bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of the Cumulative Illness Rating Scale in a Geriatric Residential Population
Authors: Parmelee Patricia A. , Thuras Paul D. , Katz Ira R. , Lawton M. Powell
Published: April 2015

OBJECTIVE: To evaluate the validity of the Cumulative Illness Rating Scale (CIRS) in a geriatric institutional population by examining its associations with mortality, hospitalization, medication usage, laboratory findings and disability.

DESIGN: A validation of the CIRS using self‐ and physician‐report surveys, with archival data drawn from medical charts and facility records.

SETTING: Long‐term care facility with skilled nursing and congregate apartments.

PARTICIPANTS: Four hundred thirty‐nine facility residents selected on the basis of completeness of self‐report data and physician ratings.

PRIMARY MEASURES: Composite measures of illness severity and comorbidity, based on physicians' CIRS ratings; time to death or acute hospitalization after assessment; medication use, drawn from pharmacy records; medical chart data on laboratory tests; self‐reported functional disability.

RESULTS: CIRS illness severity and comorbidity indices, as well as individual CIRS items, were significantly associated with mortality, acute hospitalization, medication usage, laboratory test results, and functional disability. The CIRS showed good divergent validity vis a vis functional disability in predicting mortality and hospitalization.

CONCLUSIONS: The CIRS appears to be a valid indicator of health status among frail older institution residents. The illness severity and comorbidity composites performed equally well in predicting longitudinal outcomes. Item‐level analyses suggest that the CIRS may be useful in developing differential illness profiles associated with mortality, hospitalization, and disability.
Prevalence and Subtypes of Dementia in Taiwan: A community Survey of 5297 Individuals
Authors: Liu Hsiu‐Chih , Lin Ker‐Neng , Teng Evelyn Lee , Wang Shuu‐Jiun , Fuh Jong‐Ling , Guo Nai‐Wen , Chou Pesus , Hu Han‐Hwa , Chiang Benjamin N.
Published: April 2015

OBJECTIVE: To study the prevalence rate of dementia in Taiwan, the relative frequencies of its subtypes, and its associations with age, education, gender, and residence location.

PARTICIPANTS: A total of 2753 men and 2544 women from four urban and four rural communities participated. Their age ranged from 41 to 88 years; 28% of them were at least 65 years old. Their education ranged from 0 to 20 years; 27% of them had less than 1 year of formal schooling.

DESIGN: Phase I was a screening survey by trained nurses who administered a Chinese version of the Mini‐Mental State Examination, the MMSE‐T1, to all participants. Phase II involved the assessment for dementia by neurologists on the 1521 individuals who had scored less than 24 on the 30‐point MMSE‐T1.

MAIN RESULTS: Thirty‐one cases of dementia were identified by the DSM‐III‐R criteria, including 18 cases of Alzheimer's disease, 10 cases of vascular dementia, and three cases of other dementias. The prevalence rate in individuals aged 65 and over was 2.0%. Aging and illiteracy were associated with higher rates of dementia; gender and residence location made no difference.

CONCLUSIONS: The prevalence rate of dementia was low in this Chinese population. consistent with common findings from other parts of the world, a high rate of dementia was associated with older age and illiteracy, and Alzheimer's disease was the most frequent cause.
High Density Lipoprotein Cholesterol is Associated with Serum Cortisol in Older People
Authors: Varma Vivek K. , Rushing Julia Thomas , Ettinger Walter H.
Published: April 2015

OBJECTIVE: To determine the associations between serum cortisol and HDL cholesterol, other lipoprotein lipids and cardiovascular risk factors, carotid atherosclerosis, and clinical heart disease in older people.

DESIGN: A cross‐sectional, observational, ancillary study of the Cardiovascular Health Study (CHS).

POPULATION: A total of 245 community‐dwelling people, 65 to 89 years old, were recruited consecutively for a 2‐month period from the CHS cohort in Forsyth County, North Carolina.

METHODS: Cortisol was measured by radioimmunoassay in serum collected between 7:00 and 10:00 AM after an overnight fast. Cortisol levels were correlated with lipoprotein lipids, insulin, glucose, body mass index, waist‐hip ratio, prevalent coronary heart disease, hypertension, diabetes, and carotid atherosclerosis by B‐mode ultrasound.

RESULTS: Serum cortisol was correlated negatively (r = ‐.24) with body mass index and waist‐hip ratio (r = ‐.16) but was not related significantly to fasting insulin or glucose. Cortisol was not associated significantly with triglyceride and low density lipoprotein cholesterol but showed a positive correlation (r = .21) with high density lipoprotein cholesterol. The relationship between cortisol and high density lipoprotein cholesterol persisted after adjustment for gender, body mass index, waist‐hip ratio, cigarette and alcohol use, triglyceride level, and diabetes. There was a trend toward a negative correlation between cortisol and measures of carotid atherosclerosis, but no significant relationship was indicated between cortisol and prevalent coronary heart disease, hypertension, or diabetes.

CONCLUSION: Endogenous glucocorticoid levels correlated with HDL cholesterol levels and may play a role in the physiologic regulation of high density lipoprotein levels in older people.
Insulin‐like Growth Factor 1 and Functional Status in Healthy Older Men
Authors: Papadakis Maxine A. , Grady Deborah , Tierney Mary Jo , Black Dennis , Wells Lauren , Grunfeld Carl
Published: April 2015

OBJECTIVE: To determine if insulin‐like growth factor 1 (IGF‐1) is associated with strength and functional ability in healthy older men.

DESIGN: Cross‐sectional study.

SETTING: San Francisco Department of Veterans Affairs Medical Center.

PARTICIPANTS: One hundred four ambulatory community‐dwelling men.

MEASUREMENTS: Serum IGF‐1 levels were obtained. Measured variables included strength of the knee flexors and extensors, handgrip, score on the Physical Performance Test, body composition, and three tests of cognitive function.

RESULTS: The subjects' mean age was 75.5±4.9 (SD) years (range 70–94 years), and their mean IGF‐1 level was 134.7±43.6 ng/mL. The univariate association of age with the variables was much stronger than the univariate association of IGF‐1 with the same variables. In multivariable models, age, but not IGF‐1, was associated with the variables.

CONCLUSION: In this study of healthy older men, age is the most important variable in predicting functional decline. There was no association of IGF‐1 levels to functional status independent of age. J Am Geriatr Soc 43:1350–1355,1995.
Hyponatremia in a Nursing Home Population
Authors: Miller Myron , Morley John E. , Rubenstein Laurence Z.
Published: April 2015

OBJECTIVE:To determine the prevalence of hyponatremia in a nursing home population and to identify clinical factors that increase the risk for development of hyponatremia.

DESIGN:Retrospective and prospective record review.

SETTING:A Veterans Affairs nursing home care unit.

PATIENTS:One hundred nineteen residents, who ranged in age from 60 to 103 years. Sixty ambulatory patients, 62 to 91 years of age, who attended a geriatric medicine outpatient clinic served as a reference population.

MEASUREMENTS:Most recent serum sodium, creatinine, BUN, and all serum sodium determinations during the preceding 12 months; clinical diagnoses, diet, medications, and significant events at the time of recorded hyponatremic episodes; response to acute water loading in a subset of patients; number of deaths in the 12 months following entry into the study.

RESULTS:In the 119 nursing home patients, ages 60 years or older, the most recent serum sodium identified 18% who were hyponatremic, compared with a prevalence of 8% in similarly aged ambulatory patients. When all serum sodium determinations for the previous 12 months were examined, 53% of the nursing home patients had at least one episode of hyponatremia during this time period. There was a high incidence of central nervous system (CNS) and spinal cord disease in the total nursing home population. Episodes of hyponatremia were frequently associated with an increased intake of fluids, given either orally or intravenously, and with tube feeding. Water load testing revealed abnormal water handling consistent with the syndrome of inappropriate antidiuretic hormone (ADH) secretion in 18 of 23 patients who had a history of hyponatremia. Seventeen percent of the patients with hyponatremia died over the following 12 months, compared to a death rate of 21% in the normonatremic patients.

CONCLUSIONS:Hyponatremia is a common occurrence in nursing home residents and may be a consequence of abnormal ADH secretion resulting from CNS disease. Exposure to increased fluid intake, or to a low sodium tube‐feeding diet, can lead to the onset of hyponatremia or to a worsening of an already present low‐serum sodium concentration.
Attitudes of Beginning Medical Students Toward Older Persons: A Five‐Campus Study
Authors: Reuben David B. , Fullerton Judith T. , Tschann Jeanne M. , Croughan‐Minihane Mary
Published: April 2015

OBJECTIVE: To examine the attitudes of beginning medical students toward older persons and their medical care.

DESIGN: Cross‐sectional survey.

SETTING: Five University of California medical schools.

PARTICIPANTS: Beginning medical school students from the Class of 1994.

MEASUREMENTS: Demographic characteristics, personal contacts with older persons, and previous coursework or research experience with older persons were assessed. Knowledge with regard to aging was measured with a group of 10 questions, which were modified from the Facts on Aging Quiz. The attitudes of students toward older persons were assessed using the Aging Semantic Differential (ASD), the Maxwell‐Sullivan Attitude Scale (MSAS), and two case scenarios.

RESULTS: Ninety‐two percent of the participants (554 of 603) responded; 93% of these responses were usable. Students were much less likely to admit an acutely ill 85‐year‐old woman to an intensive care unit, intubate her, and treat her aggressively than they were to treat an acutely ill 10‐year‐old girl with underlying chronic leukemia. In multivariate models, male gender and younger student age were both independently predictive of less favorable attitudes regarding a 70‐year‐old person on the ASD Instrumental‐Ineffective subscale. Asian‐Americans and males had less favorable attitudes on the Autonomous‐Dependent and the Personal Acceptability‐Unacceptability subscales. More knowledge with regard to aging was predictive of more favorable attitudes on the Autonomous‐Dependent and Personal Acceptability‐Unacceptability subscales. Male gender and Asian‐American ethnicity were significantly associated with less favorable attitudes on the two scales derived from the MSASs. Students who had previously visited a long‐term care facility were more likely to disagree that it takes too much time to care for older persons.

CONCLUSION: Beginning medical students have already formed some unfavorable attitudes about older persons. Few independent predictors (either sociodemographic or students' previous experiences) of student attitudes could be identified that would help in the selection of students who had more favorable attitudes toward older persons. Hence, attempts to generate physicians with good attitudes must rely on curricular efforts during medical school and residency training.
Depression in a Long‐Term Care Facility: Clinical Features and Discordance Between Nursing Assessment and Patient Interviews
Authors: Burrows Adam B. , Satlin Andrew , Salzman Carl , Nobel Kenneth , Lipsitz Lewis A.
Published: April 2015

OBJECTIVE: Nurses commonly observe more depression than is diagnosed and treated in nursing homes. Accordingly, we aimed to describe the clinical features of untreated nursing home residents whom nurses identify as depressed and to compare nurse ratings of depressed nursing home residents with ratings from direct interviews and patient self‐reports.

DESIGN: Cross‐sectional survey followed by semi‐structured diagnostic interviews of depressed patients and their nurses.

SETTING: A large academic, multi‐level, long‐term care facility.

PARTICIPANTS: Thirty‐seven patients aged 74–99 (mean age 88.4) whom nurses identified as having daily symptoms of depression. Subjects had Mini‐Mental State Exam (MMSE) scores >10 (mean score 21.2), were not acutely or terminally ill, and were able to participate in an interview.

MEASUREMENTS: DSM‐III‐R mood diagnoses and separate ratings of interviews with nurses and patients using the Cornell Scale for Depression.

RESULTS: Nurses observed daily symptoms of depression in 110 of 495 (22%) long‐term care residents on units not reserved for advanced dementia. Of these 110 patients, 58 (53%) were not receiving antidepressants. Of 37 patients eligible for interviews, nine met criteria for major depression, 20 met criteria for another non‐major depression diagnosis, and eight did not have a diagnosable mood disorder. Cornell scale ratings derived exclusively from interviews of nurses were similar across the three diagnostic groups (12.5, 9.9, and 9.5, respectively; P = .31; mean 10.5), whereas Cornell scale ratings from patient interviews differed among groups (15.9, 6.9, and 4.1, respectively; P < .001; mean 8.4). Correlation between nurse Cornell ratings and patient Cornell ratings was poor (r = .27), especially for patients with non‐major forms of depression (r = ‐.20). MMSE and Cumulative Illness Rating Scale (CIRS‐G) scores were similar in the three groups.

CONCLUSIONS: Nurses frequently observed symptoms of depression in a long‐term care setting, and many symptomatic patients were not being treated with antidepressants. In these patients, nurse‐derived symptom ratings did not vary across DSM‐III‐R diagnostic categories and correlated poorly with ratings from direct patient interviews. These findings suggest that nurse caregivers may contribute important diagnostic information about non‐major depression and raise questions about the application of standard diagnostic categories to late‐life depression in the nursing home.
Clinical Trials in Cognitively Impaired Older Adults: Home versus Clinic Assessments
Authors: Bédard Michel , Molloy D. William , Standish Tim , Guyatt Gordon H. , D'Souza Joseph , Mondadori Cesare , Darzins Peteris J.
Published: April 2015

OBJECTIVE: To compare the reliability of instruments used in clinical trials involving cognitively impaired older adults when the instruments are administered in‐home rather than in‐clinic and to compare withdrawal rates is these two groups.

DESIGN: This study was part of a larger n‐of‐1 clinical trial to investigate the efficacy and safety of a MAO/A inhibitor (Brofaromine) in patients with Alzheimer's disease. Participants were initially assessed at the clinic (baseline) and then randomly allocated to in‐home or in‐clinic assessments for the remainder of the trial. The baseline and second assessment (performed before initiation of the treatment) were used for the reliability analysis. Withdrawal rates were examined over the course of the 6‐month trial.

SETTING: Assessments took place at a geriatric clinic in an urban university teaching hospital and at residences of some of the patients.

PARTICIPANTS: Forty‐six Alzheimer's disease patients participated in the study, of which, 22 were randomized to in‐home assessments and 24 to in‐clinic assessments.

MEASUREMENTS: Test‐retest reliability was measured for all five instruments used in the study and was based on the first two assessments. Sample size requirements, based on within‐group variance, were calculated. Withdrawal rates were obtained for the total duration of the trial.

RESULTS: Test‐retest reliability of the instruments, as determined by intraclass correlations, was good in both groups but favored in‐clinic for all but one instrument (range: 0.47–0.90 for in‐home vs 0.57–0.92 for in‐clinic). Sample size requirements based on reliability assessment data were found to be larger for some instruments when administered in‐home. Only four in‐home patients withdrew before completion of the study, compared with eight in‐clinic patients.

CONCLUSION: The results suggest the in‐home assessments in cognitively impaired older adults may result in lower withdrawal rates but may necessitate larger sample sizes to offset larger test‐retest variability.
Limiting Treatment In Nursing Homes: Knowledge and Attitudes of Nursing Home Medical Directors
Authors: Ghusn Husam F. , Teasdale Thomas A. , Skelly Jerome R.
Published: April 2015

OBJECTIVE: To determine nursing home medical directors' knowledge about cardiopulmonary resuscitation outcome and their support of treatment limitation requests and policies.

DESIGN: Mailed questionnaire, followed by telephone interview.

PARTICIPANTS: Forty‐six medical directors of 70 community nursing homes in Harris County, Texas.

MEASUREMENTS: Medical directors were asked to estimate the CPR survival rate to discharge of all nursing home residents and that of two case scenarios. They were asked to indicate on a Likert scale their support for mandatory Do‐Not‐Resuscitate orders and for requests by nursing home patients to withhold other life support measures.

RESULTS: Responses were received from 33 directors. Overall CPR survival rate of older nursing home residents after cardiac arrest was thought to be 10.7%. The average CPR survival rate for healthy older people with witnessed arrests was believed to be 13.8%. The perceived rate for unwitnessed arrests in terminal patients was 4.6%, significantly lower than estimates for healthy older people (P = .003) and estimates of the overall survival rate (P = .02). Medical directors were split regarding mandatory Do‐Not‐Resuscitate orders for patients in vegetative states, with terminal illness, with an unwitnessed arrest, or in those older than 90 years of age. Mandatory use of Do‐Not‐Resuscitate orders for all nursing home residents was strongly opposed. Assuming a 2% survival rate did not significantly influence medical directors' opinions about mandatory DNR orders in these groups. Medical directors were more willing to support requests by stable nursing home residents to withhold resuscitation, mechanical ventilation, or hospitalization than requests to withhold antibiotics, intravenous fluids, or tube feedings (P < .005). The majority of medical directors were willing to withhold all such measures for terminal patients.

CONCLUSIONS: Health care professionals who are responsible for educating patients about the efficacy of cardiopulmonary resuscitation in nursing homes overestimate its benefit and may benefit from further education about its outcome. Although mandatory Do‐Not‐Resuscitate orders were favored for terminal or vegetative patients, medical directors are not supportive of such orders across the board. Medical directors are more willing to honor requests for treatment limitation by terminal patients than others.
Use of Unproven Therapies by People with Alzheimer's Disease
Authors: Coleman Laurel M. , Fowler Lauren L. , Williams Mark E.
Published: April 2015

OBJECTIVE: To describe the use of unproven therapies for Alzheimer's disease.

DESIGN: Descriptive survey using a written questionnaire.

PARTICIPANTS: 101 primary caregivers of people with Alzheimer's disease who attended Alzheimer's disease support group meetings.

RESULTS: Fifty‐five percent of caregivers reported that they had tried at least one alternative therapy to improve the patient's memory. Twenty percent of caregivers tried three or more unproven therapies. Vitamins were used most frequently (84%), and health foods (27%), herbal medicines (11%), “smart pills” (9%), and home remedies (7%) were also tried. Most caregivers reported trying the therapies in the early stage of the illness and did not notice significant improvement in the patient's memory. Twenty‐five percent of caregivers had tried unproven therapies for behavior problems. There was no correlation between the use of alternative therapies and the sex of the caregiver, age of the caregiver, level of caregiver frustration, presence of problem behaviors, or perceived level of physician support.

CONCLUSIONS: The use of unproven therapies by people with early Alzheimer's disease is common and cannot be predicted by characteristics of the primary caregiver. Although this use may be understandable, it exposes vulnerable people to possible side effects, increased costs, and possible exploitation. Health care workers should actively inquire about the use of alternative therapies, and explore the reasons behind their use, so that they can better understand and meet the needs of their patients and their caregivers.
Influence of Acute Inflammation on Iron and Nutritional Status Indexes in Older Inpatients
Authors: Chiari Maria Maddalena , Bagnoli Roberto , De Luca Paolo , Monti Massimo , Rampoldi Erica , Cunietti Ettore
Published: April 2015

OBJECTIVE: To investigate the relations between acute inflammation, as shown by high C‐reactive protein (CRP) serum levels, and laboratory indexes of iron and nutritional status and to ascertain whether the presence of acute inflammation affects the diagnostic reliability of these indexes.

DESIGN: Cross‐sectional study.

SETTING: Geriatric ward for rehabilitation.

PARTICIPANTS: A total of 163 patients, 77 men and 86 women aged 60 years or older.

MEASUREMENTS: CRP values > 1 mg/dL were considered to indicate the presence of acute inflammation. Iron status was explored by measuring erythrocyte mean cell volume (MCV), hemoglobin (Hb), serum iron (Fe), TIBC, percent transferrin saturation (% TS) and ferritin (SF). Nutritional status was determined by albumin (Alb) and prealbumin (pre‐Alb) serum levels.

MAIN RESULTS: In the whole series, CRP correlated significantly with all iron status variables except erythrocyte MCV (directly with SF, inversely with the others) and correlated inversely with Alb and pre‐Alb. Mean values of iron status variables were significantly different in patients with inflammation and those without: SF was higher and the other variables lower. Patients with low % TS (<16%) showed a pattern consistent with iron deficiency. Compared to the group with normal values, they had more severe anemia, lower MCV, Fe, and SF, and higher TIBC; mean Alb, pre‐Alb, and CRP values were not significantly different. The prevalence of inflammation was 50% (39.5% in the group with normal % TS). A similar pattern was observed in patients with microcytosis (MCV < 84 fL) associated with low % TS; dividing this subgroup according to SF values (low, <30 μg/L) did not provide more information because patients with acute inflammation were excluded.

CONCLUSIONS: Patients with acute inflammation present altered iron status indexes that resemble those observed in the anemia of chronic disease. Fe, TIBC and SF lose diagnostic value. The concomitant presence of microcytosis and low % TS, and to a lesser extent the presence of one of these alterations, is suggestive of iron deficiency associated with inflammation and may warrant gastrointestinal tract investigations and ferrous salt treatment. Protein‐calorie malnutrition seems to enhance the effects of inflammation on iron status indexes.
Assessing Risk for the Onset of Functional Dependence Among Older Adults: The Role of Physical Performance
Authors: Gill Thomas M. , Williams Christianna S. , Tinetti Mary E.
Published: April 2015

BACKGROUND: Approximately 10% of nondisabled, community‐dwelling adults aged 75 years and older lose independence in basic activities of daily living (ADLs) each year. The purpose of this study was to evaluate whether simple tests of physical performance could identify older adults, independent in their basic ADLs, who were at increased risk for the onset of functional dependence.

METHODS: Among a representative cohort of 1103 community‐dwelling adults aged 72 years and older, we evaluated the 664 subjects who were cognitively intact and independent in their basic ADLs at the baseline interview. All cohort members had undergone a comprehensive assessment, including a battery of qualitative and timed performance tests. The main outcome event was the onset of functional dependence, defined as a new disability in one or more of the seven basic ADLs at the 1‐year follow‐up.

RESULTS: Functional dependence developed in 53 (9%) of the 563 subjects who had complete data at the 1‐year follow‐up. Eight of the 12 qualitative tests and all six of the timed tests were significantly associated (P < .05) with the onset of functional dependence. Both qualitative and timed performance tests demarcated subjects into groups at low and high risk for functional dependence. Four timed tests—chair stands, rapid gait, 360° turn, and bending over—showed a threshold phenomenon, where the rate of new dependence increased slowly with worsening performance until a critical point (or threshold) was reached, and the rate of dependence increased substantially. For timed chair stands, for example, the rates of functional dependence within quarters of worsening performance were 5.3%, 6.3%, 6.7%, and 16%. The risk of functional dependence was markedly elevated (30%‐50%) for subjects who were unable to perform the timed tests.

CONCLUSIONS: Several simple tests of physical performance were strongly associated with the onset of functional dependence. These results support the potential use of physical performance tests to develop a risk assessment strategy that could identify subgroups of older persons, independent in all ADLs, who are at increased risk for functional dependence.
Epidemiologic and Diagnostic Aspects of Bacteriuria: A Longitudinal Study in Older Women
Authors: Monane Mark , Gurwitz Jerry H. , Lipsitz Lewis A. , Glynn Robert J. , Choodnovskiy Igor , Avorn Jerry
Published: April 2015

OBJECTIVE: To examine month‐by‐month variability of bacteriuria in a cohort of older women and to evaluate the performance of rapid diagnostic tests commonly used to indicate the presence of significant bacteriuria.

DESIGN: Prospective, observational study.

SETTING: Community housing sites and a long‐term care institution.

PARTICIPANTS: Sixty‐one women, mean age 77.6, took part in the study.

MEASUREMENTS: Midstream clean‐catch urine samples and medical information on subjects were collected at baseline, and then monthly for 6 months.

RESULTS: Bacteriuria alone (≥105 organisms per mL) occurred in 17% of all urine samples (28% of patients), bacteriuria with pyuria in 15% (26% of patients), and bacteriuria with symptoms in 3% (10% of patients). Spontaneous clearance of bacteriuria with pyuria was common (P = .30), as were new occurrences (P = .12) over 6 months of follow‐up. For the outcome of bacteriuria with symptoms, sensitivity of urinary diagnostic tests such as bacteria and pyuria on microscopic analysis, and leukocyte esterase on dipstick testing, ranged from 79 to 93%. Negative predictive values of these tests approached 100%.

CONCLUSIONS: Bacteriuria was a very common event, occurring in almost one‐fifth of all urine samples and one‐third of all subjects during 6 months of follow‐up. Month‐by‐month follow‐up indicates that the natural history of bacteriuria is marked by frequent spontaneous alternation between positive and negative events. The high negative predictive value of many simple diagnostic tests commonly used for urinary tract disease suggests that they can quickly and cost‐effectively rule out bacteriuria in the older female patient.
Age‐Related Differences in the Utilization of Therapies Post Acute Myocardial Infarction
Authors: Malone Michael L. , Sial Shahid H. , Battiola Richard J. , Nachodsky John P. , Solomon David J. , Goodwin James S.
Published: April 2015

OBJECTIVE: To describe the effect of age on the care of patients hospitalized with acute myocardial infarction (MI).

DESIGN: Retrospective chart review of all cases with a primary or secondary discharge diagnosis of acute MI.

SETTING: Two large community hospitals in Milwaukee, Wisconsin, from July 1, 1990 to June 30, 1991.

PATIENTS: There were 771 charts reviewed, of which, 149 cases were aged 54 years or younger, 203 were 55 to 64 years, 224 were 65 to 74 years, and 195 were aged 75 years or older.

MEASUREMENTS: Hospital charts were examined for use of diagnostic and therapeutic interventions, including medications and procedures, as well as length of stay and inhospital mortality.

RESULTS: Older patients were more likely to be female (18%, 20%, 38%, and 56% for the four age groups, respectively, P < .001 chi‐square for linear trend), more likely to present with congestive heart failure (31%, 39%, 51%, and 72%, P < .001), and had a higher in‐hospital mortality rate (5%, 7%, 10%, and 18%, P < .001). Older patients had a longer length of stay in the hospital. The use of cardiac catheterization in these post‐MI patients was high and did not decrease until after age 75 (85%, 88%, 88%, and 47%, P < .001). The percentage of patients receiving balloon angioplasty decreased with age (51%, 51%, 43%, and 20%, P < .001), whereas the percentage of patients receiving myocardial revascularization did not significantly differ with age (15%, 22%, 25%, and 19%, P = .46). Aspirin was less likely to be prescribed to older patients at discharge (79%, 82%, 70%, and 62%, P < .001).

CONCLUSION: A surprisingly high percentage of those older than age 65 received invasive tests and interventions. This high utilization rate coexists with our continued ignorance about the efficacy of these tests and interventions in older adults.
Age as a Determinant of Cardiopulmonary Resuscitation Outcome in the Coronary Care Unit
Authors: Brymer Chris , Gangbar Eric , O'Rourke Keith , Naglie Gary
Published: April 2015

OBJECTIVE: To determine whether age is associated with the outcome of cardiopulmonary resuscitation (CPR) in the coronary care unit (CCU).

DESIGN: Retrospective chart review.

SETTING: The coronary care units of two Canadian tertiary care teaching hospitals.

PATIENTS: Two hundred sixty‐four coronary care unit patients undergoing cardiopulmonary resuscitation between January 1, 1985 and June 30, 1992.

RESULTS: There was no significant difference in survival to discharge after CPR between patients less than 70 years of age (17.0%) and patients 70 years of age and older (17.2%) (odds ratio = 0.99; 95% confidence interval = 0.46, 1.80). Patients 70 years of age and older who survived to discharge after CPR had significantly greater lengths of stay (28.1 vs 19.3 days, P = .008).

CONCLUSIONS: Age was not associated with a difference in survival to discharge after CPR in the CCU, although a clinically significant difference could not be excluded because of limited power.
Contractures and Loss of Function in Patients with Alzheimer's Disease
Authors: Souren Liduïn E. M. , Franssen Emile H. , Reisberg Barry
Published: April 2015

OBJECTIVE: To investigate the prevalence of contractures in patients with Alzheimer's disease and to assess possible associations between contractures and cognitive and functional decline in Alzheimer's disease.

DESIGN: Case series.

SETTING: Subjects from an outpatient, university‐based, dementia research center, followed, when necessary, into residential home and nursing home settings.

PATIENTS: A consecutive sample of 161 patients (48 men, 113 women; mean age 75.3 ± 8.6 years) with a clinical diagnosis of probable Alzheimer's disease and with deficits in basic activities of daily living or more severe functional impairment.

MAIN OUTCOME MEASURES: For cognition, the Mini‐Mental State Examination (MMSE); for functioning, the Functional Assessment Staging Scale (FAST); contracture is defined as a decrease of 50% or more of the normal passive range of motion of the joint.

RESULTS: Prevalence of contractures was correlated highly with degree of functional impairment (r = .70, P < .001). More than three quarters of patients who had lost the ability to walk manifested contractures; however, contractures were found in fewer than 11% of all ambulatory patients examined. When present, contractures involved more than one extremity in 97% of cases and involved all four extremities in more than two‐thirds of patients.

CONCLUSION: Joint contractures are very common in the severe stages of Alzheimer's disease. More than a quarter of a million institutionalized residents in US nursing homes are likely to be afflicted by this potentially painful and disfiguring condition. Possible pathophysiology and contributing factors and possible means of intervention for this major source of disability are discussed.
Mechanisms of Constipation in Older Persons and Effects of Fiber Compared with Placebo
Authors: Cheskin Lawrence J. , Kamal Neel , Crowell Michael D. , Schuster Marvin M. , Whitehead William E.
Published: April 2015

OBJECTIVE: To investigate the mechanisms of constipation and the effect of fiber supplementation on physiology, mechanisms, stool parameters, and colonic transit times in a group of constipated older patients.

DESIGN: Single‐blind, randomized, placebo‐controlled fiber intervention with crossover.

SETTING: A university‐based outpatient center.

PATIENTS: Ten community‐living older men and women, healthy except for chronic constipation.

INTERVENTIONS: Patients were given either 24 g psyllium fiber or placebo fiber daily for 1 month, then crossed over to the other arm for an additional month. Structured testing, including total gut transit time and rectal and colonic manometry, was performed at the end of each intervention month. Patients recorded stool frequency, consistency, and weights daily.

RESULTS: The predominant mechanism for constipation in these patients was outlet delay caused by pelvic dyssynergia. Fiber decreased total gut transit time from 53.9 hours (placebo condition) to 30.0 hours (P < .05). Stool weights and consistency were not significantly improved by fiber, though there was a trend toward an increase in stool frequency (1.3 vs 0.8 bowel movements per day.) Pelvic floor dyssynergia was not remedied by fiber, even when constipation was clinically improved.

CONCLUSIONS: Fiber supplementation appeared to benefit constipated older patients clinically, and it improved colonic transit time, but it did not rectify the most frequent underlying abnormality, pelvic floor dyssynergia.
Thyroid Autoantibodies in Hospitalized Chronic Geriatric Patients: Prevalence, Effects of Age, Nonthyroidal Clinical State, and Thyroid Function
Authors: Szabolcs István , Bernard Wolfdieter , Horster Franz A.
Published: April 2015

OBJECTIVE: To investigate the effect of age, clinical condition, and thyroid function on the prevalence of thyroid autoantibody positivity in hospitalized chronic geriatric patients.

DESIGN: A screening study of hospitalized chronic geriatric patients.

PARTICIPANTS: 249 non‐selected, hospitalized, chronic geriatric patients more than 60 years of age and 81 20 to 40‐year‐old healthy persons.

MEASUREMENTS: Thyrotropin (TSH); thyroxine (T4) and free thyroxine (FT4); and triiodothyronine (T3), thyroglobulin (Tg), antibodies against thyroid peroxidase (AbTPO) and antibodies against thyroglobulin (AbTg) estimation in a screening study.

RESULTS: AbTPO positivity (AbTPO+) was found more often than AbTg positivity (AbTg+) (15.3% vs 9.2%, P = .04), one being positive (Ab+) in 19.3%. The occurrence was higher in females than males (Ab+:27.1% vs 7.1%, P < .001; AbTPO+:21.9% vs 5.1%, P < .001; AbTg+:13.2% vs 3.1%, P = .0052). Among the Ab+ patients, AbTPO was more often positive than AbTg (40/48 vs 21/48, P < .001). The sensitivity, specificity, and positive predictive value of Ab positivity to detect a thyroid disorder were 0.35, 0.85 and 0.38, respectively. Within the population of euthyroid geriatric patients, the occurrence of AbTg+ (χ2(2) = 8.65, P = .013) and Ab+ (χ2(2) = 8.02, P = .018) correlated positively with the age of the patients, and there was also a female predominance (AbTPO+ 18% vs 3.7% in the males; AbTg+ 13% vs 2.4%; Ab+ 25.8% vs 6.1%). When compared with 20 to 40‐year‐old subjects, only the euthyroid ≥ 80‐year‐old patients showed a significantly higher occurrence of Ab+ (26.2% vs 9.9% χ2(1) = 5.64, P = .017). In the euthyroid ≥80‐year‐old females, AbTPO+ was 25%, AbTg:22.2%, and Ab+: 36.1%!. The nonthyroidal clinical state of the euthyroid patients did not correlate with the antibody prevalence.

CONCLUSIONS: In hospitalized chronic geriatric patients, AbTg and especially AbTPO positivity is frequent, even in euthyroid patients without goiter. This aspecific Ab positivity in the euthyroid state correlates to the age, but not to the severity of the nonthyroidal clinical condition of the patients and explains why the Ab positivity is not predictive enough for thyroid dysfunction in this subpopulation. Thus, in hospitalized chronic geriatric patients the AbTg and AbTPO titers should be examined only in cases where thyroid screening (TSH) reveals abnormal results.
Older Age and the Underreporting of Depressive Symptoms
Authors: Lyness Jeffrey M. , Cox Christopher , Curry Jennifer , Conwell Yeates , King Deborah A. , Caine Eric D.
Published: April 2015

OBJECTIVE: To determine whether older age is associated with a decrease in self‐reported depressive symptoms, independent of examiner‐rated symptoms, in inpatients with major depression.

DESIGN: Survey study.

SETTING: Inpatient psychiatric units at a university medical center.

PATIENTS: Eligible subjects were those over 20 years of age with a primary diagnosis of DSM‐III‐R major depression. Participation was sought from all subjects over 60 years of age and from every second or every third younger subject, depending on rater availability. Of 137 eligible subjects, 97 completed all study measures.

MEASUREMENTS: The Beck Depression Inventory (BDI), as a measure of self‐reported depressive symptoms, was the dependent variable. The Hamilton Rating Scale for Depression (Ham‐D) was used to assess examiner‐rated symptoms.

MAIN RESULTS: Older age (P = .03) was associated negatively and examiner‐rated depressive symptoms (P = .0001) were associated positively with BDI score. Other variables, including gender, education, age of depression onset, and medical illness burden, were not independently associated with BDI. Examination of depressive symptom subtotals (psychologic/affective vs. somatic/neurovegetative) revealed that only the self‐reported psychologic/affective subtotal was significantly associated with age (P = .0018).

CONCLUSIONS: Some older patients with clinically significant depression underreport their symptoms. When asking older patients about depressive symptoms, clinicians should view negative responses only within larger clinical contexts and should obtain information from other sources as needed. Similar concerns must temper interpretation of research that relies on subject self‐report to study depression in late life. J Am Geriatr Soc 43: 216–221, 1995.
Effectiveness of Oral Antibiotic Treatment in Nursing Home‐Acquired Pneumonia
Authors: Degelau John , Guay David , Straub Kimberly , Luxenberg Michael G.
Published: April 2015

Effectiveness of Oral Antibiotic Treatment in Nursing Home‐Acquired Pneumonia

OBJECTIVE: To determine factors associated with success or failure of oral antibiotic treatment for nursing home‐acquired pneumonia (NHAP).

DESIGN: Retrospective study of outcomes for all identifiable NHAP cases in 1991.

SETTING: The Nursing Home Services Program of St. Paul Ramsey Medical Center and 31 metropolitan St. Paul, Minnesota, community nursing homes.

PARTICIPANTS: Nursing home (NH) cohort: 124 patients (mean age 85.2 years) with a new respiratory symptom and new infiltrate on portable chest X‐ray for whom oral antibiotics were prescribed. Hospital cohort: 74 NH patients (mean age 84.3 years) admitted to hospital with new X‐ray infiltrate and pneumonia diagnosis. Supportive care status patients were excluded. Forty‐three physician/nurse practitioner (MD/NP) teams were represented.

MEASUREMENTS: Nursing home cohort: Outcomes of hospitalization within 14 days or 30‐day mortality. A discriminant model was applied to predict outcome and discriminant rule performance was analyzed. Hospital cohort: 30‐day mortality.

RESULTS: Of 198 episodes of NH pneumonia, 63% were treated in the facility; 30.6% (38) failed NH treatment. Thirty‐day mortality was 13%. There was no examination by the MD or NP for 59% of NH‐treated episodes. The hospital cohort had a higher mean pulse (P < .05) but a similar frequency of feeding dependence. Hospital cohort mortality was 17.6%. The NH treatment failure group had significantly higher proportions of pulse > 90/min, temperature > 100.5°F, respirations > 30/min, feeding dependence, and mechanically altered diets. A discriminant model using these factors was significant (P = .002). The NH treatment failure rate was 11% for no factors present, 23% for two or fewer factors, and 59.5% for three or more (likelihood ratio 3.1). Thirty‐two percent of the hospital cohort had zero or one factor present and were alive at 30 days.

CONCLUSION: The majority of NHAP episodes were treated successfully with oral antibiotics, but 31% failed treatment in the NH. Patients with a mechanically altered diet or requiring feeding assistance by staff had significantly higher failure rates. Feeding dependence and need for a mechanically altered diet as well as abnormal vital signs are associated with oral antibiotic treatment failure. These factors should be considered in treatment decisions for NHAP. J Am Geriatr Soc 43: 245–251, 1995.
Life Satisfaction and Associated Factors in Older Hong Kong Chinese
Authors: Ho S. C. , Woo J. , Lau J. , Chan S. G. , Yuen Y. K. , Chan Y. K. , Chi I.
Published: April 2015

Life Satisfaction and Associated Factors in Older Hong Kong Chinese

OBJECTIVE: To determine life satisfaction and its association with physical, functional, socioeconomic, psychological, and social support characteristics in Hong Kong Chinese aged 70 years and older.

DESIGN: Cross‐sectional study.

SETTING: Territory‐wide random sample of persons aged 70 years and older.

SUBJECTS: A total of 843 men and 714 women were selected by random sampling, stratified by age and sex, from the Old age and Disability Allowance Register, after exclusion of subjects with cognitive impairment.

MEASUREMENTS: Life satisfaction was assessed by the subjects' response to the question “Are you satisfied with life”, using a 0 to 10‐point linear scale. They were also asked to name the most important factor contributing to life satisfaction. Information was also obtained regarding physical health, functional ability, depressive symptoms, and socioeconomic factors.

RESULTS: There was a weak association between score and age. Health, adequate income to meet living expenses, and caring relatives were rated the most important factors (>65%). Some of these factors were also those associated with a high life satisfaction score. Factors associated with a life satisfaction score greater than 6 points were higher social class and educational attainment, adequate income to meet living expenses, satisfactory living arrangement, Christianity, good social support, participation in social activities, functional independence, good self‐perceived health, good hearing and vision, daily exercise, absence of recurrent falls, and low depressive symptom score. Multiple logistic regression identified having two or more relatives and tertiary education as positive associated factors, whereas inadequate income to meet expenses, dissatisfaction with living arrangement, non‐participation in religious group activities, and a high depressive symptom score were negative associated factors.

CONCLUSION: In older Chinese, social factors such as the support provided by family members, as well as adequate income to meet living expenses, play a role equal to that of physical factors in contributing to life satisfaction. J Am Geriatr Soc 43: 252–255, 1995.
Dependence in Activities of Daily Living as a Risk Factor for Fall Injury Events Among Older People Living in the Community
Authors: Langlois Jean Ann , Smith Gordon S. , Nelson David E. , Sattin Richard W. , Stevens Judy A. , DeVito Carolee A.
Published: April 2015

Dependence in Activities of Daily Living as a Risk Factor for Fall Injury Events Among Older People Living in the Community
Usefulness of M‐Mode, 2‐Dimensional, and Doppler Echocardiography in the Diagnosis, Prognosis, and Management of Valvular Aortic Stenosis, Aortic Regurgitation, and Mitral Annular Calcium in Older Patients*
Authors: Aronow Wilbert S.
Published: April 2015

OBJECTIVE: To review the diagnosis, prognosis, and management of valvular aortic stenosis, aortic regurgitation, and mitral annular calcium (MAC) with emphasis on older persons.

DATA SOURCES: A computer‐assisted search of the English‐language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.

STUDY SELECTION: Studies on the diagnosis, prognosis, and management of valvular aortic stenosis, aortic regurgitation, and MAC were screened for review. Studies in older persons and recent studies were emphasized.

DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving older persons. Relevant articles were reviewed in depth.

DATA SYNTHESIS: Available data about the diagnosis, prognosis, and management of valvular aortic stenosis, aortic regurgitation, and MAC with emphasis on studies involving older persons were summarized.

CONCLUSIONS: Valvular aortic stenosis, aortic regurgitation, and MAC are degenerative cardiac disorders which are common in older people. The presence and severity of these cardiac disorders are diagnosed by M‐mode, 2‐dimensional, and Doppler echocardiography. M‐mode, 2‐dimensional, and Doppler echocardiographic techniques are also very useful in the prognosis and management of these cardiac disorders in older persons. J Am Geriatr Soc 43: 295–300, 1995.
Exercise: The Right Prescription
Authors: Busby‐Whitehead Jan
Published: April 2015

Exercise: The Right Prescription

“Those who do not find time for exercise will have to find time for illness.” Old Proverb
The Effect of a 12‐Month Exercise Trial on Balance, Strength, and Falls in Older Women: A Randomized Controlled Trial
Authors: Lord Stephen R. , Ward John A. , Williams Philippa , Strudwick Maureen
Published: April 2015

OBJECTIVE: To determine whether a 12‐month program of regular exercise can improve balance, reaction time, neuromuscular control, and muscle strength and reduce the rate of falling in older women.

DESIGN: A randomized, controlled trial of 12 months duration.

SETTING: Conducted as part of the Randwick Falls and Fractures Study in Sydney, Australia.

PARTICIPANTS: One hundred ninety‐seven women aged 60 to 85 years (mean age 71.6, SD = 5.4) who were randomly recruited from the community.

OUTCOME MEASURES: Accidental falls, postural sway, reaction time, neuromuscular control, and lower limb muscle strength.

MAIN RESULTS: Exercise and control subjects were tested before, midway through, and at the end of the trial. At initial testing, exercisers and controls performed similarly in all tests and were well matched in relevant health and lifestyle factors. The mean number of classes attended for the 75 exercise subjects who completed the program was 60.0 (range 26–82). At the end of the trial, the exercise subjects showed improved performance in all five strength measures, in reaction time, neuromuscular control, body sway on a firm surface with the eyes open, and body sway on a compliant surface with the eyes open and closed. In contrast, there were no significant improvements in any of the test measures in the controls. In one test measure, hip flexion strength, the exercisers showed continued improvement throughout the study year. There was no significant difference in the proportion of fallers between the exercise and control subjects. Interesting trends were evident, however, between falls frequency and adherence to the exercise program.

CONCLUSIONS: These findings show that exercise can produce long‐term benefits with regard to improving sensorimotor function in older persons. The findings also suggest that high compliance to an exercise program may reduce falls frequency, although further studies are required to conclusively demonstrate that exercise offers an effective means of preventing falls.