Prior qualitative literature reviews about the use of neuroleptics in dementia suggest that they are “modestly effective” in treating agitation and that no single neuroleptic is better than another. To develop a more precise concept of the clinical efficacy of neuroleptics, a meta‐analytic review of the existing literature was performed. From double‐blind clinical trials that compared a neuroleptic with a placebo in agitated dementia patients, P values and effect‐size estimates were obtained, and were assessed by metaanalytic techniques. Results indicated that neuroleptics were significantly more effective than placebo (one‐tailed P = .004) and had a small effect size (r = .18). Clinically, neuroleptic treatment changed the improvement rate in agitated dementia patients from .41 to .59 (binomial effect‐size display). This indicates that 18 of 100 dementia patients benefited from neuroleptic treatment (beyond that of placebo) and is consistent with the modest efficacy described in previous qualitative reviews. In six studies comparing thioridazine with another neuroleptic, and in five studies comparing haloperidol with another neuroleptic, metaanalysis results did not show that these two medications differed significantly from the comparison medications, which is not inconsistent with the opinion that no single neuroleptic is better than another.
The Case of Ms. Nancy Cruzan and the Care of the Elderly
Authors: Glover Jacqueline J.
Published: April 2015

The case of Ms. Nancy Cruzan is the first so‐called “right to die” case to be heard by the US Supreme Court. The Missouri Supreme Court had ruled that Ms. Cruzan's parents, who are also her court‐appointed guardians, cannot authorize the withdrawal of artificial hydration and nutrition from their daughter. Ms. Cruzan has been in a persistent vegetative state since an auto accident more than six years ago. Even though Ms. Cruzan is only 32 years old, the decision in her case will have serious implications for care of the elderly.

Key features of the Missouri Supreme Court decision include their claims that (1) the authority for surrogate decision‐making flows from the parens patriae power of the State rather than from the authority of the incompetent person, (2) the State has an unqualified interest in the preservation of life, and (3) the medical provision of nutrition and hydration ought to be considered differently than other forms of medical treatment. Such claims are at considerable variance from accepted standards of ethically defensible decision‐making that focus on the well‐being of the patient understood according to the patient's own values and life goals.

If the US Supreme Court restricts decisions to forgo life‐sustaining treatment according to patient prognosis, capacity for decision‐making, type of treatment, or state of residence, then a patient‐centered standard of medical decision‐making will be impossible to sustain and the maximization of life extension will be required without regard to the suffering thereby imposed.
Prediction of Independent Functioning and Behavior Problems in Geriatric Patients
Authors: Kaye Kathryn , Grigsby Jim , Robbins Laurence J. , Korzun Barbara
Published: April 2015

Folstein's Mini Mental State Exam, a test assessing the capacity to perform novel and/or repetitive motor tasks (Behavioral Dyscontrol Scale) and a brief measure of working memory were used in a sample of 50 male Veterans Affairs geriatric clinic patients who ranged in age from 63 to 105 (mean, 80.1). The purpose of this study was to attempt to predict the patients' capacity to regulate their behavior independently. We hypothesized that frontal lobe disorders often impair a patient's ability to function autonomously and that the Behavioral Dyscontrol Scale, a measure of frontal lobe impairment, would best predict the capacity for independent regulation of purposeful behavior. Therefore, we examined the relationship of the Behavioral Dyscontrol Scale with spouses' and caregivers' ratings of patients' independent living skills, and with behaviors that interfere with independent functioning. The results of hierarchical regression analyses indicated that the Behavioral Dyscontrol Scale was the only predictor of functional autonomy and was the best predictor of both impulsivity and apathy among geriatric patients. The Behavioral Dyscontrol Scale appears to assess a different functional domain than do the MMSE and similar measures, which rely heavily on the evaluation of orientation and gross cognitive status.
Multiple Stumbles: A Risk Factor for Falls in Community‐Dwelling Elderly; A Prospective Study
Authors: Teno Joan , Kiel Douglas P. , Mor Vincent
Published: April 2015

To better understand risk factors for falls among community‐dwelling elderly, we analyzed data from a sample of elderly Medicare beneficiaries interviewed in 1987 and a year later. Demographic, social, medical, and functional information were obtained by telephone interviews with 736 subjects (68% women) whose average age was 76.5 (range, 65–99). At baseline, 63 subjects reported a fall and 67 reported two or more stumbles without a fall in the past month. At the second interview follow‐up information on falls in the past year was obtained on 586 subjects. One hundred twenty‐seven (22%) subjects reported one or more falls. Baseline risk factors that were independent predictors of a fall at the second interview included two or more stumbles (adjusted odds ratio [AOR] 2.3, 95% confidence interval [CI], 1.2–4.5), one or more falls (AOR 5.9, 95% CI 2.9–12.2), having spent 4 or more days in bed in the past month (AOR 7.7, 95% CI 1.9–31.0), and self‐reported declining health status (AOR 2.0, 95% CI 1.1–3.5).

Falls and stumbles are prevalent among community‐dwelling elderly. After controlling for covariates, we found subjects who reported two or more stumbles in the past month are at increased risk for a fall in the following year.
Injuries in an Elderly Inner‐City Population
Authors: Grisso Jeane Ann , Schwarz Donald F. , Wishner Amy R. , Weene Barbara , Holmes John H. , Sutton Rudolph L.
Published: April 2015

Even though injuries are a leading cause of morbidity and mortality among the elderly in the United States, no comprehensive population‐based study of nonfatal and fatal injuries has been carried out in an elderly minority inner‐city population. To study injuries in this population, we developed an active surveillance system as part of a large injury prevention program in a poor urban black community. We report 577 cases of nonfatal and fatal injuries in a community of 12,139 persons 65 years of age and older that resulted in emergency room treatment or death between March 1, 1987, and February 29, 1988.

Nearly 5% of the elderly population was treated at an emergency room for, or died as a result of, an injury during the study period; the overall injury rate was 48 injuries per 1,000 persons. Injury rates for older women exceeded those for older men and increased with advancing age in both sexes. Fall injuries accounted for 312 (54%) of all injuries and 75% of all hospitalizations for injury. Motor vehicle incidents and violence were the second and third most common injuries, accounting for 13% and 7% of injuries, respectively. Given the predominance of falls relative to other injuries, prevention of falls should receive major emphasis in injury prevention efforts in inner‐city minority populations.
Hospitalization Rates in Nursing Home Residents with Dementia
Authors: Coleman Eric A. , Barbaccia Joseph C. , Croughan‐Minihane Mary S.
Published: April 2015

Although Special Care Units (SCUs) have recently gained attention as appropriate places for caring for institutionalized patients with dementia, few studies have evaluated their effectiveness. This pilot study focused primarily on one aspect of patient care, the possible prevention of acute hospitalization. Because transfer from nursing home to the acute hospital can be a traumatic experience for patients with dementia, important services that SCUs might provide include those preventive strategies aimed at reducing the need for transfer to the acute hospital. Medical record abstraction revealed that over one year, the rate of acute hospitalization was 21% among 47 patients with dementia in SCUs, compared with 14% among 36 patients with dementia and 14% among 22 patients with no listed diagnosis of dementia residing in non‐SCU settings within the same facility. Thus, no statistically significant difference in hospitalization rates was found, although the trend was for increased hospitalization for SCU patients. There was a trend toward deterioration in functional status among SCU patients following first hospitalization (P < .10). Since the majority of these patients were hospitalized for hip fractures, this finding was not unexpected. There was a trend toward cognitive decline after hospitalization among patients with dementia who were not residing in an SCU (P < .10). In order to investigate whether acute hospitalizations among SCU patients were preventable, an expert panel was convened to review each episode of illness leading to acute hospitalization. Of the 15 hospitalizations, none were judged “preventable,” four were believed to be “possibly preventable,” and 11 were considered to have been “not preventable.” While SCUs may be an attractive alternative to traditional nursing home placement for patients with dementia, this pilot study suggests that they are probably not effective in reducing the need for acute hospitalization.
Public — Private Solution to Protection Against the Cost of Long‐Term Care
Authors: Ball Robert M.
Published: April 2015

The demographics of our population and our current reliance on Medicaid with a means test that no one likes suggest the need for revising our financing of long‐term care. Given that persons with Alzheimer's disease and related dementias are a substantial proportion of those needing long‐term care, support for research to cure or control these problems should be part of a strategy for addressing the problem of long‐term care. However, even if substantial progress is made there is still a need for revising our method of financing long‐term care. However, other pressing societal needs, such as reducing the 2 trillion dollar federal debt, addressing the needs of the growing number of children in poverty, and caring for the more than 30 million uninsured Americans, limit the role of the federal government in financing long‐term care. A proposal to provide coverage for those with functional disabilities or cognitive impairment who need chronic home care and for the initial portion of nursing home stays within a social insurance program is outlined. More extensive coverage for nursing home stays would be provided for those with community‐dwelling spouses. Major financing would be provided through either a payroll tax or by a federal income tax for all age groups with supplementation from estate taxes or capital gains taxes at death. Improvement of benefits in the Medicaid program and an important role for private insurance in protecting the estates of those who become permanent nursing home residents are also suggested.
Alcohol Intake in the Healthy Elderly
Authors: Adams Wendy L. , Garry Philip J. , Rhyne Robert , Hunt William C. , Goodwin James S.
Published: April 2015

Several cross‐sectional studies have shown a decline in alcohol intake with increasing age. Longitudinal studies have failed to confirm this trend, which suggests that cohort effects may account for the reported decline. To address this, both cross‐sectional and longitudinal analyses of alcohol use in 270 healthy elderly persons over a seven‐year period (1980–1987) were performed. Alcohol consumption was assessed by three‐day diet records. One hundred sixty‐five subjects (61.1%) remained in the study until 1987; 143 (53%) completed diet records for every year. Longitudinal analysis showed a statistically significant decline in the percent of subjects consuming any alcohol over time (slope = −2% per year; 95% confidence interval −2.8, −1.1%). A cross‐sectional analysis of the 1980 data revealed a similar decline in percent drinkers with increasing age (slope = −2.7% per year; 95% confidence interval −4.4, −1.1%). Mean alcohol intake for those who continued to drink did not change over time except among heavy drinkers (consumption of >30 g per day in 1980), who did show a significant decline in mean alcohol intake (P = .02). Thus, in our population the decline in percent of drinkers with age found by a cross‐sectional analysis was confirmed in longitudinal analyses, suggesting that this represents a true age‐related decline rather than a cohort effect.
Validity and Reliability of the Dementia Behavior Disturbance Scale
Authors: Baumgarten Mona , Becker Rubin , Gauthier Serge
Published: April 2015

Behavioral disturbance is a common and distinctive feature of Alzheimer's disease and other dementias. Existing instruments designed to quantify behavior disturbance among patients with dementia tend to be quite heterogeneous, including many items that do not refer to behavioral disturbance as such, but rather to cognitive, psychological, or somatic symptoms, or functional impairments. A 28‐item Dementia Behavior Disturbance (DBD) scale was developed to avoid some of the problems encountered with the older instruments. In two samples of patients with dementia (n = 50 and n = 46), the most common symptoms were repetitive questions, losing or hiding things, lack of interest in daily activities, nocturnal wakefulness, unwarranted accusations, excessive daytime sleeping, and pacing. The coefficient of internal consistency was greater than .80 in both samples, and the correlation between scores obtained from the same subjects at a two‐week interval was moderately high (Pearson's correlation coefficient = .71). There was a relatively high correlation between DBD scores and scores on Greene's Behavior and Mood Disturbance scale, and higher DBD scores were associated with increased duration and severity of disease. These preliminary results indicate that the DBD may be a useful and valid measure of one dimension of the dementia syndrome.
Pain in the Nursing Home
Authors: Ferrell Bruce A. , Ferrell Betty R. , Osterweil Dan
Published: April 2015

Pain is an understudied problem in geriatric medicine and especially among nursing home residents. The focus of this study was to describe the scope of the problem of pain in a long‐term care facility. Ninety‐seven subjects from a 311‐bed multilevel teaching nursing home were interviewed, and charts were reviewed for pain problems and management strategies. Functional status, depression, and cognitive impairment were also evaluated. Results indicate that 71% of residents had at least one pain complaint (range, 1–4). Of subjects with pain, 34% described constant (continuous) pain and 66% described intermittent pain. Of 43 subjects with intermittent pain, 51% described pain on a daily basis. Major sources of pain included low back pain (40%), arthritis of appendicular joints (24%), previous fracture sites (14%), and neuropathies (11%). Moderately strong correlations were found between pain and infrequent attendance at recreational and social activities (r = .50). However, little correlation was observed between pain and the Yesavage Depression Scale, the Folstein Mini‐Mental State Scale, or basic ADLs measured by the Katz Scale. Pain‐management strategies consisted of analgesic drugs, physical therapy, and heating pads. Only 15% of patients with pain had received medication within the previous 24 hours. The findings suggest that pain is a major problem in long‐term care. Strategies for pain management appear to be limited in scope and application in this setting. Important barriers were identified that influence the reporting and management of pain in this setting.
Postantibiotic Colonization with Clostridium difficile in Nursing Home Patients
Authors: Thomas David R. , Bennett Richard G. , Laughon Barbara E. , Greenough William B. , Bartlett John G.
Published: April 2015

Clostridium difficile causes pseudomembranous colitis and is responsible for 20% to 25% of cases of postantibiotic diarrhea. In an earlier study, nursing‐home patients with C. difficile infection were noted to have a high mortality rate. Because most of these infected patients had been treated with antibiotics, it was not clear whether this high mortality rate was associated with C. difficile infection or simply with antibiotic treatment. A prospective study was carried out to determine the rate of postantibiotic C. difficile colonization and risk factors for infection in patients in a 233‐bed long‐term care facility, as well as to determine whether C. difficile infection is associated with increased mortality. During a six‐month period 150 courses of antibiotics were prescribed for 108 patients. Stool specimens were collected from 36 (33%) patients following the first course of antibiotic treatment, and 12 (33%) were infected with C. difficile. Risk factors for infection included ward location and stool incontinence. Age, body‐mass index ≤18 kg/m2, and diagnoses of dementia and pressure sores tended to be associated with infection, but not significantly. Early mortality rates did not differ, but 12‐month mortality for the infected patients was higher (83% vs 50%, P = .05). Therefore, we conclude that postantibiotic C. difficile infection serves as a marker of death in nursing‐home patients, one that can be differentiated from the risk of antibiotic treatment alone. This increased death rate may be related in part to clinically unrecognized pseudomembranous colitis or, alternatively, to absorption of C. difficile toxins or even endotoxin from the gut lumen into the systemic circulation.
Plasma Dehydroepiandrosterone Sulfate in Nursing Home Men
Authors: Rudman Daniel , Shetty Kaup R. , Mattson Dale E.
Published: April 2015

Previous studies have shown the normal range of plasma dehydroepiandrosterone sulfate (DHEAS) for independent community men over 60 years old to be 30–200 μg/dL. In human adults, low levels of plasma DHEAS have been correlated with a high mortality rate. In rodents, dehydroepiandrosterone, the precursor of DHEAS, has exhibited antidiabetic, anticarcinogenic, neurotropic, and memory‐enhancing effects. We have now measured plasma DHEAS in 50 independent community men age 55–94 and in 61 nursing home men age 57–104. Mean DHEAS was significantly lower in the nursing home men than in the community men. Plasma DHEAS was subnormal (less than 30 μg/dL) in 40% of the nursing home residents and in only 6% of the community subjects. In both groups, DHEAS was inversely related to age. In the nursing home men, additionally, plasma DHEAS was inversely related to the presence of an organic brain syndrome and to the degree of dependence in activities of daily living. Plasma DHEAS was subnormal in 80% of the nursing home men who required total care. There was no significant correlation between the plasma concentrations of DHEAS and testosterone, or between plasma DHEAS and one‐year mortality rate.
Absence of Nocturnal Fall in Blood Pressure in Elderly Persons with Alzheimer‐Type Dementia
Authors: Otsuka Atsuhiro , Mikami Hiroshi , Katahira Katsutoshi , Nakamoto Yasuo , Minamitani Kaori , Imaoka Masanori , Nishide Masato , Ogihara Toshio
Published: April 2015

Circadian changes of the blood pressure and heart rate in elderly normotensive bedridden patients with severe dementia of the Alzheimer type (group D) were compared with those in elderly normotensive bedridden patients without dementia (group R), normotensive subjects with normal daily activity (group N), and hypertensive patients with normal daily activity (group H). In groups R, N, and H, the blood pressure increased in the afternoon and decreased at midnight; in group D, however, although it increased in the afternoon, it did not decrease at night. The circadian changes of the heart rate were similar in all four groups, showing maxima in the afternoon and minima at midnight. Thus, a specific alteration was found in the circadian rhythm of the blood pressure in patients with Alzheimer‐type dementia.
Prevalence and Characteristics of Multiple Analgesic Drug Use in an Elderly Study Group
Authors: Chrischilles Elizabeth A. , Lemke Jon H. , Wallace Robert B. , Drube Gregg A.
Published: April 2015

With few exceptions, use of multiple analgesic drugs achieves dubious increases in analgesia while placing elders at increased risk of the many potential adverse effects of analgesic drugs. The potential for duplication of analgesic therapy among the elderly is great due to prevalent painful chronic conditions and the variety of prescription and nonprescription analgesic remedies available. The prevalence of multiple analgesic product use and patterns of concurrent use of different analgesic categories was investigated in a geographically defined population of persons 65 years of age and older. The demographic characteristics of users of multiple analgesic drug products were examined, as were their smoking status, alcohol use, lifetime history rates of major illnesses, physical functioning, pain experiences, memory performance, and depressive symptoms. A substantial proportion of analgesic users reported taking multiple products in the preceding 2 weeks (14.4% of female and 10.5% of male analgesic users). Men who reported pain in the preceding year were more likely to use multiple analgesic products. Women who experienced pain or limited physical functioning, or who had higher depressive symptom scores or a life‐time history of ulcers were most likely to use multiple analgesic products. Thus, although some users of multiple analgesic products reported significant pain, several other factors were shown to be related to the phenomenon of multiple use.
Imidazole Salicylate Versus Piroxicam in the Treatment of Arthrosis in Elderly Patients;
Authors: Montrone F. , Petrillo M. , Ardizzone S. , Scaricabarozzi I. , Scotti A. , Caruso I. , Porro G. Bianchi
Published: April 2015

The clinical efficacy and gastroduodenal tolerability of imidazole salicylate (imidazole 2‐hydroxybenzoate, ITF 182), a new synthetic drug with an anti‐inflammatory action, was evaluated endoscopically in comparison with those of piroxicam in elderly patients suffering from osteoarthrosis. Of the 41 patients entering the trial, only 38 completed the protocol (6 men and 32 women; mean age, 71; range, 65–80 years). After upper gastrointestinal endoscopy for the purpose of excluding gastric and duodenal mucosal lesions, the patients were allocated at random, according to a double‐blind, double‐dummy protocol, to treatment either with imidazole salicylate 750 mg three times daily or with piroxicam 20 mg once daily for a period of 4 weeks.

Imidazole salicylate proved active in controlling a number of the pain symptoms caused by arthrosis, although its efficacy was inferior to that of piroxicam. Grade 2 gastric mucosal lesions were detected in 1 of 20 patients (5%) treated with imidazole salicylate; lesions corresponding to grades 2, 3, and 4 were found in 6 of 18 (33%) of those treated with piroxicam (P = .034). Painful dyspepsia was reported by 15% of the patients in the imidazole salicylate group and by 28% of those in the piroxicam group.

On the basis of these results and under the experimental conditions adopted in this trial, the authors concluded that imidazole salicylate is characterized by good gastric tolerability and can thus be used in the treatment of rheumatic diseases in the elderly. As an anti‐inflammatory drug endowed with probably less marked analgesic activity compared with piroxicam, its use is suggested for the treatment of minor arthropathy. Further study, however, is necessary to define more completely the effects of this new drug on gastric and duodenal mucosa.
Dietary Preference for Sweet Foods in Patients with Dementia
Authors: Mungas Dan , Cooper James K. , Weiler Philip G. , Gietzen Dorothy , Franzi Cheryl , Bernick Charles
Published: April 2015

Using a telephone survey, patients with probable Alzheimer's disease (n = 31) and vascular dementia (n = 14) were compared with elderly normal controls (n = 43) in preferences for different foods. Patients with Alzheimer's disease had a greater preference than normal controls for relatively high‐fat, sweet foods and for high‐sugar, low‐fat foods, but did not significantly differ in preference for other foods, including those high in complex carbohydrates and protein. Vascular dementia patients showed a similar pattern, not significantly different from that for Alzheimer's patients. Results did not consistently support a hypothesis that increased sweet preference is a nonspecific form of disinhibited behavior related to declining mental status, nor was a hypothesis relating sweet preference to serotonin activity within the brain consistently supported. Results provide preliminary evidence that craving for sweet food may be a significant part of the clinical syndrome of dementia, but further research is needed to delineate the psychological and biological mechanisms accounting for it.
An External Urine Collection Device for Incontinent Women
Authors: Johnson David E. , Muncie Herbert L. , O'Reilly Jodie L. , Warren John W.
Published: April 2015

Urinary incontinence is common in aged women, may precipitate nursing home admission, and may prompt use of a urine collection device, usually an indwelling urethral catheter. The safety and efficacy of a new external urine collection device for women that is affixed to the perineum by an adhesive developed for ostomy bags was evaluated. Applied to 26 aged women, 78% of 2,264 devices were leak‐free for 24 hours and 49% for 48 hours. The incidence of new bacteriuria was less than half that found in our earlier studies of long‐term urethral catheters in the same institution. Perineal erythema was infrequent and preexisting decubitus ulcers improved or did not change. Four patients were withdrawn, one each because of periurethral itching, diminished urine output, recurrent wetness, and fracture of the proximal femur associated with severe osteoporosis. This device may offer an alternative to urethral catheters for management of urinary incontinence but should not be used on women with urine retention and should be used with care on women with severe osteoporosis. Controlled trials must determine effects upon bacteriologic complications and health‐care costs.
Relation of Cognitive Status and Abnormal Behaviors in Alzheimer's Disease
Authors: Cooper James K. , Mungas Dan , Weiler Philip G.
Published: April 2015

Some studies suggest that abnormal behaviors are associated with increasing cognitive loss in Alzheimer's disease (AD). Other studies do not show this association. We examined the relation of cognitive loss, represented by Folstein Mini‐Mental State Examination (MMSE) score, with abnormal behaviors in 680 patients with probable AD. Six behaviors were examined: agitation / anger, personality change, wandering, hallucinations / delusions, insomnia, and depression. All but depression were associated with declining MMSE score. The number of abnormal behaviors present in each patient was also related to declining MMSE score. Several other associations were also found: hallucinations / delusions were associated with age and race; agitation / anger was related to male gender; and wandering was associated with increased age. Although these data support the general notion that five of the six abnormal behaviors studied are more likely to occur with increasing cognitive loss, the correlations are small and it is suggested that other as yet unproven factors may play an as large or greater role than MMSE score in predicting such behaviors.
Earlobe Crease and Atherosclerosis
Authors: Ishii Toshiharu , Asuwa Noriko , Masuda Shigeru , Ishikawa Yukio , Shimada Kazuyuki , Takemoto Shohei
Published: April 2015

The association between earlobe crease (ELC) and coronary and aortic atherosclerosis in 100 autopsied men ranging in age from 50 to 79 years, who died free of vascular diseases or related conditions, was studied in conjunction with blood pressure and serum total cholesterol (TC) levels. Earlobe crease was graded and defined as groups 1, 2, and 3 according to the depth and length in both ears. The extent of atherosclerosis in the coronary arteries and aortas was visually graded. Coronary atherosclerosis was significantly more severe in group 3 in all the decades examined than in groups 1 or 2. Aortic atherosclerosis in group 3 was significantly greater than in group 1 in all the decades examined, and was greater than in group 2 in the seventh and eighth decades. The TC level was significantly higher in group 3 than in groups 1 or 2 except in the sixth decade. Multivariate regression analyses demonstrated that the degree of ELC was dependent on the extent of coronary and aortic atherosclerosis, but was independent of age. Conversely, the extent of coronary atherosclerosis was dependent on the degree of ELC, but was independent of age. The extent of aortic atherosclerosis was, however, dependent not only on the appearance of ELC and TC, but on age. It is thus concluded that ELC provides a significant external marker for atherosclerosis and may reflect a persistent overload of atherosclerosis risk factors, such as TC.
Outcomes of Lower Extremity Amputations
Authors: Weiss Gerald N. , Gorton T. Ann , Read Raymond C. , Neal Linda A.
Published: April 2015

In an effort to identify variables that could be used to predict outcomes of amputation, a cohort of 97 veteran amputees with a median age of 64 years who underwent 155 lower extremity procedures during 1984 was followed for 15 months. A high incidence of postoperative complication, revision, and mortality with poor quality of life confirm the serious prognosis of these individuals. Regression analyses indicated that peripheral vascular disease and prolonged preoperative hospitalization were associated with complications. Preoperative gangrene and peripheral vascular disease were associated with the need for revision. Complications, a low body mass index, and multiple diseases were related to death. Those with multiple diseases and extensive atherosclerosis were less likely to walk. Ability to perform activities of daily living was the most important predictor of quality of life. Patients at higher risk for these adverse outcomes need to be identified early in their hospital stay. The involvement of the patient or his or her surrogate in decisions regarding the course of treatment and the level of amputation is essential.
The Effect of Hypoparathyroidism on the Aging Skeleton
Authors: Shukla Shailendra , III Thurman Gillespy , Thomas William C.
Published: April 2015

Serum concentrations of parathyroid hormone are frequently increased in elderly subjects. How much this increase may contribute to the development of osteoporosis in such subjects is unknown. Long‐standing hypoparathyroidism has been reported to be accompanied by an increase in skeletal density. In seven consecutive women, aged 40 to 83 years, with hypoparathyroidism of at least 18 years duration, the mineral density in the lumbar vertebrae was measured by quantitative computed tomography (QCT) and dual photon absorptiometry (DPA). In these subjects, the bone mineral density by dual photon absorptiometry was 1.4 to 6.2 standard deviations above mean values for age‐matched normal women. However, the mineral density of vertebral trabecular bone as determined by quantitative computed tomography was only slightly increased above values reported for normal women. The differences between the values determined by dual photon absorptiometry and quantitative computed tomography indicate that most of the increase in mineral density was a reflection of increased cortical bone. Roentgenograms of the metacarpals did not reveal consistent differences between normals and the hypoparathyroid subjects. These findings suggest the possibility that control of parathyroid function might be of value in treating osteoporotic patients.
Neuropeptides and Alzheimer's Disease
Authors: Husain Mustafa M. , Nemeroff Charles B.
Published: April 2015

Because of their putative roles as neurotransmitters, neuromodulators, and neuroregulators in the central nervous system, neuropeptides have been the focus of considerable research over the past two decades. There is evidence that alterations in the synaptic availability of particular neuropeptides occur in certain neuropsychiatric disorders, such as schizophrenia and affective disorders. Alzheimer's disease is the most common neurodegenerative disorder, affecting a sizable proportion of our aging population. Alzheimer's disease is characterized by the presence of neurofibrillary tangles and senile plaques in the central nervous system. Postmortem studies have provided evidence that several neuropeptide‐containing neurons are pathologically altered in this disorder. The purpose of this article is to describe recent advances in neuropeptide biology with a focus on the role of neuropeptides in the pathogenesis of Alzheimer's disease.
Nursing Home Patients Transferred by Ambulance to a VA Emergency Department
Authors: Kerr Harry D. , Byrd James C.
Published: April 2015

Nursing home residents are frequently transferred to hospital emergency departments. Delayed transfer may lead to poor outcomes. However, inappropriate transfer of the frail elderly may cause social and financial problems. We prospectively evaluated 221 consecutive ambulance transfers from community nursing homes to a VA emergency department. The objectives of the study were to describe the process and outcomes of transferred patients and to determine if alternative interventions were feasible. The results indicate that the problems of nearly half the study group could have been treated at the nursing home by a visiting physician with minimal medical equipment. Those admitted to the hospital (52%) were seriously ill, had prolonged lengths of stay (23.6 days), and had a high mortality rate (11%). Complex issues of physician reimbursement, proprietary nursing home budgeting, and day‐to‐day expediency appear to be involved in decisions to transport patients by ambulance to VA emergency departments.
The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons
Authors: Podsiadlo Diane , Richardson Sandra
Published: April 2015

This study evaluated a modified, timed version of the “Get‐Up and Go” Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter‐rater and intra‐rater); (2) correlates well with log‐transformed scores on the Berg Balance Scale (r = −0.81), gait speed (r = −0.61) and Barthel Index of ADL (r = −0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed “Up & Go” test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.
Physician Practices in the Diagnosis of Dementing Disorders
Authors: Somerfield Mark R. , Weisman Carol S. , Ury Wayne , Chase Gary A. , Folstein Marshal F.
Published: April 2015

Because there are both treatable and untreatable causes of dementia, the physician's ability to conduct (or refer a patient for) a differential diagnosis could have a profound effect on health outcomes for patients and on health care costs. This study was undertaken to assess physician practices with regard to the diagnosis of dementing disorders. Data from 53 physicians (a response rate of 48%) in several specialties were obtained from a self‐administered mail questionnaire. Results indicate that the majority of physicians provided history taking, physical examination, and neurological examination. Physicians were more likely to refer patients for psychiatric and neuropsychological examinations than to provide these services themselves. The results also point to deficiencies in two key areas: the use of formal, published diagnostic criteria, and the use of mental status and cognitive function tests. Over 75% of physicians surveyed did not use either DSM‐III or NINCDS‐ADRDA diagnostic criteria, and 42% of physicians did not provide any mental status tests themselves. The need for continuing education to close knowledge gaps is emphasized.
Clinicians' Predictions of Nursing Home Placement for Hospitalized Patients
Authors: Hickam David H. , Hedrick Susan C. , Gorton Ann
Published: April 2015

Identifying patients who will need long‐term care may improve the efficiency and effectiveness of acute hospital care. This prospective study evaluated clinicians' ability to identify patients requiring nursing home care. The study had two principal objectives. The first objective was to measure whether registered nurses, physicians, and social workers made similar estimates of the probability of nursing home placement early in an acute care hospitalization. The second objective was to identify the clinical characteristics of patients for whom the clinicians incorrectly predicted that they would return home. The study subjects were 342 patients older than age 55 who were admitted to the medicine, surgery, and neurology services of two university‐affiliated Veterans Affairs hospitals. Fifteen percent were discharged to nursing homes.

The nurses, physicians, and social workers had high agreement in their estimates of the probability of nursing home placement for each patient. However, each of the provider groups assigned low probability estimates to more than 20% of the patients discharged to nursing homes. Examination of the characteristics of patients assigned low probability estimates revealed that mental impairment and functional disability were higher in those patients who ultimately were discharged to nursing homes than in those patients who returned to their homes. These findings suggest that better assessment and interpretation of patient characteristics early in the hospital stay may improve discharge planning. Some clinicians appear to underestimate mental and functional impairment as risk factors for long‐term care needs.