bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurement of Height in the Elderly
Authors: Haboubi N. Y. , Hudson P. R. , Pathy M. S.
Published: April 2015

Height is an essential variable when assessing renal clearance, nutritional status, and absorption. Standard methods of estimating height are impractical in the nonambulant. One hundred sixty‐five elderly inpatients were studied. Total standing height, knee‐to‐floor height, and tibial length were measured. Total arm, upper arm, and forearm measurements were obtained in both erect and supine positions. Measured height correlated best with supine total arm length (R2 = .69), knee‐to‐floor height (R2 = .63), and erect forearm length (R2 = .61). A nomogram relating both supine total arm length and knee‐to‐floor height with the patient's measured height has been prepared.
The Necessity and Safety of Calcium and Vitamin D in the Elderly
Authors: Honkanen Risto , Alhava Esko , Parviainen Markku , Talasniemi Sakari , Mönkkönen Raija
Published: April 2015

The necessity and safety of an oral calcium (Ca) and vitamin D regimen was evaluated in a population of 66 independently living and 73 institutionalized elderly women over an 11‐week winter period. The members of both groups were randomly assigned into trial and control groups. Serum Ca, creatinine, and calcidiol levels were measured before and after the trial. The regimen consisted of 1.558 g of Ca and 45 μg (equal to 1,800 IU) of vitamin D administered daily in addition to the normal diet. The controls received no treatment. A majority of the elderly subjects living independently had ensured their Ca, and a quarter of them also their vitamin D intake on their own initiative. The mean serum calcidiol concentration before the trial was 24.1 nmol/L in the institutionalized and 38.5 nmol/L in the elderly subjects living independently (P < .001). After the trial, serum calcidiol was 10.4 nmol/L in the institutionalized control subjects and had decreased (P < .001) in both control groups, but increased (P < .001) in both treatment groups. The safety indicators, serum Ca, creatinine, and calcidiol, did not indicate any group or individual side effect.
A Newly Designed Deodorant Pad for Urinary Incontinence
Authors: Fukui Junnosuke , Sakai Yoshiyuki , Hosaka Kyoko , Yamashita Toshio , Ogawa Akimi , Shirai Hirofusa
Published: April 2015

The authors designed a new pad for urinary incontinence. It is composed of a cloth of acrylonitrile copper sulfide and another cloth of iron‐phthalocyanine. In vitro experiments showed that acrylonitrile copper sulfide cloth inhibited the growth of most bacteria causing urinary tract infection, and that iron‐phthalocyanine cloth effectively eliminated bad‐smelling gases. The use of this pad relieved diaper‐dermatitis and diminished offensive smells from feces and urine. This pad was well received by nurses and helpers taking care of incontinent elderly people.
Early Endoscopic Sphincterotomy in the Management of Acute Gallstone Pancreatitis in Elderly Patients
Authors: Shemesh Eliahou , Czerniak Abraham , Schneabaum Shlomo , Nass Shlomo
Published: April 2015

Eighteen elderly patients with acute attacks of gallstone pancreatitis underwent early endoscopic sphincterotomy of the papilla of Water. Eleven patients were considered to be at high risk for surgery due to chronic cardiorespiratory or renal problems. The outcome of these patients was compared with that of 20 consecutive elderly patients with gallstone pancreatitis treated at the same time by means other than endoscopic sphincterotomy. Endoscopic sphincterotomy resulted in an immediate clinical improvement in all patients, except in one patient who developed transient cholangitis; there was no mortality. In contrast, there was one death (5%) and 20% morbidity in the controls. Mean hospitalization period was shorter in patients undergoing sphincterotomy (6 compared with 9.5 days), although the patients managed by sphincterotomy were initially more seriously ill than controls. Only two of the 11 high‐risk patients underwent elective cholecystectomy; all others were well during a mean follow‐up of 22 months. It is concluded that early endoscopic sphincterotomy is highly effective and safe in acute attacks of gallstone pancreatitis in elderly high‐risk patients.
Assessment and Quality Control of Incontinence Care in Long‐Term Nursing Facilities
Authors: Schnelle John F. , Newman Daniel R. , Fogarty Toni E. , Wallston Ken , Ory Marsha
Published: April 2015

A statistical quality‐control process was used to assess how well incontinence management procedures were being implemented by indigenous nursing staff in four nursing homes. Eighty‐one incontinent patients were treated with the prompted‐voiding toileting procedure. Thirty‐six of these patients proved responsive to the toileting procedures, and nursing home staff was instructed to maintain the toileting program for these responsive patients. The first part of the quality‐control model involved setting job standards specifying how dry the patients should be if toileted on a 2‐hour schedule. Second, a job‐monitoring control chart was used to continuously assess how well the job standards were being met. The remaining forty‐five patients, who were unresponsive to the toileting protocol, were managed with a 2‐hour changing schedule. Job standards specifying how wet (volume) the patient would be if changed on a two‐hour basis were set. Control‐chart monitoring of these patients' urine output assessed how well the changing procedures were being implemented. Incontinence care in nursing homes is difficult to supervise because of problems in measuring how consistently nursing aides change or toilet patients. This paper describes a management system for effective incontinence care.
BOOK REVIEWS
Authors: Barzel Uriel S. , Ham Richard J.
Published: April 2015

Eternally Young: A Guide to Aging Well. By McGivney SA and McGivney JH. New York, Ageless Publishing, 1989. 154 pages. Softcover, $9.95.
Copy Task Performance and Urinary Incontinence in Alzheimer's Disease
Authors: Davidson Heather A. , Borrie Michael J. , Crilly Richard G.
Published: April 2015

The relationship between behavioral symptoms and cognitive impairment in Alzheimer's Disease (AD) is only poorly understood. The aim of the present study was to examine cognitive correlates of urinary incontinence in AD. Although incontinence is generally accepted as an accompaniment of AD, it was our clinical impression that it correlated poorly with global measures of cognitive impairment. A retrospective pilot study of 17 incontinent demented patients and 17 continent patients, matched for age, sex, and total score on the Folstein Mini‐Mental Status Exam (MMSE), revealed a striking association between an inability to do a copy task and urinary incontinence. A prospective study confirmed this finding in a sample of 45 patients meeting DSMIII‐R diagnostic criteria for dementia, probable Alzheimer's disease. The 17 incontinent patients did not differ from the 28 continent patients in age, sex distribution, or total score on the MMSE. However, the incontinent subjects scored significantly lower on a cube copying task. Qualitative analysis revealed that the drawings by incontinent patients showed features comparable with those observed in the drawings by patients with right‐sided parietal lesions, in particular, poor representation of perspective and spatial orientation. Further investigation of the relationship between copying performance and incontinence may have implications for understanding the cortical mechanisms of urinary continence. The present results also underscore the limitations of the MMSE as a measure of dementia severity and suggest there are areas of cognitive ability which are inadequately assessed by MMSE but which may be of major important in understanding the loss of functional skills in the dementing patient.
Recommendations for a Change in Living Situation Resulting from an Outpatient Geriatric Assessment: Type, Frequency and Risk Factors
Authors: Altkorn Diane L. , Ramsdell Joe W. , Jackson J. Edward , Renvall Marian
Published: April 2015

We analyzed the outcomes of 480 comprehensive outpatient geriatric assessments to determine the frequency of recommendations for home help or a change in residence and to determine whether simple clinical observations could predict such recommendations. Fifty‐eight percent (280) of the patients received no recommendation for a change in the living situation. Of the 200 patients receiving a recommendation for a change in living situation, 97 (49%) were felt to be able to stay at home with increased in‐home support and/or day care, and 51.5% (103) were advised to seek placement. After adjusting for age and gender, risk factors predicting a recommendation for change were dementia (odds–ratio = 9.98), vision deficits (odds ratio = 2.02), lower education level compared to college (odds–ratio = 1.88 high school, 1.42 for < high school), an increasing number of medical diagnoses (odds–ratio = 1.49 per diagnosis), and a functional impairment on the Katz index (odds–ratio = 1.09). The presence of these risk factors should lead to consideration of further evaluation of the home environment in this study. We conclude that geriatric patients presenting for a comprehensive outpatient evaluation commonly need a change in home situation, though most can remain in their home, and that simple clinical observations can be helpful in screening patients for further evaluation of their home enviornment.
Prevalence of Dementia in the ‘Oldest Old’ of a Dutch Community
Authors: Heeren Thea J. , Lagaay Anne M. , Hijmans Willy , Rooymans Harry G. M.
Published: April 2015

Objective

To estimate the prevalence rate of dementia in subjects 85 years of age and over.

Design

A two‐phase design with the Mini‐Mental State Examination (MMSE) in the screening phase and the Geriatric Mental State Schedule (GMS) in the diagnostic phase.

Setting

Community survey including subjects in residential care.

Subjects

All (n = 1,259) inhabitants of Leiden, The Netherlands, aged 85 years and over on December 1, 1986. First phase participation rate was 71% (17% drop‐out due to death); second phase participation rate was 82%.

Main Outcome Measure

DSM‐III diagnosis of dementia without further specification of the etiology of the dementia.

Results

An overall prevalence rate of 23% (95% C.I.: 19%–26%) was found. This included 12% mild dementia, 7% moderate and 4% severe dementia. The prevalence rate was higher among women (24%) than among men (18%). It increased with age from 19% (95% C.I.: 16%–22%) in the group of 85–89 years to 32% (95% C.I.: 26%–39%) in the group of 90–94 years to 41% (95% C.I.: 25%–58%) in the 95+ group.

Conclusion

A fifth of the 85+ and a third of the 90+ population suffer from dementia with an indication that half of the 95+ population is affected. With the expected steep rise in the number of the oldest old, dementia will stay a major health problem in the near future.
Prevalence and Characteristics of Nursing Home‐Acquired Infections in the Aged
Authors: Magaziner Jay , Tenney James H. , DeForge Bruce , Hebel J. Richard , Muncie Herbert L. , Warren John W.
Published: April 2015

Objectives: This study provides estimates of the prevalence of infections in all patients from a representative sample of 53 Maryland nursing homes; identifies risk factors for these infections; and describes diagnostic procedures carried out.

Methods: The records of 4,259 patients in a stratified random sample of 53 Maryland nursing homes were reviewed for diagnostic procedures, medical, functional, and behavioral status. Infections were identified by signs, symptoms, and laboratory findings.

Results: Study patients were characteristic of aged patients in US nursing homes. The prevalence of infections actually acquired in the nursing home (80% of all infections) was 4.4%. Multivariate analysis revealed that skin infections (35% of nursing home‐acquired infections) were associated with skin ulcers and inversely with urine incontinence. Fevers of uncertain source (13%) were associated with bladder catheters. Symptomatic urinary infections (12%) and lower respiratory infections (12%) were associated with bedfast status, and the latter with tracheostomy and lung disease. Skin ulcers, urethral catheters, and bedfast status were markers for nursing home‐acquired infection. The prevalence of infection in patients with all three markers was 32%; in patients with none, 2%.

Fewer than a quarter of the four most common nursing home‐acquired infections received an evaluation which met minimal diagnostic criteria established by a panel of infectious disease specialists and geriatricians. Patients with dementia, those in large homes (>150 beds), and those in urban homes were less likely to be evaluated in a manner meeting these criteria.

Conclusions: Use of three characteristics (ie skin ulcers, urethral catheters, bedfast status) to identify patients at risk for nursing home‐acquired infections may allow targeted infection surveillance and prevention programs. In addition, nursing home‐acquired infections are not evaluated uniformly across patients and facilities, suggesting the need to establish, through further study, guidelines for such evaluations.
Teaching Physical Diagnosis in the Nursing Home: A Prospective, Controlled Trial
Authors: Mayo‐Smith Michael F. , Gordon Victor , Gillie Edward , Brett Allan
Published: April 2015

Study Objective: To investigate the suitability of the nursing home as a site for teaching physical diagnosis to second‐year medical students.

Design: Prospective comparison of teaching sessions in the nursing home to concurrent control sessions in acute care wards.

Setting: Nursing Home Care Unit (NHCU) and acute care hospital wards of a Veterans Affairs Medical Center.

Patients: Sessions with 38 NHCU patients and 68 hospital patients.

Measurements and Main Results: Patient interviews and student questionnaires were used to obtain responses on a 1–10 scale (1 = poor, 10 = excellent). Patient responses were very favorable in both settings for overall quality of experience (mean score NHCU vs control: 8.8 vs 8.6) and willingness to participate again (8.4 vs 8.2). Student ratings showed no significant differences for patient attitude (7.4 vs 8.4) or quality of exam (7.2 vs 7.7) while quality of history (6.0 vs 7.6) and overall quality of session (7.6 vs 8.6) were rated higher (P < 0.05) for the control sessions. Students rated both environments highly (8.6 vs 8.4) but reported that fewer NHCU sessions were interrupted (15% vs 25%) or disrupted by noise (6% vs 30%, P < 0.005).

Conclusions: Advantages of the nursing home include readily available patients who view participation favorably, instructive physical findings, and a suitable environment. However, students rate the quality of the histories obtained there lower. This problem could be addressed by more careful patient selection and greater emphasis by course instructors on other goals of the history in addition to exploring the chief complaint.
The Prevalence of Undiagnosed Protein‐Calorie Undernutrition in a Population of Hospitalized Elderly Patients
Authors: Mowé Morten , Bøhmer Thomas
Published: April 2015

Objective: To determine the extent to which patients with objective signs of malnutrition had been diagnosed as such by physicians and the diagnosis documented in the medical record.

Design: Cross‐sectional.

Subjects: All non‐critically ill patients (n = 121) aged 70 years or older admitted to an Oslo hospital during a 3‐week period.

Methods: Compared problem list and other elements of the medical record with observations of height, weight, triceps skinfold, midarm circumference, and arm‐muscle circumference made on first weekday in hospital. Serum albumin available on 66 subjects.

Main Results: Nine patients had weight/height ratios below 60% of normal, 16 patients between 60% and 75%, and 41 patients between 74% and 90% of normal. Of these 66 patients, only 24 were recognized as malnourished on admission, only five received nutritional support, and none was diagnosed as having malnutrition at the time of discharge.

Conclusions: Malnutrition is underdiagnosed and under‐treated. The consequences of this are likely to be deleterious to health.
Physician Response to Notification of Acute Problems in Nursing Homes
Authors: Zimmer James G. , Watson Nancy M.
Published: April 2015

A frequently cited example of physicians' alleged disinterest in nursing home patients is their failure to respond rapidly or appropriately to telephone calls about acute events or important changes in patient status.

This study of 45 SNFs and their 15 attached ICFs evaluated the length of time required to reach physicians by phone about significant clinical changes in patients' conditions and the appropriateness and timeliness of action taken by the physicians once contact was made. Calls on administrative matters, updating of orders, and similar routine calls were excluded. Seven hundred and fifty calls were identified from 24‐hour nursing reports; the nature of the problem and the time and details of physicians' responses were recorded from patient charts. Judgment on the quality of physicians' responses was made by consensus of the regional UR committee except in the case of infections where decisions were based on detailed criteria developed in a previous study. The most frequent clinical problems were acute infections (32%), trauma (12%), GI tract disorders (11%), cardiorespiratory problems (10%), neurological disorders (7%), and diabetic control (7%). Results were very encouraging: 96% of physicians' call‐backs and actions were judged to be timely, and 87% of physicians' actions taken were judged to be appropriate. However, actions taken were judged inappropriate for certain specific clinical problems, ie, in 22% (54/243) of infections, 24% (4/17) of CVA's, and 12% (6/49) of diabetic control problems. Implications for nursing home care and recommendations for improving the response to acute problems are discussed.
On the Clinical Value of the London Psychogeriatric Rating Scale
Authors: Reid David W. , Tierney Mary C. , Zorzitto Maria L. , Snow W. Gary , Fisher Rory H.
Published: April 2015

The London Psychogeriatric Rating Scale (LPRS) was administered to 76 probable Alzheimer's patients, 59 patients with dementia unrelated to Alzheimer's, 102 neurologically normal subjects, and 27 patients with symptoms of both Alzheimer's and dementia of other etiologies. By examining the relationships among the four subscales of the LPRS and conducting factor analyses, it was demonstrated that the four subscales were not measuring different phenomena. The internal consistency of the full 36‐item scale was high (Cronbach's Alpha = 0.96) indicating the total LPRS score provided a reliable global index of behavioral function. The total LPRS scores correlated with the independently administered Goldfarb Mental Status Examination scores (r = −0.79). The LPRS differentiated between the normals and the combined demented groups and between inpatients and outpatients. The LPRS continues to have clinical value for functional assessments in a non‐intrusive manner. The LPRS may be particularly useful in situations where direct assessment of mental status is not practical.
The Utilization of the Durable Power of Attorney for Health Care among Hospitalized Elderly Patients
Authors: Cohen‐Mansfield Jiska , Droge Janet A. , Billig Nathan
Published: April 2015

Objective: To explore the potential use of the durable power of attorney for health care (DPAHC), considerations in executing a DPAHC, and influences in making decisions related to it.

Design: Interview with follow up.

Setting: A teaching hospital.

Subjects: 37 males, 60 females, aged 64–97.

Methods: Interview of ninety‐seven hospitalized patients and followup telephone interview of those who had not originally executed a DPAHC after 3 months. Patients were asked whom they would appoint as an agent for health care decisions, how this person was related to them, and why they chose this person. Patients' cognitive functioning and level of depression were assessed.

Results: Most patients (65%) chose their closest relative to make health care decisions for them if they were unable to. Reasons for choosing this person included: the agent knew the patient best, was the closest relative, and was most accessible geographically. Over half of the participants had not discussed their feelings about health care decisions with anyone. Sixteen percent had previously executed a durable power of attorney for health care, and 46% said they intended to execute one. Executing a durable power of attorney for health care was associated with higher levels of cognitive functioning but not with level of depression.

Conclusions: Both an understanding of advanced directives and a general outlook on matters of life and death seem to affect people's utilization of the DPAHC. The ability to execute a DPAHC and the choice of an agent are affected by individuals' interpersonal relations.
Correlates of Postural Hypotension in a Community Sample of Elderly Blacks and Whites
Authors: Strogatz David S. , Keenan Nora L. , Barnett Elizabeth M. , Wagner Edward H.
Published: April 2015

Postural hypotension is thought to be prevalent among the elderly, but few community‐based studies of this condition have been conducted. In addition, little is known about postural hypotension in blacks despite well documented racial differences in hypertension and stroke. Data on 659 elderly (≥60 years of age) participants in a survey of two rural, biracial townships were analyzed to describe the frequency and correlates of postural hypotension. Twelve percent of the 659 adults experienced a drop of 10 mmHg or greater in systolic blood pressure on going from sitting to standing (supine measures were not available). This degree of postural hypotension was twice as common for whites as for blacks (14.5% vs 7.5%, P = 0.01). Postural hypotension was associated with elevated sitting blood pressure and showed positive but statistically non‐significant relationships with anti‐hypertensive medications and leanness. The association between race and postural hypotension persisted after adjusting for these and other risk factors (OR = 2.2, 95% CI:1.2,4.0).
Prevalence of Coronary Risk Factors in Elderly Blacks and Whites
Authors: Aronow Wilbert S. , Kronzon Itzhak
Published: April 2015

Coronary risk factors were determined in a prospective study of 1,414 elderly persons (999 women and 415 men), mean age 82 ± 8 years. Of 1,414 persons, 215 (15%) were black and 1,140 (81%) were white. The prevalences of cigarette smoking, hypercholesterolemia, low serum high‐density lipoprotein cholesterol, and increased serum total cholesterol/high‐density lipoprotein cholesterol ratio were not significantly different in elderly blacks and whites. Elderly blacks had a higher prevalence of hypertension (50% versus 36%, P < 0.001), diabetes mellitus (27% versus 19%, P < 0.01), and obesity (11% versus 5%, P < 0.005) and a lower prevalence of hypertriglyceridemia (9% versus 15%, P < 0.05) than elderly whites. In elderly persons with hypertension, electrocardiographic left ventricular hypertrophy occurred in 19% of blacks and 14% of whites (P not significant), echocardiographic left ventricular hypertrophy occurred in 72% of blacks and 56% of whites (P < 0.01), and concentric left ventricular hypertrophy occurred in 60% of blacks and 39% of whites (P < 0.001).
The Frequency and Significance of ECG Changes after Transurethral Prostate Resection
Authors: Ashton Carol M. , Thomas JoAnn , Wray Nelda P. , Wu Louis , Kiefe Catarina I. , Lahart Christopher J.
Published: April 2015

Although many clinicians routinely recommend a baseline preoperative electrocardiogram (ECG) and obtain frequent postoperative ECGs to screen for myocardial infarction or ischemia, the diagnostic utility of screening perioperative ECGs is unknown. The present analysis evaluates the sensitivity and specificity of the perioperative ECG and examines its value as a predictor of early postoperative cardiac events and outcomes during the postoperative year. ECGs obtained preoperatively and on the first 3 postoperative days in 206 men undergoing transurethral prostate resection were analyzed using the Minnesota Code. The occurrence of cardiac events during the operative stay was assessed by measurement of the cardiospecific MB creatine kinase isoenzyme on the first 3 postoperative days and review of the entire clinical course. Twenty‐one percent of patients developed postoperative ECG changes, mostly involving the T wave; none had cardiac symptoms or sustained creatine kinase MB elevation. Changes were not significantly more common in men known to have coronary disease. The single patient who had a perioperative myocardial infarction confirmed by enzymes had no codable ECG changes. The specificity of any ECG change for perioperative infarction was 78%; of ST segment changes only, 95%. Only one of the patients (2%) who had postoperative ECG changes had a cardiac event in the year after surgery. Routine perioperative ECGs is of little diagnostic/predictive utility in situations in which the incidence of perioperative myocardial infarction is low.
The Oregon Experiment
Authors: Pawlson L. Gregory
Published: April 2015

In this issue, we open a series of papers on rationing of health care, specifically, commentaries on what has come to be known as The Oregon Experiment. The first paper describes the actions of the State of Oregon. In the second paper, Daniel Callahan expresses his analysis of these events. In later issues, we expect to publish other viewpoints on The Oregon Experiment.
A Geriatric‐Anesthesiologic Program To Reduce Acute Confusional States in Elderly Patients Treated for Femoral Neck Fractures
Authors: Gustafson Yngve , Brännström Benny , Berggren Diana , Ragnarsson Jón Ingvar , Sigaard Jarl , Bucht Gösta , Reiz Sebastian , Norberg Astrid , Winblad Bengt
Published: April 2015

The aim of this study was to evaluate the effect of a geriatrk‐anesthesiologic intervention program for the prevention and treatment of acute confusional states (ACS) in elderly patients treated for femoral neck fractures. The intervention program was based on the results of previous prospective studies in similar patient populations. The outcome of the intervention, comprising 103 patients, was compared with that of an earlier study comprising 111 patients. The intervention program consisted of pre‐ and post‐operative geriatric assessments, oxygen therapy, early surgery, prevention and treatment of peri‐operative blood pressure falls and treatment of post‐operative complications. The incidence of ACS was lower, 47.6%, in the intervention study compared with 61.3% (P < 0.05) in the control study. Furthermore, the ACS that occurred in the intervention study was less severe and of shorter duration than that in the control study. The incidence of post‐operative decubital ulcers, severe falls, and urinary retention was also lower. The mean duration of orthopedic ward stay was 17.4 days in the control study and 11.6 days in the intervention study (P < 0.001). It can be concluded that the intervention program reduced the incidence, severity, and duration of ACS which resulted in a shortened orthopedic ward stay.
Adverse Reactions to Amantadine Prophylaxis of Influenza in a Retirement Home
Authors: Stange Kurt C. , Little Dana W. , Blatnik Bernadette
Published: April 2015

Objective: Controversy exists about the safety of following the recommendation of the Immunization Practice Committee of the Centers for Disease Control that nursing home residents be given amantadine prophylaxis during influenza outbreaks. This study was undertaken to define the incidence of adverse reactions to amantadine in the elderly and to identify risk factors for side effects.

Design: A retrospective cohort study.

Setting: A retirement home which offered amantadine prophylaxis to its residents during a presumed influenza outbreak.

Participants: Of the 96 elderly residents, 79 accepted the offer of amantadine prophylaxis.

Main Outcome Measures: Attributable adverse health outcomes as assessed by chart review.

Results: 41% of the people receiving amantadine had attributable adverse reactions, of which 22% were classified as severe. Severe adverse reactions were associated with residence in the assisted living section of the facility (P = 0.002), a greater number of underlying diagnoses (P = 0.009), congestive heart failure (P = 0.02), and high serum creatinine (P = 0.02). A person with none of these risk factors had a 7% chance of having a severe adverse outcome compared to a 70% chance for someone with all four risk factors.

Conclusion: The findings raise concern that the prophylactic administration of amantadine to all elderly residents of nursing and retirement homes may be associated with a high incidence of unacceptable reactions, particularly among less healthy residents.
Cerebrospinal Fluid Markers of Alzheimer's Disease
Authors: van Gool W. A. , Bolhuis P. A.
Published: April 2015

Objective: To review studies on cerebrospinal fluid (CSF) in patients with Alzheimer's disease (AD) in order to answer the question whether CSF contains a specific marker which can be used to support a clinical diagnosis of AD.

Data sources: Studies identified through an English‐language literature search using MEDLINE (1966 to 1990) and a review of bibliographies of relevant articles.

Study Selection: All studies on CSF in AD patients were selected. Double publications on the same original data were not included. Otherwise, no particular selection was made.

Data Extraction: The diagnostic utility of more than 60 substances, including CSF measures related to classical neurotransmitters, (neuro)peptides, proteins, amino acids, purines, trace elements, and constituents of senile plaques and neurofibrillary tangles, is evaluated. Clinical epidemiological criteria for deciding on the usefulness of new diagnostic methods are emphasized in this analysis.

Data Synthesis: Concentrations of some CSF constituents are consistently found to be significantly changed in AD. However, overlap with data of control populations and methodological shortcomings in study design, limit the diagnostic value of all CSF measurements reviewed.

Conclusion: None of the CSF constituents studied so far can be used in support of the diagnosis of AD. However, increased knowledge concerning macromolecular abnormalities in amyloid containing plaques and neurofibrillary tangles makes the outlook for a diagnostic test for AD on CSF promising.
Predictors of Mortality in Older Patients following Medical Intensive Care: The Importance of Functional Status
Authors: Mayer‐Oakes S. Allison , Oye Robert K. , Leake Barbara
Published: April 2015

Objective: We examined predictors of hospital and 6‐month mortality in older Medical Intensive Care Unit (MICU) patients with particular attention to age and functional status. Age is generally thought to be strongly associated with intensive care outcomes, but this relationship may be confounded by age‐related changes. These age‐related changes may be approximated by changes in functional status (FS).

Design: We conducted a retrospective chart review and collected severity of illness data using the Acute Physiology Score (APS), pre‐hospitalization FS dichotomized as limited or not limited, and hospital mortality. County death records were reviewed for 6‐month mortality

Setting: Three community hospital MICUs.

Patients: Four‐hundred MICU patients aged 50 and older admitted during the study period.

Results: Limited FS was found in 42% of the 227 patients who had FS data in the chart. Mortality was significantly associated with APS, age, FS, immunocompromise state, comorbidity, and nursing home residence. In logistic regression analyses, while controlling for important variables, APS (P < 0.001) and age ≥75 with limited FS (P < 0.05) were associated with hospital mortality. Six‐month mortality predictors were APS (P < 0.001), hospital (P < 0.05), immunocompromised state (P < 0.05) and age ≥75 with limited FS (P < 0.05).

Conclusions: We found that among patients without functional limitations, the oldest group was no more likely to die than the youngest group. Age and functional status had a significant interaction: patients older than 75 years with functional limitations were almost six times more likely to die in hospital compared to the reference group of patients between 50–64 years old without functional limitations. We conclude that functional status is an important predictor of outcome in older MICU patients.
Nursing Home Resources and Tranquilizer Use among the Institutionalized Elderly
Authors: Svarstad Bonnie L. , Mount Jeanine K.
Published: April 2015

Objective. To examine the relationship between selected resident and facility characteristics and the frequency and quality of tranquilizer prescribing and use in skilled nursing facilities.

Design. Retrospective review of medication profiles and pharmacy billing records using standardized protocol.

Settings. Seven skilled nursing facilities.

Participants. All residents aged 65 years or older were eligible. Consent was given by 760 residents or guardians. Six refused permission.

Outcome Measures. Drug use measures included the presence or absence of a tranquilizer order, any tranquilizer use during previous 30 days, and any deviation from selected drug use criteria.

Results. Of 760 residents, 38% had an order for an antipsychotic or antianxiety agent, and 28% actually received a tranquilizer. Comparing tranquilizer practices with specific drug‐use criteria showed that nearly 19% of all elderly residents were exposed to some type of excess use such as long duration, polymedicine, or therapeutic duplication. Residents in facilities with less adequate staffing and other resources were significantly more likely to have a tranquilizer order, to have a tranquilizer administered, and to have any deviation from drug‐use criteria. The data also show higher rates of deviation from criteria among residents with a diagnosed mental disorder, younger residents, and Medicaid recipients.

Conclusion. More attention must be paid to environmental factors that may undermine current efforts to improve psychotropic drug prescribing and use in skilled nursing facilities.
The Demented Elderly in the City of Helsinki: Functional Capacity and Placement
Authors: Juva Kati , Sulkava Raimo , Erkinjuntti Timo , Valvanne Jaakko , Tilvis Reijo
Published: April 2015

Objective

To study prevalence, functional capacity, and placement of demented patients in a randomly selected population.

Design

Survey.

Setting

Random sample from population registry of the City of Helsinki.

Participants

Nine hundred subjects aged 75 years, 80 years and 85‐years, 300 in each group.

Measurements

For each participant, we completed a questionnaire for the subject and an informant and a functional‐capacity scale and Mini‐Mental Status Examination by a community nurse, including the Clinical Dementia Rating (CDR) scale. Subjects with CDR of 0.5 or greater were examined by a neurologist who diagnosed the presence or absence of dementia according to DSM‐III‐R.

Results

Ninety‐three subjects of the 656 whose CDR was known were found to have dementia. Three‐quarters of them lived in institutions, and they comprised 33%, 60%, and 68% of all institutionalized patients in the above‐mentioned age groups, respectively. Community residents suffering from dementia often lived with a caring relative and needed many services. A considerable part of the need was not met.

Conclusions

In the older age groups, the need for institutional placement due to dementia is great. According to our study, it seems unlikely that these patients could be cared for in any other way, at least not on a large scale. The need for services for home‐dwelling patients is also great, and the relatives carry a heavy load in taking care of demented patients.
PTCA in the Elderly: The “Young‐Old” versus the “Old‐Old”
Authors: Forman Daniel E. , Berman Aaron D. , McCabe Carolyn H. , Baim Donald S. , Wei Jeanne Y.
Published: April 2015

Objective

To evaluate the use of percutaneous transluminal coronary angioplasty (PTCA) in elderly coronary artery disease (CAD) patients.

Design

A prospective study of patients 60 years and older undergoing de novo PTCA. We analyze patient risk factors, underlying disease, and clinical outcomes, with at least 3‐year follow‐up. Comparisons between different age strata among these patients are made to clarify differences between the young old (60 to 69 years), the middle old (70 to 79 years), and the very old (80 years and older).

Setting

Beth Israel Hospital, Boston, both a primary care and tertiary care teaching hospital.

Patients

907 consecutive elderly cardiac patients referred for PTCA are studied.

Interventions

PTCA's were completed using the newest catheter technologies as they became available. All patients were premedicated with aspirin and dipyridamole, and all were anticoagulated with heparin.

Results

Subdivision by age demonstrates that the majority (67%) of patients aged 60 to 69 were males, but females were preponderant (61%) in those aged 80 and older. Octogenarians also had lower incidence of hypercholesterolemia, tobacco use, and family history of CAD, and a higher frequency of CHF, angina, and previous MI. Although total procedure‐complications increased with age, critical complications (MI, reocclusion, CABG, death) did not. Primary procedural success was similar in all age strata, but older patients had a higher prevalence of multi‐vessel disease and longer hospital stay. Follow‐up shows that most patients did well after PTCA; there was no increase in repeat PTCA, CABG, and MI with age.

Conclusions

While advanced age is associated with changes in risk and clinical parameters for CAD patients, age alone is not a reasonable criterion to limit the use of PTCA.
Improvement of Pain and Disability in Elderly Patients with Degenerative Osteoarthritis of the Knee Treated with Narrow‐Band Light Therapy
Authors: Stelian Jean , Gil Israel , Habot Beni , Rosenthal Michal , Abramovici Iulian , Kutok Nathalia , Khahil Auni
Published: April 2015

Objective

To evaluate the effects of low‐power light therapy on pain and disability in elderly patients with degenerative osteoarthritis of the knee.

Design

Partially double‐blinded, fully randomized trial comparing red, infrared, and placebo light emitters.

Patients

Fifty patients with degenerative osteoarthritis of both knees were randomly assigned to three treatment groups: red (15 patients), infrared (18 patients), and placebo (17 patients). Infrared and placebo emitters were double‐blinded.

Interventions

Self‐applied treatment to both sides of the knee for 15 minutes twice a day for 10 days.

Main Outcome Measures

Short‐Form McGill Pain Questionnaire, Present Pain Intensity, and Visual Analogue Scale for pain and Disability Index Questionnaire for disability were used. We evaluated pain and disability before and on the tenth day of therapy. The period from the end of the treatment until the patient's request to be retreated was summed up 1 year after the trial.

Results

Pain and disability before treatment did not show statistically significant differences between the three groups. Pain reduction in the red and infrared groups after the treatment was more than 50% in all scoring methods (P < 0.05). There was no significant pain improvement in the placebo group. We observed significant functional improvement in red‐ and infrared‐treated groups (p < 0.05), but not in the placebo group. The period from the end of treatment until the patients required retreatment was longer for red and infrared groups than for the placebo group (4.2 ± 3.0, 6.1 ± 3.2, and 0.53 ± 0.62 months, for red, infrared, and placebo, respectively).

Conclusions

Low‐power light therapy is effective in relieving pain and disability in degenerative osteoarthritis of the knee.
Routine Laboratory Assessment of Nursing Home Patients
Authors: Joseph Carol , Lyles Yvonne
Published: April 2015

Little is known about protocols for routine laboratory testing in nursing homes. To determine what laboratory protocols are employed by community nursing homes, directors of nursing service in the 73 long‐term‐care facilities in Portland, Oregon were surveyed. One‐hundred percent responded, and 56% reported having laboratory testing protocols. Ninety percent of protocols employed screening tests, and 88% employed monitoring tests, but content varied widely.

Although physicians are ultimately responsible for ordering laboratory tests, protocols were derived from various sources including nursing staff, pharmacy and laboratory consultants, and Department of Health and Human Service guidelines. It is recommended that physicians take a leadership role in helping nursing homes develop clinically useful, cost‐effective testing strategies.
The Relations among Caregiver Stress, “Sundowning” Symptoms, and Cognitive Decline in Alzheimer's Disease
Authors: Gallagher‐Thompson Dolores , Brooks John O. , Bliwise Donald , Leader Julie , Yesavage Jerome A.
Published: April 2015

Objective

To investigate the relations among the initial perceived stress of Alzheimer patients' caregivers, the rate of change of perceived stress, patients' sundowning behaviors, and patients' rate of cognitive decline.

Design

A longitudinal cohort study in which Alzheimer patients and their caregivers were assessed at 6‐month intervals.

Setting

Hospital out‐patient clinic. Patients and caregivers lived at home.

Subjects

Subjects were 35 patients (50–79 years) with Alzheimer's disease and their primary caregivers (24 males and 11 females); all caregivers were spouses.

Methods

At time of entry into the study, caregivers indicated which of seven behaviors indicative of sundowning were exhibited by the patient. Patients were evaluated successively using the Mini‐Mental State Examination, whereas caregivers completed the Perceived Stress Scale, provided an index of social support utilization, and completed the Beck Depression Inventory.

Main Outcome Measures

Caregivers' initial perceived stress and the rate of change of perceived stress, patients' sundowning behavior, and rate of cognitive decline.

Results

The pattern of correlations indicated that both rate of cognitive decline and initial sundowning behavior were significantly correlated with initial perceived caregiver stress. The average rate of increase of caregivers' perceived stress was positively correlated with the initial incidence of sundowning behaviors, even when controlling for the effects of caregiver depression and social support utilization.

Conclusion

Sundowning behavior of Alzheimer patients is associated with an increased rate of change of caregivers' perceived stress. This association may be specific to sundowning behavior because there was no relation between the rate of change of perceived stress and morning agitation. The findings suggest that future caregiver intervention programs could profitably focus on sundowning behavior rather than general agitation.
Ambulatory Monitoring of Sleep‐Wakefulness Patterns in Healthy Elderly Males and Females (>88 Years): The “Senieur” Protocol
Authors: Wauquier A. , van Sweden B. , Lagaay A. M. , Kemp B. , Kamphuisen H. A. C.
Published: April 2015

Objective

The study was designed to investigate sleep‐wake patterns in healthy elderly men and women (>88 years) using ambulatory recording techniques.

Design

Cross‐sectional observations on 2 consecutive days.

Methods

Two consecutive 24‐hour recordings were made. Each 30‐second period of the recording was scored as characteristic of wakefulness, REM, and non‐REM sleep (stages 1–4).

Setting

Interviews and recordings were done in the home of the elderly, not interfering with the habitual routine.

Participants

Among eligible members of the “Senieur” protocol, screened for wellness, seven females (88–102 years) and seven males (88–98 years) volunteered to participate.

Main Outcome Measures

Organization of sleep, sleep structure, and daytime napping.

Results

There was no difference between the first and second night recording. Important gender differences were observed: males had significantly less total sleep, shorter REM latency, more transitions to wake from REM, less NREM 3 sleep, and virtually no NREM 4. Daytime napping, REM amount, and distribution did not show sex differences. Although the variability in the amount of napping was considerable, it occupied less than 10 percent of the total sleep time in both women and men. Daytime napping was unrelated to sleep characteristics.

Conclusions

Ambulatory sleep‐wake recordings allow an objective and critical evaluation of sleep function in normal aging. Interesting findings include a shift of REM sleep to the first part of the sleep period an increased cycle variability, and non‐correlation of night‐time sleep with daytime napping. In contrast to earlier findings in elderly persons, a polygraphic and subjective first‐night effect was lacking.
Viral Respiratory Infections in the Institutionalized Elderly: Clinical and Epidemiologic Findings
Authors: Falsey Ann R. , Treanor John J. , Betts Robert F. , Walsh Edward E.
Published: April 2015

Objective

To prospectively evaluate the incidence and impact of viral respiratory infection in the institutionalized elderly during a winter season.

Design

Prospective descriptive study, without intervention.

Method

Patients with respiratory illnesses were evaluated by a directed history and physical examination. Nasopharyngeal secretions for viral culture were obtained, and acute and convalescent serum samples were obtained for analysis. Serologic evidence of infection with respiratory syncytial virus (RSV) and parainfluenza were determined by enzyme immunoassay (EIA), and influenza by hemagglutination‐inhibition assay and EIA.

Setting

A 591‐bed nursing home.

Participants

Residents with signs or symptoms of acute respiratory illness (nasal congestion, pharyngitis, cough, wheezing, or respiratory difficulty) were eligible for study.

Results

A viral etiology was documented in 62 out of 149 illnesses (42%). RSV was the most common virus associated with illness; it was documented in 27% of respiratory illnesses, followed by rhinovirus (9%), parainfluenza (6%), and influenza (1%). RSV was associated with significantly more severe disease when compared with rhinovirus. Clustering of specific viral infections occurred, suggesting nosocomial transmission.

Conclusions

Viruses are an important cause of acute respiratory infections in the institutionalized elderly during the winter months.
Study of Strategies for the Recuitment of Elders Including the Use of Community Volunteers
Authors: Cartmel B. , Moon T.E.
Published: April 2015

Objectives

The primary objective was to compare study participation when first contact was made by telephone versus an unscheduled visit to the household. The secondary objective was to compare study participation when three differing modes of questionnaire presentation were used.

Design

The residents of 300 randomly selected households were contacted by community volunteers and asked to participate in a study of the etiology of cancer and other chronic diseases. Two methods of first contact were used, a telephone call to schedule a home visit and an unscheduled visit to the household. Three modes of questionnaire presentation were used.

Participants

Residents of a retirement community in Arizona who were aged 50 or over.

Main Outcome Measures

Agreement to participate, defined as acceptance of and agreement to complete the study questionnaires. Participation in the study, defined as acceptance and completion of the study questionnaires.

Results

No difference was observed in participation when first contact was made by telephone (46%) as compared with an unscheduled visit to the household (45%) (P = 0.83). Similarly, no difference in the participation was observed between three modes of presentation of the questionnaire to the householders (P = 0.13). Agreement to participate was, however, significantly higher when first contact was made by visiting the home (81% vs 55%) (P < 0.001).

Conclusions

Neither the strategy used for first contact nor mode of questionnaire presentation affected participation.