bluuebunny/crossref_metadata_2025 huggingface dataset:
Ability of Surrogates To Represent Satisfaction of Nursing Home Residents with Quality of Care
Authors: Lavizzo‐Mourey Risa J. , Zinn Jacqueline , Taylor Lynne
Published: April 2015

Objective

To measure the ability of surrogates to accurately represent nursing home residents' satisfaction with the nursing home care.

Design

Comparison by correlation analysis of questionnaire answers by nursing‐home residents and their designated surrogates.

Setting

Four non‐profit community nursing homes.

Participants

One‐hundred fifty‐two resident‐surrogate pairs were included, based on the following criteria: (1) the resident was able to respond to questions verbally and in English, had cognitive abilities sufficient to understand the questions, and had a responsible party who had a telephone number in the medical record; (2) both the resident and the surrogate agreed to be interviewed.

Outcome Measures

A 26‐item instrument (21 specific and 5 global items) was developed to measure surrogates' perceptions of residents' satisfaction with the quality of the physician services, nursing care, and the nursing home environment. The instrument was scored on a 4‐point Likert scale in which higher scores indicated greater satisfaction and paralleled a similar instrument designed for nursing home residents. Correlation of residents' with surrogates' scores on the satisfaction instrument was examined.

Results

The mean score for most items was greater than 3.0, indicating overall satisfaction with the care. Correlations between surrogates and residents on specific items ranged from 0.1 to 0.55. Correlations were highest for global items and items addressing satisfaction with the environment.

Conclusion

We conclude that nursing home residents' surrogates cannot accurately express the residents' satisfaction with all areas of nursing home care and that their evaluations should not be taken in lieu of the residents' opinions.
Left Ventricular Hypertrophy
Authors: Aronow Wilbert S.
Published: April 2015

Objective

To review the pathophysiology, epidemiology, patterns, diagnosis, and treatment of left ventricular hypertrophy with emphasis on the elderly.

Data Sources

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

Study Selection

Studies on the pathophysiology, epidemiology, patterns, diagnosis, and treatment of left ventricular hypertrophy were screened for review. Studies on left ventricular hypertrophy in the elderly and recent studies were emphasized.

Data Extraction

Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving the elderly. Relevant articles were reviewed in depth.

Data Synthesis

Available data about the pathophysiology, epidemiology, patterns, diagnosis, and treatment of left ventricular hypertrophy with emphasis on studies involving the elderly were summarized.

Conclusions

Left ventricular hypertrophy caused by hypertension or other cardiovascular disease is not only a marker for but also a contributor to cardiovascular morbidity and mortality in elderly and young patients. The question of whether regression of left ventricular mass in patients with hypertension will decrease cardiovascular morbidity and mortality needs to be answered by prospective studies using different types of antihypertensive drugs. Future studies on the efficacy of antihypertensive drugs and on stratification of therapy should include echocardiographic estimates of left ventricular mass index.
Physical Restraint Use and Cognitive Decline among Nursing Home Residents
Authors: Burton Lynda C. , German Pearl S. , Rovner Barry W. , Brant Larry J.
Published: April 2015

Objective

This study investigated the association between physical restraint use and decline in cognition.

Design

Cohort analytic study describing changes in resident characteristics.

Setting

Eight nursing homes, both urban and suburban, operated by a proprietary corporation in a large metropolitan area.

Participants

437 nursing home admissions, with 201 remaining at 1 year.

Main Outcome Measures

Cognitive status was measured by geropsychiatrists, using the Folstein Mini‐Mental State Exam, during a psychiatric evaluation of the resident. Daily restraint use was documented from nursing orders. Observations were made at 2 weeks, 10 weeks, and 1 year.

Results

Restraint use alone and in combination with neuroleptic use was associated with poor cognition. Other variables associated with poor cognitive scores were: ADL impairment, poor adaptive behavior, and longer time in the nursing home. The use of neuroleptics alone was not significant. Variables which were associated with good cognitive status were: being non‐ambulatory but without dementia and having strong social support.

Conclusions

These findings raise the possibility that restraint use may contribute to cognitive impairment, specifically among residents who have moderate to no cognitive impairment at admission; however, the findings do not exclude an alternative explanation that residents undergoing cognitive decline are more likely to be put in restraints. Further research is needed to understand whether factors which can be manipulated contribute to cognitive decline.
Book Reviews
Authors: Puzas J. Edward
Published: April 2015

HRT and Osteoporosis. Edited by JO Drife and JWW Studd. Springer‐Verlag, New York, 1990. 394 pages. $110.00.
Positron Emission Tomography and Familial Alzheimer's Disease: A Pilot Study
Authors: Guze Barry H. , Hoffman John M. , Mazziotta John C. , Baxter Lewis R. , Phelps Michael E.
Published: April 2015

Objective

Local cerebral metabolic rates for glucose were compared between patients with familial Alzheimer's disease (FAD), sporadic Alzheimer's Disease (SAD), and normal controls (NC) to determine if FAD is associated with a unique pattern of brain metabolism.

Design

Case‐control study matched to convenience sample of FAD.

Methods

Subjects in the three diagnostic groups were scanned using fluorodeoxyglucose and the Positron Emission Tomographic (PET) technique. The criterion standard of a detailed clinical history and examination were compared to scan results.

Setting

Patients in a university hospital.

Subjects

Ambulatory controls and Alzheimer's patients, both sporadic (n = 8) and familial (n = 7). The two groups were similar in severity of cognitive dysfunction.

Results

FAD and SAD patients did not significantly differ in terms of local cerebral metabolic rates for glucose.
The Effects of Patterned Urge‐Response Toileting (PURT) on Urinary Incontinence among Nursing Home Residents
Authors: Colling Joyce , Ouslander Joseph , Hadley Betty Jo , Eisch Joan , Campbell Emily
Published: April 2015

Objective

To test an individualized form of habit training for urinary incontinence (UI) among long‐stay cognitively and/or physically impaired elderly nursing home residents over time.

Design

Randomization of subjects occurred by nursing home unit. Baseline wet checks were done hourly for one 24‐hour period at 3‐week intervals over 12 weeks followed by 72 hours of continuous electronic monitoring to establish precise voiding patterns for each subject. The 12‐week intervention period was administered by indigenous staff after they attended a 4‐hour UI educational program. Subjects were followed an additional 12 weeks to determine the extent of maintenance of the intervention among staff and subjects.

Setting

Four non‐profit nursing homes; west, mid‐west, east coast.

Patients

Consent was obtained from 154 (71%) who met primary inclusion criteria. Forty‐one failed the secondary inclusion criteria leaving 113 who entered the 37‐week study. Eighty‐eight completed the study (experimental = 51, control = 37); all were physically and/or mentally impaired, averaged age 85, and had either urge or urge/stress UI.

Results

UI was significantly decreased during the 3‐month period (P < 0.001). Eighty‐six per cent showed improvement over baseline while one‐third improved 25% or more over their baseline UI rate. The control group's UI increased during the same period of time. The volume of UI among the experimental group also decreased (P < 0.005) while the control group's UI volume increased.

Conclusions

The training program was effective in reducing UI though compliance among nursing staff averaged only 70% of the prescribed toileting times. The success of this approach is similar to other recently described behavioral programs but achieved the reduction using only regular nursing staff. This individualized approach supports the recent regulatory thrust to individualize care to promote and maintain functional abilities and autonomy.
Recombinant Hemopoietic Growth Factors: Comparative Hemopoietic Response in Younger and Older Subjects
Authors: Shank Walter A. , Balducci Lodovico
Published: April 2015

Objective

To study the effectiveness of hemopoietic growth factors in older patients.

Design

Literature review. All articles published in English language between 1987 and 1990 were reviewed. Those reporting studies without age limits as entry criteria and describing the effects of growth factors in individual patients were suitable for analysis. Bone marrow transplantation related articles were excluded.

Main Outcome Measures

The meanfold increase of granulocytes for Granulocyte‐Colony Stimulating Factor, Granulocyte Macrophage‐Colony Stimulating Factor, and Interleukin 3 and of hemoglobin for erythropoietin were compared in subjects younger and older than 65, by Mann‐Whitney U test.

Results

Of 68 studies, 23 were suitable for analysis. These included patients with myelodysplastic syndromes, aplastic anemia, chemotherapy‐induced myelosuppression, chronic granulocytopenia, anemia, and myelosuppression of malignancies and of chronic disease. Of 204 patients, 67 were 65 years of age or older and 42 were over 70. No difference was seen in meanfold increase of granulocyte and hemoglobin in time of response to growth factors or in response in presence of an absolute neutrophil count lower than 1000/μL between younger and older patients.

Conclusion

Early response to hemopoietic growth factors appears well maintained with advanced age. Prospective studies of the prolonged effects of these factors in older and younger patients are needed.
Body Composition in Elderly Men: Effect of Dietary Modification during Strength Training
Authors: Meredith Carol N. , Frontera Walter R. , O'Reilly Kevin P. , Evans William J.
Published: April 2015

Objective

To assess how dietary change affects gain in strength and muscle mass during heavy resistance training of elderly men.

Design

Randomized controlled trial.

Intervention

During 12 weeks of resistance training of knee extensors and flexors, a daily supplement of 560 ° 16 kcal/day (17% energy from protein, 43% from carbohydrate, 40% from fat) was randomly assigned to six men (S) while five men (U) received no supplement. Food intake, strength, whole body composition, and midthigh composition by CT scan were assessed before training and at 6 and 12 weeks.

Setting

The men were outpatients but lived in a Metabolic Research Unit during the three assessments.

Participants

Eleven healthy men aged 61 to 72 years.

Results

Densitometry showed no change over time in fat or fat‐free mass. However, the S men increased (P < 0.05) weight, skinfold thickness at six sites, subcutaneous midthigh fat, and creatinine excretion; in all men, changes in these values and in midthigh muscle were proportional to changes in reported energy intake (P < 0.05). There was midthigh muscle hypertrophy in both groups, but it was greater in S than U (P < 0.01). Both groups gained strength (P < 0.001) with no effect of diet.

Conclusions

During physical rehabilitation of the elderly, dietary intake may influence the increase in lean as well as adipose tissue without altering strength gain. These preliminary findings should be confirmed by a larger study with sedentary controls.
Tuberculosis in Aging Adults
Authors: Yoshikawa Thomas T.
Published: April 2015

“… It is now, however, the general opinion of all those who are acquainted with the actual state of our knowledge respecting the pathology of diseases that the tubercular affection, like cancer, is absolutely incurable, inasmuch as nature's efforts toward effecting a cure are injurious, and those of art are useless. …”—R.T.H. Laennec, 1821.1
BOOK REVIEWS
Authors: Katz Paul R. , Wear Stephen
Published: April 2015

The Last Choice: Preemptive Suicide in Advanced Age. By Prado CG. New York, Greenwood Press, 1990: 215 pages. $39.95.
BOOK REVIEWS
Authors: Kochersberger Gary
Published: April 2015

Year Book of Geriatrics and Gerontology 1991. By Beck JC, Abrass IB, Burton JR, Cummings JL, Makinodan T, and Small GW. St. Louis, Mosby, 1991. 291 pages. $54.95.
The Diagnosis of Small Bowel Bacterial Overgrowth in Elderly Patients
Authors: Donald I. P. , Kitchingmam G. , Donald F. , Kupfer R. M.
Published: April 2015

Objective

To examine the frequency of small bowel bacterial overgrowth in elderly subjects.

Design

Prospective observational study.

Setting

Department of Health Care of the Elderly in a university teaching hospital.

Patients

Thirteen elderly control subjects having undergone normal gastroscopy with normal hematology and anthropometry; 39 consecutive referrals of elderly patients with clinical or biochemical evidence of malnutrition.

Main Outcome Measures

Duodenal bacterial counts and the 14C‐glycocholate, hydrogen, and 14C‐xylose breath tests.

Results

Five of the 13 control subjects and 21 of 39 patients with malnutrition had high duodenal bacterial counts (>105 organisms/mL), whereas only seven patients were judged to have clinically significant bacterial overgrowth. The 14C‐xylose breath test showed a high specificity (89%) but a low sensitivity (30%) when compared with the results of duodenal culture. The hydrogen breath tests and the 14C‐glycocholate test showed a similar picture of moderately high specificity and low sensitivity (77% and 20%, respectively, for the hydrogen breath test, 76% and 33%, respectively, for the 14C‐glycocholate test).

Conclusions

A positive xylose breath test was the best predictor of high duodenal bacterial counts. However, since many elderly subjects have high duodenal bacterial counts, the overdiagnosis of bacterial overgrowth syndrome will result if duodenal culture is relied upon exclusively.
Dizziness in Older People
Authors: Baloh Robert W.
Published: April 2015

Patients use the term dizziness to describe a sensation of altered orientation in space. Because visual, proprioceptive, somatosensory and vestibular signals provide the main information about the position of the head and body in space, damage to any of these systems can lead to a complaint of dizziness. Changes in the brain centers that integrate these orienting signals can also result in a sensation of dizziness. This review focuses on the pathophysiology, diagnosis, and management of the common causes of dizziness in older people.
Behavioral Disturbance in Severe Alzheimer's Disease: A Comparison of Family Member and Nursing Staff Reporting
Authors: Lukovits Timothy G. , McDaniel Keith D.
Published: April 2015

Objective

The purpose of this study is to describe the behavioral disturbances in a group of patients with severe Alzheimer's disease and to compare family members' and nursing staff members' perceptions regarding these behaviors.

Design

Cross‐sectional survey.

Subjects

The 33 subjects resided in nine different long‐term care facilities in the Rochester, NY area and were selected from a group of patients enrolled in a longitudinal research study of Alzheimer's disease, based on having severe disease.

Outcome Measures

Caregivers were surveyed with a self‐administered questionnaire. The primary outcome measures were the prevalences of 13 behaviors and the magnitude of caregiver concern reported by each group of caregivers.

Results

Compared with family members, nurses reported more concern with vegetative behaviors (incontinence, dietary change, and sleep disturbance; P = 0.055). There was statistical evidence that the number of behaviors reported by the nurses decreased with increasing disease severity (P = 0.002). Although not statistically significant, the magnitude of concern reported by the nurses also decreased with increasing disease severity (P = 0.063). Family members and nurses frequently disagreed about the presence of many behaviors exhibited by individual patients, and the responses of caregivers within the same group were highly variable.

Conclusion

Institutionalized patients with severe Alzheimer's disease continue to exhibit troublesome behaviors although overall behavioral disturbance and concern appear to decrease with increasing disease severity. The assessment of these behaviors and their impact on caregivers can be very subjective, depending in part on the role of the caregiver.
Research with Alzheimer's Disease Subjects: Informed Consent and Proxy Decision Making
Authors: High Dallas M.
Published: April 2015

Because patients with Alzheimer's disease are on a path of declining capacity to give consent, advancement of research with Alzheimer's disease subjects presents challenging and perplexing ethical and legal dilemmas. Although generic regulations for the protection of human subjects apply, special considerations for cognitively impaired dementia subjects have depended on local Institutional Review Boards and relevant state laws and regulations, producing a lack of uniformity regarding encouragement of research and protection of subjects. Discussed are the dilemmas encountered in advancing research with Alzheimer's disease subjects, including (1) issues about informed consent, (2) determination of decision‐making capacity (competency), (3) problems in dealing with subjects of mild and fluctuating impairment, and (4) proxy and advance consent measures for severely impaired subjects. Proposed is an agenda of ethical research needs for advancing biomedical research on Alzheimer's disease. Needed are empirical studies concerning recruitment of Alzheimer's disease subjects, the actual processes of informed consent, and the difficulties encountered by researchers, collaborative development of tests for both diagnosing Alzheimer's disease and assessing subjects' capacities to provide informed consent, and exploration of innovative uses of advance and proxy consents for participation in Alzheimer's disease research.
The Impact of OBRA on Medical Practice within Nursing Facilities
Authors: Elon Rebecca , Pawlson L. Gregory
Published: April 2015

Major changes in the federal oversight of nursing home care were passed by Congress and became law as the Nursing Home Reform Amendments of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87). The final regulations to implement OBRA 87 were published in September, 1991. The intent of this article is to provide an overview of selected parts of the nursing home reform regulations, which have a direct impact on physician practice within nursing facilities, and to offer strategies for successful management of the changes that are required. A brief review of the origins of the legislation and the process by which law is turned into practice is provided as a context in which to understand the changes mandated by the Nursing Home Reform Amendments of OBRA 87.
Marital Coital Activity in Men at the Age of 75: Relation to Somatic, Psychiatric, and Social Factors at the Age of 70
Authors: Persson Göran , Svanborg Alvar
Published: April 2015

Objective

To find somatic, psychiatric, and social variables that predicted cessation of coital activity in elderly married men.

Design

Prospective, longitudinal, observational study

Setting

General survey of a representative sample of 70‐year‐old urban men (born in 1901–02) in Göteborg, Sweden.

Participants

Forty‐one men who were married and had coital activity at age 70 and who, at the age of 75, were still married when the sample was reinterviewed.

Main Outcome Measures

Presence (c) or absence (nc) of coital activity at age 75.

Results

Cessation of coital activity was associated with vasculogenic factors. At least one of the following disorders—systemic hypertension, ischemic heart disease, congestive heart failure, diabetes mellitus, or hypertriglyceridemia—was found in three of the C men and 14 of the NC men,P< 0.005. Systemic hypertension was the most common disorder and was found in one C man and 10 NC men,P< 0.01. Cessation of coital activity was associated with specified types of stress between 65 and 70 years of age in the subgroup of men who had stopped due to inability; six out of eight reported stress against five out of 20 in the C group,P< 0.05. There was no association with any of the psychiatric or social factors studied.

Conclusions

Cessation of coital activity is predicted by somatic disorders which are associated with vascular damage and especially by hypertension. This observation does not allow the conclusion that antihypertensive treatment would be effective in postponing the cessation of coital activity.
Occult Elevation of CK as a Manifestation of Rhabdomyolysis in the Elderly
Authors: Marcus E. L. , Rudensky B. , Sonnenblick M.
Published: April 2015

Objective

To evaluate the incidence, etiology and clinical course of rhabdomyolysis in hospitalized elderly patients.

Design

Retrospective case series.

Setting

Acute geriatric department of a university‐affiliated teaching hospital.

Patients

Twenty‐three patients who fulfilled our criteria of rhabdomyolysis. Criteria for inclusion were the finding of elevated serum creatine kinase of five‐fold or greater above the upper reference limit and greater than 97% MM isoenzyme.

Results

In a 3‐year period 23 patients out of 2,870 admissions fulfilled the criteria for rhabdomyolysis, an incidence rate of 0.8%. Diseases or insults associated with rhabdomyolysis were, in order of frequency, acute immobilization, infectious disease, cerebrovascular accident, hyperosmolar state, hyponatremia, hypernatremia, hypothermia, and a fall. Twenty‐two patients recovered from the acute illness; one patient died from respiratory failure. Seventeen patients had renal failure (serum creatinine >180 μmol/L), none necessitating dialysis. Serum creatinine always declined following recovery.

Conclusion

Elevation of CK with few other clinical features of rhabdomyolysis is common in admissions to a geriatric service. It is due to complete immobilization resulting from acute illness. Renal failure is mild and reversible, and the prognosis for recovery is excellent.
The Physician's Decision To Use Tube Feedings: The Role of the Family, the Living Will, and the Cruzan Decision
Authors: Ely John W. , Peters Philip G. , Zweig Steven , Elder Nancy , Schneider F. David
Published: April 2015

Objective

To determine the relative importance of factors influencing physicians to use tube feedings in patients lacking decision‐making capacity.

Design

Survey.

Setting and Participants

Four hundred thirty‐nine members of the Missouri Academy of Family Physicians.

Measurements

Using a mailed questionnaire, physicians were asked for a decision about feeding tube placement in an 89‐year‐old man who was unable to swallow or communicate after a stroke. Changing the conditions of the scenario, we then evaluated the influence of patient age, duration of disability, a living will, the Cruzan decision, and family preferences on the physician's decision.

Results

After reading the initial case history, 47% of physicians opposed tube feedings. Physicians who were told that the patient signed a living will specifically excluding tube feedings were more likely to oppose tube feedings than those who were told that he signed only a standard living will (53% vs 42%; P = 0.02). Forty‐two percent of physicians who initially suggested a feeding tube changed their recommendation if the family opposed it. Sixty‐six percent of physicians who initially opposed a feeding tube changed their recommendation if the family “pushed” for it. Thirty‐three percent of physicians who initially opposed tube feedings under the living will scenario would favor tube feedings if the patient had not signed a living will. Twenty‐two percent of physicians who initially opposed tube feedings would change to favor them if the issue had arisen before the Cruzan decision.

Conclusions

Among this group of physicians, there was no consensus on whether tube feedings should be initiated. However, it was found that the family's opinion was the most influential factor affecting the physician's recommendation about tube feedings. Most physicians endorsed family preferences for tube feedings even when this intervention was specifically opposed in the patient's living will.
A Clinicopathological Study of CT Scans in Alzheimer's Disease
Authors: Mendez Mario F. , Mastri Angeline R. , Zander Beth A. , Frey William H.
Published: April 2015

Objective

To investigate the accuracy of cranial computerized tomography (CT) scans in distinguishing patients with Alzheimer's disease from those with other dementing conditions.

Design

Retrospective clinicopathological correlation with pre‐mortem CT scans.

Setting

Urban and rural hospitals and nursing homes in the Upper Midwest.

Patients

All 507 patients had clinical dementia diagnosed as Alzheimer's disease during life and the subsequent referral of their brains to a dementia brain bank. Of these, 375 patients had had CT scans as part of the diagnostic work‐up for dementia.

Main Outcome Measures

The presence of neuropathological evidence of Alzheimer's disease and the specific findings on CT scans.

Results

Of the 375 patients evaluated with a CT, 28% were misdiagnosed (lacked neuropathological evidence of Alzheimer's disease); of the 132 patients evaluated without a CT scan, only 18% were misdiagnosed (P < 0.05). The degree of atrophy and other CT findings were similar in the correctly diagnosed and misdiagnosed groups except for increased ventricular size in the correctly diagnosed patients (P < 0.05).

Conclusion

Although CT scans do not usually contribute to the recognition of Alzheimer's disease, the presence of ventricular enlargement may help distinguish Alzheimer's disease from other dementias.
Glucose Tolerance in Women: The Effects of Age, Body Composition, and Sex Hormones
Authors: Busby M. Janette , Bellantoni Michele F. , Tobin Jordan D. , Muller Denis C. , Kafonek Stephanie D. , Blackman Marc R. , Andres Reubin
Published: April 2015

Objective

To determine the separate and interactive effects of age, phase of the menstrual cycle, menopausal hormone status, body fat mass, and regional fat distribution on glucose tolerance in healthy women.

Design

Retrospective study.

Setting

The Baltimore Longitudinal Study of Aging.

Patients

Two hundred sixty healthy women aged 22–89 years.

Measurements

Plasma levels of estradiol and progesterone, body mass index (BMI), waist‐to‐hip ratio (WHR), and plasma glucose values in the fasting state (FPG) as well as 120 minutes after 40 gm/m2 of oral glucose (G120) were measured for each participant.

Results

We found a progressive decline in oral glucose tolerance of 0.4 mm (6.7 mg/dL)/decade at G120) in women from early to late adult years, with no relationship to phase of the menstrual cycle and no abrupt change associated with the menopause. Multiple regression analysis revealed significant, independent effects of BMI and WHR on FPG and G120. The influence of age (P < 0.01) on G120 was stronger than that of the BMI or WHR (P < 0.05). There was no significant relationship between the levels of endogenous sex hormones and glucose tolerance after adjustments for age, BMI, and WHR. However, women taking oral contraceptives, but not those receiving postmenopausal replacement therapy, did exhibit mildly elevated G120 values.

Conclusions

Age per se, and to a lesser extent BMI and WHR, but not levels of endogenous sex steroids, contribute to the physiological decline in glucose tolerance in older women.
Functional Reach: A Marker of Physical Frailty
Authors: Weiner Debra K. , Duncan Pamela W. , Chandler Julie , Studenski Stephanie A.
Published: April 2015

Objective

To establish the concurrent validity of our new balance instrument, functional reach (FR = maximal safe standing forward reach), as a marker of physical frailty compared with other clinical measures of physical performance.

Design, Setting, and Participants

45 community‐dwelling persons age 66–104 were evaluated at one point in time using (1) FR (yardstick method), (2) Physical and Instrumental Activities of Daily Living (PADL, IADL), (3) Life Space, a 3‐point measure of social mobility, (4) 10‐item hierarchical mobility skills protocol, (5) 10‐foot walking speed, (6) one‐footed standing, and (7) tandem walking. Data analysis employed Spearman correlations. Partial r's were also calculated after controlling for age.

Results

The FR performance range was broad (4.3–16.5 inches, mean 10.9, SD 3.1). Except for PADL, the association of FR with the other physical performance measures was strong, with r‘s ranging from 0.64–0.71; the association of FR with PADL was 0.48. After controlling for age in the regression analysis, partial r‘s ranged from 0.52–0.63. The association of FR with age was—0.50.

Conclusions

Based on cross‐sectional data, FR is a practical instrument that correlates with physical frailty even more than with age.
Methicillin‐Resistant Staphylococcus aureus Colonization in a Long‐Term‐Care Facility
Authors: Murphy Sean , Denman Susan , Bennett Richard G. , Greenough William B. , Lindsay Jennifer , Zelesnick Lorrie B.
Published: April 2015

Objective

To study the prevalence and risk factors for colonization with MRSA at a long‐term‐care facility.

Design

Cross‐sectional surveillance culture survey.

Setting

A 233‐bed university‐affiliated long‐term‐care facility.

Measurements

Surveillance cultures for MRSA were performed on patients of two adjacent nursing units and on new admissions to the entire facility over a 4‐month period.

Results

On the chronic medical unit, where patients known to be colonized had been cohorted, 20 of 38 (52.6%) were colonized vs 3 of 67 (4.5%) on the skilled/intermediate unit (P < 0.001), suggesting that little intra‐facility spread of MRSA occurs. Twenty‐four of 55 (43.6%) chronic medical admissions were colonized vs 6 of 63 (9.5%) admitted to the other units (P < 0.001). Thirteen of 30 (43.3%) admissions were not previously known to be colonized. By univariate analysis, colonized admissions were younger and more often male; had more listed diagnoses, including pressure sores, a previous positive MRSA culture, and urinary incontinence; were more often fed by feeding tube; and had longer durations of hospital stay prior to admission. Logistic regression analysis showed that the most powerful independent predictors of colonization at admission were: a prior positive culture for MRSA (OR 8.8, 95% CI 2.4, 32.4), male sex (OR 8.2, 95% CI 2.3, 29.7), urinary incontinence (OR 3.8, 95% CI 1.4, 10.4), and presence of pressure sores (OR 2.9, 95% CI 0.9, 9.2).

Conclusions

Unrecognized colonization of nursing home residents with MRSA is common, and nursing homes are unwittingly repositories for patients colonized with MRSA following acute hospitalization. Gloving and careful attention to handwashing may limit spread of MRSA within nursing homes, and identification of colonized patients may be facilitated by targeted surveillance cultures of the most debilitated patients at admission.
The Significance of Age‐Related Enlargement of the Cerebral Ventricles in Healthy Men and Women Measured by Quantitative Computed X‐Ray Tomography
Authors: Kaye Jeffrey A. , DeCarli Charles , Luxenberg Jay S. , Rapoport Stanley I.
Published: April 2015

Objective

(1) To establish the range of cerebral atrophy across the adult age spectrum in optimally healthy, rigorously evaluated individuals. (2) To determine, across the age spectrum, the relation of gender and cerebral atrophy (as measured by ventricular enlargement) to cognitive function.

Design

Cross‐sectional comparison by age and gender.

Setting

Ambulatory research unit.

Participants

Sixty‐four healthy men (mean age ± SD = 49 ± 18 yr) and 43 healthy women (51 ± 18 yr) volunteers enrolled in a longitudinal study of healthy aging. The population was selected for optimal health; all were rigorously screened to exclude medical and psychiatric illness.

Main Outcome Measures

Brain atrophy by CT scan and cognitive function by standardized neuropsychological testing.

Results

After correction for inter‐subject variability in cranial volume, women had smaller lateral, but not third, ventricles. For both genders, there were significant differences with age in ventricular volume. After an approximately constant 20% increase in ventricular volume per decade in both genders, a precipitous increase in volume was found beginning in the fifth decade in men and in the sixth decade in women. In men and women, there was a significant negative correlation between ventricular volume and the sum of performance scale scores on the Wechsler Adult Intelligence Scale (WPSS) but not in the sum of the verbal scale scores (WVSS). However, after controlling for age, ventricular volume no longer significantly contributed to the relation between age and WPSS.

Conclusions

In unequivocally healthy individuals, gender plays an important role in age‐associated central cerebral atrophy as measured by progressive ventricular enlargement. Increase in ventricle volume independent of age, does not explain normal age‐related declines seen in WPSS scores.
Outcomes of Skilled Cardiopulmonary Resuscitation in a Long‐Term‐Care Facility: Futile Therapy?
Authors: Awoke Sissay , Mouton Charles P. , Parrott Marian
Published: April 2015

Objective

To assess whether cardiopulmonary resuscitation performed by in‐house physicians is effective for long‐term‐care residents.

Design

Retrospective chart review.

Setting

Long‐term‐care facility with an intermediate care unit, “skilled” care unit, and a convalescent and assessment unit at a retirement community for veterans.

Participants

All residents resuscitated from April 1987 to August 1990. All participants were male. The mean age was 75 years ± 7.3 (range 42–93 years).

Main Outcome Measurements

Charts were abstracted for demographics, advanced directives information, information about the arrest, and post‐resuscitation course.

Results

Forty‐five elderly residents underwent resuscitation during this period. Nine residents (20%) were successfully resuscitated, with seven dying within 24 hours of hospitalization. No residents survived to return to long‐term care (95% CI, 0–7%). The diagnoses were consistent with age‐related chronic disease. Seventeen (38%) arrests were witnessed. The predominant rhythm at onset of resuscitation was asystole.

Conclusion

We conclude that cardiopulmonary resuscitation, even when performed by a trained and experienced physician and team, has limited benefit for elderly long‐term‐care populations.
A Population‐Based Study of Assessed Applicants to Long‐Term Nursing Home Care
Authors: Gray Leonard C. , Farish Stephen J. , Dorevitch Michael
Published: April 2015

Objective

To examine the characteristics of all individuals assessed as requiring nursing home care arising from a population living within a defined geographical region and to study the manner in which they presented for assessment.

Design

Clinical assessment by a physician in geriatric medicine with the assistance of other disciplines.

Setting

Regional Geriatric Assessment Service.

Subjects

All persons recommended for nursing home care within the study period.

Results

The major diseases contributing to the need for nursing home care were organic brain disorders (60%) and stroke (32%). Dementia was present in 64% of cases; significant behavioral disturbance in 18%; severe communication disorders were frequent. The majority (86%) had been ill for greater than 1 year.

The mode of presentation was acute in 9%, acute‐on‐chronic in 46%, and chronic in 45%. It was associated with significant differences in case characteristics including the location at the time of assessment, diagnoses, duration of illness, physical dependency, communication disorders, behavioral disturbance, and skilled nursing care requirements.

Conclusions

These observations suggest that progression to nursing home care varies considerably. Strategies directed toward the prevention of institutionalization should be organized in recognition of these variations.
Prognosis after Hospital Discharge of Older Medical Patients with Delirium
Authors: Francis Joseph , Kapoor Wishwa N.
Published: April 2015

Objective

To determine survival, functional independence, and cognitive performance of older patients 2 years after an episode of delirium.

Design

Descriptive cohort study.

Setting

General medical wards of a teaching hospital.

Patients

Two hundred twenty‐nine consecutive patients aged 70 years or older who had been community‐dwelling prior to admission. Fifty patients met criteria for delirium (cases); these were compared to patients without delirium (controls). Two‐hundred twenty‐three patients survived hospitalization (46 cases, 177 controls) Of these, 92% were followed ≥2 years.

Main Outcome Measures

Vital status, place of residence, activities of daily living (ADL), and cognitive performance were determined by telephone interview of patients or caregivers 2 years after discharge. Independent community living was defined as survivorship outside of an institution and without dependence in any of four basic ADL (bathing, dressing, transfers, eating).

Results

Two‐year mortality in the entire population was 39% for cases and 23% for controls (relative risk 1.82, 95% confidence interval 1.04–3.19). Delirium identified those patients at risk for loss of independent community living, even after adjustment for potential confounding variables (adjusted odds ratio 2.56, 95% confidence interval 1.10–5.91). Follow‐up cognitive testing in a subset of patients with high baseline performance revealed a greater decline in performance among cases of delirium than controls (P= 0.023).

Conclusions

Delirium identifies older patients at risk for mortality or loss of independence. Delirium may also identify patients at risk for future cognitive decline.
Patient‐Related Predictors of Rehabilitation Use for Community‐Dwelling Older Americans
Authors: Mayer‐Oakes S. Allison , Hoenig Helen , Atchison Kathryn A. , Lubben James E. , De Jong Fred , Schweitzer Stuart O.
Published: April 2015

Objective

To determine patient factors that predict use of physical or occupational therapy (PT/OT) services by elderly people.

Design

Time‐series study of the relationship of PT/OT use to a variety of characteristics present at baseline.

Participants

Eight‐hundred nine community‐dwelling men and women aged 65 and older.

Setting

The Medicare Screening and Health Promotion Trial at UCLA.

Main Outcome Measures

Use of PT/OT services, as reported in a telephone survey 1 year after initial information was obtained on the same subjects by the baseline telephonic survey.

Results

Fifteen percent of the sample used PT/OT within 12 months of baseline. In multiple logistic regression analysis, PT/OT use was significantly less frequent among racial minorities, less well educated groups, and the oldest age group. PT/OT use was higher among those who had both functional disability and the presence of arthritis, heart or lung disease, or a prior history of stroke. However, neither functional disability alone nor the presence of arthritis, cardiovascular or lung disease, in the absence of limited functioning, was associated with PT/OT use. Patients who had obtained a pneumococcal vaccination or used transportation services were also more likely to receive PT/OT.

Conclusions

Our findings suggest that there may be important sociodemographic inequalities in the use of rehabilitation services and raise the possibility of inappropriate underuse in certain subgroups. Additional studies are needed to determine whether similar inequalities of PT/OT use are found in other populations and whether rehabilitation is effective in various subgroups.
Leukb‐Araiosis and Cerebral Hypoperfusion Compared in Elderly Normals and Alzheimer's Dementia
Authors: Kawamura Jun , Meyer John Stirling , Terayama Yasuo , Weathers Susan
Published: April 2015

Objective

To elucidate the pathogenesis of leuko‐araiosis in patients with Alzheimer's disease by utilizing CT densitometry of the brain and measurements of local perfusion in order to quantify the extent of leuko‐araiosis and local hypoperfusion compared with similar measurements made among age‐matched normal volunteers.

Design

Cross‐sectional case‐control study.

Setting

Out‐patient visits to a specialized laboratory located in a large hospital facility.

Patients

Eighteen elderly patients with probable dementia of Alzheimer type (DAT, aged 71.8 ± 5.1 years) and 17 neurologically and cognitively normal, age‐matched volunteers (aged 68.2 ± 9.6 years) were admitted to the study according to established criteria.

Intervention

None

Main Outcome Measures

Cerebral blood flow (mL/100 g brain/min) estimated by the xenon inhalation CT‐CBF method correlated with volume percentage ratio (%) measured by CT densitometry for leuko‐araiosis, compared to normal white and gray matter.

Results

Perfusion values for frontal and occipital white matter as well as frontal, parietal, temporal, and occipital cortex were all decreased in DAT patients. Ratios for leuko‐araiosis to total brain tissue volumes were greater among patients with DAT compared with age‐matched normal volunteers. White matter perfusion in zones of leuko‐araiosis was decreased to a similar degree in both DAT and elderly normal volunteers.

Conclusions

Perfusion is reduced to the same degree in regions of leuko‐araiosis in elderly normals as in DAT patients, but the extent of leuko‐araiosis is greater among DAT patients and presumably contributes to cognitive impairments.
Nocturia: A Risk Factor for Falls in the Elderly
Authors: Stewart Ronald B. , Moore Mary T. , May Franklin E. , Marks Ronald G. , Hale William E.
Published: April 2015

Objective: To determine if nocturia is a risk factor for reported falls and bone fractures in older persons.

Objective: Cross‐sectional study comparing falls in men and women with and without nocturia.

Setting: Longitudinal health screening program of ambulatory elderly participants.

Participants: Participants included 988 (65.5%) women and 520 (34.5%) men who had completed their tenth annual visit to the program.

Main Outcome Measures: Reported falls in the past year and reported bone fractures in the past 5 years.

Results: Participants who reported nocturia at least twice during the night were at significantly greater risk to report falls (Odds Ratio = 1.84; 95% CI = 1.05–3.22), and the risk increased in subjects reporting more than three nocturia events (Odds Ratio = 2.15; 95% CI = 1.04–4.44). The significant increase in falls reported by nocturia participants did not result in an increase in reported bone fractures in the past 5 years (P < 0.4360).

Conclusions: Nocturia is an important risk factor for falls in ambulatory elderly persons. Preventive measures should be taken to decrease nocturia events and to decrease the risk of falling during these nocturia events. J Am Geriatr Soc 40:1217–1220, 1992
Predictors of Two‐Year Post‐Hospitalization Mortality among Elderly Veterans in a Study Evaluating a Geriatric Consultation Team
Authors: Cohen Harvey Jay , Saltz Constance C. , Samsa Greg , McVey Laura , Davis Donald , Feussner John R.
Published: April 2015

Objective: To determine predictors of 2‐year post‐hospitalization mortality in a cohort of elderly hospitalized patients originally assembled to assess the impact of a Geriatric Consultation Team (GCT).

Objective: Two‐year follow‐up of an inception cohort.

Setting: University‐affiliated tertiary care VA Medical Center.

Patients: One hundred sixty‐seven veterans age 75 or older discharged following hospitalization on medical, surgical, or psychiatry services but not intensive care units.

Intervention: None specifically studied here though cohort was previously part of randomized control trial of a Geriatric Consultation Team.

Measurement: Mortality during 2 years of post‐hospitalization follow‐up.

Results: Two‐year post‐hospitalization mortality was 28 percent with no difference between the original GCT and control groups. For the entire sample, age, mental status, admission or discharge ADLs (but not change in ADL status), number of admission problems, number of discharge diagnoses, and discharge site were significant predictors of mortality in univariate analysis. Only discharge ADLs and discharge site remained significant in multivariate analysis.

Conclusion: Measures of ADLs during hospitalization are stronger predictors of mortality following hospitalization than disease diagnoses. Impaired ADLs and placement other than at home are significant predictors of mortality, suggesting that the decision for nursing home placement contains other independently predictive information within it and/or that the subsequent nursing home period produces excess mortality. As had been indicated in short‐term follow‐up, there was no survival advantage for the Geriatric Consultation Group. J Am Geriatr Soc 40:1231–1235, 1992
Alcohol Abuse in Elderly Emergency Department Patients
Authors: Adams Wendy L. , Magruder‐Habib Kathryn , Trued Sally , Broome Harry L.
Published: April 2015

Objectives: To determine the prevalence of alcohol abuse in elderly emergency department (ED) patients; to determine the prevalence of alcohol abuse for various categories of illness and injury among these patients; and to determine the frequency of detection of elderly alcohol abusers by ED physicians.

Objective: Cross‐sectional prevalence study.

Setting: The emergency department of a 625‐bed university hospital that serves a mixed urban and rural population.

Patients: 205 patients aged 65 and over who came to the ED during an 8‐week period.

Measures: A structured interview, which included the CAGE questionnaire and other questions regarding alcohol use, was administered. Emergency department records and past medical records were reviewed.

Results: The prevalence of lifetime alcohol abuse (CAGE positive or self‐reported drinking problem) was 24%. The prevalence of current alcohol abuse (CAGE positive or self‐reported drinking problem and alcohol use within the last year) was 14%. There was a particularly high prevalence (22%) among those presenting with gastrointestinal problems and a surprisingly low prevalence (7%) among those who presented with falls or other trauma. Physicians detected only 21% of the current alcohol abusers.

Conclusions: Alcohol abuse is a prevalent and important problem among elderly ED patients. It is not well detected by physicians in this setting. Alcohol abuse appears to be less common among elderly trauma patients than their younger counterparts, but is very common among patients with gastrointestinal problems. J Am Geriatr Soc 40:1236–1240, 1992