bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical Restraint Use and Falls in Nursing Home Residents
Authors: Capezuti Elizabeth , Evans Lois , Strumpf Neville , Maislin Greg
Published: April 2015

OBJECTIVE: To examine the relationship between restraint use and falls while controlling for the effect of psychoactive drug use among nursing home residents, including subgroups of nursing home residents with high rates of restraint use and/or falls.

DESIGN: Secondary analysis of data from a longitudinal clinical trial designed to reduce restraint use.

SETTING: Three nursing homes.

PARTICIPANTS: Subjects (n = 322) were either restrained (n = 119) or never restrained (n = 203) at each observation point during a 9.5‐month data collection period that preceded the intervention phase of the clinical trial.

MEASUREMENTS: We evaluated restraint status (independent variable) three times during the data collection period by direct observation over a 72‐hour period. Incident reports documenting falls and fall‐related injuries (dependent variables) were reviewed. Cognitive status was measured using the Folstein Mini‐Mental State Exam and functional status (including ambulation status) by the Psychogeriatric Dependency Rating Scale. Psychoactive drug use profile was obtained through record review.

MAIN RESULTS: Using multiple logistic regression, we compared the effect of restraint use on fall risk between a confused ambulatory subgroup and the remaining sample and found a significant difference in the odds ratio for falls and recurrent falls (P = .02; chi‐square = 5.24, df = 1; P = .003, chi‐square = 9.12, df = 1). In the confused ambulatory subgroup, restraint use was associated with increased falls (odds ratio: 1.65, 95% CI: 0.69, 3.98) as well as recurrent fall risk (odds ratio: 2.46, 95% CI: 1.03, 5.88). Increased falls and recurrent fall risk was not observed in the remaining sample (falls odds ratio: 0.49, 95% CI: 0.28,0.87; recurrent falls odds ratio: 0.42, 95% CI: 0.20,0.91). One subgroup, the nonconfused ambulatory residents, were never restrained; after removing this subgroup, the confused ambulatory continued to be associated, though not significantly, with a higher risk of falls and injuries. Only nonconfused nonambulatory restraints were associated with a lower risk of all three outcomes: falls (odds ratio: 0.28, 95% CI: 0.05, 1.58), recurrent falls (odds ratio: 0.48, 95% CI: 0.05, 4.72), and injurious falls (odds ratio: 0.42, 95% CI: 0.04, 4.01); these results, however, were not statistically significant. There was no evidence that the effect of restraint use on fall risk depended upon the use of psychoactive drugs (chi square = 4.43; df = 2, P = .11).

CONCLUSION: Restraints were not associated with a significantly lower risk of falls or injuries in subgroups of residents likely to be restrained. These findings support individualized assessment of fall risk rather than routine use of physical restraints for fall prevention. Researchers and clinicians should continue to focus efforts on developing a variety of approaches that reduce risk of falls and injuries and promote mobility rather than immobility.
Using a Mailed Survey to Predict Hospital Admission Among Patients Older than 80
Authors: Freedman John D. , Beck Arne , Robertson Barbara , Calonge B. Ned , Gade Glenn
Published: April 2015

OBJECTIVE: To determine if the results of a questionnaire mailed to older patients can help identify those patients at greatest risk of hospital admission.

DESIGN: A longitudinal cohort study.

SETTING: A prepaid managed care plan in the Denver metropolitan area.

PARTICIPANTS: Of the 4414 eligible patients at least 81 years old, 3745 (84.8%) responded.

MEASUREMENTS: We studied the predictive power of self‐reported demographic, health status, medical history, health habits, functional status (including Katz' activities of daily living and OARS instrumental activities of daily living), and socioeconomic status data to identify those older adults at greatest risk of hospitalization within 4.5 months of completing the survey. We derived our predictive model on one‐half the subjects and tested its validity it on the other half.

RESULTS: Univariate analysis revealed 25 variables significantly associated with hospital admission. In a logistic regression model, four significant variables successfully stratified the patients by risk of admission. These four variables are: the presence of heart disease, the presence of diabetes, need for help preparing meals, and limited physical independence (requiring the help of a person or mechanical aid to get around). In addition, there was an antagonistic interaction between the presence of heart disease and limited physical independence. The model stratified patients from low risk (4.5% chance of admission) to high risk (39% chance of admission). As measured by the Hosmer‐Lemeshow statistic and the area under a receiver‐operator characteristic (ROC) curve, this model fit both the derivation and validation subjects well.

CONCLUSIONS: A mailed questionnaire achieved a high response rate, and the information collected produced an effective model predictive of hospitalization in the short term. Four easily ascertained pieces of information identify those patients older than age 81 at increased risk.
Risk of Napping: Excessive Daytime Sleepiness and Mortality in an Older Community Population
Authors: Hays Judith C. , Blazer Dan G. , Foley Daniel J.
Published: April 2015

OBJECTIVE: To describe the demographic and health‐related factors related to excessive daytime sleepiness. To estimate the risk of mortality associated with excessive daytime sleepiness independent of nighttime sleep problems and other factors that limit survival.

DESIGN: Four‐year prospective cohort study with annual interviews.

SETTING: One urban and four rural counties in north‐central North Carolina.

PARTICIPANTS: Adults 65 years and older (n = 3962) living in the community.

MAIN OUTCOME MEASURES: Excessive daytime sleepiness was measured as, “How often do you get so sleepy during the day or evening that you have to take a nap?” Mortality was based on continuous surveillance of the population by field investigators and abstraction of death certificates.

RESULTS: Point prevalence of excessive daytime sleepiness in this population was 25.2%. Frequent daytime nappers were more likely than infrequent nappers to report nighttime sleep complaints and were more likely to be male and urban‐dwellers, to report more depressive symptoms, more limited physical activity, and more functional impairment, and were more likely to be overweight. Of the frequent nappers, 23.9% died, compared with 15.4% of infrequent nappers. In an adjusted Cox proportional hazard model, the 4‐year mortality rate was accelerated 1.73 times among older people who nap most of the time and make two or more errors on a cognitive status examination.

CONCLUSION: Excessive napping is associated with impaired sleep hygiene as well as with a broad range of activity‐related health deficits among community‐dwelling older adults. Frequent napping was associated with impaired sleep hygiene, male gender, urban‐dwelling, depressive symptoms, physical activity deficits, functional impairment, and excess weight. Mortality risk was elevated selectively among the most cognitively impaired subjects.
Impact of Sample Selection on APOE ∈4 Allele Frequency: A Comparison of Two Alzheimer's Disease Samples
Authors: Tsuang Debby , Kukull Walter , Sheppard Lianne , Barnhart Ross L. , Peskind Elaine , Edland Steve D. , Schellenberg Gerard , Raskind Murray , Larson Eric B.
Published: April 2015

OBJECTIVE: In a highly selected sample of unrelated Alzheimer's disease (AD) patients, we found that the APOE ∈4 allele frequency was higher than previously reported. Differing selection and ascertainment criteria may lead to these differences. To address this possibility, we compared the ∈4 allele frequency in two samples of AD patients selected from the same geographical area.

SETTING AND PARTICIPANTS: Cases (n = 55) and controls (n = 99) from a research clinic‐based sample were compared with subjects (n = 537) from a community‐based AD patient sample. The samples consisted of unrelated cases who met NINCDS/ADRDA criteria for probable AD.

DESIGN AND MEASUREMENTS: Clinical characteristics and APOE genotype data were obtained from AD cases and controls from both samples.

RESULTS: Frequency of APOE ∈4 allele in the research cases compared with the community cases (0.45 vs 0.36) was nearly significant. We compared demographic and clinical characteristics that might account for this difference and found that the research cases were younger, had an earlier age of onset, and had more advanced disease than the community cases. After onset age was controlled, there was no overall difference between ∈4 allele frequency of the two samples.

CONCLUSIONS: We found that the ∈4 allele frequency tended to be higher in the research AD sample compared the community‐based sample. The two samples differed in several demographic and clinical characteristics. We conclude that research‐based samples may lead to enrollment of younger patients with more severe disease who have higher APOE ∈4 allele load. This potential selection bias must be considered in the interpretation of studies of APOE allele frequency.
Smoking and Cognitive Impairment: A Population‐Based Study
Authors: Ford Amasa B. , Mefrouche Zak , Friedland Robert P. , Debanne Sara M.
Published: April 2015

OBJECTIVE: To test the hypothesis that there is an inverse relationship between smoking and cognitive impairment by examining the prevalence and incidence of such impairment in a representative cohort of older urban residents.

DESIGN: Survey follow‐up with three interviews over a 4‐year period.

SETTING: City of Cleveland, Ohio.

PARTICIPANTS: Six hundred forty‐seven survivors of a population‐based, multi‐stage probability sample of urban residents, aged 74 years and older in 1984.

MEASUREMENTS: Past and present cigarette smoking was measured in 1984 by direct questioning. Cognitive impairment was measured in 1984, 1987, and 1988 by the 10‐item Short Portable Mental Status Questionnaire. Mortality was determined at each interview date, and death certificates were obtained. Data were analyzed by univariate analysis, stratified analysis, and multivariate logistic regression.

RESULTS: There were 99 cases of cognitive impairment at baseline among 628 individuals for whom complete data were available. Crude data suggest that the prevalence of cognitive impairment was lower among smokers than among non‐smokers, but logistic regression, adjusted for age, income, and gender, showed this difference to be nonsignificant, OR 0.73; 95% CI (0.42,1.29).

Fifty‐one new cases of cognitive impairment occurred during the 4‐year observation period. Neither the crude data nor logistic regression showed any significant relationship between smoking and the incidence of cognitive impairment, OR 1.03; 95% CI (0.54, 1.99).

Four‐year mortality did not differ significantly between these older smokers and non‐smokers, but smokers died at a relatively younger age and were more likely to die of diseases associated with smoking.

CONCLUSION: This study does not confirm the hypothesis that there is a negative relationship between smoking and cognitive impairment. The mortality data suggest that case‐control prevalence studies of the hypothesized relationship may be distorted by complex life‐long trends in behavior, morbidity, and mortality which could result in a misleading appearance of low prevalence of cognitive impairment among smokers. Additional large, prospective, population‐based studies of the incidence of cognitive impairment and related disorders and possible protective or risk factors other than smoking are needed. J Am Geriatr Soc 44:905–909, 1996.
Report of an Outbreak: Nursing Home Architecture and Influenza‐A Attack Rates
Authors: Drinka Paul J. , Krause Peggy , Schilling Margo , Miller Barbara A. , Shult Peter , Gravenstein Stefan
Published: April 2015

OBJECTIVE: To determine factors that might account for a significantly lower attack rate in a newly constructed nursing building during an epidemic of type A influenza.

SETTING: A four‐building, long‐term care facility for veterans and their spouses, with an average daily census of 690.

DESIGN: Prospective surveillance with retrospective analysis.

PARTICIPANTS: Symptomatic residents submitting to viral culture.

MEASUREMENTS: Number of respiratory illnesses and influenza cultures in consenting symptomatic residents. Building characteristics

RESULTS: An influenza A (H3N2) outbreak was culture‐confirmed in 68 nursing home residents. Influenza A was isolated in 3/184 (2%) residents in Building A, 31/196 (16%) in Building B, 18/194 (9%) in Building C, and 16/116 (14%) in Building D. Denominators are average daily census during the outbreak. Building A had significantly fewer culture‐confirmed cases than the other buildings (P < .001). Fewer residents in Building A, 47% compared with 61% in Buildings B, C, and D, were participants in a formal study of influenza. Eight of 15 respiratory illnesses identified during the outbreak that were not cultured occurred in Building A. These factors could not account for the difference in attack rates. Building A has a unique ventilation system, more square feet of public space per resident, and does not contain office space that serves the entire four‐building facility.

CONCLUSION: Our retrospective observation suggests that architectural design may influence the attack rate of influenza A in nursing homes. J Am Geriatr Soc 44:910–913,1996.
Variability in Mammography Use Among Older Women
Authors: Burns Risa B. , McCarthy Ellen P. , Freund Karen M. , Marwill Sandra L. , Shwartz Michael , Ash Arlene , Moskowitz Mark A.
Published: April 2015

OBJECTIVE: To determine rates of and explore factors associated with mammography use among older women.

DESIGN: Retrospective review of part B (physician) bills submitted to Medicare during 1990.

SETTING: Health Care Financing Administration (HCFA) data, including sociodemographic information and part B physician bills for all services delivered to Medicare‐eligible women in 1990.

PATIENTS/PARTICIPANTS: Women age 65 or older as of January 1, 1990, residing in one of 10 states with part B coverage through December 31, 1990.

MEASUREMENTS AND MAIN RESULTS: The outcome was receipt of a mammogram (yes/no). We explored factors associated with mammography use within three age groups: 65 to 74, 75 to 84, and 85 +. The factors considered were race, state, median income of ZIP Code of residence (from the 1990 US Census, and used to divide the population into quintiles within each state), and number of primary care visits (0, 1, 2, and 3+). Overall, 15% of women had a mammogram: 20% of women age 65 to 74, 12% of women age 75 to 84, and 4% of women age 85 and older. Mammography use was lowest in Oklahoma and highest in Washington. However, in each state the older the age category, the less the mammography use (e.g., 9% vs 5% vs 2% in Oklahoma and 25% vs 16% vs 5% in Washington for women 65–74, 75–84, and 85+, respectively). Mammography use was lower for black than for white women age 65 to 74 (14% vs 21%, P < .001) and 75 to 84 (9% vs 12%, P < .001). Women in each of these two age groups had lower mammography use if they resided in the lowest income quintile and highest if they resided in the highest income quintile (17% vs 23% 65–74, and 10% vs 13% 75–84, P values < .001). Among the oldest women (those 85+), mammography use was low (4%) and varied minimally by race and income (P = .907 and .003, respectively). In all age groups, mammography use was lowest among women who did not have a primary care visit, was greater among women who had at least one visit, and continued to rise with increasing numbers of visits (all P values < .001). For example, among women age 75 to 84, mammography use increased from 5% to 10%, 14%, and 17% for those with 0, 1, 2, and 3+ visits.

CONCLUSIONS: We found that mammography use was less for women who were older, of black race, who did not visit a primary care provider, and who lived in areas with lower median income and certain geographic locations (states). Similar factors influenced mammography use in women age 65 to 74, where there is greater consensus as to who should receive a mammogram, and women age 75 to 84, where there is neither consensus nor data. Surprisingly, neither race nor income had much influence on mammography use among women age 85 or older. J Am Geriatr Soc 44:922–926, 1996.
Bacteremic Urinary Tract Infection in Older People
Authors: Ackermann Richard J. , Monroe Patrick W.
Published: April 2015

OBJECTIVES: To describe patients with bacteremic urinary tract infections, compare characteristics of young and older patients, and suggest appropriate empiric antibiotic therapy for this clinical condition.

DESIGN: Case series, with an observation period of 3 years.

SETTING: A large southeastern community hospital.

PARTICIPANTS: One hundred eighty patients more than 18 years old (101 older than age 65) with urine and blood cultures simultaneously positive for bacterial organisms.

MEASUREMENTS: Chart review‐determined demographic characteristics, clinical data, bacterial organism and antibiotic susceptibility, number of medical diagnoses, use of a urinary catheter, admission source, and mortality.

RESULTS: The 180 patients experienced bacteremias caused by 183 bacterial organisms. Sixty‐one patients were aged 65 to 79 years, and 40 were 80 years of age or older; 63.9% of patients were female; 62.2% were black. Gram‐negative organisms accounted for 80.3% of bacterial isolates, with Escherichia coli accounting for 54.1% of cases. Gram‐positive organisms accounted for 19.7% of isolates, including Staphylococcus aureus (13.1%) and Enterococcus (5.5%). Older patients had a distribution of Gram‐positive and Gram‐negative organisms similar to that of younger patients. Men and patients with chronic urinary catheters had higher proportions of Gram‐positive organisms and non‐E. coli Gram‐negative rods. Organisms showed excellent susceptibilities to commonly used antibiotics. In‐hospital mortality was 16.1%, with higher mortality in patients with chronic urinary catheters, in patients who were admitted from nursing homes, and when a Gram‐positive organism was identified. Advanced age was not associated with higher mortality.

CONCLUSIONS: Concomitant illness and especially the use of urethral catheters, but not advanced age itself, are associated with a higher mortality from bacteremic urinary tract infection. Single agent empiric antimicrobial therapy such as ceftriaxone may be appropriate in older patients with presumed urosepsis, except in catheterized patients or those with other risk factors for Gram‐positive or resistant Gram‐negative infections. J Am Geriatr Soc 44:927–933, 1996.
Free and Protein‐Bound Cobalamin Absorption in Healthy Middle‐aged and Older Subjects
Authors: van Asselt Dieneke Z. , van den Broek Wim J. , Lamers Cornelis B. , Corstens Frans H. , Hoefnagels Willibrord H.
Published: April 2015

OBJECTIVE: To study free‐ and protein‐bound cobalamin absorption and the correlation with atrophic gastritis in healthy middle‐aged and older subjects.

DESIGN: A cross‐sectional study.

PARTICIPANTS: Fifty‐two healthy subjects, aged 26 to 87 years, apparently free from conditions known to influence the cobalamin status. Middle‐aged subjects were defined as those younger than 65 years of age (median age 57 years) and older subjects as those 65 years and older (median age 75 years).

MEASUREMENTS: Protein‐bound cobalamin absorption was assessed by 48‐hour urinary excretion method following oral administration of scrambled egg yolk, labeled in vivo with 57Co‐cobalamin by injecting a hen with 57Co‐cyanocobalamin. The percentage of 57Co‐cobalamin bound to protein was 65%. Free cobalamin absorption was assessed by 48‐hour urinary excretion method following oral administration of crystalline 57Co‐cyanocobalamin. Plasma cobalamin, folate and fasting plasma gastrin, and pepsinogen A and C concentrations were determined.

RESULTS: The median urinary excretion of egg yolk 57Co‐cobalamin in middle‐aged subjects was 12.3% (25th and 75th percentiles 10.5%‐14.5%) compared with 11.7% (25th and 75th percentiles 9.8%‐13.6%) in older subjects (P = .283). The median urinary excretion after administration of free 57Co‐cobalamin in middle‐aged subjects was 25.7% (25th and 75th percentiles 20.6%‐30.7%) compared with 27.9% (25th and 75th percentiles 21.4%‐34.5%) in older subjects (P = .694). Neither egg yolk nor free 57Co‐cobalamin excretion correlated with age.

A ratio of pepsinogen A to pepsinogen C less than 1.6, indicating atrophic gastritis, was found in 13 subjects. Within the atrophic gastritis group, 11 subjects had a pepsinogen A concentration greater than or equal to 17 μg/L, indicating mild to moderate atrophic gastritis, and two subjects had a pepsinogen A concentration less than 17 μg/L, indicating severe atrophic gastritis or gastric atrophy. All subjects had normal fasting plasma gastrin concentrations. Free and egg yolk 57Co‐cobalamin excretions were not reduced in the atrophic gastritis group when compared with the non‐atrophic gastritis group.

Median plasma cobalamin concentration was not significantly lower in older subjects (P = .205). Nonetheless, plasma cobalamin concentration correlated negatively with age (r = ‐.36; P = .008).

CONCLUSIONS: We demonstrated no significant difference in either free or protein‐bound cobalamin absorption between healthy middle‐aged and older adults. In addition, no alteration in cobalamin absorption was found in subjects identified as having mild to moderate atrophic gastritis. Therefore, based on our results, the high prevalence of low cobalamin levels in older people cannot be explained by either the aging process or mild to moderate atrophic gastritis. J Am Geriatr Soc 44:949–953, 1996.
Hand Sensibility of Healthy Older People
Authors: Desrosiers Johanne , Hébert Réjean , Bravo Gina , Dutil Elisabeth
Published: April 2015

OBJECTIVE: To develop normative data for four hand sensibility modalities in older subjects.

DESIGN: Cross‐sectional.

SETTING AND PARTICIPANTS: Three hundred and sixty community‐dwelling subjects of both sexes, aged 60 to 94, randomly selected from the electoral list of the city of Sherbrooke, Quebec, Canada.

MEASUREMENTS: Touch/pressure threshold (Semmes‐Weinstein monofilaments), static and moving two‐point discrimination (Mackinnon‐Dellon Disk‐Criminator), tactile recognition (Modified Pick‐up test), and thumb kinesthesia.

RESULTS: A reduction with age was found in the performance of the study subjects, with the exception of the kinesthesia test. The values obtained in this study are clearly lower than the norms proposed for adults, underlining the importance of using reference values developed for the target clientele.

CONCLUSION: The norms will help clinicians to differentiate better between normal and pathological changes in sensibility with age. J Am Geriatr Soc 44:974–978, 1996.
Life‐Sustaining Treatment Decisions by Spouses of Patients with Alzheimer's Disease
Authors: Mezey Mathy , Kluger Malvina , Maislin Greg , Mittelman Mary
Published: April 2015

OBJECTIVE: To examine the anticipated decisions to consent to or to forgo life‐sustaining treatment by spouses of patients with Alzheimer's disease and to describe the relationship of spouse and patient characteristics to predicted decisions.

DESIGN: Prospective quantitative study.

SETTING: The Aging and Dementia Research Center (ADRC), part of an Alzheimer's Disease Center Core Grant, at New York University Medical Center.

PARTICIPANTS: Fifty spouse caregivers of Alzheimer's disease patients, evaluated at the ADRC, who had a minimum Stage 4 on the Global Deterioration Scale.

MEASUREMENTS: Spouses were presented with two conditions (critical illness and irreversible coma) and rated their agreement with, certainty of, and comfort with four treatments (resuscitation, breathing machine, feeding tube, and antibiotics). Data were also obtained as to patients' current quality of life, spouses' standard of decision‐making, and spouse burden.

RESULTS: Eighteen of 50 patients had a durable power of attorney for health care, 20 of 50 had a living will, and 26 of 50 had neither. In the face of critical illness, almost equal numbers of spouses would consent to or forgo CPR, 28 of 50 would forgo a breathing machine, 21 of 50 a would forgo a feeding tube, and 5 of 50 would forgo antibiotics. Five of 50 would forgo all four treatments, and 12 of 50 all but antibiotics. Spouses were significantly more likely to forgo treatment in the face of coma than for critical illness (P < .001). Spouses were more certain about decisions related to coma than to critical illness (P < .001), and there was a positive and significant correlation between certainty and comfort (P = .001). Those consenting to treatment were more comfortable than those forgoing treatment (for CPR and antibiotics P = .001). Spouses of patients with Stage 7 AD were more likely to forgo CPR than those with Stages 4 to 6 AD (P < .001). Only two of 50 spouses selected descriptors congruent with a purely substituted judgment standard of decision‐making. An equal number of spouses rated patient quality of life as good, fair, or poor. For critical illness, the poorer the quality of life rating, the more likely the spouses were to forgo feeding tubes (P < .001). There was a trend for highly burdened spouses to consent to treatment.

CONCLUSIONS: The results provide evidence that spouses of patients with AD anticipate forgoing life‐sustaining treatments in the face of coma but are less sure about choices for critical illness. Although preliminary in nature, findings suggest that doctors, nurses, and social workers need to provide additional support to spouses choosing to forgo rather than consent to treatment and need to inquire as to what spouses perceive as the factors that are important to them in making a decision. J Am Geriatr Soc 44:144–150, 1996.
Nutritional Assessment: A Primary Component of Multidimensional Geriatric Assessment in the Acute Care Setting
Authors: Incalzi Raffaele Antonelli , Landi Francesco , Cipriani Luca , Bruno Elvira , Pagano Francesco , Gemma Antonella , Capparella Oliviero , Carbonin PierUgo
Published: April 2015

OBJECTIVE: To test the prognostic role of nutritional variables as a component of geriatric multidimensional assessment and to study the effect of hospitalization on nutritional status.

DESIGN: Validation cohort study: multidimensional assessment on admission and at discharge and a weekly nutritional assessment.

SETTING: General Medicine and Geriatrics wards in an acute‐care university hospital.

PATIENTS: A consecutive sample of 302 patients aged 79 ± 6 years, range 70–96 years.

MAIN OUTCOME MEASURES: Mortality, longstay (>29 days), loss of lean body mass as expressed by a negative change in mid‐arm muscle circumference (MAMC).

RESULTS: Incidence of mortality, longstay, and decreased MAMC was 6.9%, 24.8%, and 64.2%, respectively. According to logistic regression analysis, mortality was independently predicted by preadmission dependency in at least one Activity of Daily Living (odds ratio = 2.08, confidence limits = 1.19–3.65), clinical diagnosis of malnutrition (OR = 1.89, CL= 1.11–3.21), serum albumin < 3.5 g/dL (OR = 1.82, CL = 1.06–3.14). This predictive model allowed us to recognize 75% of the patients at risk of death by targeting 23% of the population. Longstay was independently predicted by stroke (OR = 1.54, CL = 1.01–2.35), clinical diagnosis of malnutrition (OR = 1.41, CL = 1.04–1.93), and more than five comorbid diseases (OR = 1.39, CL = 1.01–1.94). Dependency in at least one ADL was the only independent predictor of decreased MAMC (OR = 1.71, CL = 1.27–2.30).

CONCLUSIONS: Nutrition variables are a cardinal component of multidimensional assessment in the acute‐care setting. Nutritional status deteriorates during the hospital stay, mostly in physically dependent patients. J Am Geriatr Soc 44:166–174, 1996.
Probable Adverse Drug Reactions in a Rural Geriatric Nursing Home Population: A Four‐Year Study
Authors: Cooper James W.
Published: April 2015

OBJECTIVE: To quantitate probable adverse drug reactions (ADRs) in a geriatric nursing homes population.

DESIGN: A repeated measures prospective study.

SETTING: Two nursing home populations in rural Georgia.

PATIENTS: All 332 residents present for 30 or more days over a 4‐year period.

MEASUREMENT: Admission and monthly drug regimen review for each resident, Naranjo algorithm assessment of each ADR, with monthly reports to attending physicians and follow‐up within the next month.

RESULTS: There were 444 probable ADRs in 217 of 332 residents (67.4%) during this period. The 217 residents had a mean 1.9 ± 1.3 probable adverse drug reactions (range, 1–9). The ADR group differed statistically from the rest of the population only in the number of drugs per patient (7.8 ± 2.6 vs 3.3 ± 1.3), which was almost twice the number of active problems present in both the ADR (4.0 ± 0.9) and non‐ADR populations (3.8 ± 1.4). The organ systems most commonly involved in the 444 ADRs observed were cardiovascular (188), central nervous system (129), gastrointestinal (82), endocrine (41), immune (17), hematologic (7), pulmonary (6), and renal (5). The drugs most commonly implicated in ADRs were, in decreasing order, diuretics, antipsychotics, anxiolytics, potassium supplements, digoxin, NSAIDs, insulin, theophylline, H2‐receptor antagonists, antiinfectives, anticonvulsants, and thyroid supplements. There were 39 multiple drug ADRs in 34 patients. In decreasing order the drug classes in multiple ADRs were CNS depressants, antihypertensives, potassium‐altering therapy, and NSAIDs. Numerous patients had repetitions of the same ADR, especially with antipsychotics, NSAIDs, and insulin.

CONCLUSIONS: ADRs are a common occurrence in a geriatric nursing home population, and may be related to inadequate attention to the patients history as well as to unrealistic therapeutic endpoints. J Am Geriatr Soc 44:194–197, 1996.
Protective Effect of Chronic NSAID Use on Cognitive Decline in Older Persons
Authors: Rozzini Renzo , Ferrucci Luigi , Losonczy Kathy , Havlik Richard J. , Guralnik Jack M.
Published: April 2015

OBJECTIVE

To verify whether chronic use of nonsteroidal anti‐inflammatory drugs (NSAIDs) has a protective effect against cognitive decline in older persons.

DESIGN

Prospective study with a 3‐year observation period.

SETTING

Three communities of the Established Populations for Epidemiologic Studies of the Elderly (EPESE).

SUBJECTS

A population‐based sample of 7671 subjects who received an in‐person interview at the sixth annual follow‐up. Persons with documented NSAID use at the time of the interview and 3 years before were considered chronic users (21%), while all other persons were considered as nonusers.

MAIN OUTCOME MEASURE

Change over time in cognitive function assessed as the number of correct answers to a 9‐item version of the Short Portable Mental Status Questionnaire (SPMSQ).

RESULTS

For every level of SPMSQ score measured at the beginning of the observation period, the mean SPMSQ score after 3 years was higher in chronic NSAID users than in nonusers. Cognitive function at the end of the observation period was significantly higher in chronic NSAID users than in controls, adjusting for initial SPMSQ score and potential confounders. Older age, female gender, education, and history of cerebrovascular disease were also independent predictors of lower SPMSQ score. In the multivariate analysis, the magnitude of the protective effect estimated for NSAID use was comparable to a difference in age of 3.5 years. The percentage of persons who started above a specific SPMSQ score cut‐point and deteriorated below that cut‐point over a 3‐year period was significantly lower in chronic NSAID users than in nonusers (30.2% vs 34.3%, P = .03, for decline below SPMSQ score of 8 and 12.3% vs 14.4% for decline below SPMSQ score of 6, P = .04). After controlling for potential confounders, the relative risk of cognitive declining in chronic NSAID users compared with nonusers was 0.82 (95% Confidence Interval: 0.69–0.98) for a decline below a score of 8, and 0.80 (95% CI: 0.66–0.98) for a decline below a score of 6.

CONCLUSIONS

These results support the association between NSAID use and reduction in cognitive decline in older persons. Ultimately, randomized controlled trials must be done to prove a beneficial effect definitively.
Effects of Growth Hormone and Estrogen on T Lymphocytes in Older Women
Authors: Bonello Robert S. , Marcus Robert , Bloch Daniel , Strober Samuel
Published: April 2015

OBJECTIVE

To assess the effect on peripheral blood T lymphocytes of recombinant human growth hormone administered to healthy older women.

DESIGN

Prospective, open study.

SETTING

Veterans Administration clinical research unit and community surrounding Palo Alto, California.

PARTICIPANTS

Thirty‐three women were recruited in two age groups: 20 to 40 years (n = 13) and 70 years or older (n = 24). Subjects were healthy, community‐dwelling volunteers.

INTERVENTIONS

Recombinant human growth hormone at a dose of 0.025 mg/kg body weight/day was administered to the older subjects by daily subcutaneous injection over a 6‐month study period.

MAIN OUTCOME MEASURES

Mean percentage and number of peripheral blood CD45RA+ (“naive”) T cells, mean counts per minute (CPM) of [3H]‐thymidine incorporation following stimulation of peripheral blood mononuclear cells with phytohemaglutinin (T cell proliferation).

RESULTS

Before therapy, mean percentage and number of peripheral blood CD45RA+ T cells and T cell proliferative responses were significantly reduced in older compared with younger women. The fraction of older women with CD45RA+ T cell levels or T cell proliferative responses in the young range was significantly decreased in those who were receiving estrogen (1/10) compared with those who were not (9/14). After treatment with growth hormone, there were no significant changes in the mean CD45RA+ T cell levels or proliferative responses of the older women.

CONCLUSIONS

The results suggest that T cell changes associated with the age‐related decline in secretion of growth hormone cannot be reversed by growth hormone therapy during the eighth decade.
Treatment of Progressive Supranuclear Palsy with Amitriptyline: Therapeutic and Toxic Effects
Authors: Engel Peter A.
Published: April 2015

BACKGROUND

Progressive supranuclear palsy (PSP) is a parkinsonian‐like disorder characterized by postural instability, rigidity, bradykinesia, supranuclear ocular palsy, dysarthria, dysphagia, and dementia. There is no satisfactory treatment. Two patients with advanced (PSP) reported here had clinically meaningful improvement in motor function on low dose amitriptyline (AMI) but developed cognitive and behavioral disturbances at higher doses.

CASE REPORTS

During 11 weeks of upward dose titration, a 65‐year‐old man was partially relieved of severe bradykinesia, dysarthria, and dysphagia at an optimal dose of 40 mg bid (plasma AMI 39 ng/mL) such that he could feed himself, swallow easily, and transfer from wheelchair to toilet. Nocturnal confusion and urinary incontinence appeared at 70 mg bid, then resolved at 40 mg bid. Benefits were sustained during the next 14 months. A 77‐year‐old man had substantial relief of severe rigidity, bradykinesia, poor balance, and blepharospasm at 10 mg bid, such that he could feed himself and walk independently. At 40 mg bid (plasma AMI 62 ng/mL) 3 weeks later, he became aggressive, irritable, and increasingly confused. He reverted to his untreated state with drug withdrawal, then improved when AMI was reintroduced at 10 mg bid (plasma AMI 17 ng/mL).

CONCLUSION

Low dose AMI may improve severe motor dysfunction in PSP significantly. Dosing must be individualized for optimal response and minimal toxicity.
The Evolution of Psychiatric Symptoms in Alzheimer's Disease: A Natural History Study
Authors: Jost Barbara C. , Grossberg George T.
Published: April 2015

OBJECTIVE

To characterize the natural history of Alzheimer's Disease (AD); in particular, to determine the prevalence and time of onset of psychiatric symptoms.

DESIGN

Retrospective medical records review.

SETTING

Regional brain bank operated by a university hospital.

PARTICIPANTS

One hundred randomly selected autopsy‐confirmed AD patients.

MEASUREMENTS

The presence of psychiatric symptoms (e.g., anxiety, wandering, agitation) was documented, and the time of onset relative to diagnosis was measured.

RESULTS

Irritability, agitation, and aggression were documented in 81 patients (81%) an average of 10 months after diagnosis. A total of 72% of patients experienced depression, changes in mood, social withdrawal, and suicidal ideation more than 2 years before diagnosis (26.4 months). Hallucinations, paranoia, accusatory behavior, and delusions were documented around the time of diagnosis (0.1 months after diagnosis) in 45% of patients. Patients with early‐onset disease, more years of formal education, and male gender experienced psychiatric symptoms later, relative to diagnosis, than their counterparts.

CONCLUSIONS

Psychiatric manifestations of depression may herald a diagnosis of AD, as such behaviors occurred more than 2 years before diagnosis, on average, in this cohort. Psychotic symptoms manifested around the time of diagnosis, perhaps even prompting diagnosis, whereas agitative symptoms occurred in the first year after diagnosis. The evolution of psychiatric symptoms in this cohort differed according to age at onset of disease, years of formal education, and gender.
Alcohol Use in Retirement Communities
Authors: Adams Wendy L.
Published: April 2015

OBJECTIVES

Anecdotal reports and two previous studies suggest that retirement communities have a particularly high prevalence of heavy drinking. The objective of this study was to verify or refute this finding and to identify characteristics associated with heavy drinking in retirement communities.

METHODS

This cross‐sectional study used a mailed survey to gather information from three retirement communities in suburban Milwaukee, Wisconsin. The questionnaire included alcohol use questions adapted from the Khavari questionnaire and the CAGE questionnaire to screen for alcohol abuse.

RESULTS

Three hundred seventeen of 454 independent residents of the retirement communities completed and returned surveys for a response rate of 70%. Mean age of respondents was 83 ± 6 years, 100% were white, 77% were female. Forty‐seven percent used some alcohol, 15% had one to six drinks per week, 8% had seven or more drinks per week. Only two people screened positive on the CAGE questionnaire for abusive drinking. The majority of drinkers had decreased alcohol use since moving to the community. Male sex, socialization, lack of religious affiliation, and smoking were factors whose percentages increased significantly with increasing alcohol use. Although drinkers were more likely to smoke cigarettes, no indicators suggested that they were less healthy than abstainers.

CONCLUSIONS

Despite the advanced age of this population, regular alcohol use was prevalent. In contrast to previous reports from retirement communities, heavy and abusive drinking were uncommon by our measures, perhaps because of the older age and female predominance of the sample. Drinking appears to be associated with more social contacts and, possibly, better health status.
Use of Restraints and Bedrails in a British Hospital
Authors: O'Keeffe Shaun , Jack Catherine I.A. , Lye Michael
Published: April 2015

OBJECTIVE

To determine the prevalence of restraint and bedrail use in a British hospital.

DESIGN

Cross‐sectional observational study.

SUBJECTS

Six hundred sixty‐eight patients in the acute medical, surgical, and geriatric beds of a large British teaching hospital on a single night

MEASUREMENTS

Observed use of restraints and bedrails. Reasons for restraint use were determined by interviews with nursing staff and examination of the case notes.

RESULTS

Fifty‐six (8.4%) patients had bedrails raised. No other restraints were in use. Reported indications for bedrail use were: prevention of falls (52 patients), prevention of wandering (1), and patient request (3). In stepwise logistic regression analysis, bedrail use was associated significantly with agitated confusion, age 70 years or more, and stroke, while patients on the acute geriatric wards were significantly less likely to have bedrails raised.

CONCLUSIONS

Restraint use is relatively uncommon in Britain. Nevertheless, inappropriate use of bedrails is a reason for concern.
Hearing Loss in Former Prisoners of War of the Japanese
Authors: Grossman Thomas W. , Kerr Harry D. , Byrd James C.
Published: April 2015

OBJECTIVE

To describe the prevalence, degree, and types of hearing loss present in a group of older American veterans who had been prisoners of war of the Japanese.

DESIGN

A descriptive study.

SETTING

A Veterans Affairs university hospital.

PARTICIPANTS

Seventy‐five male veterans, mean age 68 (+/− 3.6) years.

INTERVENTIONS

Hearing aids were prescribed for eight veterans.

MEASUREMENTS

Subjects were examined, and pure tone air and bone conduction, speech reception threshold, and speech discrimination were determined. Results were compared with age‐ and sex‐matched controls from the largest recent American population study of hearing loss.

RESULTS

95% of subjects had been imprisoned longer than 33 months. Starvation conditions (100%), head trauma (85%), and trauma‐related loss of consciousness (23%) were commonly reported. A total of 73% complained of hearing loss, and 29% (22/75) dated its onset to captivity. Most of those with the worst losses in hearing and speech discrimination were found in this subgroup. When the entire group was compared with published age‐ and sex‐matched controls from the Framingham Study, no significant differences were found.

CONCLUSIONS

We advocate screening examinations and long‐term follow‐up of populations with similar histories of starvation, head trauma, and torture.
Pulmonary Aspiration in a Long‐term Care Setting: Clinical and Laboratory Observations and An Analysis of Risk Factors
Authors: Pick Neora , McDonald Anne , Bennett Nancy , Litsche Mildred , Dietsche Linda , Legerwood Robert , Spurgas Richard , LaForce F. Marc
Published: April 2015

OBJECTIVE: To determine the incidence and risk factors associated with aspiration in a high risk group in a long‐term care setting.

DESIGN: A prospective study of demographic, nutritional, clinical, dental, and survival characteristics in 69 patients who suffered 98 aspiration events from May 1, 1990, to December 31, 1990. Demographic and nutritional data from 192 patients who did not aspirate were collected from September 1991 to December 1991.

SETTING: A long‐term care VA facility.

PATIENTS: Long‐term care residents, most of whom were neurologically debilitated.

MEASUREMENTS: The incidence of aspiration was measured and the clinical and microbiological characteristics of aspiration‐associated nosocomial pneumonia described. Mortality and demographic, clinical, and nutritional characteristics were compared between patients who aspirated and those who did not.

MAIN RESULTS: Twenty‐five percent of the study group aspirated during the 8‐month observational period, and 56% of the aspiration events progressed to roentgenographically proven cases of nosocomial pneumonia. Six bacteremic episodes were documented, and results of sputum cultures were consistent with mixed Gram‐positive and Gram‐negative infections. During the study period, patients who aspirated were at three times the risk of dying compared with patients who did not aspirate. Three years later, only 17% of the original group of patients who aspirated were still alive compared with 60% of the patients who had not aspirated. Multivariate analysis identified tube feeding, presence of a hyperextended neck or contractions, malnutrition, and the use of benzodiazepines and anticholinergics as risk factors.

CONCLUSIONS: Pulmonary aspiration is a common and serious event in neurologically impaired long‐term care patients. Some risk factors are amenable to change.
Atrophy of the Corpus Callosum in Alzheimer's Disease Versus Healthy Aging
Authors: Janowsky Jeri S. , Kaye Jeffrey A. , Carper Ruth A.
Published: April 2015

OBJECTIVE: To investigate the specificity of atrophic changes in the corpus callosum (CC) compared with the cerebellum and pons in patients with Alzheimer Disease (AD), healthy elderly subjects (HE), and a sample of prospectively studied subjects who have developed cognitive decline or “incipient dementia” (ID).

DESIGN: Cross‐sectional comparison by age using quantitative MRI.

SETTING: Ambulatory research unit.

PARTICIPANTS: Sixty HE subjects (mean age 78.2 years; range 66–95), 20 ID subjects (mean age 88.1 years; range 78–98) and 39 AD subjects (mean age 72.2 years; range 52–91) were enrolled in longitudinal studies of healthy aging or AD. The population was selected for optimal health; all were examined to exclude medical, neurological and psychiatric illnesses.

MEASUREMENTS: Brain atrophy by quantitative MRI.

RESULTS: AD subjects had smaller CC than HE or ID subjects, who did not differ from each other. All three sectors of the CC were smaller in AD than in HE or ID subjects. The cross sectional area of the cerebellum and pons did not differ between groups. HE and ID subjects showed a significant decline in CC size with age. No age‐related decline was found for AD subjects. The regional atrophy of the CC in AD subjects was significantly related to cognitive function but not to disease duration.

CONCLUSIONS: Atrophy of the CC differentiates HE and ID from AD subjects and tracks the cognitive decline of this disease. In addition, optimally healthy subjects show an age‐related decline in callosum size. The atrophy is specific to the CC, a cortical projection system, and does not occur in cerebellum or pons.
Cognitively Impaired Spouses as Primary Caregivers for Demented Elderly People
Authors: Boucher Lucie , Renvall J. , Jackson J. Edward
Published: April 2015

OBJECTIVE: To describe problems of dementia patients whose spousal caregivers are also cognitively impaired.

DESIGN: Retrospective chart review.

SETTING: The geriatric assessment clinic at University of California, San Diego, which is one center for the California State sponsored Alzheimer's Disease Diagnosis and Treatment Center Program.

PATIENTS: During the period from January 1992 through May 1994, 65 patients completed the assessment and met the entry criteria of being demented and having a spousal caregiver. Twelve of the spouses scored six or more error points on the Katzman Short Orientation‐Memory‐Concentration Test.

MEASUREMENTS: Patient data included age, living situation, other caregivers, use of formal and informal support systems, profiles of medical, cognitive, and functional ability, caregiver interactions, and recommendations from the evaluation.

MAIN RESULTS: Dementia patients with cognitively impaired spouses utilized fewer community resources (P = .021) and experienced difficulty with medication compliance (P = .041) more often than those with cognitively normal spousal caregivers.

CONCLUSIONS: Older caregivers of patients suffering from dementia should be screened for cognitive problems.