bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Low Plasma IGF‐I in Poliomyelitis Survivors
Authors: Rao Uma , Shetty Kaup R. , Mattson Dale E. , Rudman Inge W. , Rudman Daniel
Published: April 2015

Objective: To compare plasma levels of insulin‐like growth factor‐I (IGF‐I, also termed somatomedin C) in polio survivors and healthy control subjects and to determine their relation to selected clinical characteristics.

Design: Cross sectional study.

Setting: Polio survivors living in the community recruited from the Wisconsin Polio Support Group.

Participants: A total of 124 polio survivors (49 males and 75 females), ages 35 to 77 years, and 261 healthy control subjects (139 males and 122 females) of similar age.

Measurements: Plasma IGF‐I levels were compared in polio survivors and age‐matched control subjects. In the polio survivor group, the relation of IGF‐I to selected clinical characteristics was examined before and after adjusting for co‐variates.

Results: Statistical analyses showed that the IGF‐I concentrations were significantly lower in the polio survivors than in the controls. This difference was reflected in the means and standard errors of the two groups (0.45 ± 0.02 vs 0.60 ± 0.02 units/mL, P < 0.01). Plasma IGF‐I below 0.35 units/mL in adults indicates little or no growth hormone secretion. In polio survivors, 38% of the plasma IGF‐I values were <0.35 units/mL compared with 19% in the healthy group. Univariate analysis showed that IGF‐I in the polio survivors was significantly correlated with age, gender, and body mass index, and with dependency, pain, and difficulty in the activities of daily living (ADLs). The correlations with ADL dysfunction were independent of the correlations with age, gender, and body mass index. IGF‐I level did not correlate with the subjective report of recent decline in functional status.

Conclusion: Lower levels of IGF‐I are seen in polio survivors, and this finding correlates with ADL dysfunction. The hy‐posomatomedinemic tendency of polio survivors may have an adverse effect on their neuromuscular function and quality of life.
Oral Health Problems and Involuntary Weight Loss in a Population of Frail Elderly
Authors: Sullivan Dennis H. , Martin Wendy , Flaxman Norman , Hagen Joan E.
Published: April 2015

Objective: To evaluate whether poor oral health is a potentially reversible contributor to the development of significant involuntary weight loss in elderly rehabilitation patients.

Design: Survey (cross‐sectional study).

Setting: Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital.

Patients: One hundred ten consecutive admissions to the GRU, of whom 99% were male and 80% were white. The average age of the study patients was 77 years.

Measurements: At admission each patient completed a comprehensive medical, neuro‐psychological, social, nutritional, and dental assessment. Previous weights were documented by review of old medical records. Involuntary weight loss was considered significant if it was greater than 5% of pre‐weight‐loss weight within 6 months or 10% of pre‐weight‐loss weight within 1 year. Of the 97 variables evaluated, the strongest predictors of significant involuntary weight loss prior to GRU admission were identified using univariate and multivariate (stepwise logistic regression) analyses.

Results: The number of general oral problems was the best predictor of significant involuntary weight loss within 1 year prior to GRU admission, followed by household income, age, smoking status, adequacy of nutrient intake prior to admission, and education. When all six of the variables were included in the stepwise logistical regression analysis, the model had a sensitivity of 63.2%, a specificity of 91.1%, and overall predictive accuracy of 86.2%. The number of general oral problems was also a strong predictor of significant weight loss within 6 months prior to GRU admission.

Conclusions: Poor oral health may be an important contributing factor to the development of significant involuntary weight loss among the frail elderly. If this is true, it places even greater emphasis on the need for maintaining an optimal state of oral health in our elderly patients.
Blood Pressure and Cognitive Function in Healthy Old People
Authors: Starr John M. , Whalley Lawrence J. , Inch Susan , Shering P. Ann
Published: April 2015

Objective: Since hypertension is a major risk factor for multi‐infarct dementia, this study aimed to evaluate the effect of blood pressure on cognitive function in elderly subjects on no medication and disease‐free.

Design: A cross‐sectional survey.

Setting: Community.

Participants: 598 healthy community‐resident subjects aged 70 years and over who were on no treatment.

Measurements: Blood pressure (BP) and MMSE score, an index of cognitive function.

Results: Mean age of the sample was 75.7 years, mean BP 160/86 mmHg, mean MMSE 28.0. Systolic BP correlated negatively with MMSE (P < 0.05), but diastolic BP showed no significant overall correlation. To study possible J‐shaped curve effects of BP, the sample was stratified into three groups—low BP, normal BP, and high BP—at levels one standard deviation from the mean for both systolic and diastolic pressures. Mean MMSE scores for low, normal and high systolic BP were 28.3, 28.1, 27.5, respectively; for low, normal, and high diastolic BP scores were 28.0, 28.1, and 27.5 respectively. Multivariate analysis of variance found the differences between normal and high to be significant at P < 0.001 for systolic and P = 0.001 for diastolic BPs.

Conclusion: High blood pressure is associated with cognitive impairment in healthy, drug‐free, older people.
Biomedical and Behavioral Research in Nursing Homes: Guidelines for Ethical Investigations
Authors: Sachs Greg A. , Rhymes Jill , Cassel Christine K.
Published: April 2015

As nursing homes become increasingly important sites for biomedical and behavioral research, researchers must address the ethical problems of increased vulnerability and the high prevalence of mental and physical disorders in the nursing home population. Obtaining valid informed consent is but one of the many difficult issues that confronts the investigator in the nursing home. Efforts should be made to involve nursing home residents, as well as family and staff members, in the review of research. The benefits and burdens of research protocols should be equitably distributed, and potential conflicts of interest for staff members and physicians should be minimized or their potential adverse impact ameliorated. Appropriate attention to these ethical concerns may facilitate nursing home research while still safeguarding vulnerable residents. We offer proposed guidelines for the ethical conduct of research in nursing homes in an effort to stimulate discussion among investigators, nursing home staff and residents, residents' families, and ethicists.
Are Older Pedestrians Allowed Enough Time to Cross Intersections Safely?
Authors: Hoxie Russell E. , Rubenstein Laurence Z.
Published: April 2015

Objective

To describe the pedestrian traffic flow at a busy urban intersection and determine the percentage of older pedestrians at risk for injury as a result of reduced walking speeds.

Design

Observational study.

Setting

The intersection of Third Street and Fairfax Avenue in Los Angeles, California.

Participants

All pedestrians who started to cross the intersection during the legally acceptable parts of the traffic cycle during three days of observation (n = 1229) and a subsequent sample of 100 consecutive younger and 100 consecutive older crossers.

Measurements

The ability of all subjects to cross the intersection in the allotted time was measured. A questionnaire was administered to pedestrians who were unable to cross the intersection in time. In addition, we measured the actual gait speed of a subsequent consecutive sample of 100 younger and 100 older pedestrians.

Results

Of the 592 older pedestrians observed, 27% were unable to reach the opposite curb before the light changed to allow cross traffic to enter the intersection, and one‐fourth of this group were stranded by at least a full traffic lane away from safety. All younger pedestrians were able to cross in the allotted time. Older pedestrians took significantly longer than younger pedestrians to cross the street (P < 0.0001). The mean walking velocity ±1 SD for older and younger pedestrians was 0.86 ± 0.17 and 1.27 ± 0.17 m per second, respectively. Fifty‐three percent of those older pedestrians unable to cross in time were willing to be surveyed. Mean age was 77 years, 74% considered the intersection to be “dangerous,” and 63% stated they cross the street at least once daily. City traffic reports revealed that over the preceding 5 years about one older pedestrian per year had been hit in this intersection, and 165 such injuries had occurred city‐wide per year.

Conclusion

The timing of this pedestrian signal does not allow adequate time for many older pedestrians to cross and puts them at potential risk. Providing more crossing time may reduce pedestrian injuries and allow for an increased feeling of independence and confidence by older citizens.
Efficacy of an Influenza Hemagglutinin‐Diphtheria Toxoid Conjugate Vaccine in Elderly Nursing Home Subjects During an Influenza Outbreak
Authors: Gravenstein Stefan , Drinka Paul , Duthie Edmund H. , Miller Barbara A. , Brown C. Susan , Hensley Michael , Circo Richard , Langer Elizabeth , Ershler William B.
Published: April 2015

Objective

To compare the efficacy of an influenza hemagglutinin‐diphtheria toxoid conjugate vaccine with the commercially available influenza hemagglutinin‐subunit vaccine in preventing influenza in older adults living in a nursing home.

Design

A prospective, randomized, double‐blind vaccine trial with 5 months of follow‐up after vaccination.

Setting

Fourteen Wisconsin nursing homes.

Participants

Nursing home residents at least 65 years old who were able to give informed consent and were free of malignancy and not receiving immunosuppressive therapy.

Interventions

Participants received, by intramuscular injection, 0.5 mL of a trivalent influenza vaccine containing 15 μg each of A/Leningrad/360/86 (H3N2), A/Taiwan/1/86 (H1N1), and B/Ann Arbor/1/86 (HA) or 0.5 mL of an influenza vaccine containing the same antigens conjugated to diphtheria toxoid (HA‐D).

Measurements

Blood was obtained pre‐ and 1 month post‐vaccination to assess for any vaccine‐induced antibody titer change. Clinical surveillance for respiratory illness was performed twice weekly for 5 months. A record was kept of all signs and symptoms of new respiratory illness, and a viral culture and acute and convalescent sera were obtained.

Results

204 participants received HA and 204 received HAD. Both groups had similar baseline antibody levels to all influenza antigens. HA‐D recipients seroconverted more frequently based on serum neutralizing activity (P < 0.05), had a greater increase in geometric mean titer (GMT), and sustained the increase in antibody titer longer than HA recipients. Vaccine hemagglutinin recall was greater in a subset of HA‐D recipients as measured by lymphocyte proliferative assays (P < 0.05). During an outbreak of influenza A (H3N2 A/Shanghai/11/87‐like and A/Victoria/7/87‐like), fewer HA‐D (29/195) than HA (43/204) recipients had laboratory‐confirmed infection (P = 0.053), and, of these, fewer HA‐D‐treated subjects had lower respiratory tract involvement (5/29 HA‐D and 17/43 HA) (P = 0.022).

Conclusions

HA‐D was more immunogenic in institutionalized elderly recipients and produced greater protection from influenza infection. Superior protection may be due to HAD's ability to stimulate and recruit antigen‐presenting cells, thus enabling the recipient to achieve and maintain functional antibody titers.
Increasing the Recognition of Delirium in Elderly Patients
Authors: Rockwood Kenneth , Cosway Sylvia , Stolee Paul , Kydd David , Carver Daniel , Jarrett Pamela , O'Brien Brian
Published: April 2015

Objective

To determine if an educational intervention aimed at house staff will increase knowledge about and recognition of delirium.

Design

Before/after study, with blinding of participants to the intent of the study.

Setting

University hospital in Halifax, Nova Scotia.

Patients

One hundred eighty‐seven control patients, seen as consecutive admissions of elderly patients (65+ years) to the General Medicine services of the Victoria General Hospital prior to the educational intervention, and 247 patients seen thereafter.

Intervention

Educational intervention at grand rounds, housestaff rounds, sign‐in rounds, and bedside teaching.

Measurements

Recognition of delirium in the admitting history or progress notes, Confusion Assessment Method (CAM) as recorded by nurses, diagnosis of delirium by independent study physicians using DSM‐IIIR criteria and the Trzepacz Delirium Symptom Rating Scale.

Results

Prior to the intervention, delirium or acute confusion was diagnosed in 3% of patients; after the intervention, delirium or acute confusion was diagnosed in 9% of patients (P < 0.01). Other abnormalities in mental state were noted in 8.5% of admissions prior to the intervention, and 15.6% of admissions after the intervention. After the intervention there was a significant difference in the proportion of patients in whom a mental status questionnaire had been carried out and in whom there was formal comment on various aspects of the mental state. The nursing CAM had a sensitivity of 0.68 and a specificity of 0.97.

Conclusions

A simple educational intervention aimed at house staff appears to be effective in changing house staff behavior. Improved recognition of delirium may lead to better patient outcomes.
Effects of Antipsychotic Withdrawal in Elderly Nursing Home Residents
Authors: Thapa Purushottam B. , Meador Keith G. , Gideon Patricia , Fought Randy L. , Ray Wayne A.
Published: April 2015

Objective

To study the effects of antipsychotic withdrawal in elderly nursing home residents.

Design

Longitudinal prospective study. Setting: 12 community nursing homes that participated in a randomized controlled trial of an educational program designed to reduce antipsychotic use.

Subjects

271 residents receiving antipsychotics at baseline and remaining in the home for approximately 6 months thereafter. These were placed into two groups: those with continued use of antipsychotics at follow‐up (n = 207) and those with drug discontinued (n = 64).

Measurements

Change between baseline and follow‐up for several standard measurements. These included behavior problems, as reported by both regular care providers (Nursing Home Behavior Problem Scale) or a blinded study rater (items from the Brief Psychiatric Rating Scale), observer‐rated psychiatric symptoms (subset of the Brief Psychiatric Rating Scale), and other standard tests of function (Activities of Daily Living, Mini‐Mental State Examination, Geriatric Depression Scale, and Abnormal Involuntary Movements Scale).

Results

The frequency of behavior problems did not increase in residents with antipsychotics discontinued. For these residents, observer‐rated psychiatric symptoms decreased by 21% (P = 0.003), which resulted from a 27% decrease in adverse affective symptoms (P = 0.0002). Residents with drug discontinued had no deterioration in any of the measures of function.

Conclusion

In this sample, nursing home residents whose antipsychotics were discontinued had significantly improved affect and no discernable adverse effects.
Functional Status of Mexican American Nursing Home Residents
Authors: Chiodo Laura K. , Kanten Deanna N. , Gerety Meghan B. , Mulrow Cynthia D. , Cornell John E.
Published: April 2015

Objective

To compare sociodemographic characteristics, physical function, and cognition of Mexican American and non‐Hispanic white nursing home residents.

Design and Setting

Cross‐sectional survey of residents in eight proprietary nursing homes and one Veterans Affairs nursing home in San Antonio, Texas.

Subjects

Residents with lengths of stay greater than or equal to 90 days.

Measurements

Sociodemographic characteristics, residence prior to admission, and dependency in activities of daily living (ADL) were abstracted from the medical record. The Folstein Mini‐Mental State Examination (MMSE) was administered in the resident's self‐selected language to a subset of residents.

Main Results

There were 1160 participants, 261 Mexican American (23%) and 899 non‐Hispanic white residents (77%). Mexican Americans were younger (77.1 vs 80.7 years), more often men (44% vs 30%), less educated (6.2 vs 10.8 years), and more often dependent on Medicaid funding (66% vs 40%) than non‐Hispanic whites. Mexican Americans were less independent in feeding (34% vs 49%), transfers (18% vs 30%), toileting (19% vs 29%), and dressing (12% vs 19%). Mean MMSE scores were different in Mexican Americans and non‐Hispanic whites (8.93 vs 11.85), and this difference remained significant after adjustment for age and education (P = 0.04). ADL function was strongly associated with MMSE (P = 0.0001) and less strongly associated with ethnicity (P = 0.056) in multiple regression analysis.

Conclusions

This study provides the strongest evidence to date that Mexican American nursing home residents are more cognitively and functionally impaired than non‐Hispanic white residents. Further studies should explore whether medical conditions, selection and referral patterns or cultural factors explain functional differences between Mexican American and non‐Hispanic white nursing home residents.
Predicting Falls: The Role of Mobility and Nonphysical Factors
Authors: Studenski Stephanie , Duncan Pamela W. , Chandler Julie , Samsa Greg , Prescott Barbara , Hogue Carol , Bearon Lucille B.
Published: April 2015

Objective

Our purpose was to test a four‐domain predictive model of recurrent falls developed for this study. In this model, limited mobility is considered a necessary but not sufficient element in risk of recurrent falls. Three other domains, attitudinal, social, and environmental, are proposed to influence fall risk only in persons with impaired mobility.

Design

Prospective cohort study.

Setting

Veterans Affairs Ambulatory Care Service serving rural and urban central North Carolina.

Subjects

Male Veterans aged 70 or older (n = 306) were monitored prospectively for falls. At baseline, 159 screened as high‐risk mobility status and 147 as low‐risk mobility status.

Measurements

The primary outcome was recurrent falls. The mobility screen used for risk assignment defined immobile as unable to sit without support for 60 seconds, mobile and stable as meeting criteria for normal ambulation and stair climbing, and mobile but unstable as those who met neither of the above criteria. The high‐risk subjects were further assessed in their homes for mobility in more detail, attitude toward risk, social supports, and environmental status. Other data included demographics, functional status, diagnoses, and medications.

Results

Recurrent falls occurred in 37 (23.3%) high‐risk subjects and seven (4.8%) low‐risk subjects (relative risk = 4.8, confidence interval 2.5 to 9.6, P < 0.001). Within the high‐risk group, the probability of recurrent falls was significantly affected by degree of impaired mobility (P < 0.001), attitude toward risk (P = 0.005), and environment score (P = 0.03).

Conclusions

A simple mobility screen can identify elders at increased risk for recurrent falls. Risk within this group is further modified by risk‐taking behavior and environment.
The Effects of Changing Prompted Voiding Schedules in the Treatment of Incontinence in Nursing Home Residents
Authors: Burgio Louis D. , McCormick Kathleen A. , Scheve Ann S. , Engel Bernard T. , Hawkins Andre , Leahy Eileen
Published: April 2015

Objective

To determine the effects of different prompted voiding schedules on urinary incontinence on a continence unit (CU) and the maintenance of benefits on normal nursing units.

Design

Multiphase study with both intra‐and inter‐subject comparisons.

Participants

Subjects were 41 consenting incontinent nursing home residents. Based on clinical criteria, subjects were assigned to one of four treatment groups that varied as to the schedule of prompted voiding received.

Measurement

The study used chart review, Katz ADL, and MMSE. Urologic status, self‐initiated toileting, urine volumes voided, and incontinence assessed by pad/pants checks were measured by research nurses. Baseline pad check data were collected on residents' normal nursing units. Residents were transferred to the CU where baseline measurement was repeated, and the effects of different prompted voiding schedules were then assessed. Indigenous staff were trained to use prompted voiding, and nurse supervisors were instructed in special procedures for enhancing maintenance of the intervention. Residents were returned to their normal units and the maintenance of improvements in continence status was assessed at 2 weeks and 3 months post‐cU discharge.

Results

One of the four groups showed significant improvement on the CU in response to the 2‐Hour schedule; two groups improved on the less intensive 3‐Hour schedule (P < 0.05). Two groups maintained this improvement on their normal nursing units (P < 0.05); one group showed a non‐significant trend toward improvement. Self‐initiated toileting decreased (P < 0.05) and volume voids in an appropriate receptacle increased (P < 0.05) during training.

Conclusions

Prompted voiding is an effective treatment for urinary incontinence, and a less intensive 3‐Hour schedule may be superior to the standard 2‐Hour schedule for some residents. These improvements in dryness can be maintained by normal nursing home staff if formal staff management procedures are utilized by nurse supervisors.
Cobalamin Levels Are Not Reduced in Alzheimer's Disease: Results from a Population‐Based Study
Authors: Basun Hans , Fratiglioni Laura , Winblad Bengt
Published: April 2015

Objective: To determine whether there is a relationship between serum cobalamin levels, normal aging, and Alzheimer's Disease (AD).

Design: Cross‐sectional survey.

Setting: A district (Kungsholmen) in Stockholm, Sweden.

Participants: Population‐based cohort of 545 subjects aged more than 74 years. The sample was selected on the basis of evidence of cognitive impairment from all inhabitants in an area of Stockholm (2368 individuals), both living at home or in institutions.

Measurements: Serum cobalamin levels and diagnostic evaluation for a diagnosis of dementia and type of dementia.

Results: The serum cobalamin levels in non‐demented individuals decreased 5.5 pmol/L with an increase of 1 year of age (regression coefficient = −5.53; P < 0.0001). However, the regression coefficient was 0.21 (P = 0.91) in demented people and 2.57 (P = 0.32) in AD subjects. There was no difference between serum cobalamin levels in demented, AD, and non‐demented subjects, except for the oldest ages where demented people and AD sufferers showed higher values. AD patients still living in their own homes had significantly lower cobalamin concentrations compared with institutionalized AD sufferers. The prevalence rate of cobalamin deficiency was 15.5% (95% CI = 11.5–19.5) in normal aging and 18.1% (95% CI = 10.3–25.9) in AD.

Conclusions: These data suggest that serum cobalamin levels decrease in normal aging, but not in dementia or AD. A lower cobalamin concentration observed in AD sufferers still living in their own homes compared with institutionalized persons with AD seemed to be related to but not fully explained by eating habits. Patients with AD living in their own homes are at risk of developing cobalamin deficiency, and monitoring of serum cobalamin concentrations might be useful in this group.
Diabetic Control and Progression of Retinopathy in Elderly Patients: Five‐Year Follow‐up Study
Authors: Morisaki Nobuhiro , Watanabe Satoe , Kobayashi Junji , Kanzaki Tetsuto , Takahashi Kazuo , Yokote Koutaro , Tezuka Mariko , Tashiro Jun , Inadera Hidekuni , Saito Yasushi , Yoshida Sho , Shigemura Kentaro
Published: April 2015

Objective: To assess whether control of diabetes mellitus is as important in the elderly as in young and middle‐aged diabetic patients in terms of progression of retinopathy.

Design: A 5‐year longitudinal cohort study.

Setting: Outpatient diabetic clinic.

Patients: One hundred fourteen non‐insulin‐dependent diabetic patients (30 males, 84 females) ≥ 60 years of age.

Measurements: Retinopathy was checked at the beginning and end of the follow‐up period. During the 5‐year follow‐up period, demographic variables, body mass index, HbA***1c, blood pressure, and plasma lipids were monitored. Retinopathy was classified as follows: grade 0, no lesion; grade 1, non‐proliferative retinopathy; grade 2, pre‐proliferative retinopathy; grade 3, proliferative retinopathy. Progression of retinopathy during the 5‐year follow‐up was defined as an increase in its grade.

Results: At the start of the study, 13% of the patients already had retinopathy, all of grade 1. The 5‐year follow‐up study showed that progression of retinopathy was 23.6% in all cases, 22.2% in those with grade 0 initially, and 33.3% in those with grade 1 initially. The progression rates of retinopathy as a function of the mean HbA***1c during the follow‐up were as follows: lower than 7%, 2%; 7–8%, 20%; 8–9%, 40%; more than 9%, 61%. Multiple logistic regression analysis showed that, of the parameters examined, only HbA***1c was a significant risk factor for progression of retinopathy.

Conclusions: Control of diabetes mellitus is the most important factor associated with prevention of progression of retinopathy in elderly patients.
Small Intestinal Bacterial Overgrowth—An Incidental Finding?
Authors: Mahon M. Mac , Lynch M. , Mullins E. , O'Moore R.R. , Walsh J.B. , Keane C.T. , Coakley D.
Published: April 2015

Objectives: To assess the prevalence of typical clinical features and need for treatment of small intestinal bacterial overgrowth (SIBO) in the elderly.

Design: Random selection of patients, regardless of their nutritional status.

Setting: Acute admissions ward in the Dept. of Medicine for the Elderly.

Patients: Thirty elderly patients between 68 and 90 years of age.

Measurements: Active clinical problems, including the presence of recent weight loss and diarrhea, were recorded. Routine blood tests, including serum vitamin B12, red cell folate, albumin and calcium, and qualitative small bowel bacteriology results, were analyzed. The effect of age on all variables was studied.

Results: Twenty of the 30 small bowel aspirates had proven SIBO, and strict anaerobes were isolated in 15. The mean blood test values did not differ significantly between culture‐positive and culture‐negative patients. There was no significant correlation between those variables and the total bacterial counts. Of the 20 proven SIBO cases, eight had anemia, five had hypoalbuminemia, five had diarrhea, four complained of recent weight loss, and none had B12 deficiency. Alternative causes other than SIBO were identified for many of these abnormalities. Advancing age correlated significantly with rising counts of small bowel strict anaerobes.

Conclusions: These data suggest that age may be a predisposing factor in the development of anaerobic overgrowth but that SIBO is a benign entity in the elderly. Contrary to previous recommendations, treatment of this condition is not routinely indicated.
Breast Irradiation in the Older Woman: A Toxicity Study
Authors: Wyckoff Jennifer , Greenberg Harvey , Sanderson Roger , Wallach Paul , Balducci Lodovico
Published: April 2015

Objective: To establish the tolerance of breast irradiation by women aged 65 and older.

Design: Retrospective chart review.

Patients and Setting: Women undergoing partial mastectomy and postoperative radiation therapy at the H. Lee Moffitt Cancer Center and Research Institute between 1986 and 1990. Of 163 women eligible for the study, 100 were under age 65, and 63 were aged 65–78.

Measurements: Comparison of total treatment dose, treatment duration, number of treatment interruptions, incidence of cutaneous, mucosal, and hematological toxicity between women aged 65 and older and women younger than age 65.

Main Results: All study measurements were comparable among younger and older women: total radiation dose (P = 0.5); treatment interruptions (P = 0.063); treatment duration (P = 0.78); cutaneous toxicity (P = 0.37); anemia (P = 0.83); leukopenia (P = 0.07), and thrombocytopenia (P = 0.94). There was no mucosal toxicity, nor higher than grade 2 hematological or cutaneous toxicity. The incidence and severity of toxicity was not higher for women aged 70 and older.

Conclusions: Postoperative breast irradiation is well tolerated by older women. Age is not a contraindication to breast preservation.
Surrogate Decision‐Makers' Satisfaction with the Placement of Feeding Tubes in Elderly Patients
Authors: McNabney Matthew K. , Beers Mark H. , Siebens Hilary
Published: April 2015

Objective: To assess the satisfaction of surrogate decisionmakers with the decision to place feeding tubes in elderly patients with impaired decision‐making capacity.

Design: Inception cohort followed for 5 weeks.

Setting: Four hospitals in the greater Los Angeles area.

Participants: Fifty‐eight surrogate decision‐makers for elderly patients (over 60) who recently received a first‐time percutaneous endoscopic gastrostomy. Participants were identified through the endoscopy departments at the four hospitals.

Measurements: We surveyed surrogates by telephone within 5 days of placement for background data and after 5 weeks of use to assess satisfaction with the decision. The main outcome variables at follow‐up were: surrogate satisfaction; whether the surrogate would repeat the decision; whether the surrogate had considered removal of the tube; and surrogates' perception of patients preference for the tube.

Results: After 5 weeks of use, 84% of surrogates stated that they would repeat the decision. Fifty‐nine percent of surrogates described themselves as satisfied with the decision, and 17% were dissatisfied. Only 10% had considered removing the tube. After 5 weeks of use, 36% of surrogates felt that the patient would prefer the tube, and 31% felt they would not.

Conclusions: Most surrogates we studied would repeat the decision to have a feeding tube after experiencing its effects for 5 weeks. However, almost one‐third felt the patient would not want the tube. Physicians and surrogates may need to place greater emphasis on patients' wishes before placing feeding tubes and when reassessing their benefit to the patient after being placed.
Suicide Over 60: The San Diego Study
Authors: Carney Susanne S. , Rich Charles L. , Burke Patricia A. , Fowler Richard C.
Published: April 2015

Objectives: To see if selected clinical factors characterize suicides over the age of 60 differently from younger suicides and to ascertain if those factors characterize female and male suicides over the age of 60 differently.

Design: A group of consecutive suicides aged 60–88 was compared with groups of consecutive suicides aged 31–59 and 16–30. The female suicides aged 60–88 were also compared with the male suicides in that age group. Data were gathered from a variety of informants using a structured interview format.

Setting: The sample was gathered in San Diego County, California, between November, 1981 and September 1982.

Participants: The sample consisted of 204 consecutive suicides. These included 49 cases aged 60–88, 94 cases aged 31–59, and 61 cases aged 16–30. The older group consisted of 20 females and 29 males.

Measurements: Comparisons were made in demographic, diagnostic, and other clinical characteristics.

Results: There were no significant differences between female and male suicides over age 60 on any of the variables examined. Only minor differences were found among the groups in patterns of mental disorders diagnosed. Older suicides were significantly more likely to be married or, if not married, widowed than either of the two younger groups. They were also significantly more likely to be stressed by medical illness. They were significantly less likely to have financial problems as stressors. They were significantly less likely to have talked about suicide or made prior suicide attempts than either of the two younger groups.

Conclusions: Patterns of certain characteristics of suicides are very similar regardless of age. However, specific age‐related differences occur that need to be considered when assessing suicide risk. Older suicides may be harder for clinicians to predict and, therefore, prevent.
A Descriptive Study of Physically Aggressive Behavior in Dementia by Direct Observation
Authors: Bridges‐Parlet Sarah , Knopman David , Thompson Travis
Published: April 2015

Objective: To study, by direct observation, physically aggressive behavior (PAB) in a cohort of older persons with dementia.

Design: Cross‐sectional survey.

Setting: A locked special care unit for Alzheimer's Disease and an ordinary skilled unit of two suburban nursing homes.

Participants: Twenty men and women with a history of PAB.

Measurements and Main Results: Portable bar‐code‐readers and daily diaries were used to determine the frequency of PAB as well as to elucidate the antecedents and consequences of it. PAB was most often directed toward staff (23/28 episodes), usually in the context of personal care (15/23 episodes). In the majority of cases, verbal aggression or noncompliance preceded the PAB. Most often PAB was followed by a rapid return to non‐aggressive behavior.

Conclusions: Very little PAB was truly spontaneous, nor was it usually the participant's normal behavior. Most PAB occurred in response to intrusion into the participant's personal space by staff or other residents. The PAB is better understood as a defensive response than an expression of anger.
Treatment Seeking for Urinary Incontinence in Older Adults
Authors: Burgio Kathryn L. , Ives Diane G. , Locher Julie L. , Arena Vincent C. , Kuller Lewis H.
Published: April 2015

Objective: To examine treatment seeking for urinary incontinence among older adults and to identify characteristics associated with treatment‐seeking behavior.

Design: Survey.

Setting: Five rural counties in northwestern Pennsylvania.

Participants: 1104 community‐dwelling ambulatory older adults aged 65 to 79 years with self‐reported urinary incontinence. Participants were a subgroup of a large sample (n = 3884) who volunteered for a study of health promotion services. Those who reported urinary incontinence within the past year, during an in‐person health risk appraisal, were included in this analysis.

Measurements: Reporting incontinence to the participant's physician was the main dependent measure.

Main Results: 37.6% of the participants had told their physician about loss of urine. Reporting incontinence to a physician was strongly associated with severity of incontinence as indicated by eight measures (P < 0.001). Treatment seeking was also related to type of incontinence (P < 0.001), physical disability (P < 0.01), and the pattern of health care utilization (P < 0.01). In multiple logistic regression analyses, younger age, physical disability, and frequency of physical and rectal examinations had significant predictive value independent of severity. Not associated with treatment seeking were gender, marital status, income, employment status, educational level, and distance from health care provider.

Conclusions: The majority of older adults with urinary incontinence do not report the condition to their doctor. Severity of incontinence, physical disability, and a pattern of regular health care utilization appear to be the strongest predictors of treatment‐seeking behavior.
Rationale and Design of a Multi‐Center Randomized Trial of Comprehensive Geriatric Assessment Consultation for Hospitalized Patients in an HMO
Authors: Borok Gerald M. , Reuben David B. , Zendle Les J. , Ershoff Daniel H. , Wolde‐Tsadik Girma , Rubenstein Laurence Z. , Ambrosini Virginia L. , Fishman Linda K. , Beck John C.
Published: April 2015

Objective: To describe the evaluation of an interdisciplinary comprehensive geriatric assessment (CGA) consultation program for targeted hospitalized patients.

Design: Multi‐center randomized clinical trial (RCT) at four hospitals where patients were randomly assigned to CGA consultation or usual care by the attending physician, and a non‐equivalent control group (NCG) at two hospitals.

Setting: Six hospitals in a multi‐specialty group practice model health maintenance organization (HMO).

Participants: 3593 patients age 65 years or older meeting at least one of 13 inclusionary criteria at admission.

Intervention: Screening by hospital staff and standardized CGA consultation conducted by a nurse practitioner, social worker, and geriatrician at the four RCT hospitals.

Main Outcome Measures: Functional and health status, mortality, rehospitalization, and cost‐effectiveness of the CGA program at 1 year post‐randomization; validation of targeting (inclusionary) criteria that identify subgroups of patients deriving benefit from CGA; and physician contamination (learning from CGA and changing treatment provided to control patients).

Conclusions: A number of methodological issues need to be considered when conducting effectiveness trials of CGA. The concurrent design of a multi‐center RCT, coupled with the NCG to determine physician contamination, is an innovative approach intended to determine more precisely the cost‐effectiveness of CGA for frail hospitalized elderly persons. The large and heterogeneous patient population and the broad array of inclusionary criteria will permit the evaluation of the benefit of CGA for subgroups. All these features are intended to enhance the generalizability of study results.
Differential Diagnosis of Dementia: A Prospective Evaluation of the DAT Inventory
Authors: Coen Robert F. , O'Mahoney Denis , Bruce Irene , Lawlor Brian A. , Walsh J. Bernard , Coakley Davis
Published: April 2015

Objective: To compare prospectively the concordance between the diagnosis of dementia based on clinical criteria and using the DAT Inventory.

Design, Setting, and Participants: A prospective study of 81 consecutive patients referred to a Memory Clinic. Only patients for whom a definitive diagnosis of dementia was established after 8 to 20 months follow‐up were retained in the study (n = 76).

Measurements: The sensitivity, specificity, positive and negative predictive values, and overall diagnostic accuracy of the DAT Inventory were calculated. Kappa values were also computed.

Results: Based on all patients (n = 76), sensitivity and specificity were 71% and 95%, respectively, with 98% positive prediction, 56% negative prediction, 78% overall accuracy, and kappa of 0.54. Of 21 cases not meeting NINCDS/ADRDA criteria for DAT, one patient with multi‐infarct dementia was misclassified as DAT on the DAT Inventory. Of 55 DAT cases (NINCDS/ADRDA criteria), 16 patients, predominantly very mild or mixed cases, were classified as non‐DAT on the DAT Inventory. When mixed, very mild, and borderline cases were excluded (remaining n = 54), DAT Inventory sensitivity increased to 94%, and specificity remained unchanged at 95%, with 97% positive and 91% negative prediction, 94% overall accuracy, and kappa of 0.88.

Conclusions: In general, scores above the designated cutoff point (>14/20) on the DAT Inventory are consistent with a clinical diagnosis of DAT (NINCDS/ADRDA criteria). Concordance is best in cases of mild to moderate dementia (Clinical Dementia Rating 1–2). The Inventory is less discriminating as a differential diagnostic instrument in cases of very mild dementia, atypical presentations of DAT, or in cases of mixed pathology. J Am Geriatr Soc 42:16–20, 1994
The Appropriateness of Oral Fluoroquinolone‐Prescribing in the Long‐Term Care Setting
Authors: Pickering Terri‐Diann , Gurwitz Jerry H. , Zaleznik Dori , Noonan James P. , Avorn Jerry
Published: April 2015

Objective: To evaluate the appropriateness of ciprofloxacin‐prescribing in the long‐term care setting.

Design: Retrospective chart review.

Setting: A large academically oriented long‐term care facility.

Patients: Institutionalized elderly patients with a mean age of 88 years.

Methods: One hundred orders were randomly selected for review from all ciprofloxacin orders initiated over a 3‐year period. Criteria for appropriateness of ciprofloxacin‐prescribing were developed based on a comprehensive review of the medical literature. Evaluation of appropriateness of prescribing was based on the indication for therapy and the availability of more effective and/or less expensive alternative antibiotic regimens. Only information available to the physician at the time of the order was used to judge appropriateness. Abstracted medical records were evaluated independently by a geriatrician and an infectious diseases specialist.

Results: With respect to site of infection, the urinary tract accounted for 43% of all ciprofloxacin orders; the lower respiratory tract, 28%; and skin and soft‐tissue infections, 17%. Only 25% of orders were judged appropriate. Twenty‐three percent of orders were judged less than appropriate based on indication, and 49% due to the availability of a more effective and/or less expensive alternative antibiotic choice. There was insufficient information in the medical record to judge 3% of the orders.

Conclusion: These results indicate less than optimal prescribing of oral fluoroquinolones in the long‐term care setting, with potential consequences including the development of resistant bacterial strains and increased health care costs. J Am Geriatr Soc 42:28–32, 1994
Stroke Inpatient Rehabilitation: A Comparison across Age Groups
Authors: Falconer Judith A. , Naughton Bruce J. , Strasser Dale C. , Sinacore James M.
Published: April 2015

Objective: To examine and compare the inpatient stroke rehabilitation experience of older adults (≥75 years) with that of young adults (<65 years) and young‐old adults (65–74 years).

Design: Cross‐sectional descriptive study.

Setting: A large university‐affiliated free‐standing rehabilitation hospital.

Participants: 260 adults who were admitted to inpatient stroke rehabilitation with a primary diagnosis of recent (<120 days) stroke (ICD9 430–436).

Variables: Demographic data, diagnosis, time between stroke onset and rehabilitation admission, discharge disposition, and functional status on admission and discharge were obtained from the patient's medical record. Treatment intensity and type, length of stay, and primary payment source data were obtained from the patient's billing record. Three‐month mortality data were available from the hospital's routine follow‐up survey.

Main Results: Compared with the younger adults (<65 yrs and 65–75 years), the older adults (≥75 years) were admitted to rehabilitation earlier and with comparable cognitive but poorer motor function. Rehabilitation treatment intensity (per day) and type were similar across age groups, but the older adults (≥75 years) had significantly shorter rehabilitation stays. Three‐month survival was comparable across age groups, but the older adults (≥75 years) had poorer motor function at discharge and were more often discharged to a nursing home or required a paid caregiver.

Conclusions: Age‐associated factors may influence inpatient stroke rehabilitation referral, treatment, and outcome, particularly for patients over age 75. The cumulative effects of frailty and co‐morbid disease upon stroke disability and treatment are possible explanations for the findings. The study provides evidence of a need for further investigation of stroke rehabilitation strategies for adults over 75 years old. J Am Geriatr Soc 42:39–44, 1994
Use of Laxative Medication in Older Persons and Associations with Low Serum Albumin
Authors: Pahor Marco , Guralnik Jack M. , Chrischilles Elizabeth A. , Wallace Robert B.
Published: April 2015

Objective: To study laxative use among older persons and the association of laxative intake with hypoalbuminemia.

Design: Cross‐sectional study in a population‐based cohort.

Setting: Community and institutions in the Iowa and Washington counties, Iowa site of the Established Populations for Epidemiologic Studies of the Elderly.

Participants: Persons aged 71 years or older, who were interviewed at the 6th year of follow‐up and for whom drug intake information was obtained (n = 2,529).

Main Outcome Measures: Laxative medication use and prevalence of hypoalbuminemia.

Results: The prevalence rate of laxative use was 8.8% in the community and 74.6% in nursing homes. Increasing age was independently associated with laxative use (odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.33 to 2.07 for a 10‐year increase), after adjusting for gender, institutionalization, disability in activities of daily living, body mass index, and use of the following drugs: furosemide, benzodiazepines, antidepressants, codeine, and calcium antagonists. Laxative use was independently associated with hypoalbuminemia (OR = 3.17, 95% CI = 1.42 to 7.08) after adjusting for age, gender, anemia, number of comorbid conditions, disability in activities of daily living, body mass index, use of furosemide, and institutionalization status. Compared with those who never used laxatives, those who took laxatives only at the 6th year of follow‐up were at increased risk of hypoalbuminemia (OR = 2.65, 95% CI = 1.04 to 6.77), and those who used laxatives at both the 3rd and 6th years of follow‐up were at greatest risk (OR = 4.02, 95% CI = 1.53 to 10.06).

Conclusion: Laxatives are used by large numbers of older persons, and the investigation on unknown adverse effects is important. Prospective studies are needed to confirm the association of laxative use with hypoalbuminemia found in this study and to assess the mechanisms of this association. J Am Geriatr Soc 42:50–56, 1994
Treatment of Small Cell Lung Cancer in the Elderly
Authors: Shepherd Frances A. , Amdemichael Esiahas , Evans William K. , Chalvardjian Peter , Hogg‐Johnson Sheila , Coates Randall , Paul Karen
Published: April 2015

Objective: Since both the incidence of lung cancer and the proportion of the population over age 65 are increasing rapidly in North America, we undertook a retrospective review of elderly patients with small cell lung cancer (SCLC) in an attempt to assess the effect of age on treatment decisions, response, survival, and toxicity.

Design: Retrospective chart view.

Setting: Oncology Unit of a university‐affiliated teaching hospital.

Patients: There were 123 patients age >70 years treated from 1976–88. Chemotherapy consisted of either cyclophosphamide, doxorubicin, and vincristine, or etoposide and cisplatin.

Results: There were 74 patients aged 70–74, 35 aged 75–80, and 14 aged 80 years or older. No significant differences existed between the groups in sex, stage, performance status, or presence of co‐morbid disease. Median survivals for patients with limited and extensive disease were 11.9 and 5.2 months, respectively (P = <0.0001), with no significant difference for patients in any age group (P = 0.4). For both limited and extensive disease, survival correlated strongly with the treatment received. Twenty‐five patients received no treatment (median survival 1.1 months), 20 had radiation only (median 7.8 months), and 27 patients had <3 cycles of chemotherapy (median 3.9 months). Median survival for the 50 patients who had 4–6 cycles was 10.7 months (limited disease 15.0 months, extensive disease 8.61 months). In the Cox Model, survival correlated strongly with stage of disease and chemotherapy treatment (P < 0.0001), but only marginally with performance status (P < 0.077). Of the 77 patients who had chemotherapy, less than 50% in all age groups completed six cycles. Only two patients completed chemotherapy without a single dose reduction, and 76.7% required more than two reductions.

Conclusions: Chemotherapy should not be withheld from elderly patients with SCLC on the basis of age. The survival of patients who receive chemotherapy is significantly longer than that of untreated patients even though frequent dose reductions for toxicity may be required. The survival benefit is due to treatment effect and is not due to a selection bias in the cohort of patients chosen for therapy. J Am Geriatr Soc 42:64–70, 1994