bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Vitamin B12 Levels and Incidence of Dementia in a Healthy Elderly Population: A Report from the Bronx Longitudinal Aging Study
Authors: Crystal Howard A. , Ortof Elizabeth , Frishman William H. , Gruber Amy , Hershman Dawn , Aronson Miriam
Published: April 2015

OBJECTIVE: To determine whether low serum B12 levels are associated with an increased incidence of dementing illness.

DESIGN: Longitudinal cohort study, 5‐year follow‐up.

PARTICIPANTS: Volunteer cohort of 410 nondemented ambulatory subjects aged 75 to 85 years.

MEASUREMENTS: Annual serum B12 determinations and neuropsychological assessments including the Blessed Test of Information, Memory and Concentration (BIMC) and the Fuld Object Memory Evaluation (FOME). If subject met criteria for a major cognitive change (as defined by an increase of 4 or more points on the BIMC), a work‐up that included CT, EEG, and neurologic assessment was performed. Clinical diagnoses were made according to established criteria.

RESULTS: Mean serum B12 level of entire sample was 558 pg/mL. Twenty‐two subjects had low B12 levels defined as values <150 pg/mL. Three of these 22 subjects (13.6%) became demented, compared with 57 of 388 subjects (14.7%) with higher levels. The incidence of Alzheimer disease among the low B12 group was 4.5% compared with 7.5% in the higher B12 group. The mean B12 level at time of diagnosis in subjects who did develop Alzheimer disease was 551 pg/mL. There was no evidence of hematologic disorder among the 22 subjects with low B12. Of the 3 low B12 subjects who did become demented, none responded to monthly B12 injections.

CONCLUSION: A low B12 level may not be a risk factor for dementia in general or Alzheimer disease in particular.
Muscle Strength and Fall Rates Among Residents of Japanese and American Nursing Homes: An International Cross‐Cultural Study
Authors: Lipsitz Lewis A. , Nakajima Ikumasa , Gagnon Margaret , Hirayama Takako , Connelly Carolyn M. , Izumo Hiroko , Hirayama Toshio
Published: April 2015

OBJECTIVE: In Western society, aging is often associated with adoption of a sedentary lifestyle and associated disuse muscle atrophy and weakness. Recent studies suggest a relationship between quadriceps muscle weakness and falls in elderly residents of US nursing homes (NHs). We hypothesized that fall rates would be lower in Japanese NHs, where lifestyle differences such as squatting to toilet or sleeping on the floor may maintain quadriceps strength and result in fewer falls. Therefore, we examined the relationships between falls, muscle strength, lifestyle, and other clinical characteristics in residents of a Japanese and an American NH.

DESIGN: Cross‐culture, prospective, cohort study.

MEASUREMENTS: We evaluated disease histories and current medications, quadriceps strength, and mobility of ambulatory American (n = 76) and Japanese (n = 89) NH residents, then followed these residents prospectively for the development of falls. Project staff from both sites trained together to assure uniform data ascertainment.

MAIN RESULTS: During a 6‐month follow‐up period, fall rates were nearly 4‐fold higher in the American than in the Japanese residents (49% vs 13%, respectively; P < 0.0001). In the American sample, fall rates declined with increasing muscle strength, while in Japan there was no relationship between fall rates and quadriceps strength. Residents also differed in number of medical diagnoses and use of medications, which were greater among American residents. The Japanese had slower gait speeds. Very few Japanese residents practiced squatting behaviors while living in the NH.

CONCLUSIONS: The relationship between muscle weakness and falls is probably modified by multiple characteristics of the individual, their culture, and their environment. Information from cross‐cultural studies may provide new insights into effective fall prevention strategies for nursing home residents.
Prevalence of Associated Diseases in Different Types of Dementia Among Elderly Institutionalized Patients: Analysis of 3447 Records
Authors: Holstein Josiane , Chatellier Gilles , Piette François , Moulias Robert
Published: April 2015

OBJECTIVE: To determine the prevalence of dementia in a population of hospitalized or institutionalized elderly patients, and that of associated diseases according to dementia type.

DESIGN: Retrospective analysis of a database of diagnostic codes.

SUBJECTS: All patients admitted to 1 of the 4 geriatric units participating in the study at the Charles Foix Hospital between 1980 and 1989.

MEASUREMENTS: All diagnoses mentioned in the discharge summary that could cause or contribute to hospitalization were recorded for each patient. A final list of 54 different diagnoses could be recorded for each patient. Dementia was subdivided into 3 subtypes: Alzheimer dementia (DAT), vascular dementia (VD), and other types of dementia (unclassifiable dementia).

MAIN RESULTS: The study involved 3447 patients aged 81.0 ± 8.3 years, of whom 27.7% were men. Dementia was the most frequent disease in this population (34.3%); Alzheimer disease was responsible for 15%, vascular dementia for 9.5%, and other types for 9.8%. The average number of associated diseases was 3.23 ± 2.10 in the Alzheimer dementia group, 4.73 ± 2.38 in the vascular dementia group, and 3.96 ± 2.26 in the nondemented group. Parkinson disease was present in 15.5% of patients with unclassifiable dementia, compared with 7.6% in the nondemented group (P < 0.001). There were significantly more diseases commonly seen in bedridden patients in the group of patients with both other types of dementia and Parkinson disease than in the group of other types of dementia patients without Parkinson disease (P < 0.01).

CONCLUSION: Dementia was the most common disease observed in our elderly institutionalized population. Alzheimer patients had significantly fewer associated diseases than nondemented patients, whereas the reverse was found in the vascular dementia group. The co‐existence of Parkinson disease and dementia in our population was associated with the poorest health status, as these patients were more likely to present simultaneously such conditions as pressure sores, incontinence, dehydration, or iatrogenesis.
Is the Phenotypic Combination A1B8Cw7DR3 a Marker for Male Longevity?
Authors: Rea I. M. , Middleton D.
Published: April 2015

OBJECTIVE: To study whether individual Human Leucocyte Antigens (HLA) at the HLA 1 or 11 loci or the phenotypic combination A1B8Cw7DR3 were associated with longevity.

DESIGN: Direct comparison of the > 90‐year‐old subjects with a control group.

SETTING: Northern Ireland population with little migratory mobility.

SUBJECTS: The > 90‐year‐old group (79 females, 38 males) was compared with a control group consisting of 150 unrelated blood donors (81 females, 69 males).

MEASUREMENTS: Human Leucocyte Antigen (HLA) Class 1 typing was carried out on 117 nonagenarians (mean age 93.7 years) and 150 younger controls (mean age 33.7 years) using conventional serological methods; HLA DR typing was carried out on 102 of the 117 > 90‐year‐old subjects, together with the 150 control subjects, and performed using restriction fragment length polymorphisms. The frequency of the phenotypic combination A1B8Cw7DR3 was measured in both groups.

RESULTS: There were no significant differences in the HLA antigen frequencies between the very elderly groups and the younger subjects at the A, B, C, and DR loci. The phenotypic combination A1B8Cw7DR3 was significantly increased (×3) in nonagenarian men compared with young men but not between elderly women and young women. There was a trend for increased representation of this phenotype in elderly men compared with women of the same age.

CONCLUSIONS: The frequency of the supratype A1B8Cw7DR3 was significantly increased in very elderly men but not in elderly women. Since this phenotypic combination has been associated with immune surveillance and/or hyperactivity in Caucasians, there is the suggestion that it could influence longevity through immune mechanisms but that sex differences may exist in its influence and expression.
Physical Activity and Related Factors Among Nursing Home Residents
Authors: Ruuskanen J. M. , Parkatti T.
Published: April 2015

OBJECTIVE: The purpose of this study was to examine physical activity and the predictors of physical activity and exercise among nursing home residents.

DESIGN: Population study.

PARTICIPANTS: The sample (n = 190) was obtained by selecting every man and every second women from the entire nursing home population (n = 346) in the city of Jyväskylä, central Finland, in autumn 1989. Information was eventually collected by interview from 158 persons (49 men and 109 women).

SETTING: An in‐home interview carried out among nursing home populations.

MEASUREMENTS: Independent variables were the questions describing physical activity among nursing home populations. Dependent variables were the predictors of physical activity: depression, contentment with nursing home living, activities outside the nursing home, and self‐rated functioning.

MAIN RESULTS: Walking and home gymnastics were the most common forms of physical exercise. The intensity of overall exercise was rather low, and the men carried out physical exercise more intensively than the women. More than 30% of the respondents reported decreased physical activity during their stay in the nursing home. However, attitudes toward physical exercise among the residents were largely positive. The primary factor limiting physical exercise was poor health status. Among the men, physical exercise was significantly associated with self‐rated functioning, depressive symptoms, and contentment with life in the nursing home. Among the women, higher contentment with the nursing home and less depression were associated with a physically active life.

CONCLUSIONS: The results suggest that living conditions and factors related to health and functional capacity affect the level of physical activity among nursing home residents. In order to encourage this population to be physically active, attention should be paid not only to physical exercise but also to associated factors, such as satisfaction with everyday life and health.
Voluntary Active Euthanasia and Physician‐Assisted Suicide in Dutch Nursing Homes: Requests and Administration
Authors: Van der Wal G. , Muller M. T. , Christ L. M. , Ribbe M. W. , van Eijk J. Th. M.
Published: April 2015

Objective: To learn how many requests for voluntary active euthanasia and/or physician‐assisted suicide (EAS) are made to Dutch nursing home physicians (NHPs) and how often these requests are honored.

Design: Retrospective survey.

Setting: The Netherlands.

Participants: All Dutch NHPs affiliated with the Dutch Association of Nursing Home Physicians (n = 713).

Measurements: An anonymous postal questionnaire was sent to all Dutch NHPs affiliated with the Dutch Association of Nursing Home Physicians (n = 713). Respondents were asked how often they had received an explicit request for EAS and whether they had complied with that request. Those who had complied were asked questions about the last occasion on which they had administered either voluntary active euthanasia or physician‐assisted suicide.

Results: The response rate was 86% (n = 582). Of the respondents, 88% had never administered EAS in nursing homes. The remaining 12% (n = 69) had received 164 requests for voluntary active euthanasia and 53 requests for physician‐assisted suicide in the period 1986 through mid‐1990. Of these requests, 74 were granted (51 voluntary active euthanasia and 23 physician‐assisted suicide). Dutch NHPs together receive an average of 300 requests for EAS a year. They comply with 25 of such requests annually.

Conclusion: Not many requests for EAS are made in Dutch nursing homes. Of these requests, fewer than 1 in 10 result in the actual administration of EAS. The data presented are relatively constant for the 4.5‐year period studied.
An In‐Home Preventive Assessment Program for Independent Older Adults: A Randomized Controlled Trial
Authors: Fabacher Diana , Josephson Karen , Pietruszka Fern , Linderborn Karen , Morley John E. , Rubenstein Laurence Z.
Published: April 2015

Objective: To evaluate the effectiveness of in‐home geriatric assessments as a means of providing preventive health care and improving health and functional status of community‐living elderly veterans.

Design: Randomized controlled trial with 1‐year follow‐up.

Setting: Home visits performed in a suburb of Los Angeles.

Participants: Community‐living veterans 70 years and older not currently receiving health care at the Sepulveda VA Medical Center (n= 131 intervention; 123 controls).

Intervention: A home visit by a physician's assistant or nurse, to screen for medical, functional and psychosocial problems, followed by a letter describing findings and recommendations, and follow‐up visits by trained volunteers at 4‐month intervals for 1 year. Controls received only telephone interviews at 4‐month intervals to collect outcome data.

Measurements: Compliance with recommendations was studied for the intervention group. Outcome comparisons between the two groups included: mortality, medication usage, functional status, immunization rates, and nursing home and hospital utilization.

Main Results: A mean of four new or suboptimally treated problems was identified for intervention subjects. Subjects complied with 76% of recommendations to see a physician or initiate a specific health practice. At 12‐month follow‐up, intervention subjects had significantly increased their immunization rates (P< 0.001) and had a significantly increased likelihood of having a primary care physician (P< 0.05). Twelve‐month functional status (IADL) scores were significantly higher for intervention subjects than for controls; intervention subjects maintained their functional status, while controls experienced significant decline during the follow‐up year (P< 0.05). Non‐prescription drug use increased significantly among controls, but not among intervention subjects (P< 0.05).

Conclusions: A brief geriatric screening assessment performed in the home can detect unrecognized and treatable problems, even among relatively healthy older adults. The use of trained volunteers is a feasible strategy for providing health education and follow‐up contacts. These results support the concept that preventive gerontological approaches can help maintain important aspects of health and function.
Effect of the Omnibus Reconciliation Act 1987 on Antipsychotic Prescribing in Nursing Home Residents
Authors: Semla Todd P. , Palla Kavita , Poddig Barbara , Brauner Daniel J.
Published: April 2015

Objective: To determine the impact of OBRA 87 on antipsychotic prescribing in a 485‐bed nursing home.

Design: Twelve‐month retrospective cohort review of medical charts, medication administration records, and computerized pharmacy records.

Measurements: The percent of residents by diagnostic group and antipsychotic use.

Main Results: An attempt was made to stop or lower the dose of antipsychotic in 75% of the 107 residents studied. Antipsychotics were stopped in 45% of residents with a dementia‐only diagnosis and 25% of residents with a psychiatric diagnosis (P < 0.05). Residents with documented symptoms appropriate for the use of an antipsychotic, per OBRA 87, were significantly less likely to have their antipsychotic stopped. Twenty percent of residents whose antipsychotic was either stopped or its dose lowered had the agent restarted or its dose increased.

Conclusion: OBRA 87 had a significant impact on antipsychotic use in this facility.
Restraint Reduction in a Nursing Home and Its Impact on Employee Attitudes
Authors: Sundel Martin , Garrett Rosa M. , Horn Robyn D.
Published: April 2015

Objective: To reduce physical restraint use in a nursing home and increase employee support for the restraint‐reduction program.

Design: A one‐group pretest‐posttest design with repeated measures was used to determine changes in restraint use with participants over a 14‐month interval. All individuals employed at the nursing home were surveyed at two time periods to determine their opinions on restraint use.

Setting: A 265‐bed private, non‐profit nursing home in Dallas, Texas.

Participants: A restrained cohort of 170 residents with a mean age of 84 years; 84% were female. A total of 182 employees participated in the first survey and 209 in the second.

Intervention: Formation of a project team that planned and supervised restraint removal. Inservice training on restraint use was conducted for all employees.

Measurements: Type and frequency of restraint use among the restrained cohort at four evaluation points within a 14‐month interval. The frequency of restraint use in the nursing home population was also recorded. Survey measures included employee responses to a 16‐item closed‐end questionnaire before and after training.

Results: The mean number of restraints used with each resident in the restrained cohort decreased from 1.56 to 0.67. The number of residents on restraints in the nursing home was reduced during the course of the study (67.5% vs. 36.7%, P < 0.0001). Changes in employee opinions about restraint use were found after training. On the second survey, more than twice as many employees indicated that restraints should be removed from almost all residents who have them (15.2% vs 36.3%, P < 0.0001).

Conclusion: A restraint‐reduction program in a nursing home can produce positive results in terms of decreased restraint use and supportive employee attitudes. More practical alternatives to restraints need to be developed for application in the training of nursing home employees. Future studies on resident, employee, and family attitudes about restraint use are suggested.
Do Geriatric Programs Decrease Long‐Term Use of Acute Care Beds?
Authors: Brymer Christopher D. , Kohm Catherine A. , Naglie Gary , Shekter‐Wolfson Lorie , Zorzitto Marissa L. , O'Rourke Keith , Kirkland James L.
Published: April 2015

OBJECTIVE: To determine whether the introduction of coordinated geriatric and discharge planning services at teaching and community hospitals in Toronto has changed the number of beds occupied by patients awaiting transfer to long‐term care institutions.

DESIGN: Retrospective review of social work records for the period 1985–1992.

SETTING: Two tertiary and four primary acute care hospitals in Metropolitan Toronto.

PARTICIPANTS: Hospitals were matched for location, acuity, and teaching affiliation.

MAIN OUTCOME MEASURES: The numbers of beds occupied by patients awaiting transfer to nursing homes or chronic care hospitals were noted.

RESULTS: In those teaching and community hospitals that had introduced coordinated geriatric and discharge planning services, there was a reduction in the percentage of beds occupied by patients awaiting long‐term care placement (average −51%), whereas in hospitals without geriatric services, the percentage of beds occupied by patients awaiting long‐term care placement increased (average +25%) (P = .05 by Fisher's exact method, 95% confidence limit odds ratio 0, .9999).

CONCLUSION: The introduction of coordinated geriatric and discharge planning services was associated with a decrease in the percentage of beds occupied by patients awaiting long‐term care in both teaching and community hospitals. J Am Geriatr Soc 43:885–889, 1995.
Hearing Impairment in Older Adults: New Concepts
Authors: Jerger James , Chmiel Rose , Wilson Nancy , Luchi Robert
Published: April 2015

OBJECTIVE: To review present information about the epidemiology, etiologies, pathogenesis, evaluation, and quality of life aspects of hearing loss and to present an approach to rehabilitation for hearing loss in older adults.

DESIGN: A survey of recent findings on the problem of hearing loss in older adults, efficacy of intervention with amplification, and new developments in intervention strategies.

CONCLUSIONS: The complex nature of hearing problems in older adults involves changes in the auditory periphery as well as in the central mechanisms for processing sound input. These changes affect the social and emotional impact of the hearing disorder. The importance of understanding the many implications of hearing loss on quality of life is emphasized.

Both older adults and immediate family members need information and advice about the consequences of age‐related hearing loss. The physician has a key role in helping them to overcome negative attitudes toward a hearing handicap.

For most older persons, hearing aids alleviate many of the handicaps of hearing impairment. For some older persons who do not benefit adequately from conventional hearing aids, assistive listening devices may be helpful. Many old persons and their relatives are reluctant to confront the reality of hearing handicap and try to hide the fact that they need sound amplification. One important future direction is to foster acceptance of hearing loss and to support the more open use of amplification systems. J Am Geriatr Soc 43:928–935, 1995.
Older Patients' Willingness to Trade Off Urologic Adverse Outcomes for a Better Chance at Five‐Year Survival in the Clinical Setting of Prostate Cancer
Authors: Mazur Dennis J. , Merz Jon F.
Published: April 2015

OBJECTIVE: To assess whether patients report a willingness to trade‐off urologic adverse outcomes–urinary incontinence and total impotence–for a better chance of 5‐year survival in the clinical setting of prostate cancer; and, if so, whether patients' current levels of symptoms of urinary incontinence, impotence, and frequency of sexual activity influence their decisions.

DESIGN: Structured interviews with a convenience sample of male patients.

SETTING: A university‐based Department of Veterans Affairs Medical Center.

PATIENTS: One hundred sixty‐three patients seen consecutively in General Medicine Clinic at the Department of Veterans Affairs Medical Center in Portland, Oregon, were enrolled in the study. Mean age of the patients was 65.2 years (SD = 10.6, range = 35–84); mean level of formal education completed was 13 years (SD = 2.7, range = 5–19).

MEASUREMENTS: In a hypothetical clinical setting of prostate cancer, patients were offered a choice of two procedures–Treatment A (surgery: worse short‐term, better long‐term survival) and Treatment B (radiation therapy: better short‐term, worse long‐term survival)–with varying benefit/risk trade‐offs in time. Patients were presented with pairs of treatment curves that were developed from research data on survival for surgery versus radiation therapy for stage II prostate cancer confined to the prostate gland. Treatments were not identified to control for labeling effects. Patients were asked their willingness to accept a chance of immediate mortality for better 5‐year survival in one of four treatment curve comparisons. Of those who accepted the net beneficial procedure, we then inquired as to whether urologic complications–urinary incontinence and wearing an appliance to collect urine or total impotence–altered the acceptability of that treatment.

RESULTS: Ninety‐four percent (153/163) of patients were willing to choose Treatment A (worse short‐term, better long‐term survival) on one of the four scenarios; the remainder (10/163) were unwilling to take Treatment A (worse short‐term, better long‐term survival) on any of the four scenarios. Sixty‐two percent (95/153) of patients were willing to accept a 100% chance of urinary incontinence; 83% (127/153) were willing to accept a 100% chance of impotence (chi‐square = 16.8 with 1 df, P = .0001).

CONCLUSIONS: Our results in an older male veteran population suggest than many patients are more concerned with long‐term survival in the clinical setting of prostate cancer than with short‐term treatment risks. In addition, patients are more willing to accept an impotence outcome than a urinary incontinence outcome, but this result was not related to patients' reported frequency of sexual activity. J Am Geriatr Soc 43:979–984, 1995.
Healthy Young and Old Women Differ in Their Trunk Elevation and Hip Pivot Motions When Rising from Supine to Sitting
Authors: Alexander Neil B. , Fry‐Welch Donna K. , Marshall Lisa M. , Chung Carolyn Chia‐Fung , Kowalski Ann Marie
Published: April 2015

OBJECTIVE: To describe the differences between healthy young and older women in regards to trunk elevation and hip pivot motions when rising from a supine to a seated position.

DESIGN: Cross‐sectional comparison.

SETTING: University laboratory.

PARTICIPANTS: Two groups of healthy female volunteers: young adult female controls (n = 22, mean age 23.5 years) and community‐dwelling older female adults (n = 17, mean age 73.8 years).

MEASUREMENTS: Subjects were videotaped as they performed three controlled bed mobility tasks, starting from a supine position: (1) rising to a seated position at the edge of a firm plinth surface (SS); and rising to a seated position without moving to the edge of the bed while either (2) using hands (SUH) or (3) not using hands (SUNH). A series of movements involving the trunk were identified as subjects performed the SS task.

RESULTS: The older women were more likely to rotate and laterally flex their trunks, particularly in the later phases of the SS task. In addition, during the SS task, the older group was more likely to bear weight on their hip/gluteal area, particularly in the later phases, and more likely to use a broad pivot base, consisting of the hip and the elbow. While all young and old performed the SUH task, less than half of the older group could complete the SUNH task. Moreover, the subgroup of older adults who could not complete the SUNH task may have accounted for much of the differences between the young and the old on the SS task.

CONCLUSION: Healthy young and older women differ in their ability to rise from a supine to sitting position, primarily in the strategies used to elevate the trunk and facilitate a pivot. Trunk flexion ability likely contributes to the age group differences noted in rising. These data provide the basis for a biomechanical analysis of the critical body segment motions and the strengths required to perform bed mobility tasks.
Wheelchairs as Mobility Restraints: Predictors of Wheelchair Activity in Nonambulatory Nursing Home Residents
Authors: Simmons Sandra F. , Schnelle John F. , MacRae Priscilla G. , Ouslander Joseph G.
Published: April 2015

OBJECTIVE: The purpose of this paper is to describe factors affecting wheelchair mobility in nonambulatory nursing home (NH) residents.

DESIGN: Prospective descriptive study of a convenience sample of nonambulatory NH residents.

SETTING: Seven nursing homes.

PARTICIPANTS: Sixty‐five nonambulatory residents.

MEASUREMENTS: One‐minute, time‐sampled observations of behavior for each resident were made every 15 minutes for 8 to 11 hours across 2 days, noting wheelchair propulsion activity for the dependent variable; independent variables included measures of wheelchair level of assistance, speed, endurance, handgrip strength, and balance.

MAIN RESULTS: A stepwise Multiple Regression analysis found wheelchair speed to be the single best predictor of the percentage of time residents were behaviorally observed wheelchair propelling (Multiple r = .45, P < .02). Handgrip strength and wheelchair endurance measures were highly intercorrelated with wheelchair speed. Wheelchairs that were either dysfunctional or inappropriately fitted to the residents' size were a major barrier to wheelchair use, affecting 46% of residents using wheelchairs.

CONCLUSION: Improving wheelchair skills with targeted intervention programs, along with making chairs more “user friendly” (e.g., grip extensions on brakes, foot pedals that one can move without bending over), could result in more wheelchair propulsion with resultant improvements in the NH resident's independence, freedom of movement, and quality of life.
Attitudes Toward Self‐Determined Death: A Survey of Primary Care Physicians
Authors: Duberstein Paul R. , Conwell Yeates , Cox Christopher , Podgorski Carol Ann , Glazer Rachel S. , Caine Eric D.
Published: April 2015

OBJECTIVE: To survey physicians to determine whether sociodemographic and practice‐related variables are predictive of their attitudes toward suicide.

DESIGN: Mailed questionnaire survey.

SETTING: Monroe County, New York.

PARTICIPANTS: A 50 percent random sample of practicing primary care physicians. Of 186 potential respondents, 114 (61.3%) physicians returned questionnaires.

MEASUREMENT: In addition to age and gender, independent variables included medical specialty, practice composition defined in terms of patient age, and textbook knowledge of depression and suicide. The dependent variable, attitude toward suicide, was measured using four standard opinion survey questions and six items based on a case vignette. Dependent variables were rated on a Likert‐type scale and subsequently dichotomized for use in logistic regression analysis.

RESULTS: Approximately 61 percent of the respondents believe that suicide can be rational under certain circumstances, 51 percent believe that physicians should not assist suicides under any circumstances, and 31 percent support legalization of assisted suicide under certain circumstances. Regression analyses revealed that gender was a significant predictor for three of the ten attitude items. Medical specialty, clinical and epidemiological knowledge of depression and suicide, and physician age significantly predicted one attitude item.

CONCLUSIONS: These results suggest that physicians' attitudes toward suicide are multidetermined. Although gender, age, medical specialty, and knowledge of depression and suicide predict certain attitudes, the logistic regression analyses were not highly successful in predicting respondents' attitudes. Given the power of physicians to command public attention and to influence public and legal opinion, it is vital that future research continue to explore the determinants of physicians' attitudes toward self‐determined death.
Feasibility and Accuracy of a Postcard Diary System for Tracking Healthcare Utilization of Community‐Dwelling Older Persons
Authors: Reuben David B. , Wong Richard C. , Walsh Kathleen E. , Hays Ron D.
Published: April 2015

OBJECTIVE: To test the feasibility of and to validate a self‐report weekly postcard diary of health care utilization.

DESIGN: Case‐series and validation study.

SETTING: Community‐based sample of fee‐for‐service and health maintenance organization (HMO) patients.

PARTICIPANTS: A convenience sample of 24 community‐dwelling older persons who had failed a self‐administered screen and were eligible for a study of outpatient comprehensive geriatric assessment consultation.

MEASUREMENTS: Subjects completed and mailed in a weekly postcard diary documenting medical, counseling, or rehabilitation therapy visits. If a subject did not respond within 10 days after the end of the week, a telephone call was placed to gather the information. For a subset of 10 subjects who were HMO enrollees, all records were reviewed to determine accuracy of the postcard diaries.

RESULTS: Of the 24 subjects enrolled, one HMO enrollee dropped out following hip surgery after 4 weeks of completing diaries. The remaining 23 subjects (96% of total entered) provided complete information for 12 weeks. Telephone follow‐up to either obtain or clarify utilization information was required for 22% of subjects. For the subset of 10 HMO subjects, seven underreporting, two overreporting, and one incorrect day errors were detected–a total of 10 errors representing 9% of diaries and 1.3% of patient‐days. Kappa as a measure of agreement between the two methods (self‐report and chart review) was 0.82 (P < .0001). Compared with chart review, the diary report was 75.0% sensitive and 99.8% specific. Positive and negative predictive values were 91.3% and 99.2%, respectively.

CONCLUSION: These findings suggest that a postcard diary system with telephone follow‐up is both a feasible and reasonably accurate method of tracking health care utilization by community‐dwelling older persons, although a small percentage will be unable to adhere to this method.
Beyond Labels: Nursing Home Care for Alzheimer's Disease In and Out of Special Care Units
Authors: Grant Leslie A. , Kane Rosalie A. , Stark Alice J.
Published: April 2015

OBJECTIVE: To compare dementia special care units (SCUs) with their non‐SCU counterparts in terms of unit and facility characteristics.

DESIGN: Cross‐sectional telephone survey and secondary database.

SETTING: 1247 units in 436 Minnesota nursing homes.

MEASUREMENTS: Specialized dementia care practices (e.g., staffing, environmental design and programming features) and organizational characteristics (e.g., size, geographic location, type of ownership, proportion dementia, case‐mix and percentage Medicaid).

RESULTS: Comparing unit level data for all units in 436 facilities, we found that 75 SCUs offered more dementia‐specific features than did the 1122 units not designated as SCUs, but most units offered some dementia‐specific features similar to those of SCUs. The designation of SCU did not automatically translate into richer or more tailored services for dementia compared with units without the designation. Facilities with designated SCUs are more likely to be rural, larger and divided into more units, have a higher proportion of residents with dementia, and have fewer residents at higher levels of acuity.

CONCLUSION: Presence of a SCU in a facility may be related to care of dementia in the rest of the nursing home in complex ways; some dementia‐specific features were less likely to be found in regular units of nursing homes with designated SCUs.
When Home Caregiving Ends: A Longitudinal Study of Outcomes for Caregivers of Relatives with Dementia
Authors: Gold Dolores Pushkar , Reis Myrna Feldman , Markiewicz Dorothy , Andres David
Published: April 2015

OBJECTIVES: To study caregivers' decisions to end home care for relatives with dementia; to study the changes in caregiver functioning over time.

DESIGN: A prospective longitudinal follow‐up study.

SETTING: Individual homes and chronic care facilities in Montreal.

PARTICIPANTS: 157 caregiver‐dependent dyads, followed up 2 years later; dependents had been diagnosed as having progressive dementia.

MEASUREMENTS: A standard interview and a series of standardized psychological questionnaires were given to caregivers, assessing their functioning and their appraisals of the dependent person in their care. Dependents received the Mini‐Mental State Examination.

MAIN RESULTS: Caregivers cited patient deterioration as the most common reason for ending home care. Most caregivers did not prepare their relative before institutionalization. Most caregivers were satisfied with having ended home care and believed the decision was positive for themselves and their dependent, but a sizable minority of caregivers and dependents had difficulty adjusting to the end of home care. Repeated measures multivariate analyses indicated that caregivers who had discontinued home care because of placement or death of the dependent had improved functioning and quality of life and better health than caregivers still providing home care.

CONCLUSIONS: Caregivers most frequently cite deteriorating patient conditions as the main causes of ending home care. Caregiver exhaustion is the single most frequently given reason. Caregivers who were still providing home care at the end of the study were functioning less well than caregivers who had ended home care, despite having initially functioned at better levels.
Access to Hospice Programs in End‐Stage Dementia: A National Survey of Hospice Programs
Authors: Hanrahan Patricia , Luchins Daniel J.
Published: April 2015

OBJECTIVE: Because care of end‐stage dementia is a significant clinical problem for which alternative modes of care are needed, this study examined the extent to which hospice programs served dementia patients.

DESIGN: A survey of 1694 hospices with 1184 respondents (70%).

PATIENTS: Identifed patients had end‐stage dementia, with no concurrent terminal illness.

MEASURE: The proportion of end‐stage dementia patients in hospice was measured.

RESULTS: Fewer than 1% of hospice patients had a primary diagnosis of end‐stage dementia, and only 21% of the hospices served such patients. However, 7% of hospice patients had a dementia secondary to another terminal illness, and 56% of the hospices served such patients. For 80% of the hospices, the major problem in serving dementia patients was the difficulty in predicting their survival time. A higher proportion of for‐profit hospices served dementia patients (42%) compared with non‐profit programs (22%) or public programs (15%), P < .001.

CONCLUSIONS: A national survey of hospices revealed that few patients with primary dementia are currently treated by these programs, unless they have other terminal illnesses. An inability to predict survival was the major reason offered to explain this phenomenon. The higher percentage of patients with secondary dementia in hospice suggests that dementia per se does not make hospice care unfeasible. Similarly, the high proportion of for‐profit hospices that enrolled patients whose dementia was primary implies the fiscal feasibility of providing hospice care for these patients. Further study is needed concerning the determinants of survival time in end‐stage dementia. J Am Geriatr Soc 43: 56–59, 1995.
Diagnostic and Prognostic Value of Ambulatory Electrographic Monitoring in Older Patients
Authors: Tresch Donald D.
Published: April 2015

OBJECTIVE: To review the use of ambulatory electrocardiographic monitoring in detecting transient cardiac arrhythmias and myocardial ischemia in older patients and to determine the significance of these findings in predicting future cardiac events.

DATA SOURCES: Reports on ambulatory electrocardiographic monitoring's capabilities in the detection and quantification of arrhythmias and myocardial ischemia were identified by multiple searches on the MEDLINE database and citations from relevant articles.

STUDY SELECTION: Studies that demonstrated good research methodology were reviewed. Review was limited to studies that used reel‐to‐reel or cassette recorders (not reel‐time monitors).

DATA EXTRACTION AND SYNTHESIS: Pertinent data were extracted from the studies, with specific emphasis on studies involving older patients. Prognostic findings were critically analyzed and compared between younger patients and older patients. Differences in prognoses between patients with and without underlying heart disease were assessed.

CONCLUSION: Ambulatory electrocardiographic monitoring is a noninvasive procedure that is beneficial in stratifying older patients with heart disease into high and low risk groups for future cardiac events. The presence of complex ventricular arrhythmias or silent myocardial ischemia as documented on 24‐hour monitoring, especially in combination with left ventricular dysfunction or left ventricular hypertrophy, is highly predictive of future cardiac events, including sudden cardiac death and total cardiac mortality. The use of preoperative, intraoperative, and postoperative electrocardiographic monitoring may also be beneficial in stratifying older surgical patients into high and low risks for postoperative cardiac events.
Relationship Between Physical Performance and Self‐Perceived Physical Function
Authors: Cress M. Elaine , Schechtman Kenneth B. , Mulrow Cynthia D. , Fiatarone Maria A. , Gerety Meghan B. , Buchner David M.
Published: April 2015

OBJECTIVE: The objective of this study was to compare two methods of measuring physical function in subjects with a broad range of abilities and to evaluate the effects of cognitive, social, educational, and age factors on the relationship between the two methods.

DESIGN: Multiple regression analysis was used to compare self‐perceived (dependent variables) with performance measures (independent variables). Covariates included age, gender, Mini‐Mental State Exam score, education, living status, and depression score.

SETTING: Five community‐dwelling and two nursing home sites.

PARTICIPANTS: 417 community‐dwelling subjects and 200 nursing home residents aged 62–98 years.

MEASUREMENTS: Self‐perceived physical function was assessed with the physical dimension summary score of the Sickness Impact Profile, which comprises three subscales: ambulation, mobility, and body care and movement. Physical performance was evaluated by self‐selected gait speed, chairstand time, maximal grip strength, and a balance score.

RESULTS: Nursing home residents and community‐dwellers were significantly different (P < .0001) in all variables except age and gender. Self‐perceived and performance‐based measures were moderately correlated, with a range from r = −.194 to r = −.625 (P < .05). Gait speed was the strongest independent predictor of self‐perceived physical function in both groups. Symptoms of depression were also an independent predictor of self‐perceived function in nursing home residents; subjects who had such symptoms report more self‐perceived dysfunction than would be predicted based on performance tests.

CONCLUSIONS: Self‐selected gait speed is a global indicator of self‐perceived physical function over a broad range of abilities. External determinants (depressive symptoms, cognitive function, marital status, etc.) affect self‐perceived function in both groups, but gait speed is the greatest single predictor of self‐perceived function. In nursing home residents depressive symptomatology is related to self‐perceived function, but gait speed is not.
Predictors of Skilled Nursing Placement in a Multilevel Long‐Term‐Care Facility
Authors: Osterweil Dan , Martin Marla , Sykdulko Karl
Published: April 2015

OBJECTIVE: To determine if cognitive and functional data gathered before admission to residential care (i.e., board and care) placement can predict nursing home placement.

DESIGN: Retrospective study using Cox proportional hazards analysis and pairwise assessment of adjusted relative risk factors to determine which independent variables predicted skilled nursing placement. Subjects were followed for an average of 23.7 months (SD = 18.6 months).

SETTING: Multilevel 735‐bed long‐term care facility, Jewish Home for the Aging, Reseda, California.

PARTICIPANTS: Of the 248 consecutive residential care admissions studied, 80% were women. Subject's mean age was 84.8 years (SD = 5.0); 67% had no significant cognitive impairment.

INDEPENDENT VARIABLES: Categorical variables were classifications with respect to dementia status, incontinence, hearing, and ambulation. Interval variables were number of medications, Katz ADL, and five neuropsychological tests. Demographic variables were gender, age, language of origin, and education.

OUTCOME VARIABLE: Time between preadmission testing and the move up to skilled nursing placement.

RESULTS: Pairwise assessment of adjusted potential risk factors indicated that cognitive dysfunction, less than perfect Katz ADL performance, and hearing loss were the most important independent risk factors for nursing placement.

CONCLUSIONS: The findings remind us to pay careful attention to residents exhibiting even relatively mild cognitive deficits upon admission because these residents are likely to need increased environmental support.
An Epidemiologic Study of Fall‐Related Fractures Among Institutionalized Older People
Authors: Cali Clorinda M. , Kiel Douglas P.
Published: April 2015

OBJECTIVES: The purpose of this study was to assess the incidence of fall‐related fractures, and the circumstances surrounding these events, during a 5‐year period among all residents of a long‐term care facility.

PARTICIPANTS: The study group was composed of residents with radiologically confirmed fractures that were the direct result of a fall occurring between the years 1988 and 1992. This group was 82% female and had a mean age of 89±6 years.

DESIGN: The study was designed as a 5‐year retrospective cohort study in a long‐term care institution where annual incidence rates of fracture were assessed.

RESULTS: There were 296 fall‐related fractures during the 5‐year period. Annual incidence rates remained fairly constant (72, 86, 84, 70, and 94 per 1000 person‐years, respectively) despite a 54% decline in the use of physical restraints during the 5‐year period. Hip fractures comprised almost 50% of all fractures. Based on incident reports of these fractures, 42% occurred during the day, 55% took place in the bedroom or adjoining bathroom. 67% occurred while the resident was ambulating, and a wet floor was in evidence in 16% of the incidents.

CONCLUSION: Fracture incidence in this long‐term care facility has remained stable despite reduced restraint use. The incident reporting system may contribute valuable information to the identification of factors that should receive further attention in studies of risk factors for fracture in the long‐term care setting.
Use of the Minimum Data Set to Rate Incontinence Severity
Authors: Crooks Valerie C. , Schnelle John F. , Ouslander Joseph P. , McNees M. Patrick
Published: April 2015

OBJECTIVES: To assess the relationship of the MDS incontinence severity ratings to direct measures of incontinence frequency.

DESIGN: Two methods of measuring incontinence were compared: the MDS rating as recorded by nursing home (NH) staff and physical checks for wetness performed by research staff.

SETTING AND PARTICIPANTS: A total sample of 293 older residents from nine nursing homes located in Iowa, the State of Washington, and the Los Angeles area were assessed once. A subsample of 49 incontinent residents were assessed twice, before and after the implementation of a prompted voiding program.

INTERVENTION: This study is a part of a larger study evaluating the use of a computer‐aided incontinence management system (IMS). Incontinent residents were assessed, and, if they met predefined criteria, they were treated with prompted voiding.

MEASUREMENTS: Three measures of incontinence were used: the MDS rating recorded by NH staff, physical checks for wetness performed by NH staff while assessing residents for and treating them with prompted voiding, and physical checks for wetness performed independently by research staff.

RESULTS: There was a statistically significant correlation (r = .49; P ≤.001) between research staff wet checks and the MDS ratings, but wetness checks performed by NH staff had an insignificant correlation with MDS ratings (r = .003; P < 0.914). There was wide variability within and between NHs in the correlation. For residents who were placed on the prompted voiding program, the pre to post wet rate, as measured by research staff, improved significantly (from 28 to 14%; t = 6.73; df= 48; P < .001), whereas the pre to post MDS ratings did not change significantly (from 1.7 to 2.0; t = −1.42;df=4S;P< .075).

CONCLUSIONS: Although the MDS appears to identify incontinent NH residents accurately, its clinical utility may be limited by disagreements between actual wet check data and MDS categorical severity rankings for residents known to be incontinent. The wide variability between direct observational measures of wetness and the MDS scores denoting incontinence severity we observed may limit the potential usefulness of the MDS for detecting changes in incontinence severity. It is possible that more information and instructions are needed for staff completing the MDS if the goal is to discriminate between different levels of incontinence severity and measure changes over time in response to therapeutic interventions.