bluuebunny/crossref_metadata_2025 huggingface dataset:
The weakness of evidence supporting tropical niche conservatism as a main driver of current richness–temperature gradients
Authors: Boucher‐Lalonde Véronique , De Camargo Rafael Xavier , Fortin Jean‐Michel , Khair Shahira , So Rachel I. , Vázquez Rivera Héctor , Watson Dale , Zuloaga Juan , Currie David J.
Published: April 2015

Aim

Geographical variations in species richness are highly correlated with current temperature. The tropical niche conservatism hypothesis proposes that this relationship is driven by the evolutionarily conserved ancestral tolerances of species to the warm environments in which most clades originated. The hypothesis predicts that the slope of the richness–temperature gradient is positively related to the temperature of the period during which the clade originated. Here, we test this prediction for bird and mammal families in the Americas and by revisiting a global analysis of 343 groups of organisms (Romdal et al., 2013, Global Ecology and Biogeography, 22, 344–350).

Location

The Americas and world‐wide.

Methods

We computed the slope of the species richness–current temperature relationship within each bird and mammal family in the Americas. We used palaeoclimate reconstructions to estimate temperature at the time of the family's origination, taken from the fossil record. We then tested how much of the among‐family variance in the richness–temperature slope could be explained by the temperature at the time of family origination. We repeated this test for the 343 groups of organisms world‐wide.

Results

Contrary to the prediction of tropical niche conservatism, the temperature at which bird and mammal families originated does not explain variations in the richness–temperature relationships. Similarly, we show that, although the predicted relationship was statistically detected in a broad range of groups of organisms in a previous study, it in fact statistically explains only 1.2–2.9% of the variance among groups in the slope of richness gradients.

Main conclusions

We found evidence inconsistent with the hypothesis that tropical niche conservatism is the main mechanism underlying the ubiquitous richness–climate relationship.
Technical Change and the Un/Troubling of Gendered Ageing in Healthcare Work
Authors: Halford Susan , Kukarenko Natalia , Lotherington Ann Therese , Obstfelder Aud
Published: April 2015

Whilst recent years have seen increasing pressure to extend the participation of older people in the labour market, it is clear that there remain significant challenges in achieving this and that these take specifically gendered forms. This paper explores if and how these might be shaped in intra‐action with the rapid pace of technological change linked to the pervasive spread of digital technologies in the workplace. We take our theoretical lead from critical gerontology, feminist accounts of inter‐sectionality and Science & Technology Studies, which together insist on an anti‐essentialist and performative account of gendered ageing that focuses on everyday practices and the conditions that shape these in particular spaces, places and times. Our empirical focus is on healthcare work, where we find that gendered ageing appears in more or less troubled relations to the increasingly technological practices of medicine and nursing. We conclude with a discussion exploring the implications of our theoretical perspective and empirical findings.
Experimental study on the role of intra‐articular injection of MSCs on cartilage regeneration in haemophilia
Authors: Ravanbod R. , Torkaman G. , Mophid M. , Mohammadali F.
Published: April 2015

Mesenchymal stem cells (MSCs) therapy is a field in progress in cartilage repair strategies. We tried to investigate the functional properties of the joint and cartilage in experimental haemarthrosis (EH) after MSCs intra‐articular (IA) injection. One millilitre of fresh autologous blood was injected twice a week for three consecutive weeks in three groups including control haemophilia 10 days (n = 8), control haemophilia 38 days (n = 8) and MSCs (n = 8) group. In later, 10 days after the end of IA blood injections, MSCs IA injection was performed. Eight animals received no treatment as the normal control group. Thirty‐eight days after the end of IA blood injections, animals were sacrificed. Joint friction and stress‐relaxation tests were done, inflammatory cytokines of synovial membrane and scanning electron microscopy of the cartilage assessed. Joint friction decreased in MSCs in comparison to other groups and was significant with normal control group, (P = 0.011). The mechanical properties of cartilage showed no significant differences between groups. Tumour necrosis factor alpha and interleukin 1 beta decreased and IL‐4 very slightly increased in MSCs in comparison to the time‐matched control group. Scanning electron microscopy enabled acquisition of good structural properties of the surface and layers of the cartilage after MSCs injection. The hole induced in the medial plateau of the tibia bones, after inducing haemarthrosis, were covered with cartilage‐like structure. The results showed that MSCs IA injection has some beneficial effects on cartilage structure and function in haemarthrosis model and is promising in patients with haemophilia.
The Premonitory Phase of Migraine – What Can We Learn From It?
Authors: Maniyar Farooq H. , Sprenger Till , Monteith Teshamae , Schankin Christoph J. , Goadsby Peter J.
Published: April 2015

This review aims to understand the prevalence of premonitory symptoms in migraine, postulate their mechanisms, and compare these with functional imaging studies. A thorough literature review was conducted using PubMed for prevalence studies of premonitory symptoms in migraine and functional imaging studies in the premonitory phase. The majority of studies have been retrospective reporting a prevalence of 7‐88% for premonitory symptoms in migraine. Only one study has investigated premonitory symptoms prospectively and used preselected patients with recognized premonitory symptoms. The majority of patients were able to predict correctly the onset of migraine headache. Only one functional imaging study has been conducted in the premonitory phase that showed activation of posterolateral hypothalamus, midbrain tegmental area and substantia nigra, periaqueductal gray, dorsal pons, and various cortical areas including occipital, temporal, and prefrontal cortex. Subgroup analysis of patients with photophobia more than without photophobia in the premonitory phase showed activation of the occipital cortex. Comparison of patients with nausea more than without nausea in the premonitory phase showed activation in upper dorsal medulla and periaqueductal gray. Premonitory symptoms are common in migraine, although the true prevalence cannot be stated with certainty in the absence of prospective studies in unselected patients. Hypothalamic involvement can explain many of the premonitory symptoms. Activation of the the brainstem structures and hypothalamus before pain suggests a pivotal role of these structures in the pathogenesis of migraine. Hypersensitivity to light and occurrence of nausea in migraine is associated with activation of central brain structures involved in these pathways, and this can occur in the absence of pain.
Micro‐evolutionary diversification among Indian Ocean parrots: temporal and spatial changes in phylogenetic diversity as a consequence of extinction and invasion
Authors: Jackson Hazel , Jones Carl G. , Agapow Paul‐Michael , Tatayah Vikash , Groombridge Jim J.
Published: April 2015

Almost 90% of global bird extinctions have occurred on islands. The loss of endemic species from island systems can dramatically alter evolutionary trajectories of insular species biodiversity, resulting in a loss of evolutionary diversity important for species adaptation to changing environments. The Western Indian Ocean islands have been the scene of evolution for a large number of endemic parrots. Since their discovery in the 16th century, many of these parrots have become extinct or have declined in numbers. Alongside the extinction of species, a number of the Indian Ocean islands have experienced colonization by highly invasive parrots, such as the Ring‐necked Parakeet Psittacula krameri. Such extinctions and invasions can, on an evolutionary timescale, drive changes in species composition, genetic diversity and turnover in phylogenetic diversity, all of which can have important impacts on species potential for adaptation to changing environmental and climatic conditions. Using mtDNA cytochrome b data, we resolve the taxonomic placement of three extinct Indian Ocean parrots: the Rodrigues Psittacula exsul, Seychelles Psittacula wardi and Reunion Parakeets Psittacula eques. This case study quantifies how the extinction of these species has resulted in lost historical endemic phylogenetic diversity and reduced levels of species richness, and illustrates how it is being replaced by non‐endemic invasive forms such as the Ring‐necked Parakeet. Finally, we use our phylogenetic framework to identify and recommend a number of phylogenetically appropriate ecological replacements for the extinct parrots. Such replacements may be introduced once invasive forms have been cleared, to rejuvenate ecosystem function and restore lost phylogenetic diversity.
Association between Atherogenic Dyslipidemia and Recurrent Stroke Risk in Patients with Different Subtypes of Ischemic Stroke
Authors: Zhao Lu , Wang Ruihao , Song Bo , Tan Song , Gao Yuan , Fang Hui , Lu Jie , Xu Yuming
Published: April 2015

Background

The association between atherogenic dyslipidemia and stroke recurrence remains unclear, and may be influenced by different subtypes of ischemic stroke.

Aims

We aimed to investigate whether atherogenic dyslipidemia contributed to stroke recurrence in ischemic stroke patients and in those with certain subtypes of ischemic stroke.

Methods

We conducted a prospective hospital-based study enrolling patients with acute ischemic stroke. Atherogenic dyslipidemia was defined as high-density lipoprotein cholesterol <40 mg/dl and triglycerides ≥200 mg/dl. Ischemic stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment criteria. The patients were followed up at 3, 6,12 and 24 months after stroke onset. The association between atherogenic dyslipidemia and stroke recurrence was analyzed by using multivariable Cox regression model.

Results

In the 510 ischemic stroke patients, 64 patients (12·5%) had atherogenic dyslipidemia, and 66 patients (12·9%) experienced stroke recurrence events within 24 months. Kaplan-Meier analysis revealed that stroke recurrence rate was significantly higher in patients with atherogenic dyslipidemia than those without in all the stroke patients (20·3% vs. 11·9%; P = 0·048), and more evident in those of large-artery atherosclerosis subtype (31·0% vs. 14·1%; P = 0·014), but not in the other subtypes. Multivariable Cox regression analysis revealed that atherogenic dyslipidemia was associated with higher stroke recurrence risk among stroke patients of large-artery atherosclerosis subtype (hazard ratio, 2·79; 95% confidence interval, 1·24–6·28), but not significant in all the stroke patients (hazard ratio, 1·69; 95% confidence interval, 0·85–3·37).

Conclusions

Atherogenic dyslipidemia is associated with higher risk of stroke recurrence in ischemic stroke patients. Such association might be more pronounced in large-artery atherosclerosis subtype and needs further investigation to establish such relationship.
Every 15-Min Delay in Recanalization by Intra-Arterial Therapy in Acute Ischemic Stroke Increases Risk of Poor Outcome
Authors: He Anna H. , Churilov Leonid , Mitchell Peter J. , Dowling Richard J. , Yan Bernard
Published: April 2015

Background

Intra-arterial therapy has improved recanalization rates compared with intravenous thrombolysis for acute ischemic stroke; however, superior clinical efficacy has not been convincingly demonstrated. Time to recanalization is postulated as a mechanism hindering the efficacy of intra-arterial therapy.

Aim

To investigate the effects of time to recanalization on clinical outcome postintra-arterial therapy for acute ischemic stroke.

Methods

Clinical data were collected prospectively for consecutive patients undergoing intra-arterial therapy for acute ischemic stroke at a single center between 2009 and 2013. Ninety-day functional outcome was assessed by the modified Rankin scale. Univariate analyses identified candidate clinical variables for inclusion in the multivariable model; multivariable logistic regression analyses identified variables independently associated with good outcome, defined as modified Rankin scale 0–2.

Results

One hundred and seven patients were included in the analysis. Median (interquartile range) age was 67 (54–77) years, 41 (38%) were female, and median (interquartile range) baseline National Institute of Health Stroke Severity score was 18 (13–22). Median time from symptom onset to recanalization was 330 min (interquartile range 277–397). Fifty-four (50%) patients achieved a favorable modified Rankin scale at 90 days. Age, successful recanalization, and time to recanalization were independently associated with good outcome at 90 days in multivariable logistic regression analysis. For every 15 min delay in recanalization, the odds of good outcome decreased by 10%.

Conclusions

Longer time to recanalization was associated with poorer functional outcome post intra-arterial therapy. We recommend that a systematic approach to minimize time delay to treatment is warranted in intra-arterial therapy for acute ischemic stroke.
Frailty and Injuries in Later Life: The FICSIT Trials
Authors: Ory Marcia G. , Schechtman Kenneth B. , Miller J. Philip , Hadley Evan C. , Fiatarone Maria A. , Province Michael A. , Arfken Cynthia L. , Morgan Derek , Weiss Sharlene , Kaplan Michael ,   FICSIT Group
Published: April 2015

Physical frailty and fall‐related injuries present two of the biggest threats to older people's functioning and quality of life. The Frailty and Injuries: Cooperative Studies of Intervention Techniques (FICSIT) trials represent a set of eight different clinical trials concerning physical frailty and injuries in later life. This report documents the history and organization of the trials and provides an overview of the measures being collected at multiple sites and the analytic strategies to be used for multi‐site investigations.
Development of the Common Data Base for the FICSIT Trials
Authors: Buchner David M. , Hornbrook Mark C. , Kutner Nancy G. , Tinetti Mary E. , Dry Marcia G. , Mulrow Cynthia D. , Schechtman Kenneth B. , Gerety Meghan B. , Fiatarone Maria A. , Wolf Steven L. , Rossiter Jane , Arfken Cynthia , Kanten Keanna , Lipsitz Lewis A. , Sattin Richard W. , DeNino Louis A. ,   FICSIT Group
Published: April 2015

The eight FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) sites test different intervention strategies in selected target groups of older adults. To compare the relative potential of these interventions to reduce frailty and fall‐related injuries, all sites share certain descriptive (risk‐adjustment) measures and outcome measures. This article describes the shared measures, which are referred to as the FICSIT Common Data Base (CDB). The description is divided into four sections according to the four FICSIT committees responsible for the CDB: (1) psychosocial health and demographic measures; (2) physical health measures; (3) fall‐related measures; and (4) cost and cost‐effectiveness measures. Because the structure of the FICSIT trial is unusual, the CDB should expedite secondary analyses of various research questions dealing with frailty and falls.
Does the Clock Drawing Test Predict Cognitive Decline in Older Persons Independent of the Mini‐Mental State Examination?
Authors: Ferrucci Luigi , Cecchi Francesca , Guralnik Jack M. , Giampaoli Simona , Noce Cinzia Lo , Salani Bernardo , Bandinelli Stefania , Baroni Alberto ,   FINE Study Group
Published: April 2015

OBJECTIVE: To evaluate the value of the Clock Drawing Test (CDT) in predicting cognitive deterioration over a 4‐year period, independent of baseline cognitive status evaluated by the Mini‐Mental State Examination (MMSE).

DESIGN: A preplanned analysis of data collected during the second (1991) and the third (1995) follow‐up of the Italian rural cohorts of the FINE Study (Finland, Italy, the Netherlands Elderly).

SUBJECTS: Of the 427 men (mean age 77.6 ± 4.1 years; range 72–90 years) interviewed in 1991, 264 survived and were reinterviewed in 1995. The study population included 247 persons who were interviewed and received a complete cognitive evaluation in both 1991 and in 1995.

MEASUREMENTS: Cognitive assessment in 1991 included the MMSE, the Dementia Rating Scale (DRS), and the CDT. The CDT was classified as normal or pathological, based on previously established criteria. The MMSE and the DRS were repeated in 1995.

RESULTS: Independent of age and baseline MMSE score, subjects with pathological CDT compared with normal CDT had lower MMSE scores at follow‐up (P < .01). These results were also confirmed by evaluating cognitive decline through its impact on change over time in daily life autonomy, as measured by the DRS (P < .01). Among persons scoring more than 21 on the MMSE, compared with persons with a normal CDT, those with pathological CDT performance were 5.4 (95%CI: 2.1–14.2) and 5.5 (95%CI: 1.6–19.6) times more likely to have a MMSE score below 21 and 18, respectively, 4 years later, independent of age and baseline MMSE score.

CONCLUSIONS: Findings suggest that the CDT identifies older persons at high risk of cognitive decline and adds prognostic information that supplements the standard MMSE test. J Am Geriatr Soc 44:1326–1331, 1996.
Reducing Frailty and Falls in Older Persons: An Investigation of Tai Chi and Computerized Balance Training
Authors: Wolf Steven L. , Barnhart Huiman X. , Kutner Nancy G. , McNeely Elizabeth , Coogler Carol , Xu Tingsen ,   Atlanta FICSIT Group
Published: April 2015

OBJECTIVE: To evaluate the effects of two exercise approaches, Tai Chi (TC) and computerized balance training (BT), on specified primary outcomes (biomedical, functional, and psychosocial indicators of frailty) and secondary outcomes (occurrence of falls).

DESIGN: The Atlanta FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques), a prospective, randomized, controlled clinical trial with three arms (TC, BT, and education [ED]). Intervention length was 15 weeks, with primary outcomes measured before and after intervention and at 4‐month follow‐up. Falls were monitored continuously throughout the study.

SETTING: Persons aged 70 and older living in the community.

PARTICIPANTS: A total of 200 participants, 162 women and 38 men; mean age was 76.2.

MEASUREMENTS: Biomedical (strength, flexibility, cardiovascular endurance, body composition), functional (IADL), and psychosocial well‐being (CES‐D scale, fear of falling questionnaire, self‐perception of present and future health, mastery index, perceived quality of sleep, and intrusiveness) variables.

RESULTS: Grip strength declined in all groups, and lower extremity range of motion showed limited but statistically significant changes. Lowered blood pressure before and after a 12‐minute walk was seen following TC participation. Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group (P = .046 and P = .058, respectively). After adjusting for fall risk factors, TC was found to reduce the risk of multiple falls by 47.5%.

CONCLUSIONS: A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty. This intervention can also have favorable effects upon the occurrence of falls. Tai Chi warrants further study as an exercise treatment to improve the health of older people.
A Randomized Trial of Dementia Care in Nursing Homes
Authors: Rovner Barry W. , Steele Cynthia D. , Shmuely Yochi , Folstein Marshal F.
Published: April 2015

OBJECTIVE: To evaluate the efficacy of a dementia care program to reduce behavior disorders in nursing home patients with dementia.

DESIGN: Randomized controlled clinical trial with 6‐month follow‐up.

SETTING: A 250‐bed community nursing home.

PATIENTS: The nursing home was screened to identify patients with dementia and behavior disorders. A total of 118 patients were eligible for randomization. Of these, 89 (75.4%) were randomized, and 81 of these (91.0%) completed the trial.

INTERVENTION: The A.G.E. dementia care program consisted of Activities, Guidelines for psychotropic medications, and Educational rounds. The control treatment was usual nursing home care.

MEASUREMENTS: Behavior disorders, antipsychotic drug and physical restraint use, patient activity levels, and cognitive and functional status.

RESULTS: After 6 months, 12 of 42 (28.6%) intervention patients exhibited behavior disorders compared with 20 of 39 (51.3%) controls (OR = 0.38; 95% CI [0.15, 0.95]; P = .037). Controls were more than twice as likely to receive antipsychotics (OR = 2.55, 95% CI [0.96,6.76]; P < .056), to be restrained during activity times (OR = 2.98, 95% CI [1.10, 8.04]; P < .028), and to be restrained on nursing units (OR = 2.14, 95% CI [0.9,5.3]; P < .10). Intervention patients were much more likely to participate in activities (OR = 13.71; 95% CI [4.51,41.73]; P = .001).

CONCLUSIONS: The A.G.E. program reduces the prevalence of behavior disorders and the use of antipsychotic drugs and restraints. It is practical, feasible, and appears to improve the lives of patients with dementia in nursing homes. J Am Geriatr Soc 44:7–13, 1996.
Multi‐site Study of Incidence of Pressure Ulcers and the Relationship Between Risk Level, Demographic Characteristics, Diagnoses, and Prescription of Preventive Interventions
Authors: Bergstrom Nancy , Braden Barbara , Kemp Mildred , Champagne Mary , Ruby Elizabeth
Published: April 2015

OBJECTIVE: To determine the incidence of pressure ulcers in varied populations, and whether demographic characteristics (age, gender, race) and primary diagnosis are factors in pressure ulcer development when the level of risk for developing ulcers is considered. To determine if there is a difference in the type of preventive services prescribed for persons who do or do not develop pressure ulcers when risk is controlled and whether differences can be related to demographic characteristics.

DESIGN: Cohort study.

SETTING: Two skilled nursing homes, two university operated tertiary care hospitals, and two Veteran's Administration Medical Centers (VAMCs) in Omaha, NE, Durham, NC, and Chicago, IL.

PATIENTS: A total of 843 randomly selected patients more than 19 years of age who did not have pressure ulcers on admission to their place of care. Subjects were 63% male, 79% white, and had a mean age of 63 (± 16) years.

MEASURES: A head‐to‐toe skin assessment for pressure ulcers recording site and stage of ulcers, scores for the Braden Scale for Predicting Pressure Sore Risk, demographic characteristics (age, sex, race), and primary diagnosis and preventive interventions (turning or repositioning orders and pressure reduction surface) were documented on the patient record. Observations were made every 48 to 72 hours for a minimum of 1 to a maximum of 4 weeks.

MAIN OUTCOME MEASURES: Presence/absence and stage of pressure ulcers.

MAIN RESULTS: One hundred eight of 843 (12.8%) subjects developed pressure ulcers. The incidence was 8.5%, 7.4%, and 23.9% in tertiary care, VAMCs, and nursing homes, respectively. Logistic regression demonstrated that lower Braden Scale scores, older age and white race predicted pressure ulcers; gender was not predictive. Primary diagnoses were not significant predictors of pressure ulcer risk when the Braden Scale score was entered into the regression. Prescription of turning was predicted by Braden Scale scores and by white race, whereas prescription of pressure reduction was predicted by Braden Scale scores, white race, and female sex.

CONCLUSIONS: Risk assessment, rather than diagnoses or demographic characteristics, is recommended as the basis for prescriptive decisions. Risk assessment should cue health care providers to make more judicious use of turning and support surfaces to prevent pressure ulcers. Persons who are at risk for pressure ulcers should have turning and pressure reduction surfaces consistently prescribed and implemented. The costs and goals of preventive prescription for those not at risk for pressure ulcers should be considered. J Am Gcriatr Soc 44:22–30, 1996.
Use of Cardiovascular Drugs in an Older Swedish Population
Authors: Wills Phillippa , Fastbom Johan , Claesson Cecilia B. , Cornelius Christel , Thorslund Mats , Winblad Bengt
Published: April 2015

OBJECTIVE: To describe the use of cardiovascular drugs in an older population with respect to age, sex, housing type, and creatinine clearance.

DESIGN: A cross‐sectional survey.

PARTICIPANTS: All residents of a district of Stockholm (Kungsholmen), Sweden, aged 75 and older, living in institutions or at home.

MEASUREMENTS: Cardiovascular drug use, serum creatinine, electrolytes, height, weight, and symptoms.

RESULTS: A total of 43 cardiovascular (CV) drugs were used. The most common drugs were digoxin (used by 18.2%), furosemide (16.4%), and glyceryl trinitrate (12.4%). Drugs with an antihypertensive effect accounted for 61% of all CV drugs. CV drug use increased with age for cardiac glycosides and diuretics, but decreased with age for calcium antagonists and β‐blockers. Drug doses tended to be less than the recommended daily dose except for a few drugs, e.g., furosemide. There was a trend toward decreasing dose with increasing age, but this was not significant. Diuretics were the only CV drugs used more often in women. People living in institutional care used the least amount of CV drugs. The dose of drugs taken did not appear to be related to estimated creatinine clearance. Comparisons between drug use and complaint of symptoms showed a strong correlation between the use of cardiac glycosides and anorexia, calcium antagonists and constipation, and nitrates and vertigo. There were weaker correlations with cardiac glycosides and visual disturbances and with potassium sparing diuretics and a high potassium.

CONCLUSIONS: CV drugs are used commonly in older people. We suggest that the symptoms correlating with cardiac glycoside use may be signs of unrecognized toxicity, and this may relate to our finding that drug use is often not tailored to renal function as measured by creatinine clearance. J Am Geriatr Soc 44:54–60, 1996.
Outcomes for Older Men and Women with Congestive Heart Failure
Authors: Burns Risa B. , McCarthy Ellen P. , Moskowitz Mark A. , Ash Arlene , Kane Robert L. , Finch Michael
Published: April 2015

OBJECTIVES: To describe and compare outcomes for men and women discharged alive following a hospitalization for congestive heart failure (CHF).

DESIGN: Prospective cohort study

PARTICIPANTS: A total of 519 patients, aged ≥ 65, who were discharged alive after a hospitalization for CHF (DRG = 127).

MEASUREMENTS: Outcomes (Activities of Daily Living (ADLs), shortness of breath when walking, perceived health, living situation, rehospitalization, and mortality) were measured at 3 times (6 weeks, 6 months, and 1 year) post‐discharge.

RESULTS: The 205 men were, on average, younger (77 ± 7 vs 80 ± 8, P < .001), wealthier (46% vs 21% earned ≥ $10,000, P < .001), and more often married (50% vs 19%, P < .001). Men were more likely than women to have a previous history of CHF (71% vs 63%, P = .052). Men also had higher 1‐year mortality than women (48% vs 35%, P = .009), even after adjusting for age, comorbidity, physiological severity (APACHE II APS and RAND discharge instability), radiological evidence of CHF, prior ADLs, walking ability, living situation, and perceived health. Men and women survivors at 1‐year had similar and substantial impairment for all non‐fatal outcomes considered (all P values ≥ .489). Their adjusted mean ADL scores were consistent with complete dependence on one essential activity (range 0–6 dependencies); 35% were short of breath walking less than 1 block; 62% had fair or poor perceived health; 32% received some formal care; and 46% were rehospitalized within 1 year of discharge.

CONCLUSIONS: Men with CHF have a higher mortality than women with CHF. Men and women who survive have similar and substantial impairment for all non‐fatal outcomes (ADLs, shortness of breath upon walking, perceived health, living situation, and rehospitalization).
The Economic Cost of Hip Fractures in Community‐Dwelling Older Adults: A Prospective Study
Authors: Brainsky Ada , Glick Henry , Lydick Eva , MD Robert Epstein , Fox Kathleen M. , Hawkes William , Kashner T. Michael , Zimmerman Sheryl Itkin , Magaziner Jay
Published: April 2015

OBJECTIVES: To evaluate the incremental cost in the year after hip fracture.

DESIGN: Prospective cohort study

SETTING: Baltimore, Maryland

PARTICIPANTS: 759 community dwelling older patients who sustained a hip fracture and participated in the Baltimore Hip Fracture Study.

MEASUREMENTS: Resource use for direct medical care, formal nonmedical care, and informal care in the 6 months before and the year after fracture was estimated from interviews with patients or proxy respondents. Costs in 1993 dollars were estimated by multiplying resources times national unit cost estimates.

RESULTS:: The annualized costs in the year before the fracture ranged between $18,523 and $20,928. The costs in the year after the fracture equaled $37,250. The incremental costs in the year after the fracture, compared with the costs in the year before the fracture, ranged between $16,322 and $18,727. The largest cost differences were attributable to hospitalizations, nursing home stays, and rehabilitation services.

CONCLUSIONS: Because we compared the costs after a fracture with costs before, our estimates of the incremental cost of a hip fracture are lower than others in the literature. These results, obtained from interviews with patients enrolled in a cohort study, or their proxies, provide the best data available to date on the economic cost of hip fractures among community‐dwelling older persons.
A Longitudinal Examination of Functional Recovery Among Older People with Subcapital Hip Fractures
Authors: Young Yuchi , Brant Larry , German Pearl , Kenzora John , Magaziner Jay
Published: April 2015

OBJECTIVE: Few studies have examined the time‐dependent change in functional recovery along with the factors that affect the change among older hip fracture patients. The focus of this study is to examine the predictors of functional recovery in community‐dwelling older people with subcapital fractures using longitudinal data analysis methods.

DESIGN: A 1‐year prospective study. Information was obtained through structured interviews following surgery and at 2, 6, and 12 months after hospital discharge and from medical chart review.

SETTING AND PATIENTS: The sample consisted of 312 community‐dwelling older adults, admitted to one of the seven Baltimore area hospitals with a subcapital fracture, who received either internal fixation or hemiarthroplasty.

RESULTS: The longitudinal data analysis using mixed‐effects regression indicates that time and prefracture physical activities of daily living (PADL) had a significant association with PADL functional recovery over the course of 1 year. Among those 85 years and older, those who were disoriented after surgery had poorer PADL functional recovery over time than those who were not disoriented. Also, recovery in instrumental activities of daily living (IADL) was associated significantly with time, prefracture IADL function, unsteady gait prefracture, hospital length of stay, and discharge to an institution. The type of surgical procedure performed was not associated significantly with either PADL or IADL functional recovery.

CONCLUSIONS: The factors that are related to functional recovery in this study shed light on the complexity of the recovery process in hip fracture patients. The rate of recovery in postsurgical PADL and IADL function is not constant over time; postsurgical IADL function among disoriented patients (without dementia) continues to deteriorate over time compared with the nondisoriented group; this difference in trends of deterioration on IADL function is most profound in the oldest‐old aged group, those 85 and older. The types of surgical procedure performed was not significantly associated with postsurgical functional recovery.
Prevalence of Diabetes and Effect on Quality of Life in Older French Living in the Community: The PAQUID Epidemiological Survey
Authors: Bourdel‐Marchasson Isabelle , Dubroca Bénédicte , Manciet Gérard , Decamps Arnaud , Emeriau Jean‐Paul , Dartigues Jean‐François
Published: April 2015

OBJECTIVES: To evaluate the prevalence of diabetes mellitus in older French subjects and to examine the different aspects of quality of life in an older diabetic population.

DESIGN: From a random sample of 2792 people older than age 65 living in the community, a diabetic sample was selected using three items from a questionnaire: Are you diabetic? Are you on a diabetic diet? What kind of medications do you take daily? Validation of the questionnaire was carried out previously to correct the observed prevalence.

MEASUREMENTS: The questionnaire assessed social and demographic aspects, physical, mental, and subjective health, and functional disabilities. Because quality of life assessment was mainly subjective, demented subjects were excluded.

RESULTS: The diabetic group consisted of 237 subjects from the older sample of 2792 (8.5%). No age difference was demonstrated between the two groups (mean, distribution), but the male/female ratio was significantly higher in those with diabetes (49.4% vs 39.3%, P = .003). Corrected prevalence of diabetes was 10.3%. After exclusion of demented subjects, 230/2726 people were investigated. Diabetic subjects were heavier (P < .001), had higher systolic blood pressure (P < .001), and had more frequent symptoms of ischemic heart disease (P < .001) and painful peripheral arterial disease (P < .001) and dyspnea (P < .001), but antecedents of stroke were similar in both groups. Diabetics were more often lacking in autonomy according to the IADL Lawton scale (P < .001), Rosow and Breslow scale (P < .001), and Mobility scale (P = .043), but not according to the Katz ADL scale. They more often exhibited symptoms of depression on the CES‐D self‐rating scale (21.3% vs 12.7%, P < .001), but evaluation of cognitive function was similar in both groups.

Thirteen percent of diabetics, compared with 7.6% of non‐diabetics, were unsatisfied with their own situation (P = .002). Health was rated as fair, bad, or very bad by 67.8% of diabetics compared with 49% of non‐diabetics (P < .001). Diabetics rated themselves as feeling worse than others (15.3% vs 9.2%, P << .001) and worried more about their health status (78% vs 63%, P << .001).

CONCLUSION: The observed prevalence of diabetes in older French people living in the community was 8.5%. Quality of life in older diabetics was poorer than that of other people of the same age.
MODELS OF GERIATRICS PRACTICE: A University‐Affiliated Community Hospital Inpatient Geriatrics Program Functioning in an Administrative and Educational Capacity*
Authors: Cefalu Charles A. , Colbourne George , Duffy Maureen , Johnson Ernest , Lestter Mary , Wright Jeff
Published: April 2015

OBJECTIVE: To demonstrate an unusual form of inpatient geriatric assessment with unique outcomes.

DESIGN: A prospective evaluation of patients admitted to a community hospital‐based inpatient geriatrics unit utilizing traditional members of the assessment team along with educational assessment of nurses and satisfaction profiles of patients and/or families.

SETTING: A non‐profit community hospital in Northeast Washington, DC.

PARTICIPANTS: All patients older than age 62 admitted to the 42‐ bed Geriatric Unit during a 4 1/2 year time period.

MEASUREMENTS: Number of total and category recommendations taken by attending physicians from the Inpatient Geriatric Assessment Team, periodic evaluation of unit nurses' geriatric knowledge base and certification, and patient satisfaction through periodic surveys.

RESULTS: More than 4500 patients have been evaluated during the past 4 1/2 years. The number of recommendations taken by attending physicians has averaged 31.3 to 50.7% during four consecutive chart reviews involving the first 25 consecutive patients for the month each performed every six months (n = 100). The average age of patients evaluated was 77.2 (minimum of 62 and maximum of 97); 67% were females and 33% males. The average number of recommendations communicated per patient was 4.1, and the average number adhered to 1.6/patient. The overall knowledge base and certification in geriatric nursing has increased significantly over a 2.5‐year period. Composite monthly unit patient satisfaction survey scores increased as well.

CONCLUSIONS: The program is unique in its development, limitations, and outcomes. Other than the cost of limited geriatric nurse practitioner and faculty salary support, the program has been implemented using only current hospital department personnel. The role of the assessment team is to educate attending nurses and staff physicians. It has not yet been possible to measure objective outcomes. However, the current program also serves the purpose of introducing a new medical program to a community hospital in a nonthreatening way and offers opportunities for research. In addition, the program offers further opportunity for expansion and change.
Postural Balance and Self‐Reported Functional Ability in 75‐Year‐Old Men and Women: A Cross‐National Comparative Study
Authors: Era P. , Avlund K. , Jokela J. , Gause‐Nilsson I. , Heikkinen E. , Steen B. , Schroll M.
Published: April 2015

OBJECTIVE: To study postural balance in relation to selfreported functional ability (mobility and ADL) and general physical activity in elderly men and women living in three different Nordic environments.

PARTICIPANTS: A random sample of 448 men and 556 women from among the 75‐year‐old residents in Glostrup, Denmark, and Göteborg, Sweden, and all the residents of relevant age (127 men and 261 women) in Jyväskylä, Finland.

MEASUREMENTS: Assessment of postural balance with eyes open and closed using a piezoelectric force platform. A structured interview on self‐reported functional ability and physical activity. An in‐laboratory medical examination.

RESULTS: In spite of some differences in balance between the groups studied (better results in women compared with men and, to some extent, better results in the participants from Denmark and Finland than in those from Sweden), the performance in the balance tests was similarly associated with functional ability within all groups. The subjects reporting no need of help in performing the ADL and mobility functions performed significantly better in the balance tests. These differences were seen more clearly in the control of anteroposterior movement of center of forces than in the mediolateral direction. The performance in the balance tests was also significantly better among the subjects reporting a higher level of general physical activity than in their less active counterparts. Physical activity and certain long standing illnesses modified significantly the relationship between postural balance and ADL‐performance. When these factors were analyzed simultaneously, the role of balance as a predictor of ADL‐performance largely disappeared.

CONCLUSIONS: The results suggest that good balance is one of the prerequisites of performance without difficulty in mobility and ADL functions. Physical exercise may help to maintain balancing abilities in old age; good balance, in turn, may also enable a physically active way of life. The associations of balance with functional ability and physical activity were independent of sex and locality. The results also support the validity of static stabilometry as a tool for evaluating threats to functional limitations in older subjects.
Predictors of Pressure Ulcer Healing Among Long‐Term Care Residents
Authors: Berlowitz Dan R. , Brandeis Gary H. , Anderson Jennifer , Brand Harriet K.
Published: April 2015

OBJECTIVES: To identify predictors of pressure ulcer healing among long‐term care residents.

DESIGN: A retrospective cohort study.

SETTING: Department of Veterans Affairs (VA) long‐term care facilities.

PARTICIPANTS: All long‐term care residents with a pressure ulcer on April 1, 1993, who remained institutionalized as of October 1, 1993. Patients and pressure ulcer status were identified from the Patient Assessment File, a VA administrative database.

MEASUREMENTS: Pressure ulcers were considered healed if patients were without an ulcer on October 1, 1993. Predictors of pressure ulcer healing were selected from among patient characteristics in the Patient Assessment File.

RESULTS: Pressure ulcers were present in 7.7% of the long‐term care residents institutionalized as of April 1, 1993. Among the 819 pressure ulcer patients remaining institutionalized as of October 1, 1993, ulcers had healed in 442 (54.0%). Seventy‐two percent of patients with Stage 2 ulcers were ulcer‐free at 6 months, compared with 45.2% of patients with Stage 3 ulcers and 30.6% of those with Stage 4 ulcers (P < .001). Significant (P < .05) independent predictors of healing included pressure ulcer size (Odds ratio (OR) = 5.2 for Stage 2 ulcers, OR = 1.5 for Stage 3 ulcers), older age (OR = 1.5), and receiving rehabilitation services (OR = 1.3 for each additional type of therapy). Both immobility (OR = .3) and incontinence (OR = .7) were associated with ulcers not healing.

CONCLUSIONS: Most Stage 2 pressure ulcers, and many larger ulcers encountered in long‐term care settings will heal. Baseline patient characteristics are important predictors of healing. Interventions may then be targeted at patients whose ulcers are unlikely to heal, and observed facility performance may be compared with expected outcomes.
Functional Outcome of Cognitively Impaired Hip Fracture Patients on a Geriatric Rehabilitation Unit
Authors: Goldstein Felicia C. , Strasser Dale C. , Woodard John L. , Roberts Vicki J.
Published: April 2015

OBJECTIVES: To compare outcomes (physical functions and discharge destinations) of cognitively impaired and intact older hip fracture patients, and to identify cognitive skills related to functional gains.

DESIGN: Prospective longitudinal study of hip fracture patients treated on an acute inpatient rehabilitation service, with evaluation of functional performance and living status determined at admission and discharge.

SETTING: A specialized inpatient geriatric rehabilitation program at Wesley Woods Geriatric Hospital, which is affiliated with Emory University School of Medicine.

SUBJECTS: Fifty‐eight hip fracture patients, 35 with and 23 without cognitive impairment.

MEASUREMENTS: Cognitive functioning measured by the Mattis Dementia Rating Scale (MDRS); functional outcome assessed by the Functional Independence Measure (FIM); comparison of pre‐fracture with discharge living environments.

MAIN RESULTS: Both cognitively impaired and intact hip fracture patients exhibited similar overall FIM motor improvements as well as functional gains in specific FIM areas measuring self‐care, sphincter control, and locomotion (e.g., walking). Cognitively intact patients, however, displayed significantly greater gains in mobility (e.g., transfers) at discharge. Cognitively impaired patients who lived in the community were as likely as intact patients to return to the community. Patients who entered the program at a modified dependence level (FIM 3–5) and achieved motor independence at discharge (FIM 6–7) had higher MDRS initiation/perseveration and memory scores.

CONCLUSIONS: Hip fracture patients with cognitive impairments can achieve positive outcomes as defined by functional improvement and discharge destination. Intensive post‐fracture rehabilitation in the early phase of recovery may promote functional independence and a return to the community for older patients at risk for nursing home placement. Future research should examine the long‐term maintenance of these improvements and explore how rehabilitation interventions can be altered to enhance outcome.
A Comparison of Nursing Home‐Acquired Pneumonia Patients with Patients with Community‐Acquired Pneumonia and Nursing Home Patients Without Pneumonia
Authors: Marrie Thomas J. , Blanchard Wade
Published: April 2015

OBJECTIVES: To determine the factors responsible for mortality and characteristics unique to patients with nursing home acquired pneumonia (NHAP).

DESIGN: A prospective study of 71 patients with NHAP, 79 patients admitted from nursing homes for conditions other than pneumonia (NP), and 93 patients with community‐acquired pneumonia (CAP).

SETTING: A teaching hospital that serves as the community hospital for the City of Halifax.

RESULTS: The 32% in‐hospital mortality rate for NHAP was higher than the 14% rate for CAP (P < .05) but not significantly higher than the 23% mortality rate for NP patients. The most important determinants for long‐term (52 weeks) outcome were complications during hospital stay, odds ratio for mortality 3.55, and self sufficiency at time of admission, odds ratio for mortality 0.306. While bacteremia rates were similar at 8% for NHAP, 13% for CAP, and 17% for NP, there was a trend toward a higher rate of pneumococcal bacteremia in the CAP group. CAP patients were more likely to receive ventilatory support, 13% versus 3% for NHAP and 4% for no pneumonia patients despite similar levels of hypoxemia in the two pneumonia groups.

CONCLUSIONS: The in‐hospital mortality rate for NHAP is higher than that for CAP. The 1‐year survival rate is determined by self‐sufficiency at time of admission and absence of complications during hospital stay and is not group (e.g., nursing home) dependent.
Foot Position Awareness in Younger and Older Men: The Influence of Footwear Sole Properties
Authors: Robbins Steven , Waked Edward , Allard Paul , McClaran Jacqueline , Krouglicof Nicholas
Published: April 2015

OBJECTIVES: To test the hypotheses that foot position awareness is related positively to stability, positively to shoe sole hardness, and negatively to shoe sole thickness, and that foot position awareness declines with advancing years.

SETTING: Older subjects were consecutive volunteers from a medical clinic; younger subjects were volunteers from the community.

DESIGN: Randomized‐order, cross‐over, controlled comparison.

PARTICIPANTS: Older subjects were a random sample of 13 healthy men, mean age 72.58 years, SD ± 4.50. Younger subjects were a random sample of 13 male subjects from the general population, mean age 28.13 years, SD ± 3.96. Additional selection criteria were absence of disabilities influencing ability to walk and no history of frequent falls.

MEASUREMENTS: Balance failure frequency, defined as falls per 100 meters of beam walking; rearfoot angle in degrees, measured via an optical position measurement system; perceived maximum supination when walking, in degrees, estimated by subjects using a ratio scale; foot position error, in degrees, was defined as the rearfoot angle minus perceived maximum supination.

RESULTS: Foot position error during walking: (1) increases with advancing years; footwear conditions absolute mean error for older sample of 15.48°, SE ± 1.56°, and younger sample 5.44°, SE ± 1.03° (P > .001); (2) is positively related to stability (r = .367, P < .001); (3) is positively related to midsole thickness (F(1,11) = 19.89, P < .001); (4) is negatively related to midsole hardness (F(2,22) = 29.80, P < .001); (5) correlates best with perceived maximum supination (r = .901, P < .001).

CONCLUSION: Foot position awareness is related causally to stability; shoes with thin, hard soles provide better stability for men than those with thick, soft midsoles. Foot position awareness declines with advancing years.