bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of climate change on cold hardiness of Douglas‐fir (Pseudotsuga menziesii): environmental and genetic considerations
Authors: Bansal Sheel , St. Clair J. Bradley , Harrington Constance A. , Gould Peter J.
Published: April 2015

The success of conifers over much of the world's terrestrial surface is largely attributable to their tolerance to cold stress (i.e., cold hardiness). Due to an increase in climate variability, climate change mayreduceconifer cold hardiness, which in turn could impact ecosystem functioning and productivity in conifer‐dominated forests. The expression of cold hardiness is a product of environmental cues (E), genetic differentiation (G), and their interaction (G × E), although few studies have considered all components together. To better understand and manage for the impacts of climate change on conifer cold hardiness, we conducted a common garden experiment replicated in three test environments (cool, moderate, and warm) using 35 populations of coast Douglas‐fir (Pseudotsuga menziesiivar. menziesii) to test the hypotheses: (i) cool‐temperature cues in fall are necessary to trigger cold hardening, (ii) there is large genetic variation among populations in cold hardiness that can be predicted from seed‐source climate variables, (iii) observed differences among populations in cold hardinessin situare dependent on effective environmental cues, and (iv) movement of seed sources from warmer to cooler climates will increase risk to cold injury. During fall 2012, we visually assessed cold damage of bud, needle, and stem tissues following artificial freeze tests. Cool‐temperature cues (e.g., degree hours below 2 °C) at the test sites were associated with cold hardening, which were minimal at the moderate test site owing to mild fall temperatures. Populations differed 3‐fold in cold hardiness, with winter minimum temperatures and fall frost dates as strong seed‐source climate predictors of cold hardiness, and with summer temperatures and aridity as secondary predictors. Seed‐source movement resulted in only modest increases in cold damage. Our findings indicate that increased fall temperatures delay cold hardening, warmer/drier summers confer a degree of cold hardiness, and seed‐source movement from warmer to cooler climates may be a viable option for adapting coniferous forest to future climate.
Awareness and preference for functional foods: the perspective of older Italian consumers
Authors: Annunziata Azzurra , Vecchio Riccardo , Kraus Artur
Published: April 2015

The literature has identified several factors that specifically influence how older consumers view and consume functional foods (FFs), including the perceived need for the product and perceived health benefit. Health claims (HCs), symbols and logos on FF labels can thus play a central role in enhancing product attractiveness and perception of health benefits. Nevertheless, few studies have examined how elderly consumers perceive non‐verbal communication (such as symbols) associated with health‐related information on FFs. Research undertaken on 400 Italian consumers aged over 60 revealed that HCs on FF influence older consumers' perceptions of the healthiness of products. However, respondents also stated that they had difficulties reading and interpreting HCs and nutritional information on food labels. The findings highlight the existence of significant barriers to FF acceptance and use by older consumers, namely price sensitivity, availability and general scepticism on the reliability of the information provided by food manufacturers.
Factors Associated with Six-Month Outcome of Pediatric Stroke
Authors: Gordon Anne L. , Anderson Vicki , Ditchfield Michael , Coleman Lee , Mackay Mark T. , Greenham Mardee , Hunt Rod W. , Monagle Paul
Published: April 2015

Background

Pediatric stroke outcome studies are often cross sectional in design. Prospective information regarding the clinical course following diagnosis is lacking, but may inform clinical management beyond the acute period.

Aims

To describe the outcome of arterial ischemic stroke in infants, children and adolescents at one-month and six-months post-stroke across health domains, and explore the relationship between lesion characteristics and early outcome with six-month adaptive behavior.

Methods

A single center prospective longitudinal study at a tertiary level children's hospital. Recruitment was undertaken from December 2007 to January 2012. Participants were children aged birth to 18 years presenting acutely with first diagnosed arterial ischemic stroke. Lesion characteristics on brain imaging were classified. Children were grouped according to age at diagnosis for analysis (neonates vs. those aged >30 days).

Results

In 50 children with a median age of 47 months at diagnosis, sensorimotor impairments were most evident upon neurological examination acutely, especially in the older children. At both one-month and six-months motor functioning was significantly impaired in the older age group but no significant cognitive or language sequelae were identified. Lesion characteristics alone were not associated with six-month adaptive behavior outcomes.

Conclusions

For patients surviving arterial ischemic stroke, the most significant clinical consequences both acutely and at six-months, are sensorimotor impairments, particularly evident in the older children. In contrast cognitive or language sequelae were not identified. Long-term surveillance is required to describe clinical course and rehabilitation needs, particularly for neonates and infants.
Measurement of oxyhemoglobin concentration changes in interstitial cystitis female patients: A near‐infrared spectroscopy study
Authors: Matsumoto Shinya , Matsumoto Shinichi , Homma Yukio
Published: April 2015

Objectives

To investigate brain activity related to bladder sensation in interstitial cystitis patients.

Methods

A total of 10 interstitial cystitis patients (all women; mean age 68 years) and 10 healthy controls (all women; mean age 64 years) participated in the present study. Frontal lobe blood flow was measured non‐invasively by using multichannel near‐infrared spectroscopy with large and small bladder volumes (created by infusing water) up to the first desire to void.

Results

The frontal cortex of the right and left hemisphere was activated, and the activation was detected as an increase in oxyhemoglobin concentration. The increase during the first desire to void in the interstitial cystitis group was greater than that in the control group. In addition, this difference was particularly observed in Brodmann's areas 9, 44, 45 and 46, reportedly associated with micturition and sensory modulation.

Conclusions

The present study shows that the frontal area is largely activated during bladder filling in interstitial cystitis patients. Our findings suggest that the major change in cerebral blood flow is related to the characteristic urinary symptoms of interstitial cystitis patients.
Declining Cholesterol and Mortality in a Sample of Older Nursing Home Residents
Authors: Grant Mark D. , Piotrowski Zdzislaw H. , Miles Toni P.
Published: April 2015

OBJECTIVE: To examine the association between declining serum cholesterol and mortality in a sample of older nursing home residents.

DESIGN: A retrospective cohort study.

SETTING: A 203‐bed nursing home.

PARTICIPANTS: Persons aged 65 and older, resident in the nursing home on January 1, 1988, or admitted through December 31, 1989, were eligible (n = 185) for the study. Follow‐up for mortality was conducted until June 30, 1991. Fifty‐five survivors with two or more cholesterol levels recorded before January 1, 1990, and the 76 decedents with two or more recorded cholesterol levels constituted the analytic sample (71% of eligible subjects).

OUTCOME MEASURE: Mortality of the nursing home residents.

RESULTS: Cholesterol declined 31.1 mg/dL/yr (95% confidence interval [CI], 19.7 to 42.6) among decedents, versus 4.2 mg/dL/yr (95% CI, −4.9 to 13.2) among survivors. The association between cholesterol decline (absolute or relative rates) and mortality was examined using logistic regression controlling for age, sex, and tube feeding. Compared with a referrent group with no change or increase, declining cholesterol greater than 45 mg/dL/yr was accompanied by an adjusted relative odds for death of 6.2 (95% CI, 2.1 to 18.4); declining cholesterol greater than 20% per year was accompanied by an adjusted relative odds for death of 7.3 (95% CI, 2.4 to 22.2). Extreme declines greater than 20% per year occurred in 47% of decedents but in only 15% of survivors.

CONCLUSION: Precipitously declining cholesterol appeared to be a marker for mortality in the sample and may help explain the low cholesterol‐mortality association in older nursing home residents. J Am Geriatr Soc 44:31–36, 1996.
Enhancement of Proxy Appointment for Older Persons: Physician Counselling in the Ambulatory Setting
Authors: Meier Diane E. , Gold Gabriel , Mertz Kristan , Taylor Brian , Cammer‐Paris Barbara E. , Seckler Allison , Mulvihill Michael
Published: April 2015

OBJECTIVE: To determine the effectiveness of physician‐initiated counselling on the rate of health care proxy appointment.

DESIGN: Observational study of an intervention in a convenience sample.

SETTING: A geriatric outpatient clinic in a tertiary care teaching hospital, New York, New York

PARTICIPANTS: A total of 687 patients enrolled in the geriatric clinic during the study period March 1991 through June 1993.

INTERVENTION: Physician counselling about the New York State Health Care Proxy Law, distribution of educational materials and healthcare proxy forms, and reminders in 331 of 466 eligible patients.

MEASUREMENTS: Rate of healthcare proxy appointment in eligible and counselled groups; predictors of appointment and non‐appointment; time elapsed from counselling to appointment; reasons for non‐appointment; characteristics of the proxy appointment process.

RESULTS: A healthcare proxy was appointed for 31.5% of patients eligible for counselling and for 44% of patients who actually received the intervention, compared with a 2.3% proxy appointment rate at baseline. Eighty‐one percent of the patients completing the proxy appointment process did so at or before their third clinic return visit after the counselling intervention. Of the counselled patients who did not appoint a proxy, 25% explicitly declined, and 75% had not come to a decision by the end of the study period. Proxy completion was associated with ethnicity, education, and more frequent clinic visits. Of those who appointed a proxy, 97% had good or fair comprehension of the procedure, 92% discussed the appointment with their designees, 63% appointed a daughter or son, and 80% discussed their wishes for care at the end of life with their proxy.

CONCLUSIONS: Physician counselling of older outpatients is an effective means of increasing healthcare proxy appointments. J Am Geriatr Soc 44:37–43, 1996.
Occurrence of Fibroadenomas in Postmenopausal Women Referred for Breast Biopsy
Authors: Hunter Tim B. , Roberts Catherine C. , Hunt K. Rebecca , Fajardo Laurie L.
Published: April 2015

OBJECTIVE: To examine the occurrence of breast fibroadenomas in postmenopausal patients referred for breast biopsy.

DESIGN: A retrospective review of breast biopsy outcome and of patient demographics, including menstrual and hormonal status.

SETTING: The Tucson Breast Center, a large outpatient breast cancer detection clinic affiliated with the University of Arizona Health Sciences Center in Tucson, Arizona.

PARTICIPANTS: All women seen at the Tucson Breast Center between 1985 and 1990 who were referred for breast biopsy.

RESULTS: A total of 100 fibroadenomas were found in 709 breast biopsies whose results were known. Fifty‐two of these were in premenopausal women and 44 in postmenopausal women; the menopausal status of four women was unknown. In postmenopausal women, 11 of the 44 patients reported hormone use. Fibroadenomas constituted 20% (39 of 195) of the benign masses and 12% (39 of 339) of all breast masses in postmenopausal women. Fibroadenomas constituted 10% (44 of 447) of all biopsies in postmenopausal women, including those with breast masses, abnormal calcifications, or other lesions.

CONCLUSION: Noncalcified fibroadenomas of the breast are not confined to young women and may constitute a small but noteworthy proportion of lesions coming to breast biopsy in postmenopausal women. J Am Geriatr Soc 44:61–64, 1996.
Evaluation of Four Methods for the Diagnosis of Respiratory Syncytial Virus Infection in Older Adults
Authors: Falsey Ann R. , McCann Robert M. , Hall William J. , Criddle Mary M.
Published: April 2015

OBJECTIVE: To evaluate four methods of rapid diagnosis of respiratory syncytial virus (RSV) infection in older adults and to compare sensitivities with serologic analysis.

DESIGN: Prospective comparative analysis.

SETTING: Two adult daycenters.

PATIENTS: Frail older persons attending the daycenter who developed signs or symptoms of acute respiratory illness between the months of December and February.

MEASUREMENTS: Viral cultures performed by standard technique and bedside inoculation: antigen detection by indirect immunofluorescence assay (IFA) and Directigen enzyme immunoassay (EIA) on nasal brush samples; serologic analysis of acute and convalescent sera using EIA.

RESULTS: RSV infection was documented by serology in 11 of 54 (20%) subjects during the study period. Bedside viral cultures were the most sensitive assay and were positive in 6/9 infections. Standard viral culture detected 5/11 cases. Both methods of rapid antigen detection were found to be insensitive, with 1/11 detected by IFA and 0/11 detected by EIA.

CONCLUSION: Rapid antigen tests for the diagnosis of RSV in older persons should be used with caution. J Am Geriatr Soc 44:71–73, 1996.
Approach to Fever and Infection in the Nursing Home
Authors: Yoshikawa Thomas T. , Norman Dean C.
Published: April 2015

OBJECTIVE: To summarize current information on the scope, epidemiology, clinical manifestations, diagnostic approach, and general management of infectious diseases in nursing home residents, as well as the specific treatment of common infections occurring in the nursing home setting.

DESIGN: Survey and literature review of the diagnostic and therapeutic problems of nursing home residents with infections.

CONCLUSIONS: Older persons residing in nursing homes as well as other types of long‐term care facilities are at increased risk for infections. Moreover, infection is the most frequent reason for patients to be transferred from nursing homes to an acute‐care facility. The most common infections that are acquired in nursing homes are urinary tract infection (cystitis pyelonephritis), respiratory infections (pneumonia, bronchitis), and skin/soft tissue infections (infected pressure ulcers, cellulitis). Most serious infections in this setting are caused by bacteria; however, influenza and other respiratory viruses as well as herpes zoster may cause significant morbidity in older nursing home residents. Mycobacterium tuberculosis infects nursing home residents at a higher rate than it infects older community dwellers. Infections in older nursing home residents may manifest clinically, with atypical symptoms and signs, including the absence of fever. Rapid diagnostic evaluation and early therapeutic intervention are essential for minimizing the high mortality and morbidity associated with infections in this older population; most nursing home residents with serious infections should be considered for hospitalization. J Am Geriatr Soc 44:74–82, 1996.
Short‐Term Functional Outcomes of Long‐Term Care Residents with Pneumonia Treated with and without Hospital Transfer
Authors: Fried Terri R. , Gillick Muriel R. , Lipsitz Lewis A.
Published: April 2015

OBJECTIVE: To determine 2‐month mortality and functional status outcomes after resolution of pneumonia in older long‐term care facility (LTCF) patients treated with and without hospital transfer.

DESIGN: Retrospective cohort study.

SETTING: Hebrew Rehabilitation Center for Aged, a 725‐bed LTCF affiliated with an academic medical center, whose residents are cared for by staff physicians and geriatric fellows.

PATIENTS: LTCF residents with an acute episode of pneumonia, defined as a new respiratory sign or symptom and a new infiltrate on chest radiograph.

MEASUREMENTS: Functional decline or death in the 2 months after the resolution of pneumonia.

RESULTS: Of 312 cases of pneumonia, 246 (79%) were treated in the LTCF and 66 (21%) were treated in the hospital. Equal proportions of patients died of their pneumonia (13% vs 12%), but a larger proportion of those hospitalized had either worsening in their functional status or had died at 2 months (P = .005, Mantel‐Haenszel trend test). In a logistic regression model controlling for differences between patients treated at the two sites, hospital treatment remained associated with poorer 2‐month outcome (AOR 3.02, 95% CI 1.32, 7.22), with a significant interaction between respiratory rate and treatment site. LTCF treatment was associated with better 2‐month outcomes only among patients with a lower respiratory rate. For these patients, the difference in outcome between LTCF treatment and hospital treatment was greatest for patients who were independent or mildly dependent at baseline.

CONCLUSIONS: In this academic LTCF, treatment for pneumonia without hospital transfer resulted in better 2‐month outcomes compared with hospital treatment. Although the difference in outcome may be explained in part by differences between patients treated with and without hospital transfer, it persisted after correcting for these differences. The benefits of LTCF treatment appear to be greatest for those with less severe pneumonia and more independent functional status.
Gait Changes in Older Adults: Predictors of Falls or Indicators of Fear?
Authors: Maki Brian E.
Published: April 2015

OBJECTIVE: To determine, in a cohort of ambulatory older adults, whether spatial‐temporal measures of foot placement during gait can predict the likelihood of future falls or whether these measures are more likely to be indicative of adaptations associated with pre‐existing fear of falling.

DESIGN: Prospective cohort study.

SETTING: Baseline gait measurements were performed in a gait and balance laboratory; subsequent history of falling was monitored prospectively for 1 year in two self‐care facilities.

PARTICIPANTS: Fourteen male and 61 female consecutive volunteers (mean age = 82, SD = 6) who were independent in activities of daily living and able to walk 10 m unaided.

MEASUREMENTS: Spatial gait parameters were derived from digitized “footprints”; temporal parameters were derived using footswitches. A clinical activity‐based gait assessment was also performed. The dependent variables were pre‐existing fear of falling (reported at baseline) and future falling (experiencing one or more falls during the 1‐year follow‐up).

MAIN RESULTS: Reduced stride length, reduced speed, increased double‐support time, and poorer clinical gait scores were associated with fear but showed little evidence of an independent association with falling. Conversely, increased stride‐to‐stride variability in stride length, speed, and double‐support was associated independently with falling but showed little evidence of relationship to fear. Increased stride width showed some evidence of association with both falling and fear. Stride‐to‐stride variability in speed was the single best independent predictor of falling.

CONCLUSIONS: Changes in gait cited previously as risk factors for falling, i.e., decreased stride length and speed and prolonged double support, may in fact be stabilizing adaptations related to fear of falling. Stride‐to‐stride variability in the control of gait is an independent predictor of falling and may be a useful measure for identifying high‐risk individuals and evaluating preventive interventions. Stride width may also be a useful outcome measure. Contrary to common expectation, a wider stride does not necessarily increase stability but instead seems to predict an increased likelihood of experiencing falls.
Sleep Disturbance, Psychosocial Correlates, and Cardiovascular Disease in 5201 Older Adults: The Cardiovascular Health Study
Authors: Newman Anne B. , Enright Paul L. , Manolio Teri A. , Haponik Edward F. , Wahl Patricia W. ,   On behalf of the Cardiovascular Health Study Research Group
Published: April 2015

OBJECTIVES: To describe the prevalence of self reported sleep disturbances in older men and women and to describe their relationships with health status and cardiovascular diseases (CVD).

DESIGN: Cross‐sectional study of sleep disturbance, CVD, general health, psychosocial factors, physical function, and use of psychotropic medications.

SETTING: Participants of the Cardiovascular Health Study, 5201 adults aged 65 and older recruited from a random sample of noninstitutionalized Medicare enrollees in four US communities.

MEASURES: Self‐reported sleep disturbances and standardized questionnaires for cardiopulmonary symptoms and diseases, depression, social support, activities of daily living, physical activity, cognitive function, and current medications, spirometry, ECG, echocardiography, and carotid ultrasound.

RESULTS: Women were twice as likely as men to report difficulty falling asleep (30% vs 14%). Daytime sleepiness, difficulty falling asleep, and frequent awakenings increased in prevalence with age. All symptoms were related strongly to depression. Symptoms of daytime sleepiness were also related strongly to poor health and limitations in activities of daily living in men and women. In multivariate analysis, men taking benzodiazepines were likely to report difficulty falling asleep and daytime sleepiness, whereas women taking benzodiazepines reported difficulty falling asleep and waking up too early. After accounting for these factors, the only cardiovascular disease independently associated with sleep disturbances was angina. Men and women with confirmed angina were 1.6 times more likely to report trouble falling asleep. Independent relationships between sleep disturbances and cardiovascular risk factors such as obesity, hypertension, smoking, and diabetes were relatively weak and inconsistent, though smokers were less likely to report frequent awakenings.

CONCLUSIONS: Sleep disturbances are relatively common in older men and women and are associated with poor health, depression, angina, limitations in activities of daily living, and the use of benzodiazepines.
The Association Between Human Leucocyte Antigens (HLA) and Mortality in Community Residents Aged 85 and Older
Authors: Izaks Gerbrand J. , van Houwelingen Hans C. , Schreuder Geziena MT , Ligthart Gerard J.
Published: April 2015

OBJECTIVE: The association between Human Leucocyte Antigens (HLA) and aging was investigated. It is possible that HLA antigens are associated with longevity, either indirectly through disease associations or directly through involvement in the aging mechanism.

DESIGN: Community‐based follow‐up study.

SETTING: Leiden, the Netherlands.

PARTICIPANTS: A total of 919 subjects were HLA typed in this community‐based study. All subjects were aged 85 and older and were white. Seventy‐two percent of the cohort was female.

MEASUREMENTS: Age‐ and sex‐adjusted Mortality Rate Ratios (MRR) were estimated for 79 antigens by the subject‐years method. HLA‐A, ‐B and ‐C typing was performed with the standard NIH lymphocytotoxicity test, HLA‐DR and ‐DQ typing was performed with the two‐color fluorescence test. Homozygosity for HLA‐A, ‐B, and ‐DR was defined as only one detectable antigen at a locus.

RESULTS: The mean follow‐up period (SD) was 5.0 (0.6) years. At the end of the follow‐up, 70% of the subjects had died. The MRR (95%CI) for B60 was 0.96 (0.75‐1.23), and for DR11 it was 0.82 (0.66‐1.01). For A2 and A26 only, the MRR (95%CI) was significantly different from 1:0.85 (0.73‐0.99), P = .04 and 1.45 (1.06‐1.99), P = .02, respectively (P values not corrected for the number of antigens tested). Homozygosity was not associated with mortality.

CONCLUSIONS: HLA was not associated with mortality after the age of 85. Therefore, direct involvement of HLA in aging is unlikely. We suggest that the findings of previous studies are attributable to methodological shortcomings such as small sample size and differences in genetic background of the subjects.
A Survey of Habitual Snoring in Centenarians
Authors: Shiomi Tshiaki , Guilleminault Christian , Kayukawa Yuhei , Wakida Yasushi , Okamoto Yasuyoshi , Kobayashi Tadashi
Published: April 2015

OBJECTIVE: To ascertain whether centenarians in the surveyed group would be nonhabitual snorers.

DESIGN AND SETTING: A cross‐sectional survey of centenarians residing in the Aichi Prefecture of Japan.

PARTICIPANTS: A total of 103 centenarians (21 men and 82 women).

MEASUREMENTS: Questionnaire on sleep habits, breathing, and snoring.

RESULTS: Nineteen centenarians (18.4%; 5 men and 14 women) were habitual snorers and two (1.9%) were suspected of having sleep apnea syndrome because of the presence of heavy snoring and nocturnal respiratory arrest.

CONCLUSION: Most centenarian subjects were non‐snorers and without breathing pauses during sleep; their snoring rates were no different from those of younger aged older adults in the same population.
The Impact of Aging and Chronic Disease on Use of Hospital and Outpatient Services in a Large HMO: 1971–1991
Authors: Haan Mary N. , Selby Joe V. , Quesenberry Charles P. , Schmittdiel Julie A. , Fireman Bruce H. , Rice Dorothy P.
Published: April 2015

OBJECTIVES: To examine overall and diagnosis‐specific trends in the use of inpatient and outpatient medical services (1970–1988) among older members of a large HMO.

DESIGN: Two cohorts of approximately 3000 persons aged 65 or older in 1971 and 1980 were compared for hospital and outpatient utilization during 9‐year follow‐up periods (1971–79 and 1980–88). All subjects were evaluated for vital status throughout the follow up period as well.

PARTICIPANTS: All 6057 subjects were members of the Northern California Kaiser Permanente Medical Care Program in 1971 or 1980. The study sample was sex‐age stratified (65–69, 70–79, 80+) at baseline.

MEASUREMENTS: Data on demographics, outpatient health services utilization, categories of outpatient utilization and disease diagnoses were obtained from membership lists or medical chart review; inpatient utilization, including admitting and discharge diagnosis, length of stay, and number of hospital days was assessed from computerized hospitalization records.

RESULTS: Hospital discharge rates (sex‐age adjusted) increased by 12% between cohorts, with the largest increases at the oldest ages. There was a 25% increase among women and a 9% increase among men. Length of stay decreased by 20%. Hospitalization for ischemic heart disease decreased by 17%. Congestive heart failure (CHF) discharge rates (sex‐age adjusted) were 92% higher in the 1980–88 cohort. For diagnoses related to nursing home institutionalization and frailty, discharge rates were significantly higher in the 1980–88 cohort: pneumonia (+ 34%), urinary tract infections (+ 104%), dehydration (+ 110%), osteoarthritis (+ 64%), syncope (+ 246%), leg cellulitis (+ 70%). In‐hospital survival improved, but overall percent of readmissions also increased by 4%; readmissions for CHF increased by 13% and those for conditions of frailty by 120%. Overall outpatient visits increased by 17%. Use of laboratory tests (+ 57%) and outpatient surgeries (+ 99%) increased for all age strata in 1980–88 compared with 1971–79.

CONCLUSIONS: While overall outpatient and inpatient utilization has largely decreased over the past 30 years, as a result of economic factors and improved treatments for some major diseases, there has been an increase in utilization among older people. Hospitalization for diagnoses associated with end‐stage cardiovascular disease (CHF), musculoskeletal disease, frailty and iatrogenic aspects of institutionalization are clearly increasing substantially. The largest impact of aging on health care may be the result of institutionalization and its sequelae. Improved treatment for cardiovascular disease may also be leading to increased utilization at later stages in the disease process.
Blood Pressure Reduction and Tolerability of Felodipine ER in Older and Younger Hypertensive Patients
Authors: Fagan Timothy C. ,   Felodipine ER in the Elderly versus Young Working Group
Published: April 2015

OBJECTIVE: To evaluate and compare blood pressure reduction and tolerability of felodipine ER (extended‐release), in younger and older patients.

DESIGN: A multicenter, double‐blind, placebo‐controlled, parallel group study.

SETTING: Nineteen study sites; approximately half of the sites were at academic medical centers and half were in private primary care practices. Patients were non‐hospitalized and free‐living.

PATIENTS: There were 243 younger (≤61 years) and older (≥64 years) patients, age range 26 to 83, with sitting diastolic blood pressure (SDBP) of 95–115 mm Hg (higher stage 1 to lower stage 3) on placebo. Patients volunteered for the study.

INTERVENTIONS: After a 2 to 4 week, single‐blind, placebo baseline period, patients with SDBP of 95–115 mm Hg were randomized to treatment with felodipine ER 2.5 mg qd or placebo at a ratio of 3:1, felodipine:placebo. The dose of felodipine ER was increased to 5 mg qd after 3 weeks and to 10 mg qd after 6 weeks if the SDBP was greater than 90 mm Hg.

MEASUREMENTS: The main outcome measure was change in SDBP. Secondary Outcome measures were change in sitting systolic blood pressure (SSBP) and percent of responders, defined as SDBP less than 90 mm Hg or a ≥ 10 mm Hg reduction. Other measurements included heart rate, weight, routine laboratory values, and self‐reported adverse events.

RESULTS: By Week 9, felodipine ER reduced blood pressure in the older subjects (n = 77) by 13/12 mm Hg; in the younger patients, (n = 102), the reduction was 12/8 mm Hg. All reductions were significantly different from placebo (P ≤ .003). The reduction in diastolic, but not systolic, blood pressure was significantly greater in the older than in the younger patients (P = .004 and P = .188, respectively). The percentage of patients reporting a clinical adverse experience was similar for felodipine ER and placebo treatment groups. The incidence of side effects was similar between old and young patients. Discontinuation occurred in 9% of the felodipine‐treated patients and 19% of the placebo‐treated patients. Older patients required lower doses of felodipine ER to achieve equivalent blood pressure control.

CONCLUSIONS: Felodipine ER is effective in lowering blood pressure and is well tolerated in both young and old people.
Abnormal Exercise Electrocardiograms in Master Athletes After Three Months of Deconditioning
Authors: Katzel Leslie I. , Busby‐Whitehead M. Janette , Hagberg James M. , Fleg Jerome L.
Published: April 2015

OBJECTIVE: To determine the effects of 3 months of voluntary deconditioning on cardiac function in master athletes.

DESIGN: A prospective study.

SETTING: Research participants at the University of Maryland School of Medicine and Johns Hopkins Bayview Medical Center

PARTICIPANTS: Ten older (59 ± 8 years, mean ± SD), highly conditioned (maximal aerobic capacity V̇O2 max 50 ± 5 mL/kg/min), aerobically trained athletes

MEASUREMENTS AND RESULTS: Three months after the cessation of training, three of the 10 athletes had unexpected, new, markedly asymptomatic, ischemic‐appearing, exercise‐induced ST‐segment depression on their maximal exercise tests. After retraining, the ST‐segment changes disappeared in two of the subjects, but it persisted, although at a higher work load, in one of the athletes.

CONCLUSION: In three master athletes, voluntary cardiopulmonary deconditioning was associated with the development of new, asymptomatic, exercise‐induced ST‐segment depression on exercise ECG. The mechanisms underlying these new ischemic‐appearing ST‐segment changes accompanying detraining and their clinical significance are not known and warrant further investigation.
The Effect of DHEAS on Influenza Vaccination in Aging Adults
Authors: Degelau John , Guay David , Hallgren Helen
Published: April 2015

OBJECTIVE: To determine whether simultaneous administration of dehydroepiandrosterone sulfate (DHEAS) exhibits adjuvant activity in the immune response of aging humans by supplementing influenza vaccination with the maximum single dose of DHEAS that could be practically injected subcutaneously (approximately 7.5 mg).

DESIGN: A randomized, double‐blind, placebo‐controlled trial of DHEAS injection with 1993–94 and 1994–95 influenza vaccine in older subjects. In addition, initial safety, tolerability, and control testing with 1993–94 influenza vaccine was conducted in young subjects.

SETTING: An urban primary care geriatrics clinic.

PARTICIPANTS: Seventy‐eight older adult volunteers (mean age 78.61 ± 3.43 years, range 73–90 years) and 20 younger controls (<40 years, means age 32.76 ± 5.39 years) were recruited from clinic and community advertising. Subjects were free of disease or medication known to affect immune function.

MEASUREMENTS: Immune responses to vaccine at 0, 2, and 4 weeks were measured by vaccine antigen‐induced lymphoproliferation in peripheral blood mononuclear cells (PBMC) and serum antibody response by hemagglutination inhibition (HI).

RESULTS: The maximum DHEAS dose that could be practically administered subcutaneously was 7.5 mg. Baseline DHEAS levels were significantly lower in older adults (52.1 vs 236.4 μg/dL, P < .001). The 1993 old adult DHEAS group HI response tended to be higher for the H3N2 Beijing antigen but not for the H1N1 or B antigen. In subjects with HI titers less then 1:40 for the H3N2 Beijing antigen (n = 29), the post‐vaccination titer response tended to be higher among the 16 subjects who received DHEAS (P = .06). The peak response for the H3N2 antigen was associated with the initial DHEAS serum concentration in the DHEAS and placebo groups (R2 =.22, P = .04 and R2 = .21, P = .06, respectively). No significant differences were found for antibody responses to the H1N1 and B antigens or vaccine‐antigen induced lymphoproliferation.

CONCLUSION: A one‐time supplemental dose of DHEAS with influenza vaccination appeared to enhance the specific HI antibody response to the 1993–94 H3N2 antigen in a small group of older adults. These findings were limited to those with lower prevaccination titers and lower DHEAS concentrations. Although clinical implications of these findings for influenza vaccine are uncertain, these results suggest additional detailed immunologic investigations on the role of DHEAS in the aging human immune response are warranted.
Use of Digoxin, Diuretics, Beta Blockers, Angiotensin‐Converting Enzyme Inhibitors, and Calcium Channel Blockers in Older Patients in an Academic Hospital‐Based Geriatrics Practice
Authors: Fishkind Deborah , Paris Barbara E. C. , Aronow Wilbert S.
Published: April 2015

OBJECTIVE: To investigate the prevalence of and indications for digoxin use and the prevalence of beta blocker and calcium channel blocker use in older patients with pevious myocardial infarction or coronary artery disease (CAD), and the prevalence of use of diuretics, beta blockers, angiotensin‐converting enzyme (ACE) inhibitors, and calcium channel blockers in older patients with hypertension in an academic hospital‐based geriatrics practice.

DESIGN: A retrospective analysis of charts from 528 unselected older patients, seen from June 1995 through July 1996 at an academic hospital‐based geriatrics practice, was performed to investigate the prevalence of digoxin use and indications for digoxin use, the prevalence of beta blocker and calcium channel blocker use in older patients with previous myocardial infarction or coronary artery disease (CAD), and the prevalence of use of diuretics, beta blockers, angiotensin‐converting enzyme (ACE) inhibitors, and calcium channel blockers in older patients with hypertension.

SETTING: An academic hospital‐based, primary care geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.

PATIENTS: A total of 416 women and 112 men, mean age 81 ± 8 years (range 58 to 101), were included in the study.

MEASUREMENTS AND MAIN RESULTS: Ninety‐two of the 528 patients (17%) were taking digoxin. Recorded indications for digoxin were atrial fibrillation with or without congestive heart failure (CHF) in 39% of patients, CHF with sinus rhythm and abnormal left ventricular ejection fraction (LVEF) in 18% of patients, a clinical assessment of CHF with sinus rhythm and no recorded measurement of LVEF in 20% of patients, paroxysmal atrial fibrillation in 14% of patients, and coronary artery disease (CAD) in 9% of patients. Of 121 patients with previous myocardial infarction, 23 (19%) were prescribed beta blockers, and 54 (45%) were taking calcium channel blockers. Of 173 patients with CAD, 41 (24%) were treated with beta blockers, and 79 (46%) were taking calcium channel blockers. LVEF was not recorded in the charts of 90 of 121 patients (74%) with prior myocardial infarction and of 125 of 173 patients (72%) with CAD. Of 480 older patients with hypertension, 154 (37%) were treated with diuretics, 55 (13%) were treated with beta blockers, 160 (38%) were treated with ACE inhibitors, and 197 (47%) were treated with calcium channel blockers.

CONCLUSIONS: In 528 older patients seen in an academic hospital‐based geriatrics practice, the prevalence of digoxin use was 19%. Appropriate indications for digoxin were documented clearly in the charts of 53 of 92 patients (57%). Calcium channel blockers were used more often than beta blockers in patients with previous myocardial infarction or CAD. Calcium channel blockers were the most frequently used antihypertensive drugs.
Determinants of Initiation and Suboptimal Use of Anti‐ulcer Medication: A Study of the Quebec Older Population
Authors: Moride Yola , Melnychuk David , Monette Johanne , Abenhaim Lucien
Published: April 2015

OBJECTIVES: To describe the use of anti‐ulcer medication in the Quebec older population; to examine determinants of initiation, suboptimal use, and switches between products.

DESIGN: Population‐based retrospective cohort study.

SETTING: Universal health program for older adults in Quebec.

PARTICIPANTS: 5000 users and 5000 non‐users of antiulcer medications were selected randomly. Use was defined as the presence in the 1991 prescription database of an antiulcer prescription. Among users, 1697 (34%) were new users and were considered as the exposure group. Subjects were followed for 365 days after inclusion.

MEASUREMENTS: Measured were patient's age, gender, prescribed duration of anti‐ulcer medication, concomitant medications, and gastrointestinal diagnostic procedures.

RESULTS: A total of 17% of new users had unusually short courses; 18% were long‐term users. There was no difference in duration for omeprazole compared with other anti‐ulcer medications. First‐time use of NSAIDs was the strongest predictor of initiation of anti‐ulcer medication (odds ratio = 3.21; 95% CI, 2.66–3.88). Twenty‐six percent of users switched brands. Only 9.5% of new users underwent a diagnostic procedure before initiation of therapy, and 49% of long‐term users ever underwent such procedure.

CONCLUSION: Despite a relatively homogeneous recommended duration of therapy, patterns of use of anti‐ulcer medication among older people are highly variable, and treatment is often not accompanied by a diagnostic procedure.
Oropharyngeal Candidosis in the Older Patient
Authors: Shay Kenneth , Truhlar Mary R. , Renner Robert P.
Published: April 2015

Colonization of the oral and pharyngeal regions by Candida spp., particularly C. albicans, is extremely common in humans, particularly in early and late life. A variety of local and systemic conditions predispose the transformation of the benign colonization to a pathological state, which may have severe local or serious systemic consequences. The finding of oropharyngeal candidosis in an older patient, therefore, merits investigation of the likely host factors responsible for the organism adopting its pathogenic behavior. This paper provides non‐dental clinicians managing older patients a review of the clinical characteristics, risk factors, diagnosis, and management of oropharyngeal candidosis in older adults.
Dental Status, Quality of Life, and Mortality in an Older Community Population: A Multivariate Approach
Authors: Appollonio Ildebrando , Carabellese Corrado , Frattola Alessandra , Trabucchi Marco
Published: April 2015

OBJECTIVE: To evaluate the relationships between a functional measure of dental status (FDS), several variables belonging to a quality of life (QOL) profile, and mortality in an older community population.

DESIGN: Cross‐sectional analysis for FDS and QOL; 10‐year prospective study for mortality.

SETTING: The historical and central district of the city of Brescia, northern Italy

PARTICIPANTS: The entire cohort of 70 to 75‐year‐old people living in the above‐mentioned district (n = 1303): 1201 subjects were eligible for interview at baseline; 11 refused the physical examination; 52 were lost to follow‐up; data are presented for the remaining sample of 1137 subjects.

MEASUREMENTS: FDS examination was used to classify the subjects into three groups: naturally adequate (ADS) (25.2%), naturally inadequate (IDS) (14.3%) dental status, and denture wearers (DW) (60.4%). Various QOL domains were assessed: mood level, cognitive status, instrumental activities of daily living (IADL), social relationships, indexes of somatic health, and health behaviors. The demographic and socioeconomic parameters were used as covariates.

RESULTS: Univariate analysis showed that both the ADS and the DW groups had a better QOL profile than the IDS group. Multiple logistic regression indicated that ADS and DW conditions were predicted independently by better educational and financial conditions, higher social relationships and a better IADL level in comparison with IDS. Moreover, compared with IDS, DS was a significant predictor of a better level at the SELF, IADL, and HCU scales whereas DW predicted only a better IADL level.

Crude survival analysis showed that ADS was associated with a lower mortality risk compared with both DW and IDS, which did not differ from each other. FDS also remained a significant and independent predictor of mortality in a more general Cox's regression model.

CONCLUSIONS: Within this cohort of 70 to 75‐year‐old urban residents, FDS is associated with several QOL domains and with long‐term survival. A hierarchy of reciprocal relationships exists among these parameters. The present study provides a basis for encouraging more extensive use of dentures. Longitudinal studies using oral health outcomes are warranted before clinical recommendations can be made. J Am Geriatr Soc 45:1315–1323, 1997.
Factors Associated with Cognitive Impairment Among Older Italian Inpatients
Authors: Cattin Luigi , Bordin Paolo , Fonda Maurizio , Adamo Claudia , Barbone Fabio , Bovenzi Massimo , Manto Andrea , Pedone Claudio , Pahor Marco ,   Gruppo Italiano di Farmacovigilanza nell'Anziano (G. I. F.A.)
Published: April 2015

OBJECTIVE: To examine the association of cognitive impairment with educational, demographic, and nutritional variables in older hospitalized people.

DESIGN: Survey of older patients admitted consecutively to a hospital during two 2‐month periods in 1993.

SETTING: Patients admitted for general medical care at 35 hospitals participating in the GIFA study throughout Italy.

PARTICIPANTS: A total of 3628 patients aged 65 or older were studied.

MEASUREMENTS: The Hodkinson Abbreviated Mental Test (HAMT) was used as a screening method to assess the patients' basic cognitive function. Multiple logistic regression was used to examine the association between cognitive impairment and demographic, educational or nutritional variables.

RESULTS: Twenty‐nine percent of older inpatients were classified as having cognitive impairment, with similar distribution of HAMT score found in both genders. Educational attainment has a highly significant inverse relationship with cognitive impairment (highest education: OR 0.32; 95% CI 0.20–0.52). Moreover, cognitive impairment decreased with increasing body mass index (3rd tertile: OR 0.69; 95% CI: 0.51–0.93), cholesterol serum level (highest values: OR 0.59; 95% CI 0.37–0.93), circulating lymphocytes (highest values: OR 0.55; 95% CI 0.45–0.69), and serum albumin (highest values: OR 0.60; 95% CI 0.47–0.76), with a gradient of influence for each variable.

CONCLUSIONS: Educational attainment affects cognitive function in older inpatients. The strong association between cognitive impairment and nutritional variables suggests that every effort to improve nutritional status is needed in approaching cognitive impairment in older patients. J Am Geriatr Soc 45:1324–1330, 1997.
Utility of Ultrasound to Assess Risk of Fracture
Authors: Cheng Sulin , Tylavsky Frances , Carbone Laura
Published: April 2015

Traditional assessments of bone properties have utilized densitometry techniques such as Dual Energy X‐ray Absorptiometry (DXA). Recently, quantitative ultrasound (QUS) has been introduced as an alternative method of assessing bone properties. Advantages of QUS over X‐ray techniques include low costs, portability, and nonionizing radiation. Proponents of QUS have claimed that this technology can provide information not only about the density but also about the structure and mechanical properties of bone. There are two major questions that need to be answered for those who seek to diagnose bone disorders with ultrasound: (1) what does quantitative ultrasound actually measure, and, even more importantly, (2) what is its clinical utility? In this review we will briefly examine the first question and will focus on the utility of ultrasound in clinical trials to discriminate between fractures and non‐fractures and to predict the risk of fractures. J Am Geriatr Soc 45:1382–1394, 1997.
Clinical Trial Participant Satisfaction: Survey of SHEP Enrollees
Authors: Schron Eleanor B. , Wassertheil‐Smoller Sylvia , Pressel Sara ,   Behalf of the SHEP Cooperative Research Group
Published: April 2015

OBJECTIVE: The purpose of this study was to determine older persons' reasons for joining a clinical trial, and to provide data that could be useful in planning and carrying out clinical trials in older and minority populations.

DESIGN: A survey.

PARTICIPANTS: The sample included 4281 men and women 60 years of age or older who were randomized to the Systolic Hypertension in the Elderly Program (SHEP).

MEASUREMENTS: A 10‐item satisfaction/attitude questionnaire was designed to evaluate (1) what personal benefits people expect from participation in this trial, (2) motivation for joining, and (3) satisfaction with clinic staff and operations. Each question had a response category asking for a measure of agreement, satisfaction, or importance.

RESULTS: The most important reasons for joining the clinical trial were to contribute to science (96%), improve the health of others (96%), and improve their own health (93%). Free medical care and social aspects were less important reasons to join. There were no differences by treatment assignment, but differences in reasons for joining SHEP by age, race, gender, and education were observed.

CONCLUSION: Older adults were enthusiastic about clinical trial participation. Recruitment, participant management strategies, and allocation of resources should consider the needs of specific patient groups. J Am Geriatr Soc 45:934–938, 1997.