bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of Anemia in Older People: An Epidemiologic Study in a Well Defined Population
Authors: Anía Basilio J. , Suman Vera J. , Fairbanks Virgil F. , Rademacher Diana M. , III L. Joseph Melton
Published: April 2015

OBJECTIVE: To assess the incidence and clinical spectrum of anemia among older people.

DESIGN: Inception cohort assembled and followed by medical records linkage until death or last clinical contact through January 1994.

SETTING: Population‐based study in Olmsted County, Minnesota.

PARTICIPANTS: All 618 Olmsted County men and women aged 65 years or more with anemia by World Health Organization criteria that was first recognized in 1986.

MEASUREMENTS: Age‐ and sex‐adjusted incidence rates, corrected for prevalent anemia, and survival estimates using the Kaplan‐Meier method, with calculation of standardized mortality ratios for specific causes of death.

RESULTS: The corrected annual incidence of anemia rose with age, and rates were higher in men (90.3 per 1000; 95% CI, 79.2–101.4) than women (69.1 per 1000; 95% CI, 62.3–75.8). In 465 cases (75%), anemia was detected in conjunction with a hospitalization, but admission was due to anemia in only 57 instances. Half of the cases were caused by blood loss, two‐thirds of these as a result of surgery. The cause of anemia was uncertain in 102 cases (16%). One‐third of the patients were transfused with a median of 3 units each. Overall survival was worse than expected but was better among those with anemia caused by blood loss. Mortality attributable to malignancy, mental disorders, circulatory and respiratory diseases, ill‐defined conditions, and injuries was significantly increased among these older patients with anemia.

CONCLUSIONS: The incidence of anemia among older people is 4 to 6 times greater than that suspected clinically, rises with age, and is higher in men than in women. The apparent cause in half the cases is blood loss. Even mild anemia is associated with reduced survival, especially during the first year, but this could relate to underlying comorbid conditions.
Factors Predicting Fractures During Falling Impacts Among Home‐Dwelling Older Adults
Authors: Luukinen Heikki , Koski Keijo , Laippala Pekka , MD Sirkka‐Liisa Kivelä
Published: April 2015

OBJECTIVE: To investigate the predictors of fractures during falling impacts among home‐dwelling older adults.

DESIGN: A case‐control study within a prospective, population‐based survey.

SETTING: Five rural municipalities in northern Finland.

PARTICIPANTS: The study population consisted of all home‐dwelling persons aged 70 or older living in these five municipalities (n = 790 (85%)). The cases for this study were those with fracture, using the first fracture (n = 82) in the analyses, during a follow‐up period of 4 years. Controls (n = 82) were selected from among the persons who suffered soft tissue injuries; matching was by age, sex, and location of the first injury during the period.

MEASUREMENTS: During a 4‐year follow‐up period, all falls in the population were recorded using fall diaries, telephone interviews, and information from medical records. Risk factors for fractures during the 4‐year follow‐up were determined according to the number and severity of previous falls, circumstances and place of falls, disease history, use of medicines, symptoms, clinical examinations and tests, nutritional status, functional abilities and social and health behavior. Cross‐tabulations for categorial variables, paired t tests for the means of continuous variables, and conditional logistic regression analysis were performed.

RESULTS: According to the bivariate analyses, the risk factors for falls resulting in a fracture were frequent fear of falling, abnormal heel‐shin test, reduced knee extension strength, reduced grip strength, poor distance visual acuity, low supine pulse rate, inability to carry a 5‐kg load 100 meters, not doing heavy outdoor work, and no habitual exercise. A limited amount of social participation was associated negatively with fracturing. Conditional logistic regression analysis showed that the risk factors for fracture‐causing falls were frequent fear of falling (OR 2.50; CI 1.11–5.65), reduced knee extension strength (OR 3.38; CI 1.00–11.4), and poor distance visual acuity (OR 3.45; CI 1.13–10.6), whereas limited social participation (OR 0.29; CI 0.11–0.79) protected against the occurrence of fractures.

CONCLUSION: Impaired perception, muscle strength, and psychological and social functioning may influence fracture risk during injurious fall impacts. Studies with larger sample sizes are needed to confirm this and to examine the circumstances and mechanisms contributing to the fracture risk during falls via these risk factors. J Am Geriatr Soc 45:1302–1309, 1997.
Mammography Underutilization Among Older Women in Connecticut
Authors: Preston Jeanette A. , Scinto Jeanne D. , Ni Weijia , Wang Yun , Galusha Deron , Schulz Allyson F. , Petrillo Marcia K.
Published: April 2015

OBJECTIVES: The primary goals were to examine mammography use rates among older women in Connecticut and to determine if there was significant variation among different areas and racial groups in the state. The secondary goal was to examine what impact the initiation of Medicare reimbursement for mammography screening has had on mammography use.

DESIGN: Statewide use rates were determined by retrospective Medicare Part B mammography claims analysis. Small area analysis methodology (SAA) was used to identify mammography rates for 23 hospital service areas (HSAs), representing all of the catchment areas for Connecticut's acute care hospitals.

PARTICIPANTS: Female Medicare beneficiaries 65 years and older with Part B coverage residing in Connecticut during the study period.

MEASUREMENTS: The main outcome (the use of at least one mammogram) was calculated for the calendar years 1991, 1992, and 1993. Mean annual use rates in 1993 were generated for the 23 HSAs and the different racial groups in Connecticut. To examine the effect that Medicare reimbursement for screening mammograms has had on mammography use, rates were calculated for women who met Medicare reimbursement criteria in 1991 through 1993. The rates in 1992 and 1993 were then compared with those in 1991, when the reimbursement program was first initiated.

MAIN RESULTS: The mean statewide annual rates among women aged 65 years and older were 23.4% (1991), 24.5% (1992), and 24.9% (1993). The mammography use rates among black women 65 years and older were significantly lower than their white peers in 1991 (18.8% black vs 23.8% white, P .001), 1992 (20.6% vs 24.7%, P <.001), and 1993 (22.0% vs 25.1%, P < .001). Significant variation was identified among hospital service areas (HSAs) within the state for each time interval studied. The use rates among women aged 65 years and older who were eligible for Medicare screening mammography reimbursement increased significantly from 14.6% in 1991, when Medicare reimbursement for screening mammograms was first initiated, to 18.9% in 1992 (P < .001). The rates in 1993 (17.4%) also increased from the baseline year 1991 (P < .001). However, the observed increases since 1991 have been limited in magnitude.

CONCLUSIONS: Low mammography use persists among older women in Connecticut and, in particular, among older black women. The initiation of Medicare reimbursement for screening mammograms in 1991 has had some impact on mammography use although its effects are still limited. Through the use of small area analysis methodology, significant underutilization of mammography in localized areas of the state was identified. These findings have facilitated local outreach interventions. Additional research is needed to understand if health service barriers are contributing to the local variation in rates observed in this study. J Am Geriatr Soc 45:1310–1314, 1997.
Noncognitive Disturbances in Alzheimer's Disease: Frequency, Longitudinal Course, and Relationship to Cognitive Symptoms
Authors: Marin Deborah B. , Green Cynthia R. , Schmeidler James , Harvey Philip D. , Lawlor Brian A. , Ryan Theresa M. , Aryan Mohsen , Davis Kenneth L. , Mohs Richard C.
Published: April 2015

OBJECTIVE: To investigate the frequency and longitudinal course of symptoms of depression, agitation, and psychosis in a longitudinally studied sample of patients with Alzheimer's disease (AD).

DESIGN: Longitudinal study of AD patients with follow‐up assessments at 6‐month intervals for an average of more than 3 years.

SETTING: Alzheimer's Disease Research Center of the Mount Sinai Medical Center and the Bronx VA Medical Center, New York.

PARTICIPANTS: A total of 153 AD patients.

MEASUREMENTS: Blessed Test of Information, Memory and Concentration (BIMC) and the Alzheimer's Disease Assessment Scale cognitive (ADAS‐Cog) and noncognitive (ADAS‐NC) subscales.

RESULTS: At entry into the study, more than 90% of patients had a behavioral disturbance that was rated as mild or worse on one of the 10 ADAS noncognitive items; and 40% had at least one rating that was moderate or severe. Correlational analyses indicated that, with the exception of the two mood‐related items, noncognitive symptoms on the ADAS were not highly correlated with one another. Only one of the noncognitive items, concentration, was strongly correlated with the severity of cognitive impairment. On average, patients showed progressively worse cognitive functioning over time as measured both by the ADAS‐Cog and the BIMC. The mean severity of noncognitive symptoms did not change during the course of a 5‐year follow up. The severity of behavioral disturbance at any one evaluation was negatively correlated with change in behavior during the next 6 months and was not correlated with cognitive decline.

CONCLUSION: Mild behavioral disturbances are common, whereas moderate to severe behavioral symptoms are less frequent in this population of AD patients. Disturbances in mood and manifestations of agitation and psychotic symptoms are not closely related to one another and show little progressive worsening over time. Rather, they tend to be episodic such that increasing severity at one time is usually followed by improvement later. Concentration problems are a manifestation of cognitive dysfunction rather than behavioral disturbance in AD. Implications of these results for treatment of noncognitive disturbances in AD are discussed. J Am Geriatr Soc 45:1331–1338, 1997.
Validation of Multi‐Frequency Bioelectrical Impedance Analysis in Detecting Changes in Fluid Balance of Geriatric Patients
Authors: Rikkert Marcel G.M. Olde , Deurenberg Paul , Jansen René W.M.M. , van't Hof Martin A. , Hoefnagels Willibrord H.L.
Published: April 2015

OBJECTIVES: Multi‐Frequency Bioelectrical Impedance Analysis (MFBIA) is a quick, simple, and inexpensive method to assess body fluid compartments. This study aimed at determining the validity of MFBIA in detecting clinically relevant changes of fluid balance in geriatric patients.

DESIGN: A prospective, observational study.

SETTING: The 22‐bed Geriatric Department of the University Hospital Nijmegen.

PARTICIPANTS: Hospitalized patients were eligible if they did not have a pacemaker, were not suffering from terminal illnesses, and did not have psychogeriatric diseases likely to interfere with capacity to consent or comply. During a 16‐months period, 218 patients were admitted, of whom 78 patients were eligible and 53 consented to participate.

MEASUREMENTS: Each subject's fluid balance was diagnosed twice a week as dehydrated, overhydrated, or euvolemic, based on standardized physical examination, laboratory tests, and weight evaluation. Changes in fluid balance were quantified by measuring total body water (TBW) and extracellular fluid (ECF) applying deuterium‐and bromide‐dilution techniques. Impedance at 1, 5, 50, and 100 kHz and body weight were measured daily. Sensitivity and Guyatt's responsiveness indexes of MFBIA in detecting dehydration and overhydration were determined.

RESULTS: In total, 1071 MFBIA measurements were performed, during which 14 transitions from dehydration to euvolemia and 13 transitions from overhydration to euvolemia were monitored. Rehydration of dehydrated patients caused an increase in TBW and ECF of 3.4 ± 1.8 L and 1.9 ± 1.9 L, respectively, which resulted in significant decreases in impedance of 133 ± 67 Ω at 1 kHz and 93 ± 61 Ω at 100 kHz (P = .001). Treatment of overhydrated patients caused a TBW and ECF loss of 3.8 ± 4.2 L and 3.1 ± 3.8 L, respectively, which resulted in significant increases in impedance of 104 ± 72 Ω at 1 kHz and 81 ± 68 Ω at 100 kHz (P < .001). Sensitivity of a single MFBIA in diagnosing dehydration and overhydration was 14% and 17%, respectively. Responsiveness indexes of weighing and MFBIA for dehydration and overhydration were similar at all frequencies and greater than one.

CONCLUSION: The sensitivity of a single impedance measurement in detecting dehydration and overhydration was low. However, responsiveness of serial measurements to intra‐individual changes in fluid balance was good. Therefore, this noninvasive technique may be used in clinical practice to improve monitoring fluid balance in geriatric patients, especially when daily weighing is difficult. J Am Geriatr Soc 45:1345–1351, 1997.
Acceptability of Mobile Mammography Among Community‐Dwelling Older Women
Authors: Levin Jennifer R. , Hirsch Susan H. , Bastani Roshan , Ganz Patricia A. , Lovett Marci L. , Reuben David B.
Published: April 2015

OBJECTIVE: To test the acceptability of mobile mammography among community‐dwelling older women and to identify factors predictive of mobile mammography acceptance.

DESIGN: Case series.

SETTING: Twelve community meal sites sponsored by the City of Los Angeles Area on Aging.

PARTICIPANTS: Two hundred fifty‐five volunteers aged 60 to 84 years who attended community meal sites.

INTERVENTION: On‐site mammography offered to women who had not had a mammogram within the last year.

MEASUREMENTS: Mammography acceptance rates, reasons for accepting or declining the mammogram, and breast cancer knowledge, beliefs, and intentions.

MAIN RESULTS: One hundred seven of the 255 (42%) women were ineligible because they had received mammograms within the last year. Of the 148 women eligible, 57% accepted the mammograms and 43% declined; moreover, 20 of the 42 (48%) women who had not had a mammogram within the last 5 years or who never had a mammogram also accepted on‐site mammography in the mobile van. Variables identified as predictive of mammogram acceptance included Asian American status, not being an HMO member, being married, a reported willingness to accept a screening mammogram if recommended by a physician, and previous mammogram screening history.

CONCLUSION: Mobile mammography is acceptable to many older community‐dwelling women. Although mobile mammography does not eliminate all barriers that inhibit a woman from receiving a mammogram, it may substantially increase screening for some groups.J Am Geriatr Soc 45:1365–1370, 1997.
Eligibility of Alzheimer's Disease Clinic Patients for Clinical Trials
Authors: Schneider Lon S. , Olin Jason T. , Lyness Scott A. , Chui Helena C.
Published: April 2015

OBJECTIVES: To identify the percentage of patients with Alzheimer's disease (AD) in a general clinic population who would be provisionally eligible for randomized clinical trials and the extent to which these patients represent the overall clinic‐based population.

BACKGROUND: Many randomized clinical trials have restricted enrollment criteria that may limit generalizability, i.e., AD patients who fulfill selection criteria for phase III clinical trials may not be representative of other AD patients in clinical settings.

DESIGN AND SETTING: Patients diagnosed as probable or possible AD from the nine clinical sites of the State of California's Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) were selected on the basis of their provisionally fulfilling the inclusion and exclusion criteria of two typical AD clinical trials at the time of their first visit (ECG and brain imaging criteria were not available).

RESULTS: From a sample of 3470 subjects with possible or probable AD, overall, only 4.4% or 7.9% would have been provisionally eligible for each of two trials. Patients provisionally eligible were younger, relatively underrepresented by women, better educated, wealthier, and more likely to be white than ineligible patients. The major independent demographic predictors for eligibility were (1) income greater than $15,000 per year, (2) male gender, and (3) college education. More than 60% of probable AD patients were excluded because of significant behavioral problems; approximately one‐quarter each were excluded because of significant medical or neurological problems. Allowing patients with probable or possible AD to enroll would have resulted in 10.6% being eligible.

CONCLUSION: Selection criteria for AD clinical trials result in a demographically and clinically constrained subgroup that is not representative of the overall clinic population. J Am Geriatr Soc 45:923–928, 1997.
Proxies' Decisions About Clinical Research Participation for Their Charges
Authors: Muncie Herbert L. , Magaziner Jay , Hebel J. Richard , Warren John W.
Published: April 2015

OBJECTIVE: To examine the process by which proxies decide about their charges' participation in clinical research.

DESIGN: Using eight hypothetical research studies encompassing a variety of risks and benefits, we interviewed 315 competent persons > 65 years old (charges) and, separately, the individuals who would be designated as their proxies if the charges were to become incompetent. The proxies were asked what they thought their charges would decide and what decisions they would make for their charges and for their own participation.

SETTINGS: A medical house‐call program, two apartment complexes, and three nursing homes.

PARTICIPANTS: Charges > 65 years old and their proxies.

MAIN OUTCOME MEASURE: Comparison of decisions made by charges and by proxies for their charges.

RESULTS: The agreement between the proxies' and charges' decisions was not significantly different from random agreement (range of kappa statistics, 0.05–0.15). Rather, proxies' decisions for their charges were significantly related to the proxies' decisions for themselves (kappas, 0.52–0.86). When the paired proxies' and charges' decisions differed, the proxies were protective, more frequently refusing their charges' participation in the perceived riskier research studies.

CONCLUSIONS: Proxies did not know what their charges would decide. Their choices for the charges related more to the proxies' decisions about their own participation (which they knew) than to the decisions of their charges (which they didn't know). This is similar to the process of a reasonable person making the decision, a characteristic of decisions made in the best interests of the patient.
Adverse Drug Events In High Risk Older Outpatients
Authors: Hanlon Joseph T. , Schmader Kenneth E. , Koronkowski Michael J. , Weinberger Morris , Landsman Pamela B. , Samsa Gregory P. , Lewis Ingrid K.
Published: April 2015

OBJECTIVE: To describe the prevalence, types, and consequences of adverse drug events (ADEs) in older outpatients with polypharmacy.

DESIGN: A cohort study.

SETTING: General Medicine Clinic at the Durham Veterans Affairs Medical Center.

PATIENTS: A total of 167 high risk (taking > 5 scheduled medications) ambulatory older veterans who participated in a year long health service intervention trial.

MEASUREMENTS: Potential ADEs were identified by asking patients during closeout interviews whether, in the past year, they had experienced any side effects, unwanted reactions, or other problems from any medication. All reported medications and corresponding adverse experiences were assessed for plausibility by a research clinical pharmacist using two standard pharmacological textbooks and categorized by predictability, therapeutic class, and organ system.

RESULTS: Eighty self‐reported ADEs involving 72 medications taken by 58 (35%) of 167 patients were textbook confirmed. Seventy‐six of 80 (95%) ADEs were classified as Type A (predictable) reactions. Cardiovascular (33.3%) and central nervous system (27.8%) medication classes were most commonly implicated. Gastrointestinal (30%) and central nervous system (28.8%) ADE symptoms were common. Sixty‐three percent of patients with ADEs required physician contacts, 10% emergency room visits, and 11% hospitalization. Twenty percent of medications implicated with ADEs required dosage adjustments, and 48% of ADE‐related medications were discontinued. No significant differences (P > .05) were observed when ADE reporters (n = 58) and non‐reporters (n = 109) were compared.

CONCLUSION: Predictable ADEs are common in high risk older outpatients, resulting in considerable medication modification and substantial healthcare utilization.
The Relationship Between Self‐Rated Health and Depressive Symptoms in an Epidemiological Sample of Community‐Dwelling Older Adults
Authors: Mulsant Benoit H , Ganguli Mary , Seaberg Eric C.
Published: April 2015

OBJECTIVE: To confirm the association between depression and self‐rated general health, independent of demographics, functional disability, physical illness burden, and health services utilization.

DESIGN: Logistic regression analyses of data obtained in a cross‐sectional epidemiological survey.

SETTING: The mid‐Monongahela Valley, a rural, nonfarm, low SES community.

PARTICIPANTS: Random sample of 880 subjects aged 65 and older.

MEASUREMENTS: The dependent variable was self‐rated overall health, categorized as excellent, good, fair, or poor. The independent variables were demographics (age, gender, education), number of depressive symptoms, number of impaired instrumental activities of daily living (IADLs), measures of physical illness burden (individual medical conditions, number of affected organ systems or disease processes, and number of prescription medications), and measures of health services utilization (number of visits to physicians, and acute hospitalization).

RESULTS: Univariate analyses indicated that poorer self‐rated health was associated with lesser education, higher numbers of depressive symptoms, impaired IADLs, prescription medications, physician visits, hospitalizations, and affected organ systems, and with the presence of several specific conditions. However, multiple logistic regression analyses revealed that only the following variables were associated independently with poorer self‐rated health: age less than 75 years, education less than high school graduation, greater numbers of depressive symptoms, impaired IADLs, prescription medications, and physician visits.

CONCLUSIONS: Even when controlling for physical illness and functional disability, subjective rating of overall health remains strongly and independently associated with depressive symptoms.
Effect of the National Resident Assessment Instrument on Selected Health Conditions and Problems
Authors: Fries Brant E. , Hawes Catherine , Morris John N. , Phillips Charles D. , Mor Vince , Park Pil S.
Published: April 2015

OBJECTIVE: To evaluate the effect of the implementation of the National Resident Assessment Instrument (RAI) system on selected conditions representing outcomes for nursing home residents.

DESIGN: Quasi‐experimental, pre‐/post‐design, with assessments at baseline and 6‐month follow‐up.

SAMPLE: Two thousand one hundred twenty‐eight residents from 268 nursing homes in 10 states before RAI implementation, and 2,088 from 254 of the same nursing homes after implementation.

MEASURES: From the full RAI Minimum Data Set, measures of dehydration, falls, decubitus, vision problems, stasis ulcer, pain, dental status (poor teeth), and malnutrition were examined at baseline and 6 months later. Poor nutrition was evaluated using a body mass index score below 20 and vision using a 4‐level scale; other conditions were represented by their presence or absence. Decline and improvement were computed as the changes in level between baseline and follow‐up, limiting the sample to those who could manifest each such change.

MAIN RESULTS: Of eight health conditions representing poorer health status, dehydration and stasis ulcer had significantly lower prevalence after the implementation of the RAI (1993) compared with 1990. At the same time, there was an increase in the prevalence of daily pain. Fewer residents declined over 6 months in nutrition and vision after implementation. Although for these two conditions there were also significantly reduced rates of improvement, the net was an overall reduction in the 6‐month rate of decline for all residents. Pain also demonstrated a decline in the postimplementation rate of improvement. The combined eight conditions showed reductions in the rates of both decline and improvement.

CONCLUSIONS: Several outcomes for nursing home residents improved after implementation of the RAI. Of the four conditions for which there are significant declines in prevalence or outcome changes, three are specifically addressed in the care planning guidelines incorporated the RAI system (all except stasis ulcer, although there is a RAP for decubitus ulcer). Pain, the only other condition with a significant result — an increase in baseline prevalence — also has no RAP. Although the changes might be ascribed otherwise, they support the premise that the RAI has directly contributed to improved outcomes for nursing home residents.
Predictive Validity of the Pra Instrument Among Older Recipients of Managed Care
Authors: Pacala James T. , Boult Chad , Reed Richard L. , Aliberti Ellen
Published: April 2015

OBJECTIVE: to determine the validity of the Pra instrument in predicting the use of health‐related services by older enrollees in a managed care plan.

DESIGN: Cohort study. At baseline, a survey was administered by mail. Responses were entered into the Pra formula to estimate each person's probability of using health‐related services heavily in the future. The subjects' use of services during the following year was monitored through claims submitted to their managed care organization.

SETTING: Urban and suburban areas of Southern California.

PARTICIPANTS: Persons aged 65 years and older enrolled in a Medicare risk health plan (n = 6802).

MEASUREMENTS: Baseline data included demographic, health‐related, social, functional, and previous‐use‐of‐service characteristics. Follow‐up data included the use of and claims for payment for inpatient hospital care, emergency room services, nursing home services, home care, ambulance services, outpatient surgery, and durable medical equipment.

RESULTS: High‐risk subjects (highest quartile of Pra values) incurred hospital admissions and claims that were 2.5 and 2.7 times greater than those of low‐risk subjects (lower three quartiles).

CONCLUSIONS: The Pra formula is recommended for screening older adults enrolled in managed care organizations (as well as for screening those in the fee‐for‐service environment). It identifies older people who may benefit from interventions designed to avert health crises and the need for expensive care.
Efforts to Improve Primary Care Delivery to Nursing Home Residents
Authors: Fama Teresa , Fox Peter D.
Published: April 2015

OBJECTIVE: To describe a primary care practice model used by health maintenance organizations (HMOs) that serve Medicare beneficiaries to improve the provision of primary care to nursing home residents.

PARTICIPANTS: Medicare beneficiaries who reside in nursing homes and who are enrolled in HMOs.

CONCLUSION: Several HMOs are using physician‐nurse practitioner teams to provide primary care to nursing home residents. The potential to improve the delivery of these services in nursing homes, particularly to long‐stay residents, is apparent. However, obstacles arise in developing this practice model in HMOs, including difficulty recruiting both nurse practitioners and physicians and the lack of HMO‐based research on the effects of such a model.
GERIATRIC BIOSCIENCE: Speech Perception in Older Adults: The Importance of Speech‐Specific Cognitive Abilities
Authors: Sommers Mitchell S.
Published: April 2015

OBJECTIVE: To provide a critical evaluation of studies examining the contribution of changes in language‐specific cognitive abilities to the speech perception difficulties of older adults.

DESIGN: A review of the literature on aging and speech perception.

CONCLUSIONS: The research considered in the present review suggests that age‐related changes in absolute sensitivity is the principal factor affecting older listeners' speech perception in quiet. However, under less favorable listening conditions, changes in a number of speech‐specific cognitive abilities can also affect spoken language processing in older people. Clinically, these findings suggest that hearing aids, which have been the traditional treatment for improving speech perception in older adults, are likely to offer considerable benefit in quiet listening situations because the amplification they provide can serve to compensate for age‐related hearing losses. However, such devices may be less beneficial in more natural environments, (e.g., noisy backgrounds, multiple talkers, reverberant rooms) because they are less effective for improving speech perception difficulties that result from age‐related cognitive declines. It is suggested that an integrative approach to designing test batteries that can assess both sensory and cognitive abilities needed for processing spoken language offers the most promising approach for developing therapeutic interventions to improve speech perception in older adults.
The Association Of Antihypertensive Agents with MRI White Matter Findings and with Modified Mini‐Mental State Examination in Older Adults
Authors: Heckbert Susan R. , Longstreth W.T. , Psaty Bruce M. , Murros Kari E. , Smith Nicholas L. , Newman Anne B. , Williamson Jeff D. , Bernick Charles , Furberg Curt D.
Published: April 2015

OBJECTIVES: To examine the association of antihypertensive regimen with magnetic resonance imaging (MRI) white matter hyperintensity and with cognitive impairment in older adults.

DESIGN: Cross‐sectional study.

SETTING: The Cardiovascular Health study, an observational prospective cohort study of risk factors for coronary heart disease and stroke in men and women 65 years of age and older.

PARTICIPANTS: 1268 men and women with pharmacologically treated hypertension.

MEASUREMENTS: Information on medication use, medical history, and health habits was collected at clinic examinations. Participants completed the Modified Mini‐Mental State Examination (3MS) and underwent MRI examination. Without clinical information, study neuroradiologists assigned an overall grade of white matter signal intensity on MRI on a scale from 0 (no findings) to 9 (extensive findings).

RESULTS: Adjusted mean white matter grade was higher for users of calcium channel blockers (2.59, P = .007) and users of loop diuretics (2.60, P = .015) than for users of beta blockers (2.12). The association was present for both dihydropyridine and non‐dihydropyridine calcium channel blockers. Adjusted mean 3MS scores were lower for users of calcium channel blockers (89.6, P < .002), especially dihydropyridines, and users of loop diuretics (89.7, P < .006) than for users of beta blockers (92.3). No statistically significant association could be shown for users of other drug regimens, including thiazides and ACE inhibitors.

CONCLUSION: In this study, users of antihypertensive regimens which included calcium channel blockers or loop diuretics had more severe white matter hyperintensity on MRI and worse performance on 3MS than users of beta blockers. J Am Geriatr Soc 45:1423–1433, 1997.
Physical Activity and the Changes in Maximal Isometric Strength in Men and Women from the Age of 75 to 80 Years
Authors: Rantanen Taina , Era Pertti , Heikkinen Eino
Published: April 2015

OBJECTIVE: To research the natural changes in maximal isometric strength, over a period of 5 years, in men and women aged 75 at baseline, and to study the effect of everyday physical activity on strength alterations.

DESIGN: A 5‐year longitudinal study.

SETTING: Exercise laboratory

PARTICIPANTS: The target group in 1989 was the total 75‐year‐old population of Jyväskylä. One hundred one men (81%) and 186 women (75%) participated in baseline strength tests, and after 5 years, 55 men and 111 women (70% and 72% of the survivors) took part in the follow‐up measurements.

METHODS: Maximal isometric hand grip, arm flexion, knee extension, trunk flexion, and trunk extension forces were measured using dynamometers. Self‐rated physical activity was recorded using a scale by Grimby (1986). Strength changes were compared between groups based on the amount of everyday physical activity: (1) remained active (AA, 24 men, 24 women); (2) remained sedentary (SS, 11 men, 43 women); (3) decreased activity (AS, 11 women); and (4) increased activity (SA, 32 women). AS and SA could be formed for women only because of the small number of men. All analyses were stratified by gender.

MAIN RESULTS: The average percentage change in strength over 5 years among survivors varied from a 4% increase in knee extension strength observed in men and women to a 16% decrease in grip strength in women. The grip strength decrease was greater in women than men. The AA men maintained their trunk extension strength at a higher level than the SS men. Time by group interactions in men were not significant. In women, the rate of decline in AS was 32% in grip and 27% in elbow flexion strength, which was greater than in the other activity groups. The AA women retained their knee extension strength at a higher level than the other groups. Those who died before follow‐up tests exhibited poorer strength test results at baseline. Physical activity decreased over follow‐up.

CONCLUSIONS: Strength alterations with age differed between muscle groups. Undertaking everyday physical activities such as household work, walking, and gardening, which are also the most common physically demanding activities of older people, may play an important role in maintaining strength at an adequate level for independent living. J Am Geriatr Soc 45:1439–1445, 1997.
Differences in Psychosocial and Health Correlates of Major and Minor Depression in Medically Ill Older Adults
Authors: Koenig Harold G.
Published: April 2015

OBJECTIVES: To compare the differences in correlates of different levels of depression in medically ill hospitalized older adults.

DESIGN, SETTING, AND PARTICIPANTS: A consecutive series of 542 patients aged 60 or older admitted to the medical inpatient services of Duke Hospital underwent a structured psychiatric evaluation administered by a psychiatrist.

MEASUREMENT: A wide range of demographic, social, psychiatric, and physical health data were collected, and associations with major and minor depression were assessed. RESULTS: Compared with patients without depression, those with major depression were more likely to have a history of prior episodes of depression, higher dysfunctional attitude scores, greater overall severity of medical illness, cognitive impairment, and symptoms of pain or other somatic complaints. Specific medical diagnosis was less important a predictor of major depression than overall severity of medical illness. Compared with patients without depression, those with minor depression were more likely to report non‐health‐related stressors during the year before hospital admission, have a diagnosis of immune system disorder, and have greater severity of medical illness. When major and minor depression were compared directly, on the other hand, no significant differences were observed except for history of depression, and that relationship was weak and present only when the etiologic approach to diagnosis was used.

CONCLUSION: During hospital admission, certain psychosocial, psychiatric, and physical health characteristics of older medical patients place them at high risk for different levels of depression. Patients with major and minor depression resemble each other more than they do patients without depression. These findings may help clinicians better understand the causes of different types of depression in this setting and lead to improved diagnosis and treatment. J Am Geriatr Soc 45:1487–1495, 1997.
Psychiatric Assessments of Nursing Home Residents Under OBRA‐87: Should PASARR Be Reformed?
Authors: Borson Soo , Loebel J. Pierre , Kitchell Margaret , Domoto Sylvia , Hyde Thomas
Published: April 2015

OBJECTIVE: As part of nursing home practice reforms, OBRA‐87 mandates formal psychiatric assessments (PASARR) of nursing home residents suspected of having mental disorders, a responsibility it delegates individually to states. We describe the initial year of implementation of the PASARR process in King County, Washington, and characterize the mental disorders and mental health services needs of nursing home residents referred for psychiatric screening.

DESIGN: Cross‐sectional study.

SETTING: The 54 Medicare‐certified King County nursing homes (total beds = 7013).

PARTICIPANTS: All patients referred for psychiatric evaluation under PASARR (n = 510).

MEASUREMENTS: A systematic, multidimensional evaluation including a semistructured psychiatric diagnostic examination, validated measures of cognitive dysfunction, depression, and global psychopathology, functional variables relevant to need for nursing home care, and selected mental health services indicators.

RESULTS: Fewer than 10% of all nursing home residents were referred for psychiatric evaluation. A primary mental illness, evenly divided between psychoses and mood disorders, was found in 60% of the sample, and a psychiatric disorder associated with dementia or mental retardation was found in 25%. Six percent had complex neuropsychiatric features defying classification, and 4% had no mental disorder. Other disorders, such as substance abuse, were rare. Cognitive impairment and global psychopathology were prevalent in all diagnostic groups, and depressive symptoms were common even in patients without affective diagnoses. Eighty‐eight percent of the sample were appropriately placed, based on their needs for daily care. Fifty‐five percent had unmet mental health services needs.

CONCLUSIONS: The PASARR referral process detected a group of seriously mentally ill, functionally disabled patients, most of whom required the level of care that nursing homes provide. Depressed and psychiatrically impaired dementia patients were underrepresented in the referral pool as measured against widely accepted prevalence figures for mental disorders in nursing home populations. The PASARR process as currently configured appears to be most efficient in identifying schizophrenic patients, who represent a small minority of nursing home residents, and the skewed sample it generates fails to provide an adequate basis for estimating overall mental health services needed in nursing homes. The PASARR process should be altered to improve referral rates for depressed and behaviorally disturbed dementia patients.
Development and Testing of a Process Measure of Nursing Home Quality of Care
Authors: Holtzman Jeremy , Degelau John , Meyers Roberta , Christianson Craig , Lurie Nicole
Published: April 2015

OBJECTIVE: To develop and test quality of care process measures for three medical conditions of nursing home patients: fever, shortness of breath, and chest pain.

DESIGN: Flowsheets designed to capture the critical elements of care for the above conditions were developed by an expert panel. Nursing home residents charts were reviewed retrospectively using the flow sheets. The reviews were translated into clinical scenarios, and the quality of care the scenarios represented was rated by an expert panel.

SETTING: All nursing homes in Hennepin County, MN, that care for Medicaid patients.

PATIENTS: A random sample of 1405 Medicaid nursing home residents from 1984 and 1988.

MEASURES: Measures of quality of physician assessment and intervention, quality of nurse assessment and intervention, and global quality were developed and the intra‐ and interrater reliability were tested. The measures' validity was assessed by their ability to predict resident death.

RESULTS: Intrarater reliability was measured as the correlation of the ratings of blinded duplicates. The correlation for the global scale and the four subscales ranged from. 74 to. 88 (P <.001 for all). Interrater reliability was tested by examining what percentage of the quality ratings were within one unit (1–5 scale) for all three raters. All three raters were within one unit for more than 72% scenarios for all scales. The subscale of quality of physician assessment was able to predict resident death when the worst episode of care (OR =. 47, 95%CI(.31−.74)) or the mean episode of care (OR. 54, 95% CI(.30−.99)) was used. None of the other subscales or the global measure predicted death.

CONCLUSIONS: Through the use of an expert panel, measures of nursing home quality of care were developed for shortness of breath, fever, and chest pain. These measures have reasonable reliability and significant face validity. Their validity is supported further by the ability of one of the measures to predict resident death.
Effect of Genetic Risk Factors and Disease Progression on the Cerebrospinal Fluid Tau Levels in Alzheimer's Disease
Authors: Arai Hiroyuki , Terajima Masanori , Miura Masakazu , Higuchi Susumu , Muramatsu Taro , Matsushita Sachio , Machida Nobuo , Nakagawa Takuma , Lee Virginia M.‐Y. , Trojanowski John Q. , Sasaki Hidetada
Published: April 2015

OBJECTIVE: This study was undertaken to gain insights into the clinical utility of measuring cerebrospinal fluid tau protein (CSF‐tau) to aid in the diagnosis of Alzheimer's disease (AD).

SETTING: AD patients from Tohoku University Hospital, Sendai Japan were sampled.

SUBJECTS AND METHODS: CSF‐tau levels were examined by sandwich enzyme‐linked immunosorbent assay in a total of 62 patients carrying different α1 ‐antichymotrypsin (ACT) and presenilin‐1 (PS‐1) polymorphic alleles. Further, the CSF‐tau levels were followed up on two occasions during the progression of the disease in 17 AD patients.

RESULTS: There was no evident gradient for tau protein in CSF. Neither the ACT/A allele nor the PS‐1/1 allele affected the CSF‐tau levels. Although CSF‐tau levels changed to a variable extent over time, the CSF‐tau levels were significantly increased (P <.01) during the follow‐up period. Three of the AD patients demonstrated decreasing values, whereas 14 patients showed increasing values. Finally, these temporal changes in CSF‐tau levels were not influenced by the apolipoprotein E ∍4, ACT/A or PS‐1/1 alleles during the progression of AD.

CONCLUSION: Regardless of the mechanisms leading to the degeneration of neurons in AD, our findings provide further evidences that monitoring CSF‐tau levels may provide useful information about AD irrespective of the background of genetic risks and disease progression. J Am Geriatr Soc 45:1228–1231,1997.
Management of Erectile Dysfunction by the Geriatrician
Authors: Godschalk Michael F. , Sison Alfredo , Mulligan Thomas
Published: April 2015

Erectile dysfunction (ED) is the most common health disorder to afflict elderly men. Although 67% of men aged 70 years have ED, and their interest in sexual intercourse remains high, less than 5% receive adequate treatment. In this report, we review recent developments in our understanding of the pathophysiology of ED, how geriatricians can perform an office‐based evaluation, and rational (evidence‐based) treatment of this important disorder.
Over‐the‐Counter Medication Use in an Older Rural Community: The Mo VIES Project
Authors: Stoehr Gary P. , Ganguli Mary , Seaberg Eric C. , Echemen Deborah A. , Belle Steven
Published: April 2015

OBJECTIVE: To examine the self‐reported use of over‐the‐counter (OTC) medications and the factors associated with OTC use in a rural older population.

DESIGN: A cross‐sectional study of an age‐stratified random community sample.

SETTING: The mid‐Monongahela Valley, a rural area of Southwestern Pennsylvania.

PARTICIPANTS: A total of 1059 older individuals with a mean age of 74.5 (± 5.5) years, 96.9% of whom were white and 57.3% of whom were women.

MEASUREMENTS: Self‐reported over‐the‐counter drug use and demographic information, and information about prescription drug use and recent use of health services.

RESULTS: The majority (87.0%) of the sample were taking at least one OTC medication; 5.7% reported taking five or more OTCs. Women took significantly more OTCs than did men (P < .001). Individuals with more education took significantly more OTCs than those who had less (P = .018).

The OTC category used most commonly was analgesics (66.3% overall), followed by vitamin and mineral supplements (38.1%), antacids (27.9%), and laxatives (9.7%). The use of analgesics decreased significantly (P = .018) with increasing age, whereas the use of laxatives increased significantly (P < .001). Women were more likely than men to be using each of these four major OTC groups.

Unlike the associations with prescription drug use we reported previously in the same population, there were no significant associations for overall OTC use with age or with the use of health services. However, although vitamin use (as an example of an OTC drug taken for “preventive” purposes) was not associated with health services use, the use of laxatives (as an example of a “curative” OTC) was significantly associated (P ≤ .002) with a greater number of physician visits, emergency room visits, hospitalizations during the past 6 months, home health care service utilization, and number of prescription medications.

CONCLUSIONS: A substantial proportion of our older sample reported using a variety of over‐the‐counter drugs. Analgesics and vitamin/mineral supplements were the most frequently used categories. Women and those with more education were taking more OTC drugs. OTC use was not related to age, but the use of analgesics decreased with age while laxative use increased with age. Unlike prescription drug use, overall OTC drug use was not associated with health services utilization.
Continuity of Do‐Not Resuscitate Orders Between Hospital And Nursing Home Settings
Authors: Ghusn Husam F , Teasdale Thomas A , Jordan Darlene
Published: April 2015

OBJECTIVE: To determine the relationship between interinstitutional communication and continuity of advance directives from hospital to nursing home (NH) settings.

DESIGN: Retrospective chart review of discharges to hospital affiliated or community NHs.

SETTING: Teaching Veterans Affairs Hospital and affiliated and community nursing homes.

MEASUREMENTS: Demographic characteristics, medical diagnoses, presence of advance directives, and documentation that relates to the topic.

RESULTS: A total of 83 patients were discharged to either setting. Before discharge to a NH, the prevalence of chronic obstructive pulmonary disease and cancer was higher among those who had a DNR order. Overall, subsequent discussions about advance directives were equally common in NHs. Having a hospital discussion about advance directives or having a hospital DNR order were associated with a higher rate of advance directive discussions in NHs. Hospital DNR orders were continued for 93% and 41% of patients admitted to the hospital‐affiliated NH compared with community NHs, respectively (P < .001). Specific communication of hospital DNR status to the receiving NH was associated with better continuity of DNR orders (49% vs 9%, P = .001). Factors that predicted continuity of DNR orders in logistic regression analysis correctly included hospital DNR status, communication of advance directives to the receiving NH, and NH advance directive discussions.

CONCLUSIONS: There is higher continuation rate of DNR orders between the hospital under study and its affiliated NH than to community NHs despite a similar frequency of confirmation discussions. Completing advance directives before patients are discharged to NHs, communication of advance directives to the receiving NH, and follow‐up discussions at the NH may improve the continuity of advance directives between hospitals and nursing homes.