bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing a New Metric for ADLs
Authors: Finch Michael , Kane Robert L. , Philp Ian
Published: April 2015

BACKGROUND: Most ADL summary measures add up the number of dependencies. They assume an equal weighting among items and require an arbitrary definition of dependency.

METHODS: A panel of experts in geriatrics was asked to rate a set of ADL and IADL components in terms of the contribution of each to overall dependency using a magnitude estimation (ME) technique. The ratings were done for both domains and for levels of function within each domain. The resultant scores were compared with the usual dependency count approach.

RESULTS: The distribution of weighted items appears to have face validity. The pattern of dependency traced by the ME model was intermediate between those created by simple counts with two different definitions of dependency. The ME approach has stronger statistical properties than the ordinal scoring approach.

CONCLUSIONS: The ME approach appears to be a reasonable and workable method for creating a measure that permits meaningful statements about the mean value of functional dependencies. This result can be used for any comparison of means, such as across individuals, across aggregates of individuals, or across time. J Am Geriatr Soc 43:877–884, 1995.
Effect of Season and Climate on Choice of Therapy for Breast Cancer in Older Women
Authors: Goodwin James S. , Nattinger Ann B.
Published: April 2015

OBJECTIVES: We and others have previously found a relative underutilization of breast‐conserving surgery with adjuvant radiation therapy in older women diagnosed with early stage breast cancer. Because adjuvant radiotherapy involves daily trips to a facility for 6 weeks, we reasoned that season and climate might influence choice of therapy. Specifically we hypothesized that in northern states, a lower proportion of women would receive breast‐conserving surgery plus radiation in the winter months than in summer, whereas in sunbelt states there would be no relationship between season and therapy.

DESIGN: Analysis of national Medicare billing tapes for 1990 and SEER tumor registry data for 1983–1990.

PARTICIPANTS: 43,083 women aged 65 to 79, diagnosed with local or regional breast cancer in 50 states or Washington, DC, who underwent mastectomy or breast‐conserving surgery in 1990, and 32,502 women aged 65 to 79 who underwent mastectomy or breast‐conserving surgery from 1983 to 1989 at any of the nine SEER sites.

RESULTS: Using a variety of analytical approaches, we could find no consistent effect of cold winter climate on choice of breast cancer therapy.

CONCLUSION: Bad weather does not appear to discourage the choice of breast‐conserving treatment. It is not known if bad weather influences actual receipt of radiotherapy.
Implications of the Most Bothersome Prostatism Symptom for Clinical Care and Outcomes Research
Authors: DuBeau Catherine E. , Yalla Subbarao V. , Resnick Neil M.
Published: April 2015

OBJECTIVES: Because treatment of benign prostatic hyperplasia (BPH) is based largely on patients' symptoms, understanding and measuring the impact of these symptoms from the patient's perspective is critically important for clinical care. Such knowledge also is crucial for comparing patient‐weighted outcomes because the increasing array of medical and surgical BPH treatments differ in their impact on specific symptoms. Our purpose was to determine the most bothersome symptom in older men seeking evaluation for symptomatic BPH and to examine whether age, comorbidity, or urodynamic evidence of prostatic obstruction were important covariates.

DESIGN: Prospective evaluation of a consecutive series.

SETTING: Veterans Affairs urology clinic.

PARTICIPANTS: 115 men (age 69 ± 6 years) presenting for initial evaluation of prostatism.

MEASUREMENTS: Scores on standard symptom index and patients' reports of the most bothersome symptom. Bladder outlet obstruction was assessed by multichannel videourodynamic evaluation.

RESULTS: An “irritative” symptom (frequency, urgency, or nocturia) was cited as most bothersome significantly more often than an “obstructive” symptom (weak stream, hesitancy, etc.) (53 vs. 35%, P < .05); older men were significantly more likely to name an irritative symptom as most bothersome (x2 for trend = 6.63, P < .025). Even among men with prostate obstruction, most cited an irritative symptom as the most bothersome, regardless of the severity of obstruction. These associations were not confounded by comorbid conditions or medications that independently may cause symptoms.

CONCLUSIONS: Because irritative symptoms are most bothersome, have a diverse differential diagnosis, and do not respond as well to BPH treatment, neither providers nor researchers should rely solely on global assessments of symptom severity and bother in assessing men with voiding symptoms. Additional focus on individual symptom impact and etiology is needed, especially in older men.
Attitudes of Older People Toward Suicide and Assisted Suicide: An Analysis of Gallup Poll Findings
Authors: Seidlitz Larry , Duberstein Paul R. , Cox Christopher , Conwell Yeates
Published: April 2015

OBJECTIVES: To describe the older population's attitudes toward suicide and assisted suicide, and to determine whether lenient attitudes are associated with known demographic and psychosocial risk factors for completed suicide.

DESIGN: Telephone survey conducted by the Gallup Organization in November 1992.

PARTICIPANTS: A sample of 802 adults in the United States (541 women and 261 men) aged 60 years and older.

MEASUREMENTS: The dependent variables, attitudes toward suicide, were assessed with five attitude statements. Participants rated their agreement with each statement on 4‐point Likert‐type scales, subsequently dichotomized for use in univariate analyses and logistic regressions. The independent variables included income and demographic and psychosocial risk factors for suicide: age, gender, race, marital status, religiousness, self‐rated health, and satisfaction with family relationships.

RESULTS: The majority of respondents did not express lenient attitudes. In comparison with survey findings of physicians and the general population, a relatively smaller percentage (41%) of these older respondents believe that physician‐assisted suicide should be legalized. Agreement with one or more of the attitudes presented was associated with age, gender, race, marital status, and religiousness in univariate analyses (P < .05), and race, religiousness (P < .001), gender, self‐rated health, and satisfaction with family relations (P < .08) in logistic regressions.

CONCLUSIONS: The hypothesized relations between risk factors for suicide and lenient attitudes toward suicide were supported. Although none of the risk factors was associated with all five attitudes, in combination the results suggested that a common set of variables predict both lenient attitudes toward suicide and suicidal behavior. Future research is necessary to determine the role of depression and other factors that may mediate the observed relationships and to determine whether the presence of specific, strongly held attitudes sanctioning suicide in an older person signals the need to assess suicide risk.
Internal Validity of the Physical Activity Index over 26 Years in Middle‐Aged and Older Men
Authors: Young Deborah Rohm , Sharp Dan S. , Petrovitch Helen , Curb J. David
Published: April 2015

OBJECTIVE:To determine the internal validity of the physical activity index (PAI).

DESIGN:Three time periods over a 26‐year period (1965/68 examination, n = 7911; 1980/82 examination, n = 2054; 1991/93 examination, n = 3425).

SETTING:Honolulu, Hawaii.

PARTICIPANTS:Middle‐aged to older Japanese‐American men.

MEASUREMENTS:PAI, other physical activity measures, body mass index (BMI), tricep skinfold thickness, subscapular skinfold thickness, and HDL cholesterol.

RESULTS:PAI level was associated significantly with levels of other physical activity measures at all time periods. Higher PAI level was associated with lower BMI at the baseline examination (1965/68), lower subscapular skinfold thickness at the 1965/68 and 1980/82 examinations, lower tricep skinfold thickness at all examinations, and higher HDL cholesterol at the 1980/82 examination. Change in PAI level from 1965/68 to 1980/82 was associated with change in BMI, subscapular, and tricep skinfold thickness levels, but there were no significant associations between change in PAI level and change in BMI, skinfold thicknesses, or HDL cholesterol levels from 1980/82 to 1991/93.

CONCLUSION:PAI level is a relatively valid estimate of overall daily energy expenditure that may be an acceptable general measure across the middle‐to‐late stages of life. The PAI may also be sensitive enough to discern a shift toward less physical demanding activities as a population becomes older, although further studies should be conducted to better determine its validity in older populations.
Lack of Carbamazepine Toxicity in Frail Nursing Home Patients: A Controlled Study
Authors: Tariot Pierre N. , Frederiksen Kirsten , Erb Rosemary , Leibovici Adrian , Podgorski Carol Ann , Asnis Jamie , Cox Christopher
Published: April 2015

OBJECTIVE: To assess the effects of carbamazepine and placebo on measures of toxicity in frail nursing home patients.

DESIGN: A nonrandomized, double‐blind, placebo‐controlled crossover study.

SETTING: Two nursing homes in Rochester, New York.

PARTICIPANTS: Twenty‐five subjects (mean age 84.5 years) with dementia.

INTERVENTION: Carbamazepine and placebo during two 5‐week periods separated by a 2‐week washout. The modal dose for each patient was 300 mg/day.

MEASUREMENTS: Adverse experiences, comorbid events, and physical signs and symptoms were assessed continuously, and laboratory data were examined at the beginning and end of each treatment period.

RESULTS: One subject died with a pneumonia (and elevated white blood cell count), and one subject developed probable carbamazepine‐induced tics. There was a minimal drop in hematocrit and a slight elevation of liver enzymes, none of which was clinically significant. There was otherwise no excess of adversity or comorbid events on carbamazepine versus placebo, and there was no change in electrolytes or other laboratory measures.

CONCLUSION: The findings indicate that carbamazepine in this dose range was well tolerated for the 5‐week treatment period in this frail sample. These data supplement the literature regarding carbamazepine toxicity, which is devoid of controlled studies in older subjects.
Nutrient Intake of Nursing‐Home Residents Receiving Pureed Foods or a Regular Diet
Authors: Johnson Rita M. , Smiciklas‐Wright Helen , Soucy Irene M. , Rizzo Joyce A.
Published: April 2015

OBJECTIVE: To evaluate (1) the nutrient content of menus planned for regular consistency meals and pureed meals in a long‐term care facility and (2) to assess nutrient intakes of women consuming these meals.

DESIGN: A descriptive survey.

SETTING: A nursing home facility in central Pennsylvania.

PARTICIPANTS: Fifty‐one female nursing home residents were chosen randomly. Thirty‐one received a regular diet and 20 received a pureed diet.

MEASUREMENTS: Demographic and health variables were collected from medical records. Nutrient variables were calculated for regular and pureed consistency meals, as served. Nutrient intake data for each woman were based on seven consecutive days of food intake and nutrient supplement use.

MAIN RESULTS: Energy and nutrient values for regular diet menus (i.e., food served) were higher than for pureed menus, but both had values exceeding recommended allowances for most nutrients. Average energy and nutrient intakes were similar for both groups of women (t test, P < 0.05). Data showed that many women in both groups had lower than the recommended intakes of iron, zinc, calcium, and Vitamin D.

CONCLUSIONS: Both regular and pureed consistency diets provided to residents met current recommended allowances. Diet consistency did not affect nutrient intakes. Intakes were adequate overall; however, a low intake of the same nutrients generally occurred in both groups.
Difficulty with Holding Urine Among Older Persons in a Geographically Defined Community: Prevalence and Correlates
Authors: Wetle Terrie , Scherr Paul , Branch Laurence G. , Resnick Neil M. , Harris Tamara , Evans Denis , Taylor James O.
Published: April 2015

OBJECTIVE: The goal of this study was to estimate the prevalence and correlates of difficulty holding urine among a population of community‐dwelling older people.

DESIGN: Population‐based cross‐sectional study.

SUBJECTS: A population census identified all residents aged 65 years and older residing in East Boston, Massachusetts, in 1982.

MEASURES: Data collected via in‐home interviews were used to estimate the prevalence of difficulty holding urine and to provide information regarding potential correlates of urinary difficulty.

RESULTS: Of the 3809 study participants (85% response rate), 28% reported having “difficulty holding urine until they can get to a toilet” at least some of the time, and 8% reported difficulty “most” or “all of the time.” Difficulty was associated with age and sex; 44% of women and 34% of men reported some difficulty (P < .001), and 9% of women and 6% of men (P < .001) reported difficulty most or all of the time. For respondents aged 65 to 74 years, 40% reported some difficulty, compared with 47% of those aged 85 and older (Ptrend < .001); difficulty most or all of the time was reported by 6% of those aged 65 to 74 and 12% of those aged 85 and older (Ptrend < .001). Difficulty holding urine was associated with important health and functional measures including depression, stroke, chronic cough, night awakening, fecal incontinence, problems with activities of daily living, decreased frequency and ease in getting out of the house, and poor self‐perception of health.

CONCLUSIONS: Difficulty holding urine is a prevalent condition among older people living in the community and is associated highly with a number of health conditions and functional problems.
Xerostomia, Xerogenic Medications and Food Avoidances in Selected Geriatric Groups
Authors: Loesche W. J. , Bromberg J. , Terpenning M. S. , Bretz W. A. , Dominguez B. L. , Grossman N. S. , Langmore S. E.
Published: April 2015

OBJECTIVE: To study the relationship between complaints of xerostomia and salivary performance and food avoidances in four geriatric groups chosen to reflect a broad spectrum of individuals along the health‐disease continuum. To determine whether xerogenic medications taken by these individuals could be associated with either complaints of xerostomia or with food avoidances.

DESIGN: Cross‐sectional survey. Clinical examinations and interview.

SETTING: A VA dental clinic and a retirement home.

PATIENTS AND OTHER PARTICIPANTS: Subjects were 529 individuals older than 56 years of age, living both in institutions and in the community (average age 70 years). Two hundred eight persons were recruited from a VA Dental Clinic, 114 from a residential retirement home, and 132 from a nursing/long‐term‐care facility; 75 were from an acute care ward and had a diagnosis of a cerebral vascular accident or other neurological condition.

OUTCOME MEASURES: Prevalence of xerostomia, dental morbidity, salivary flow, and food avoidances.

RESULTS: About 72% of the subjects experienced xerostomia sometime during the day. Stimulated salivary flow was found to be significantly lower in individuals who complained of xerostomia than in those who did not. Fifty‐five percent of participants reported using one or more xerogenic medications, with an 86% prevalence in the nursing/long‐term‐care facility. Individuals with xerostomia had difficulty in chewing and in starting a swallow and were significantly more likely to avoid crunchy foods such as vegetables, dry foods such as bread, and sticky foods such as peanut butter in their diets. Specific medications such as the inhalants ipratropium and triamcinolone and the systemic agents oxybutynin and triazolam could be statistically associated with xerostomia and/or low salivary flow, and/or specific food avoidances.

CONCLUSION: Xerostomia apparently affects the ability to chew and start a swallow. This leads to avoidance of certain foods, which raises the possibility that xerostomia could contribute to undernutrition in older persons. The topically applied ipratropium and triamcinolone and the systemic agents amitriptyline, oxybutynin and triazolam could be statistically associated with one or more complaints of xerostomia.
Social and Leisure Activities and Risk of Dementia: A Prospective Longitudinal Study
Authors: Fabrigoule Colette , Letenneur Luc , Dartigues Jean François , Zarrouk Mounir , Commenges Daniel , Barberger‐Gateau Pascale
Published: April 2015

OBJECTIVE: To study the relationship between social and leisure activities and risk of subsequent dementia in older community residents.

SETTING: A cohort study of people aged 65 and older were followed‐up 1 and 3 years after a baseline screening (the Paquid study).

PARTICIPANTS: 2040 older subjects living at home in Gironde (France) were randomly selected and followed for at least 3 years.

DATA COLLECTION: Information about social and leisure activities was collected during the baseline screening with an interview by a psychologist. Incident cases of dementia were detected during the first and third year follow‐up screenings according to the DSM‐III‐R criteria.

MAIN RESULTS: All but one of the social and leisure activities noted were significantly associated with a lower risk of dementia. Only golden club participation was not significantly associated with this risk. After adjustment for age and cognitive performance measured by the Mini‐Mental State Exam, visual memory test, and verbal fluency test, only traveling (Relative risk (RR) = .48, 95% Confidence Interval (95%CI) = .24‐.94), odd jobs or knitting (RR = .46, 95%CI = .26‐.85), and gardening (RR = .53, 95%CI = .28‐.99) remained significant.

CONCLUSIONS: Regular participation in social or leisure activities such as traveling, odds jobs, knitting, or gardening were associated with a lower risk of subsequent dementia.
Dysphagia and Dietary Levels in Skilled Nursing Facilities
Authors: Groher Michael E. , McKaig T. Neil
Published: April 2015

OBJECTIVE: To determine the appropriateness of dietary levels of residents with suspected feeding and/or swallowing disorders.

DESIGN: Chart review, evaluation, intervention, observation.

SETTING: Two skilled nursing facilities, one in Washington, one in Florida.

SUBJECTS: Two hundred twelve residents, mean age 72.9, suspected of having feeding and/or swallowing disorders.

MEASUREMENTS: After documentation of dietary level, each resident on a mechanically modified diet was given an evaluation by a speech/language pathologist specific to their feeding and swallowing skills. Changes in the dietary level were made, and the residents were followed for 30 days to evaluate their response.

RESULTS: Thirty‐one percent of the residents in the two facilities were prescribed a mechanically altered diet. Ninety‐one percent were at dietary levels below that which they could tolerate safely; four percent were at dietary levels higher than they could tolerate; five percent were considered to be at the appropriate diet level.

CONCLUSIONS: Many nursing home residents may be inappropriately placed or maintained on mechanically altered diets. Regular reevalution of their dietary level is necessary because most may be able to eat safely at higher levels. Active participation by speech/language pathologists knowledgeable in the assessment of oropharyngeal dysphagia is helpful in this process.
The Use of Expandable Metal Stents for Large Airway Obstruction in Older Patients
Authors: Jack Catherine I.A. , Lye Michael , Wilson Graeme , Hind Charles R.K.
Published: April 2015

OBJECTIVE: To review the indications, management, and outcome of 30 older patients who had expandable metal stents inserted for large airway obstruction.

DESIGN: Information was collected retrospectively from case notes about presentation, radiographic appearances, pulmonary function, including arterial oxygen tension, and histology. Survival data were collected by reviewing hospital or General Practice records.

MEASUREMENTS: Spirometry, peak expiratory flow rate, and blood gases were recorded before and after stent insertion.

MAIN RESULTS: There was a significant improvement in the patient's mean forced expiratory volume in 1‐second (FEV1) and mean peak expiratory flow rate (PEFR). The arterial oxygen tension (pO2) increased from 8.6 Kpa to 10.6 Kpa. The mean length of survival for the whole group was just under 5 months.

CONCLUSIONS: Airway stenting for obstruction provides palliative and functional benefits in these severely disabled patients and a consequent improvement in quality of remaining life.
The Effect of Medical Status on the Activity Level of Older Pain Clinic Patients
Authors: Farrell Michael J. , Gerontol M , Gibson Stephen J. , Helme Robert D.
Published: April 2015

OBJECTIVE: This project sought to assess the effect of disease status on the activity level of older people suffering from chronic pain.

DESIGN: A retrospective comparison of groups defined by disease attributes.

SETTING: Outpatient pain management clinic for older people.

SAMPLE: The sample consisted of 115 patients, of a possible 144, aged between 52 and 91 years, who were assessed upon admission to a multidisciplinary pain management clinic. Subjects were allocated to groups for comparison on the basis of the diagnosis of their pain problem and the extent of coexistent medical problems.

MEASUREMENTS: Groups were compared on scores of activity level using the Human Activity Profile, with and without pain (McGill Pain Questionnaire) and depressive symptom (Geriatric Depression Scale) scores as covariates.

MAIN RESULTS: Both pain diagnosis and number of additional medical problems characterized groups that were distinguishable by level of activity. A musculoskeletal disorder was associated with greater impact on activity than either postherpetic neuralgia or pain associated with a psychiatric diagnosis. Less activity was also evident among the subjects with several additional medical problems. However, this effect did not operate independently of depressive symptoms.

CONCLUSIONS: Disease status is a factor that rarely explains variations in the pain experience of young adult patients with chronic pain. The results from this study suggest that disease state does influence self‐reported activity level in older people with chronic pain. The influence of medical status should be acknowledged as an important factor when assessing and managing the older patient with chronic pain.
Predictors of Hand Function in Older Persons: A Two‐Year Longitudinal Analysis
Authors: Hughes Susan L. , Gibbs James , Dunlop Dorothy , Singer Ruth
Published: April 2015

OBJECTIVE: To validate a hierarchical model of hand function in older persons, using longitudinal data.

DESIGN: Longitudinal observational study (2‐year data from an ongoing longitudinal study).

SUBJECTS: 689 persons older than age 60, including Continuing Care Retirement Community (n = 230), homebound (n = 204), and ambulatory (n = 255) respondents. Mean age at baseline 76.6 (SD = 8.8).

MEASUREMENT: Independent variables included sociodemographics, physician measures of upper joint impairment, self‐reported comorbidity, arthritis pain, depression, and anxiety. The dependent variables included grip strength and a timed manual performance test.

MAIN RESULTS: Using generalized estimated equations (GEE) to test our hierarchial model, we found that gender and upper extremity joint impairment were the strongest predictors of a longitudinal measure of grip strength. Grip strength, in turn, along with demographics, comorbidity, and a measure of psychological status, was significantly related to timed manual performance.

CONCLUSIONS: The longitudinal analyses confirmed a previous cross‐sectional finding that upper extremity joint impairment contributes significantly to reduced grip strength, which, in turn, contributes to reduced hand performance on a timed test.
Depression in Alzheimer's Disease Patients: Caregivers as Surrogate Reporters
Authors: Logsdon Rebecca G. , Teri Linda
Published: April 2015

OBJECTIVE: To evaluate the use of caregivers as surrogate reporters of depressive symptoms in Alzheimer's disease (AD) patients on five depression measures.

DESIGN: Scale characteristics, including means, ranges, internal consistency, sensitivity, and item content of modified self‐report questionnaire and interview depression measures were compared.

PARTICIPANTS: Seventy‐six patients, diagnosed with both depression and AD, and their family caregivers participated in this investigation. All subjects were community‐residing participants in a treatment outcome investigation of behavioral treatment for depression.

MEASUREMENTS: A Schedule for Affective Disorders and Schizophrenia (SADS) interview was completed on all subjects to establish a diagnosis of depression. Caregivers then completed three additional questionnaire measures about their patient: the Beck Depression Inventory (BDI), the Geriatric Depression Scale (GDS), and the Center for Epidemiological Studies‐Depression Scale (CESD), all modified to provide a surrogate report of their patient's depressive symptoms. In addition, two interview measures were completed based on interviews with the caregiver and patient: the Hamilton Depression Rating Scale (HDRS) and the cornell Scale for Depression in Dementia (CSDD).

RESULTS: Mean scores for this sample were above the recommended cutoff score for mild levels of depression on all measures. coefficient alpha levels were comparable to levels reported for the traditional self‐report formats. Sensitivity varied among the measures, with the CSDD most sensitive and the HDRS least sensitive. Item content varied across measures, particularly between questionnaire and interview measures.

CONCLUSIONS: Based on these results, it appears that caregivers are able to act as surrogate reporters of depression in AD patients. The modification of self‐report questionnaires did not decrease their internal consistency, and they remained highly correlated with each other, supporting their validity when used in this manner. A two‐step process of evaluating AD patients for depression is recommended: first, a surrogate report questionnaire completed by caregivers to screen patients, eliminating those who are unlikely to be depressed, and then a more extensive interview with those patients‐and their caregivers‐ who appear likely to be depressed.
Health Services Use and Mortality Among Older Primary Care Patients with Alcoholism
Authors: Callahan Christopher M. , Tierney William M.
Published: April 2015

OBJECTIVE: To describe the prevalence of alcoholism in an older primary care population and to compare rates of health services use and mortality among those with and those without evidence of alcoholism.

DESIGN: Baseline screening for alcoholism using the CAGE questionnaire and longitudinal assessment of health services use and mortality using an electronic medical record system.

SETTING: An academic primary care group practice at an urban ambulatory care clinic.

PATIENTS: A total of 3954 patients aged 60 and older who completed the CAGE alcoholism screening questionnaire during routine office visits.

MAIN OUTCOME MEASURES: Comorbidity, preventive health services use, hospital episodes and length of stay, emergency room visits, ambulatory care visits, total outpatient charges, and mortality.

RESULTS: The prevalence of current evidence of alcoholism, as defined by a CAGE score ≤ 2 and alcohol use in the previous 12 months, was 10.6%. Patients with evidence of alcoholism were younger (66.2 vs 68.3 years), had fewer years of education (8.4 vs 9.1), were more likely to be male (65.8 vs 27.2%), black (71.2 vs 62.6%), smokers (40.4 vs 26.3%), and malnourished (32.5 vs 26.3%). Patients with alcoholism were more likely to have a diagnosis of obstructive lung disease (22.9 vs 18.3%), injuries (14.2 vs 8.3%), and gout (6.7 vs 2.9%) and less likely to have a diagnosis of hypertension (56.9 vs 61.8%), arthritis (23.3 vs 29.3%), and diabetes (15.9 vs 23.3%). Among those with evidence of alcoholism, 41.6% had a diagnosis of alcoholism in their outpatient medical record. Rates of completion of preventive health services did not differ between the two groups, and there was no difference in the number of ambulatory care visits, emergency room visits, or total outpatient charges.

Patients with evidence of alcoholism were more likely to be hospitalized (21.5 vs 16.9%) and more likely to die within 2 years (10.6% vs 6.3%).

CONCLUSIONS: One of 10 older patients in this primary care practice had current evidence of alcoholism, fewer than half of whom had documentation of alcohol abuse in their medical records. These patients were more likely to be hospitalized and more likely to die but did not consume a greater amount of outpatient resources. Further research is needed to determine if interventions to reduce alcohol use would also reduce excess hospitalizations and mortality among these older patients.
Determinants of Functional Abilities in Dementia
Authors: Hill Robert D. , Bäckman Lars , Fratiglioni Laura
Published: April 2015

OBJECTIVES: To determine the extent to which selected variables within demographic, psychometric, and memory domains can predict functional abilities in dementia.

DESIGN: Hierarchical regression analyses were employed to predict functional abilities, while controlling for disease severity, using the Mini‐Mental State Exam (MMSE).

SETTING AND PARTICIPANTS: A total of 2368 inhabitants of Kungsholmen parish in Stockholm, Sweden, aged 75 years of age or older. Eighty‐one subjects with confirmed dementia (MMSE, M = 17.9; SD = 5.26) were selected from the study population. The mean age was 84.5 years (SD = 5.58), and 72% were female.

MEASUREMENTS: Participants received a battery of standardized neuropsychological instruments and selected experimental tasks that measured visuospatial ability as well as primary and episodic memory. Self‐care was assessed using the Katz index of activities of daily living (ADL); instrumental activities of daily living (IADL) were assessed through the primary caregiver, who responded to questions related to functional competence of the participant.

RESULTS: Hierarchical regression procedures revealed that disease severity was the strongest predictor of ADL and IADL performance. Controlling for disease severity, a measure of visuoperception (Poppelreuter's figures) also made a significant contribution to the explanatory variance in both ADL and IADL function. Beyond disease seve—ity and visuoperception, years of schooling and disease duration were marginally predictive of IADL performance.

CONCLUSION: It is possible to predict functional abilities in dementia on the basis of individual difference variables. Multiple variables were initially correlated with ADL and IADL performance; however, after controlling for disease severity, visuoperception was the only predictor of ADL scores. In addition to visuoperception, IADL scores were also marginally predicted by education and disease duration. These findings highlight the importance of peripheral sensory processes in adaptive function in dementia. They also suggest that although many variables may be correlated with functional ability, their explanatory role, particularly with regard to self‐care skills, is diminished in the presence of the disease.
Sexual Function of Men Ages 40 to 79 Years: The Olmsted County Study of Urinary Symptoms and Health Status Among Men
Authors: Panser Laurel A. , Rhodes Thomas , Girman Cynthia J. , Guess Harry A. , Chute Christopher G. , Oesterling Joseph E. , Lieber Michael M. , Jacobsen Steven J.
Published: April 2015

OBJECTIVES: Knowledge of male sexual function is somewhat limited because of a lack of current population‐based data. This study provides information on sexual function and satisfaction in a population‐based sample of men.

METHODS: Men aged 40 to 79 years (n = 2115) were selected randomly from the Olmsted County population for the baseline component of a prospective cohort study (the Olmsted County Study of Urinary Symptoms and Health Status Among Men) during 1989–1990. The men completed a self‐administered questionnaire that included questions about sexual concerns, performance, satisfaction, drive, and erectile dysfunction.

RESULTS: For all five sexual parameters queried, the prevalence of problems and dysfunction increased with age. A comparison of men aged 70 to 79 years with men aged 40 to 49 years suggested that older men were more worried about sexual function (46.6% vs 24.9%), had worsened performance compared with a year ago (30.1% vs 10.4%), expressed extreme dissatisfaction with sexual performance (10.7% vs 1.7%), had absent sexual drive (25.9% vs 0.6%), and reported complete erectile dysfunction when sexually stimulated (27.4% vs 0.3%). Logistic regression analyses suggested that sexual dissatisfaction was significantly associated with erectile dysfunction, decreased libido, and the interaction between erectile dysfunction and libido, but not age.

CONCLUSIONS: These population‐based cross‐sectional data corroborate the previously reported age‐related decrease in sexual function. The age‐related increase in dissatisfaction could, however, be accounted for primarily by the age‐related increase in erectile dysfunction, decreased libido, and the interaction between erectile dysfunction and decreased libido.
The Use of Medicines with Anticholinergic Effects in Older People: A Population Study in an Urban Area of Sweden
Authors: Fastbom Johan , Claesson Cecilia B. , Cornelius Christel , Thorslund Mats , Winblad Bengt
Published: April 2015

OBJECTIVE: To investigate the use of medicines with anticholinergic properties among older people in an urban population in Sweden.

DESIGN: A cross‐sectional survey.

SETTING: Ordinary homes, sheltered accommodations, nursing homes, and geriatric departments.

PARTICIPANTS: All residents aged 75 and older in a district of Stockholm, Sweden.

MEASUREMENTS: Structured interviews with older persons, their relatives and/or health care personnel; prescription forms; medical records.

RESULTS: The overall use of medicines with anticholinergic effects was comparatively low. Doses of these medicines were also generally low. Concurrent use of several such medicines was uncommon. The most prevalent therapeutic/pharmacological group was neuroleptics. In contrast, antidepressants were used by few older people. The prevalence of medicines with anticholinergic effects was highest at institutions, where neuroleptics were frequent and use of low‐potency neuroleptics was not uncommon.

CONCLUSION: Our results indicate that the risk of anticholinergic side effects may be quite low in the present population as a whole. However, there may be grounds for revising the therapy in institutions, where the use of neuroleptics was shown to be high and low‐potency neuroleptics, known to have a higher incidence of anticholinergic side effects, were not avoided.
MODELS OF GERIATRICS PRACTICE
Authors: Reuben David B. , Evans Lois K. , Yurkow Johanna , Siegler Eugenia L.
Published: April 2015

BACKGROUND AND OBJECTIVES: Frail older adults are especially vulnerable in a health system that is fragmented and fails to focus on preservation or restoration of function. The School of Nursing at the University of Pennsylvania, together with the School of Medicine and the Hospital of the University of Pennsylvania, established the Collaborative Assessment and Rehabilitation for Elders (CARE) Program to meet the needs of this population. We used the British Day Hospital as a model because it provides a comprehensive approach to care and a bridge between acute, home‐based, and institutional long‐term care. We have designed our program to provide innovative, interdisciplinary care as well as to be reimbursable under current and future payment structures. This nurse‐managed, collaborative practice seeks to maximize independent functioning, promote health, and enhance quality of life for chronically ill, frail older adults living in the community whose needs are left unmet by existing services. The program was certified as a Comprehensive Outpatient Rehabilitation Facility (CORF) in December 1993 to maximize reimbursement of services through Medicare and other third party payers. With a Gerontological Nurse Practitioner as care manager, clients receive an intensive, individualized, time‐limited program of nursing, rehabilitation, mental health, social, and medical services in one setting several days each week. Additional geriatric services, such as primary care, are available in the same location when needed.

SETTING: The program is housed in renovated space devoted to the care of older people. The academic and clinical offices of the University of Pennsylvania's nursing and medical gerontologic and geriatric faculty are in the same building.

PARTICIPANTS: We have targeted those persons older than age 65 who have complex health problems and are living at home. Individuals must need multiple services, including at least one rehabilitation therapy, and they must be unsuitable‐for inpatient rehabilitation.

DESCRIPTION OF THE POPULATION: In its first 8 months of operation, the program received 97 referrals and admitted 53 clients. Clients were, on average, 78 years of age. Over three‐fourths (77%) were women and 58% were black. The average stay in the program was 6 weeks. FIM scores, which improved a mean of 2.4 points, were found to lack sensitivity to the functional improvements achieved by clients.

CONCLUSION: Under existing Medicare and third party reimbursement policies, it is feasible to establish a nurse‐managed comprehensive outpatient rehabilitation program designed to meet the needs of frail older persons. Preliminary data support the beneficial effects of the program as well as the economic feasibility of this approach.
Epidemiology of Injury in People with Alzheimer's Disease
Authors: Oleske Denise M. , Wilson Robert S. , Bernard Bryan A. , Evans Denis A. , Terman Eric W.
Published: April 2015

BACKGROUND: Previous studies have suggested that the risk of injury is elevated among persons with dementia, but these studies have focused primarily on falls and fractures. This study characterizes all injuries incurred in a large sample of community‐dwelling persons with a specific form of dementia, Alzheimer's disease (AD).

SUBJECTS AND METHODS: The sample consisted of 281 community‐dwelling persons diagnosed with AD according to NINCDS/ADRDA guidelines. Information regarding all injuries occurring within the previous 6 months was obtained through a structured interview of a caregiver.

RESULTS: The rate of injuries was 58.4 per 100 persons per year. Although falling was the single most common mechanism by which injuries occurred, it accounted for only 43.8% of all injuries. Fractures accounted for 13.7% of injuries. Medical treatment was sought for 52.1% of the injuries. After adjustment for age and gender, the likelihood of injury was significantly associated with cognitive impairment and with ADL limitation, but the independent contribution of these two factors could not be assessed.

CONCLUSIONS: The findings suggest that injuries are a significant problem in persons with AD
Accuracy of Rapid Urine Screening Tests Among Incontinent Nursing Home Residents with Asymptomatic Bacteriuria
Authors: Ouslander Joseph G. , Schapira Moises , Fingold Susan , Schnelle John
Published: April 2015

OBJECTIVE: To determine the accuracy of rapid urine screening tests in detecting bacteriuria among incontinent nursing home residents.

SETTING: Six nursing homes.

PARTICIPANTS: 214 chronically incontinent, but otherwise asymptomatic, nursing home residents who were enrolled in a clinical intervention trial for urinary incontinence.

MEASUREMENTS: 684 urine specimens were collected, the majority (76%) by a clean catch technique and the remainder by in‐and‐out catheterization. Each specimen underwent dipstick testing for nitrite and leukocyte esterase, a rapid, enzyme‐based screening test for bacteriuria, and a quantitative urine culture using standard laboratory techniques.

RESULTS: No one screening test or combination of tests had adequate sensitivity and specificity for clinical purposes. However, using all three tests, the sensitivity increases to 97% in females and 92% in males when any one of the tests is positive, and the specificity increases to 95% in females and 97% in males when all three tests are negative. Among nursing home residents suspected of having a symptomatic urinary tract infection, the prevalence of bacteriuria is probably higher than in our study population (e.g., 60–70%, compared with 32%). At these prevalence rates, the positive predictive value of any of the three tests being positive is 93% and higher, and the negative predictive value of all three tests being negative is 80 to 90%.

CONCLUSIONS: Our data must be interpreted cautiously because of the specimen collection methods, the definitions we used, and the fact that we studied a population who did not have symptoms of an acute urinary tract infection. In addition, we did not examine the absolute accuracy of the screening tests, but their accuracy as a clinician might use them in a nursing home. Despite these caveats, our data suggest that a combination of these screening tests could be useful in the initial assessment of nursing home residents for bacteriuria, and result in considerable cost savings. Studies are needed to replicate our findings among nursing home residents with symptomatic urinary tract infections.
Posturography and Balance Problems in Older People
Authors: Baloh Robert W. , Spain Sharon , Socotch Tina M. , Jacobson Kathleen M. , Bell Theodore
Published: April 2015

OBJECTIVE: To determine which measurements and test conditions on posturography are most useful for identifying balance problems in older people.

SUBJECTS: Two samples of 70 community‐dwelling older subjects (>75 years). One group (controls) considered their balance normal for their age, and the other (patients) complained of imbalance.

MEASUREMENTS: Velocity of sway on static (with and without foam) and dynamic posturography, Tinetti gait and balance score, self‐reported fear of falling, and number and circumstances of falls.

RESULTS: Mean sway velocity was significantly increased in patients compared with controls. The greatest difference between patients and controls occurred with measures of anterior‐posterior sway velocity during angular tilt of the platform. Sway velocity was not significantly increased in patients or controls who reported falls compared with those who did not report falls. Even when comparing those who fell as a result of loss of balance with those who fell because of trips or slips, there was no significant difference in sway velocity. By contrast, those who reported fear of falling (patients and controls) had significantly increased sway velocity compared with those who did not report fear of falling.

CONCLUSION: On average, velocity of sway (particularly in the anterior‐posterior direction) is higher in older subjects who complain of imbalance compared with age‐matched controls, and the difference is greater with dynamic posturography than with static posturography. However, the posturography data provided little information about the cause of the imbalance and did not correlate with the frequency of reported falls.
Older Community‐Dwelling Adults' Attitudes Toward and Practices of Health Promotion and Advance Planning Activities
Authors: Fried Terri R. , Rosenberg Roberta R. , Lipsitz Lewis A.
Published: April 2015

OBJECTIVE: To describe the attitudes toward and practice of health prevention and advance planning measures by a group of community‐dwelling older adults and to examine the effect of age on these practices.

DESIGN: A descriptive study performed by mail survey.

PARTICIPANTS: Members of a research registry who were 65 years of age or older.

MEASUREMENTS: By means of a written questionnaire, we asked about knowledge of various health prevention and advance planning topics, including exercise, cholesterol screening, rectal examination, influenza vaccination, sigmoidoscopy, mammography, prostate cancer screening, organ donation, autopsy, health care proxy, and advance directives. Of those who knew about the topic, we asked if the respondent had discussed it with a physician, who initiated the conversation, and if the respondent participated in the activity. We also asked how important the topic was to the respondent.

RESULTS: We received 598 completed surveys, a response rate of 83%. Respondents had a mean age of 74 years, were predominately white (96%), and were well educated, with 44% having completed college. The respondents were all knowledgeable about the topics, and, with the exception of sigmoidoscopy, organ donation, and autopsy, more than 70% thought these topics were important. In the case of health screening and prevention activities, a large percentage of respondents reported having discussed the topic with a physician, and a slightly smaller percentage reported regular participation. In the case of health care proxies and advance directives, however, only about one‐half of those who had made these arrangements said they had discussed them with a physician. When discussion did occur, it was much more likely to have been initiated by the respondent. Controlling for level of education, age was inversely associated with the likelihood of a woman reporting she had undergone mammography (P < .05). Age, however, was not associated with decreased frequency of undergoing other screening tests.

CONCLUSIONS: Among a group of well educated older adults, reported interest in and compliance with health screening, health promotion, and advance planning activities were high. However, sigmoidoscopy, a relatively more invasive procedure that is generally recommended as a screening tool, is reported less likely to be practiced than prostate cancer screening, a less invasive procedure without such recommendation. Older adults state they are pursuing health care proxies and advance directives, often without the involvement of their physicians. Of the screening tests about which we asked, age was associated only with less frequent practice of mammography.
A Low, ‘Normal’ Score on the Mini‐Mental State Examination Predicts Development of Dementia After Three Years
Authors: Braekhus Anne , Laake Knut , Engedal Knut
Published: April 2015

OBJECTIVES: To study whether a low, “normal” sumscore (i.e., 24 or higher) on the Mini‐Mental Status Examination (MMSE) near the cutpoint usually employed for identifying persons with cognitive impairment predicts later development of dementia.

DESIGN: A prospective study of a random sample of nondemented persons aged 75 years and older, according to DSM‐III criteria, with follow‐ups after 3 and 6 years.

PARTICIPANTS: The subjects were 215 persons living at home, mean age 81 years, 81% women. Their mean MMSE sumscore at the start of the study (T0) was 27.9 (range 24–30).

MAIN RESULTS: A low MMSE sumscore at T0 was identified as a statistically strongly significant predictor of dementia after 3 years (P < .001), when more than 40% of those with a sumscore of 24 or 25 at T0 had become demented. A similar, although weaker and statistically nonsignificant, trend was observed for the risk after 6 years in relation to MMSE scoring at baseline.

CONCLUSION: Persons with a sumscore of 24 or 25 and classified as not suffering from dementia according to the DSM‐III criteria are at high risk of developing dementia within 3 years.