bluuebunny/crossref_metadata_2025 huggingface dataset:
The Experience of Living‐Dying in a Nursing Home: Self‐Reports of Black and White Older Adults
Authors: Engle Veronica F. , Fox‐Hill Emily , Graney Marshall J.
Published: April 2015

PURPOSE: The purpose of this study was to describe and compare the experiences, needs, priorities, and concerns reported by black and white nursing home residents during the living‐dying interval. The living‐dying interval is defined as the time between the knowledge of one's impending death and death itself.

DESIGN: This qualitative study was part of a larger ethnographic project. Residents participated in from one to four individual, in‐depth, semi‐structured, audiotaped interviews.

SETTING: Residents lived in two large county‐financed nursing homes that have historically provided care to indigent black and white older adults.

PARTICIPANTS: Purposive sampling was used to identify eight black and five white residents with terminal cancer diagnoses who could serve as rich resources about the experience of living‐dying in a nursing home.

MEASURES: Residents were asked open‐ended questions about how things have been and what would make things better; what comforts them and would make them more comfortable; what dying means to them; and what things are important for nursing staff to know.

RESULTS: Verbatim transcripts of the interviews were coded using QRS NUD‐IST software. Codes were placed in categories, categories were reviewed for common and different concepts, themes, and patterns, and a conceptual model was developed. The model identified six care needs: (1) day‐today living; (2) inadequate pain relief for black residents; (3) difficulty chewing and swallowing; (4) importance of religious activities; (5) giving care to others; and (6) appreciation of respectful and prompt care. Residents validated all components of the conceptual model.

CONCLUSION: Black and white terminally ill residents focused on the quality of living rather than on dying, and black residents may be undertreated for pain. Important care needs for pain and religion are not routinely addressed by the Minimum Data Set (MDS) and Resident Assessment Protocol (RAP) triggers.
Elder‐Proxy Agreement Concerning the Functional Status and Medical History of the Older Person: The Impact of Caregiver Burden and Depressive Symptomatology
Authors: Long Kristie , Sudha S. , Mutran Elizabeth J.
Published: April 2015

OBJECTIVES: To examine the influence of caregiver burden and depressive symptomatology on elder‐proxy response concordance regarding the older person's functional status and medical history.

DESIGN: Cross‐sectional study via telephone interviews.

SETTING: Community‐dwelling older people and caregivers in North Carolina.

PARTICIPANTS: 340 matched pairs of frail persons aged 65 and older and their respective caregivers.

MEASUREMENTS: Multidimensional Functional Assessment: The OARS methodology

RESULTS: Percent agreement on the ADL items ranged from 97.6% on personal hygiene to 99.7% for toileting, with moderate kappa coefficients. IADL percent agreement ranged from 71.5 to 93.7%, with fair to moderate kappa coefficients. Agreement among the medical history items ranged from 76.3 to 98.5% (κ = .138–.831). Response bias for the IADL composite measure is influenced marginally by caregiver burden (F[259] = 1.751. P = .098). Five of the individual IADL bias items are influenced significantly by burden. such that an increase in burden results in a greater likelihood that the caregiver will overstate disability compared with the rating by the older person. Response bias on the ADL scale was increased among persons who experienced more caregiver burden (OR = 1.096, 95% CI = 1.000, 1.192) and those who spent more hours providing care (OR = 1.012, 95% CI = 1.001, 1.024). Additionally, black caregivers were more likely than white caregivers to disagree with the older people on the ADL scale (OR = 2.73, 95% CI = 1.642, 3.809). A composite of the medical history items is influenced by the relationship of the caregiver to the older person; bias is more likely among adult children ((F[227] = 1.56, P = .081).

CONCLUSION: Elder‐proxy concordance is highest among ADL items, followed by medical history items and IADL items. Caregiver depressive symptomotology had no significant impact on elder‐proxy response concordance on any of the three outcomes of interest: IADL and medical history bias and ADL disagreement. However, caregiver burden was marginally predictive of bias on the total ADL and IADL scales. Additionally, increased burden was significantly predictive of bias on five of the seven individual items of the IADL scale, suggesting that the more burden a caregiver feels, the greater likelihood that s/he will overstate the older person's disability compared with self‐report. These findings suggest that clinicians and researchers who use proxy reports to determine treatment regimens and complete data collection efforts may do so with confidence on ADL individual items and medical history items when the older person's frailty is marginal. However, caregiver burden may result in misleading representation of the older person's functional status, specifically in regard to IADL items.
Outbreak of Pneumonia in a Long‐term Care Facility: Antecedent Human Parainfluenza Virus 1 Infection May Predispose to Bacterial Pneumonia
Authors: Fiore Anthony E. , Iverson Chris , Messmer Trudy , Erdman Dean , Lett Susan M. , Talkington Deborah F. , Anderson Larry J. , Fields Barry , Carlone George M. , Breiman Robert F. , Cetron Martin S.
Published: April 2015

OBJECTIVES: To determine the causes of an outbreak of lobar pneumonia.

DESIGN: Matched (1:2) case‐control study.

SETTING: A 70‐bed chronic care facility for older people.

PARTICIPANTS: Residents of the facility.

RESULTS: Ten residents developed pneumonia over a 10‐day period. Two residents died. One case‐patient had Streptococcus pneumoniae bacteremia; another had polymerase chain reaction evidence of S. pneumoniae infection. No other etiologic agent was identified. Only four of 10 case‐patients had received routine diagnostic cultures of blood or sputum before the administration of antibiotics. Symptoms of upper respiratory illness (URI) among residents before the pneumonia outbreak corresponded with elevation of antibodies to human parainfluenza virus 1 (HPIV1). In a matched case‐control study, six of 10 case‐patients, compared with five of 20 controls, had symptoms of URI during the preceding month (matched odds ratio (MOR) = 4.5, 95% CI = 0.8–33). Nine case‐patients had serum available, and five of these had both serologic evidence of recent HPIV1 infection and recent URI, compared with two of 18 controls (MOR = 9.0, 95% CI = 1.2–208). Only three residents had documentation of pneumococcal vaccination.

CONCLUSIONS: Noninfluenza viral infections may play a role in the pathogenesis of some bacterial pneumonias. S. pneumoniae was the cause of at least two pneumonias; lack of preantibiotic cultures may have interfered with isolation of S. pneumoniae in others. Recent HPIV1 infection was epidemiologically linked to subsequently developing pneumonia. Spread of HPIV1 in the facility may have contributed to increased susceptibility to S. pneumoniae and, potentially, to other bacterial pathogens.
Improving the Utility of Urine Flow Rate to Exclude Outlet Obstruction in Men with Voiding Symptoms
Authors: DuBeau Catherine E. , Yalla Subbarao V. , Resnick Neil M.
Published: April 2015

OBJECTIVES: Many older men with voiding symptoms do not have bladder outlet obstruction (BOO) but have conditions amenable to medical treatment. If primary care providers could reliably exclude men who have BOO, then they could initiate appropriate evaluation and treatment in a substantial proportion of the remainder. Urine flow rate, although widely used, is insufficiently sensitive to exclude BOO reliably. We investigated whether the decline in flow rate with age could be utilized to improve the utility of flow rate for excluding BOO in symptomatic men, especially when combined with knowledge of the patient's postvoiding residual volume (PVR).

DESIGN: Prospective study using two patient cohorts.

SETTINGS: A Veterans Affairs urology clinic serving community‐dwelling and institutionalized healthy older men.

PARTICIPANTS: 111 men with voiding symptoms (mean age 72.4 ± 9.2 years).

MEASUREMENTS: Maximum urine flow rate, measured with standard flowmeter, and PVR, measured by catheterization. BOO was determined by multichannel videourodynamic testing.

RESULTS: The sensitivity of flowrate for BOO increased significantly with age (P = .0001) and did not appear to be confounded by comorbid conditions. An algorithm incorporating age, flow rate, and PVR had a sensitivity of 90%, specificity of 43%, and accuracy of 74% in screening for BOO. The algorithm's sensitivity was better than that of flow rate alone (55%); its sensitivity was also similar to a “refer all” strategy (100%) but had improved specificity (41% vs 0%).

CONCLUSIONS: Flow rate alone is insufficiently sensitive as a screening test to exclude BOO, but a simple diagnostic algorithm using age, flowrate, and PVR was more sensitive and accurate. This algorithm allows primary care evaluation and initial management of men with voiding symptoms while potentially reducing unnecessary referrals and costs.
Compliance with PASARR Recommendations for Medicaid Recipients in Nursing Homes
Authors: Snowden Mark , Piacitelli John , Koepsell Tom
Published: April 2015

OBJECTIVE: To determine the rate of compliance with placement and mental health recommendations of the preadmission screening and annual resident review (PASARR) program.

DESIGN: A retrospective observational study using PASARR screening forms to identify recommendations of inpatient psychiatric care for people needing more care than nursing homes provide, alternate disposition for individuals needing less than nursing home level care, and recommendations for new mental health services when needed but not provided. Service use as indicated in Medicaid billing data during the following year was used to determine receipt of service.

PARTICIPANTS: All Washington state Medicaid recipients screened from 1992 through 1993.

MAIN OUTCOME MEASUREMENTS: Compliance rates for placement and service recommendations.

RESULTS: Inpatient psychiatric care was recommended for four of the 523 Medicaid recipients (0.8%), all of whom received it. Screeners recommended alternate dispositions in 131 (25%) subjects, and compliance occurred in 29% of these. Recommendations for new services were made in 310 (59%) cases. Compliance rates averaged 35%, ranging from 73% for medication recommendations to 7% for consultation. Depressed individuals were less likely to receive recommended services.

CONCLUSIONS: Many individuals needed additional mental health services but did not receive them, and a significant minority of patients could have been given an alternate disposition but rarely were.
An Evaluation of Antiepileptic Drug Therapy In Nursing Facilities
Authors: Schacbter Steven C. , Cramer Gena W. , Thompson Gregory D. , Chaponis Robert J. , Mendelson Marilyn A. , Lawborne Larry
Published: April 2015

OBJECTIVES: To describe the prescribing and use of anti‐epileptic drug (AED) therapy in nursing facility residents.

DESIGN: A retrospective, multicenter drug use evaluation.

SETTING: A total of 85 nursing facilities (average size, 119 beds) in five states.

PARTICIPANTS: 1132 residents of the total 10,168 residents screened were prescribed at least one AED

MEASURES: Demographic information, primary indication for AED, comorbid conditions, prescribing physician's specialty, concomitant medications, and AED dosage regimen information were collected. Laboratory tests obtained in the most recent 6 months and seizure occurrence and seizure‐related diagnostic assessments made in the most recent 3 months were also recorded.

RESULTS: Of 1132 residents receiving AED therapy, 892 (78.8%) were prescribed AED therapy for a seizure‐related diagnosis although 86% of seizure types were unspecified. Another 215 residents (19.0%) were prescribed AEDs for nonseizure diagnoses, and 25 (2.2%) had no indication for AED therapy. AEDs most frequently prescribed were phenytoin (56.8%), carbamazepine (23.0%), phenobarbital (15.6%), and valproic acid (13.1%). For residents with a seizure diagnosis, the most frequently prescribed monotherapy agents were phenytoin (52.0%), carbamazepine (12.2%), and phenobarbitol (7.1%). Almost 25% of residents with a seizure diagnosis took a combination of AEDs; more than 50% of all combinations included phenobarbital. About 9% of residents with a seizure diagnosis had one or more documented seizures during a 3‐month review period.

CONCLUSION: Among the substantial percentage of residents treated with AEDs, the lack of diagnosis of seizure type has serious implications for the choice of AED therapy. Opportunities exist for prescribing physicians, consultant pharmacists, and nursing staff to improve the medical management of nursing facility residents with seizures and of others receiving AEDs.
Shoulder Pain in Older People
Authors: Daigneault John , Cooney Leo M.
Published: April 2015

Shoulder pain is encountered commonly in older people. Most of the conditions are amenable to nonoperative treatment, but a clear understanding of the anatomy and those conditions encountered most commonly is essential. A careful history and physical examination, as well as limited diagnostic tests, point to a clear diagnosis in the majority of patients. Most often, conservative measures are effective. Steroid injections are often helpful for both diagnostic and therapeutic reasons. A small percentage of patients do not respond to conservative management and require operative intervention.
The Prognostic Value of Sensory Impairment in Older Persons
Authors: Reuben David B. , Mui Silbey , Damesyn Mark , Moore Alison A. , Greendale Gail A.
Published: April 2015

OBJECTIVES

To determine the relationships between visual and hearing impairment and subsequent functional dependence and mortality among community‐dwelling older persons.

DESIGN

A Prospective, cohort study.

SETTING

Community‐based.

PARTICIPANTS

A total of 5444 men and women aged 55 to 74 years at baseline.

MEASUREMENTS

Self‐reported and measured visual impairment, self‐reported and measured hearing impairment, self‐reported and measured combined sensory impairment, 10‐year mortality, and dependency in activities of daily living (ADL), instrumental ADL (IADL), and Rosow‐Breslau (RB) function.

RESULTS

In multiply‐adjusted models, adjusting for length of follow‐up, socio‐demographic characteristics, and chronic conditions, only measured visual impairment was predictive of mortality. Measured visual impairment was also predictive of 10‐year ADL and IADL dependence; measured hearing impairment was predictive of RB dependence. Self‐reported visual impairment predicted functional impairment on all scales at 10 years, although self‐reported hearing impairment predicted only subsequent RB dependence. Measured combined impairment was associated with the highest risk of 10‐year functional dependence.

CONCLUSIONS

Sensory impairment is predictive of subsequent functional impairment in older persons.
Lifelong Treatment with Oral DHEA Sulfate Does Not Preserve Immune Function, Prevent Disease, or Improve Survival in Genetically Heterogeneous Mice
Authors: Miller Richard A. , Chrisp Clarence
Published: April 2015

OBJECTIVES

To determine whether lifelong exposure to dehydroepiandrosterone sulfate extends the lifespan or retards immune senescence in mice.

DESIGN

Double‐blind, placebo‐controlled intervention trial.

SETTING

A specific pathogen‐free rodent vivarium.

PARTICIPANTS

120 mice bred as a cross between CB6F1 females and C3D2F1 males.

INTERVENTION

DHEAS at 100 μg/mL in drinking water from weaning until death.

MEASUREMENT

Age at death, cause of death, antibody production after erythrocyte immunization, and T cell subset profiles in peripheral blood at ages 8 and 18 months.

RESULTS

DHEAS ingestion did not lead to a significant increase in mean or maximal longevity: the 95% confidence interval for DHEAS effect on mean lifespan ranged from +35 days to −80 days. There were no significant effects of DHEAS on incidence of lethal illnesses, except for a trend toward higher levels of mammary adenocarcinoma in DHEAS‐treated females and mouse urinary syndrome in DHEAS‐treated males. DHEAS treatment did not improve the ability of middle‐aged mice to produce antibody to a foreign particulate antigen, and it did not alter the proportions of age‐sensitive T cell subsets in middle‐aged animals.

CONCLUSION

Although differences among species in pharmacokinetics complicate interpretation of studies in which DHEA or DHEAS is administered to rodents, our data provide no support for the idea that chronic exposure to this steroid retards immune senescence or prevents late life illness.
Nursing Home‐Acquired Pneumonia
Authors: Medina‐Walpole Annette M. , Katz Paul R.
Published: April 2015

Nursing Home‐Acquired Pneumonia is a significant infection that is often seen in the long‐term care setting. It is associated with substantial morbidity, healthcare expenditure, and mortality rates as high as 44%. Uniform diagnosis and therapeutic strategies have not been specifically established for pneumonia in the nursing home setting. This paper will update the long‐term care provider with the unique features and challenges of pneumonia in this setting and review the approaches to the diagnosis and treatment of this important illness. The discussion will conclude with details regarding overall prevention of nursing home‐acquired pneumonia and the critical role played by the nursing home medical director in this process. J Am Geriatr Soc 47:1005–1015, 1999.
Home Visits by an Occupational Therapist for Assessment and Modification of Environmental Hazards: A Randomized Trial of Falls Prevention
Authors: Cumming Robert G. , Thomas Margaret , Szonyi George , Salkeld Glenn , O'Neill Elizabeth , Westbury Christine , Frampton Gina
Published: April 2015

OBJECTIVE: To determine whether occupational therapist home visits targeted at environmental hazards reduce the risk of falls.

DESIGN: A randomized controlled trial.

SETTING: Private dwellings in the community in Sydney, Australia.

PARTICIPANTS: A total of 530 subjects (mean age 77 years), recruited primarily before discharge from selected hospital wards.

INTERVENTION: A home visit by an experienced occupational therapist, who assessed the home for environmental hazards and facilitated any necessary home modifications.

MEASUREMENTS: The primary study outcome was falls, ascertained over a 12‐month follow‐up period using a monthly falls calendar.

RESULTS: Thirty six percent of subjects in the intervention group had at least one fall during follow‐up, compared with 45% of controls (P = .050). The intervention was effective only among subjects (n = 206) who reported having had one or more falls during the year before recruitment into the study; in this group, the relative risk of at least one fall during follow‐up was 0.64 (95% confidence interval, 0.50‐0.83). Similar results were obtained when falls data were analyzed using survival analysis techniques (proportional and multiplicative hazards models) and fall rates (mean number of falls per person per year). About 50% of the recommended home modifications were in place at a 12‐month follow‐up visit.

CONCLUSIONS: Home visits by occupational therapists can prevent falls among older people who are at increased risk of falling. However, the effect may not be caused by home modifications alone. Home visits by occupational therapists may also lead to changes in behavior that enable older people to live more safely in both the home and the external environment. J Am Geriatr Soc 47:1397–1402, 1999.
A U‐Shaped Association Between Home Systolic Blood Pressure and Four‐Year Mortality in Community‐Dwelling Older Men
Authors: Okumiya Kiyohito , Matsubayashi Kozo , Wada Tomoko , Fujisawa Michiko , Osaki Yasushi , Doi Yoshinori , Yasuda Nobufumi , Ozawa Toshio
Published: April 2015

BACKGROUND: Several studies in older people have found a U‐shaped or J‐shaped association of blood pressure with mortality. The increased mortality associated with the lowest levels of blood pressure in older people have been explained by concurrent illnesses and frailty, but previous studies used blood pressure measured on a single occasion. Such a casual value is different from the long‐term average of blood pressure. We investigated the relation between the average level of 5‐day consecutive home blood pressure and mortality in older people while adjusting for potential confounding factors including morbidity and frailty at baseline.

METHODS: In 1992, 1186 community residents of a rural Japanese town, Kahoku, aged 65 or older, measured their blood pressure in their homes 20 times (four times per day, 5 consecutive days). The mean value of the 20 measurements was used to examine the association between home BP and subsequent 4‐year mortality. A proportional hazards model was fitted while adjusting for activities of daily living impairment, medical history, antihypertensive medication, smoking, use of alcohol, and depression.

RESULTS: A total of 134 persons died during the four‐year follow‐up period. There was no significant evidence that frailty is more prevalent in the lowest or highest systolic BP group than in intermediate groups. A U‐shaped association between the average level of home systolic blood pressure and mortality was found in men while adjusting for potential confounding factors, including morbidity and frailty. We also showed the U‐shaped curve of the association of systolic BP with all cause and noncardiovascular mortality in the whole population and the linear association of systolic BP with cardiovascular mortality.

CONCLUSIONS: We showed a U‐shaped association between the average level of systolic blood pressure measured at home and mortality in older men while adjusting for potential confounding factors including morbidity and frailty. Not only high home systolic BP, but also low home systolic BP, is an independent risk factor for mortality in older men. The mechanisms underlying the association between BP and mortality differ by levels of systolic BP. Cardiovascular deaths tended to be higher in the highest SBP group, and only noncardiovascular deaths were increased in the lowest SBP group. The latter finding suggests that low SBP may be not only an independent risk of mortality but also an indicator of a subclinical noncardiovascular comorbid condition. J Am Geriatr Soc 47:1415–1421, 1999.
Synthetic Somatostatin Analog (Octreotide) Suppresses Daytime Growth Hormone Secretion Equivalently in Young and Older Men: Preserved Pituitary Responsiveness to Somatostatin's Inhibition in Aging
Authors: Mulligan Thomas , Jaen‐Vinuales Alejandro , Godschalk Michael , Iranmanesh Ali , Veldhuis Johannes D.
Published: April 2015

OBJECTIVE: To gain greater insight into the mechanisms controlling the low daytime rate of growth hormone (GH) secretion in older men.

DESIGN: We conducted a randomized, controlled study of GH secretion during inhibition by octreotide, a somatostatin analog.

PARTICIPANTS: Nine young (35–44 years) and ten older (62–79 years) healthy men participated.

INTERVENTION: Octreotide versus nothing, while subjects were on a standardized diet.

MEASUREMENTS: All subjects were assessed on two separate occasions: baseline and at time of the intervention of octreotide (100 μg subcutaneously); the order of the intervention was randomly assigned. Octreotide was administered at 8:00 a.m. Venous sampling was performed every 10 minutes for 8 hours (8:30 a.m. to 4:30 p.m.). To estimate the joint parameters of pulsatile and basal (between secretory pulses) GH secretion, we used an ultrasensitive chemiluminescence‐based GH assay and multiparameter deconvolution analysis.

RESULTS: Compared with baseline, octreotide markedly reduced mean (8‐hour) serum GH concentrations in both young (0.585 ± 0.255 μg/L vs 0.070 ± 0.029 μg/L; P = .008) and older (0.397 ± 0.107 μg/L vs 0.087 ± 0.027 μg/L; P = 0.005) men. In younger men, octreotide decreased the serum GH concentration primarily by suppressing the mass of GH released per secretory pulse (2.4 ± 0.9 μg/L vs 1.0 ± .7 μg/L; P = .015) and the interpulse (basal) rate of GH release (0.0014 ± 0.0003 μg/L/min vs 0.0006 ± 0.0002 μg/L/min; P = .051). In older men, octreotide also restrained the mass of GH per secretory pulse (1.5 ± 0.4 μg/L vs 0.4 ± 0.1 μg/L; P = .028) and lowered basal GH release (0.0014 ± 0.0003 μg/L/min vs 0.0004 ± 0.0001 μg/L/min; P = .007). There were no significant differences when the older men were compared with the young controls.

CONCLUSIONS: Our data suggest that the daytime relative GH deficiency seen in older men is not a result of excessive pituitary susceptibility to the inhibitory capabilities of somatostatin, but more likely reflects impoverished endogenous GHRH drive and/or heightened release of brain somatostatin. J Am Geriatr Soc 47:1422–1424, 1999.
Use of Prescribed Drugs Among Older People in Japan: Association with Not Having a Regular Physician
Authors: Tsuji‐Hayashi Yoko , Fukuhara Shunichi , Green Joseph , Kurokawa Kiyoshi
Published: April 2015

OBJECTIVES: Minimizing the overuse of prescribed drugs among older people is a goal of geriatricians and healthcare policy makers. Indirect evidence indicates that use of prescribed drugs is more common in Japan than in some Western countries, but the actual situation in Japan is unknown. The first aim of this study was to clarify the use of prescribed drugs among older people in Japan. We also tested the hypothesis that using five or more prescribed drugs is associated with a situation that is modifiable and is relatively common in Japan: not having a regular physician.

DESIGN: A cross‐sectional survey.

PARTICIPANTS: Subjects representing the Japanese general population aged 65 years and older were selected by two‐stage stratified sampling; 617 persons were eligible for the study.

MEASUREMENTS: Each subject was given a self‐report questionnaire about current medications, sociodemographic characteristics, current state of health, health‐related quality of life, and whether they had a regular physician. Among users of prescribed drugs, the association between using five or more prescribed drugs and not having a regular physician was assessed by univariate analysis and by stepwise logistic regression.

RESULTS: The questionnaire was returned by 491 (80%) of the eligible subjects, 299 (61%) of whom were taking at least one prescribed drug. Nearly 30% of those subjects were taking at least five prescribed drugs. The distribution of the number of prescribed drugs being taken was positively skewed; the minimum was one and the maximum was 17, the middle 50% of the values ranged from two to five, and the median was three. About half of those who were taking at least five prescribed drugs did not have a regular physician. Compared with those who had a regular physician, those who did not were 2.5 times more likely to be taking at least five prescribed drugs (95% confidence interval, 1.4 − 4.6).

CONCLUSIONS: Older people in Japan are less likely to be taking many prescribed drugs if they have the continuity of care provided by a regular physician. J Am Geriatr Soc 47:1425–1429, 1999.
Prevalence of Significant Knee Pain Among Older Americans: Results From the Third National Health and Nutrition Examination Survey
Authors: Andersen Ross E. , Crespo Carlos J. , Ling Shari M. , Bathon Joan M. , Bartlett Susan J.
Published: April 2015

OBJECTIVE: To assess the prevalence of persistent knee pain among older adults in the US.

DESIGN: A nationally representative cross‐sectional survey with an in‐person interview and medical examination

SETTING AND PARTICIPANTS: Between 1988 and 1994, 6596 adults aged 60 to 90+ years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans and non‐Hispanic blacks were over‐sampled to produce reliable estimates for these groups.

MAIN OUTCOME MEASUREMENTS: Participants were asked to report whether they had experienced knee pain on most days for the 6 weeks preceding their medical exam.

RESULTS: Overall, 18.1% of US men and 23.5% of US women aged 60 years and older reported knee pain. Sixty‐ to ninety‐year‐old men reported knee pain less frequently than their age‐matched female counterparts. There was a trend for reports of knee pain to increase steadily as these adults aged from 60 to 85 years. The highest prevalence of knee pain was reported among 85‐ to 90‐year‐old men (23.7%) and women (30.0%). Among non‐Hispanic white adults older than age 60, 18.4% of men and 22.0% of women reported knee pain. Reports of knee pain among non‐Hispanic black men and Mexican American men were similar to those of their non‐Hispanic white counterparts. In contrast, 26.4% of Mexican American women and 32.8% of non‐Hispanic black women reported knee pain. We also found that difficulty in performing physical functioning activities was associated with a higher prevalence of knee pain.

CONCLUSIONS: Many US adults older than age 60 years report knee pain, and the prevalence is higher in older adults. Reports of knee pain are highest among non‐Hispanic black women and the oldest Americans. Intervention strategies are needed to prevent and better manage knee pain among older US adults to stem the adverse health consequences and diminished quality of life associated with this common problem. J Am Geriatr Soc 47:1435–1438, 1999.
Managing Dyslipidemia in Older Adults1
Authors: Carlsson Cynthia M. , Carnes Molly , McBride Patrick E. , Stein James H.
Published: April 2015

OBJECTIVES: To summarize and critically review clinical trial data regarding dyslipidemia as a risk factor for coronary heart disease (CHD) and the efficacy and safety of lipid‐lowering interventions in older adults. Based on these data, clinical recommendations for diagnosing and managing dyslipidemia in older adults are provided.

METHODS: Peer‐reviewed journal articles were identified by a MEDLINE search and a review of journal article references. Studies that were performed exclusively in subjects older than 65 years or that included a large subgroup of older adults were included.

CONCLUSIONS: Elevated low density lipoprotein and total cholesterol levels are independent risk factors for CHD events in patients aged older than 65 years. Older adults have a higher risk of mortality attributable to hypercholesterolemia. Diet and lipid‐lowering medications safely and effectively lower cholesterol levels in this age group. Exercise increases high‐density lipoprotein cholesterol levels and decreases triglyceride levels. If accompanied by weight loss, exercise may reduce low‐density lipoprotein and total cholesterol levels. Improving lipid levels in older adults with CHD decreases the risk of future coronary events by up to 45%, and significant effects on outcome measures may be observed within 2 years of the initiation of therapy. J Am Geriatr Soc 47:1458–1465, 1999.
Heart Failure in Community‐Dwelling Older Persons: Aims, Design and Adherence Rate of the ICARe Dicomano Project: An Epidemiologic Study
Authors: Di Bari Mauro , Marchionni Niccolò , Ferrucci Luigi , Pini Riccardo , Antonini Enrico , Chiarlone Melisenda , Marsilii Alberto , De Alfieri Walter , Fumagalli Stefano , MD Giulio Masotti
Published: April 2015

BACKGROUND: The prevalence of heart failure (HF) increases with age, and HF is a major cause of disability and mortality in older persons. Detection of HF in epidemiological studies has relied on criteria validated only in young and middle‐age adults, and, therefore, may prove inadequate in older subjects, because they do not take into account the pathophysiologic and clinical peculiarities of HF in old age. Thus, the true prevalence of HF in the older general population remains uncertain and has probably been underestimated in previous studies. Moreover, the mechanism and the extent by which HF hinders physical functioning in older people has not been fully elucidated.

OBJECTIVES: This paper describes the design of the ICARe study, carried out in an older home‐dwelling population to collect data about: (1) the sensitivity and specificity of diagnostic criteria used previously in epidemiological studies of HF; (2) the prevalence of the different pathophysiologic forms of HF; and (3) the impact of HF on overall health status, and on physical functioning, in the absence or presence of chronic comorbidity.

DESIGN AND SETTING: This was a cross‐sectional survey. Eligible were all community‐dwelling persons aged 65 years or older recorded in the Registry Office of Dicomano, a small town nearby Florence (Italy). All the domains of multidimensional geriatric assessment were explored through different phases of the study (home interview, laboratory testing, geriatric visit) that comprised an extensive cardiopulmonary instrumental assessment including: color Doppler echocardiography, echotomography of the carotid arteries used in an original method to determine arterial compliance, and bell spirometry. Presence of major chronic conditions was ascertained by predefined, standard algorithms that were based largely on clinical examination.

RESULTS: There were 864 older persons eligible for the ICARe study. Even with a substantial decline from home interview (91.2%) to the cardiopulmonary study (71.1%), the adherence rate remained high throughout the study, and the population examined was fairly representative of the original eligible population. Thus, we believe that the data collected in this study offer a unique opportunity to assess the validity of the diagnostic clinical criteria for HF in the general older population, to identify the pathophysiology underlying the syndrome, and to investigate the relationship between HF, comorbidity, and disability. J Am Geriatr Soc 47:664–671, 1999.
Subclinical Hypothyroidism in a Biethnic, Urban Community
Authors: Lindeman Robert D. , Schade David S. , LaRue Asenath , Romero Linda J. , Liang Hwa Chi , Baumgartner Richard N. , Koehler Kathleen M. , Garry Philip J.
Published: April 2015

OBJECTIVES: To evaluate the association between hypothyroidism, and the health status of older Hispanic and non‐Hispanic white (NHW) men and women. To accomplish this, we determined the prevalences of the treated and untreated conditions and examined the associations between an elevated serum thyroid stimulating hormone (TSH) and cognitive and affective (mood) functions and the prevalences of symptoms and comorbidity, specifically coronary heart disease (CHD), diabetes, hypertension, and hyperlipidemia.

DESIGN AND SETTING: A cross‐sectional study of equal numbers of Hispanic and NHW men and women selected randomly from the Health Care Financing Administration (Medicare) rolls and recruited for a home interview followed by a 4‐hour interview/examination in a senior health clinic.

PARTICIPANTS: 883 volunteers, mean age 74.1 years, participated in interviews/examinations

MEASUREMENTS: Serum TSH was determined in 825 participants responding to questions about thyroid replacement therapy. Serum free thyroxine (free T4) concentrations were determined in 139 participants with elevated TSH concentrations (>4.6 μU/mL). Symptoms, cognitive tests, a screen for depression, comorbidities (e.g., CHD), and risk factors (e.g., lipid abnormalities, diabetes, and hypertension) were compared in participants with high versus normal TSH values.

RESULTS: Subclinical hypothyroidism is more common in women than in men and in non‐Hispanic white women compared with Hispanic women. No differences were observed between participants with TSH elevations from 4.7 to 10 μU/mL and those with normal TSH concentrations, and only a few differences were observed in those with TSH concentrations above 10.

CONCLUSIONS: Subclinical hypothyroidism is a common condition in community‐living older people, especially women. However, it appeared to have no effect on any of the measures of health status utilized until serum TSH concentrations exceeded 10 μU/mL, and even then the effects were rarely significant. J Am Geriatr Soc 47:703–709, 1999.
Misreporting of Total Energy Intake in Older Men and Women
Authors: Tomoyasu Naomi J. , Toth Michael J. , Poehlman Eric T.
Published: April 2015

Misreporting of total energy intake occurs frequently in dietary studies. Relatively few studies have been performed in older individuals who may be vulnerable to obesity and its associated health risks. In the present study, we examined misreporting of total energy intake by comparing self‐reported food intake, measured by 3‐day food diaries, to energy expenditure, measured with the doubly labeled water technique, in a relatively large sample of older men (n = 39) and women (n = 43). An additional objective was to identify potential predictors of misreporting, including body composition, fitness as assessed by peak Vo2, and sociodemographic characteristics such as gender, living arrangement, education, and income. In general, men and women underreported total energy intake. The magnitude of the underreporting, as measured by percent difference between reported intake and measured total energy expenditure, was comparable between the sexes. Body mass index, waist circumference, and fat mass were significant correlates of underreporting of total energy intake, with heavier individuals underreporting more than leaner individuals. Among the demographic variables, living arrangement was a significant determinant of misreporting of total energy intake in older people. Individuals in marriage‐like living arrangements underreported their total energy intake to a greater extent than married individuals. However, the magnitude of misreporting by those living alone did not differ from that of married individuals. The results of the present study highlight the need to examine misreporting of total energy intake in older individuals, who are more prone to obesity and its health risks. J Am Geriatr Soc 47:710–715, 1999.
The Efficacy of Omeprazole‐Based Short‐Term Triple Therapy in Helicobacter pylon‐Positive Older Patients with Dyspepsia
Authors: Moshkowitz Menachem , Brill Shlomo , Konikoff Fred M. , Reif Shimon , Arber Nadir , Halpern Zamir
Published: April 2015

OBJECTIVE: To evaluate the efficacy of 1‐week triple therapy with omeprazole, clarithromycin, and tinidazole (OCT) in Helicobacter pylori‐positive older patients with dyspepsia.

DESIGN: A prospective, nonrandomized therapeutic study.

SETTING: The primary care and referral center of a gastroenterological outpatient clinic at a central university hospital serving an urban population (>1 million) in Israel.

PARTICIPANTS: The study group consisted of 134 patients (71 men, and 63 women) more than 60 years old who were referred for evaluation of symptoms of dyspepsia and were endoscopically diagnosed as H. pylori positive. The patients were divided into two groups: those who received their first course of anti‐H. Pylori therapy during this study (Group 1) and those who had previously received standard metronidazole and bismuth combination therapies that failed to eradicate the H. pylori (Group 2).

MEASURMENTS: All the patients underwent upper gastrointestinal endoscopy, and H. pylori infection was confirmed by a rapid urease test (CUTest) and/or histological staining. Therapeutic efficacy was assessed by a 13C‐urea breath test 4 weeks after completion of treatment.

RESULTS: The mean age of the study population was 68.8 years (range 60–87). There were 112 patients in Group 1 and 22 patients in Group 2. Endoscopic findings were: gastritis (in 46), gastric ulcer (8), duodenal ulcer (52), and duodenitis (28). The H. pylori eradication rate was significantly higher in Group 1 patients (104/112, 92.9%) than in patients of Group 2 (15/22, 68.2%). There was no difference in the eradication rate in relation to gender, endoscopic diagnosis, more advanced age, place of birth, or smoking habits. The compliance in both groups was equally good, and no major side effects were recorded.

CONCLUSIONS: A 1‐week OCT triple therapy is well tolerated and effective as first line therapy for H. pylori among older people. It is less effective in patients previously treated. J Am Geriatr Soc 47:720–722, 1999.
Long‐Term Functional Outcome After Intensive Care
Authors: Roche Vivyenne M.L. , Kramer Andrew , Hester Eric , Welsh Carolyn H.
Published: April 2015

OBJECTIVE: Although age‐related mortality after intensive care unit (ICU) admission has been studied, functional recovery for different age groups following ICU admission is not well characterized. We hypothesized that compared with younger age groups, fewer patients older than age 65 admitted to an ICU would regain their full prehospitalization functional ability and that their recovery would be slower than that of younger patients.

DESIGN: A prospective observational cohort study with convenience sampling.

SETTING: Intensive care units of an urban university‐affiliated Veterans Administration Medical Center.

PARTICIPANTS: A total of 222 patients during the first 72 hours after entry to a medical or surgical ICU at the Denver Veteran's Administration Medical Center between September 1991 and July 1992.

MEASUREMENTS: We collected baseline data on patient demographics and on the severity of acute illness using the Acute Physiology and Chronic Health Evaluation (APACHE II), Acute Physiology Score (APS), and functional status (highest level of physical activity level 1 month before admission). We recorded survival and patient‐perceived global functional status at 6 weeks and 6 months after admission. Post‐ICU function was adjusted for baseline function, age, APACHE II, and APS using multiple regression.

RESULTS: Average patient age was 62 ± .74 years (mean ± SEM). Fifty‐two percent of the entire cohort returned to baseline function at 6 months. Although baseline function was better for younger people, there was no difference in recovery at 6 weeks in older compared with younger patients. Most functional recovery occurred by 6 weeks, with maintenance of this recovery at 6 months. Baseline function was the major determinant of both 6 week recovery (P < .001) and 6 month recovery (P < = .002), whereas APACHE II was not (P = .3). Age predicted recovery significantly (P = .04) at 6 months but not at 6 weeks (P = .26). APACHE II (P < .001) and baseline function (P = .03) predicted mortality.

CONCLUSIONS: Older people had worse functional ability at ICU admission, but the proportion of older people who recovered and their rate of recovery was the same as for younger people. Baseline functional status, rather than abnormal physiologic status (as measured by APACHE II) on admission, was the major determinant of recovery, whereas APACHE II was the main correlate of mortality. Together, baseline function and physiologic status provide valuable complementary information for clinically relevant outcomes following an ICU admission.
Who Dies at Home? Determinants of Site of Death for Community‐Based Long‐Term Care Patients
Authors: Fried Terri R. , Pollack Daphna M. , Drickamer Margaret A. , Tinetti Mary E.
Published: April 2015

OBJECTIVE: To determine characteristics associated with site of death in a cohort of long‐term homecare patients.

DESIGN: Cohort study.

SETTING: Community‐based long‐term care program.

SUBJECTS: All patients 65 years of age or older who died within 1 year of admission during 1989 and 1990.

MAIN OUTCOME MEASURE: Site of death.

RESULTS: Of 620 subjects, site of death was hospital for 302 (49%), home for 132 (21%), nursing home for 124 (20%), and inpatient hospice for 45 (7%). Among patients living at home before death, factors associated with dying at home rather than in a hospital or inpatient hospice included female gender (relative risk (RR) 1.40, 95% confidence interval (CI) 1.00, 1.90); severely dependent functional status (RR 2.38, CI 1.39, 4.17) and cognitive status (RR 1.51, CI 1.10, 2.06); and dying of cancer (RR 1.68, CI 1.11, 2.55), chronic lung disease (AOR 1.75, CI 1.04, 2.95), or coronary artery disease (RR 1.93, CI 1.21, 3.09). Living with a child (RR 1.45, CI .99, 2.11) showed a trend toward association with dying at home.

CONCLUSIONS: Even among a subgroup of older persons receiving community‐based long‐term care, the frequency of home death is low. The finding of an association between functional, social, and disease status and site of death suggests that the relationship between these factors and patients' preferences and care needs must be examined in order to understand how to optimize the site of terminal care.
Drugs and Falls in Older People: A Systematic Review and Meta‐analysis: II. Cardiac and Analgesic Drugs
Authors: Leipzig Rosanne M. , Cumming Robert G. , Tinetti Mary E.
Published: April 2015

OBJECTIVES: To evaluate critically the evidence linking specific classes of cardiac and analgesic drugs to falls in older people.

DESIGN: Fixed‐effects meta‐analysis.

DATA SOURCES: English‐language articles in MEDLINE (1966 – March 1996) indexed under accidents or accidental falls and aged or age factors; bibliographies of retrieved papers.

STUDY SELECTION: Systematic evaluation of cardiac or analgesic drug use and any fall in people aged 60 years and older.

DATA EXTRACTION: Study design, inclusion and exclusion criteria, setting, sample size, response rate, mean age, method of medication verification and fall assessment, fall definition, and the number of fallers and nonfallers taking specific classes of cardiac and analgesic drugs.

RESULTS: Twenty nine studies met inclusion criteria. None were randomized controlled trials. For one or more falls, the pooled Odds Ratio (95% Confidence Interval) was 1.08 (1.02‐1.16) for diuretic use, 1.06 (0.97‐1.16) for thiazide diuretics, 0.90 (0.73‐1.12) for loop diuretics, 0.93 (0.77‐1.11) for beta‐blockers, 1.16 (0.87‐1.55) for centrally acting antihypertensives, 1.20 (0.92‐1.58) for ACE inhibitors, 0.94 (0.77‐1.14) for calcium channel blockers, 1.13 (0.95‐1.36) for nitrates, 1.59 (1.02‐2.48) for type la antiarrhythmics, and 1.22 (1.05‐1.42) for digoxin use. For analgesic drugs, the pooled OR was 0.97 (0.78‐1.20) for narcotic use, 1.09 (0.88‐1.34) for nonnarcotic analgesic use, 1.16 (0.97‐1.38) for NSAID use, and 1.12 (0.80‐1.57) for aspirin use. There was no statistically significant heterogeneity of pooled odds ratios. There were no differences between the pooled odds ratios for studies with mean subject age <75 versus ≥75 years old or for studies in communities with <35% versus ≥35% fallers. In studies of the relationship between psychotropic, cardiac, or analgesic drugs and falls, subjects reporting the use of more than three or four medications of any type were at increased risk of recurrent falls.

CONCLUSION: Digoxin, type IA antiarrhythmic, and diuretic use are associated weakly with falls in older adults. No association was found for the other classes of cardiac or analgesic drugs examined. The evidence to date, however, is based solely on observational data, with minimal adjustment for confounders, dosage, or duration of therapy. Older adults taking more than three or four medications were at increased risk of recurrent falls. As a result of the incidence of falls and their consequences in this population, programs designed to decrease medication use should be evaluated for their impact on fall rates.