bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender Differences in Cognitive Function with Age: The Rancho Bernardo Study
Authors: Barrett‐Connor Elizabeth , Kritz‐Silverstein Donna
Published: April 2015

BACKGROUND: Estrogen deficiency has been proposed as a cause of memory loss in postmenopausal women. If true, men should have less memory loss with age than women. The present study is designed to examine the postulated effect of estrogen on memory by studying the effect of gender on the age‐related decline in cognitive function.

METHODS: Cross‐sectional study of 800 women and 551 men aged 65 to 95 years, members of the community‐based Rancho Bernardo Study (begun in 1972 and 1974) who completed the Beck Depression Inventory in 1984–1987 and 12 standardized tests of cognitive function in 1988–1991. All participants were white, middle to upper‐middle class, relatively well educated, and ambulatory. At all visits, use of estrogen therapy was ascertained and validated.

RESULTS: Test performance worsened with age in both sexes, with similar patterns in men compared with women who were current, past, or never users of estrogen. Betweengender comparisons of the slope for age on each cognitive function test after adjustment for education, depressed mood, and estrogen use (in women) indicated that men had a significantly steeper decrement with age than women on the Buschke total recall and long‐term memory tests (P <.001), on the immediate and delayed recall tasks of the visual reproduction tests (P < .01 and .05, respectively), and on category fluency (P < .05). Similar results were obtained when gender comparisons included only women who had never used estrogen.

CONCLUSION: These weak or absent gender differences in decline in cognitive function with age do not support the thesis that estrogen deficiency is associated with a decline in cognitive function in postmenopausal women. J Am Geriatr Soc 47:159–164, 1999.
Medication Adherence in Rheumatoid Arthritis Patients: Older Is Wiser
Authors: Park Denise C. , Hertzog Christopher , Leventhal Howard , Morrell Roger W. , Leventhal Elaine , Birchmore Daniel , Martin Mike , Bennett Joan
Published: April 2015

OBJECTIVES: To create a profile of individuals nonadherent to their medications in an age‐stratified sample (ages 34–84) of community‐dwelling rheumatoid arthritis patients. The relative contributions of age, cognitive function, disability, emotional state, lifestyle, and beliefs about illness to nonadherence were assessed.

DESIGN: A direct observation approach was used in conjunction with structural equation modeling. All participants were administered a preliminary assessment battery. Medications were then transferred to vials with microelectronic caps that recorded medication events for all medications for the next 4 weeks.

PARTICIPANTS AND SETTING: A volunteer sample of 121 community‐dwelling rheumatoid arthritis (RA) patients were recruited from newspaper ads, posters, and via informal physician contact from private rheumatology practices in Atlanta and Athens, Georgia. Written verification of the RA diagnosis and a disease severity rating were obtained from personal physicians before patients were enrolled in the study. Patients were tested in a private physician's office, and their medication adherence was monitored electronically for a month in their every‐day work and home settings.

MEASUREMENTS AND RESULTS: Structural equation modeling techniques were used to develop a model of adherence behavior. Cognitive and psychosocial measures were used to construct latent variables to predict adherence errors. The model of medication adherence explained 39% of the variance in adherence errors. The model demonstrated that older adults made the fewest adherence errors, and middle‐aged adults made the most. A busy lifestyle, age, and cognitive deficits predicted nonadherence, whereas coping with arthritis‐related moods predicted adherence. Illness severity, medication load, and physical function did not predict adherence errors. Omission of medication accounted for nearly all errors.

CONCLUSION: Despite strong evidence for normal, age‐related cognitive decline in this sample, older adults had sufficient cognitive function to manage medications. A busy lifestyle and middle age were more determinant of who was at risk of nonadherence than beliefs about medication or illness. Thus, practicing physicians should not assume that older adults have insufficient cognitive resources to manage medications and that they will be the most likely to make adherence errors. Very busy middle‐aged adults seem to be at the greatest risk of managing medications improperly. J Am Geriatr Soc 47:172–183, 1999.
Risk of a New Benzodiazepine Prescription in Relation to Recent Hospitalization
Authors: Grad Roland , Tamblyn Robyn , Holbrook Anne M , Hurley Jerry , Feightner John , Gayton David
Published: April 2015

OBJECTIVE: To determine if recent hospital admission was associated with new outpatient prescribing of benzodiazepines among community‐dwelling older people.

DESIGN: Nested case‐control study using administrative data sets of the provincial health insurance board.

SETTING: Province of Quebec.

PARTICIPANTS: Cases were 4127 community‐dwelling older people who were newly dispensed a benzodiazepine during an 8‐month period in 1990. Controls were 16,486 community‐dwelling older people who were dispensed any drug (except a benzodiazepine) on the same day as the case‐defining index prescription.

EXPOSURE AND OUTCOME MEASURES: Admission to an acute care hospital within a 30‐day period before a new dispensing of a benzodiazepine. Other variables measured were patient age, gender, number of ambulatory physician visits, healthcare region, Chronic Disease Score (CDS), and use of drugs for depression and psychosis.

RESULTS: Cases were more than three times as likely as controls to have been hospitalized in the 30‐day period before the index date (adjusted odds ratio (OR) 3.09; 95% CI, 2.78‐3.45). The use of prescription drugs for physical health problems modified this association in that cases who used more medication were also more likely to receive a new benzodiazepine prescription following a recent hospital admission (adjusted OR 4.09; 95% CI, 3.59‐4.65 when the CDS was equal to 5 vs adjusted OR 1.96; 95% CI, 1.66‐2.31 when the CDS was equal to 0).

CONCLUSIONS: Recent hospitalization confers an increased risk of a new outpatient benzodiazepine prescription among community‐dwelling older people in Quebec. Those who use more medication, and who may be more vulnerable to drug‐related adverse events, are more likely to be newly dispensed a benzodiazepine following a recent, acute‐care hospital admission. J Am Geriatr Soc 47:184–188, 1999.
Prevalence and Risks of Dementia in the Japanese Population: RERF's Adult Health Study Hiroshima Subjects
Authors: Yamada Michiko , Sasaki Hideo , Mimori Yasuyo , Kasagi Fumiyoshi , Sudoh Shinji , Ikeda Junko , Hosoda Yutaka , Nakamura Shigenobu , Kodama Kazunori
Published: April 2015

OBJECTIVES: To study the prevalence rate of dementia and its subtypes in Japan and to investigate the relationship of risk factors, such as demographic features and disease history, to the prevalence of Alzheimer's disease or vascular dementia.

DESIGN: A prevalence study within a longitudinal cohort study.

SETTING: The original Adult Health Study (AHS) cohort consisted of atomic‐bomb survivors and their controls selected from residents in Hiroshima and Nagasaki using the 1950 national census supplementary schedules and the Atomic Bomb Survivors Survey. Since 1958, the AHS subjects have been followed through biennial medical examinations.

PARTICIPANTS: Subjects were 637 men and 1585 women aged 60 years or older in the AHS cohort. Forty‐eight subjects resided in hospitals and institutions.

MEASUREMENTS: In addition to the biennial medical examinations ongoing since 1958, a screening test for cognitive impairment (CASI) was conducted by trained nurses between September 1992 and September 1996. The prevalence of dementia and its subtypes was assessed in 343 subjects suspected to have dementia and in 272 subjects with high CASI scores who were selected randomly.

RESULTS: The prevalence of dementia based on DSM III/R criteria, using neurological examination, the IQCODE, and CDR ≥ 1, was 7.2%. The prevalence of Alzheimer's disease was 2.0% in men and 3.8% in women, and the prevalence of vascular dementia was 2.0% in men and 1.8% in women. The relationship of risk factors to Alzheimer's disease or vascular dementia was investigated by the multivariate logistic linear regression analysis. Odds ratios of Alzheimer's disease for age (in 10‐year increments), attained education (in 3‐year increments), history of head trauma, and history of cancer are 6.3, 0.6, 7.4, and 0.3, respectively. Odds ratios of vascular dementia for age, history of stroke, and history of hypertension are 2.0, 35.7, and 4.0, respectively. Neither type of dementia showed any significant effect of sex or radiation exposure.

CONCLUSION: This study is the first study of Japanese dementia rates carried out with a protocol similar enough to that of a US study to allow meaningful comparisons. The prevalence rates demonstrated are more similar to US rates than were found in many previous reports in Japan. J Am Geriatr Soc 47:189–195, 1999.
Misclassification and Selection Bias When Identifying Alzheimer's Disease Solely from Medicare Claims Records
Authors: Newcomer Robert , Clay Ted , Luxenberg Jay S. , Miller Robert H.
Published: April 2015

BACKGROUND: Medicare claims as the basis for health condition adjustments is becoming a method of choice in capitation reimbursement. A recent study has found that claims‐based beneficiary classification for Alzheimer's disease produces lower prevalence estimates and higher average costs than previous healthcare cost studies in this population. These sets of studies differ in data sources, period length, and in their specification of dementia.

OBJECTIVES: Participants in the Medicare Alzheimer's Disease Demonstration (MADDE) provide a sample of persons known to have some form of dementia. This group is used to test the adequacy of claims data for identifying eligible cases and any bias in expenditure differences between those flagged or not flagged by a claim in a given period.

DESIGN: A prospective cohort design using up to 36 months of claims data.

SETTING: The demonstration enrolled 4166 participants in treatment, and 3942 in a control group in eight communities across the US. Cases were combined in this analysis.

PARTICIPANTS: Persons with available Medicare Part A & B claims data: those receiving care under fee for service reimbursement were used in the analysis. A total of 5379 MADDE cases received fee for service care during 1991 and 1992, the period of primary interest in the analysis.

MEASUREMENT: Client health and functional status interviews and Medicare Part A & B claims.

RESULTS: Less than 20% of MADDE participants were classified with Dementia of the Alzheimer type (DAT) from a single year of claims although 68% had a DAT diagnosis from a referring physician. Annualized expenditures were 1.7 times higher among those with DAT from claims compared with those known otherwise to have dementia but who had not been identified with this condition from Medicare claims.

CONCLUSION: Underclassification of dementia from claims records can be partially remedied by increasing the period during which claims are compiled, but additional diagnostic sources will likely be needed to increase prevalence counts closer to 100% of true cases. Risk adjustment based on a single year of reported claims expenditures may overpay providers, at least in the short term, because payment incentives will likely increase prevalence reporting. J Am Geriatr Soc 47:215–219, 1999.
Aging and Postural Control: Postural Perturbations Caused by Changing the Visual Anchor
Authors: Simoneau Martin , Teasdale Normand , Bourdin Christophe , Bard Chantal , Fleury Michelle , Nougier Vincent
Published: April 2015

OBJECTIVE: To determine the effect of modifying the stable visual anchor on the postural stability of older individuals. The visual anchor was changed by opening doors similar to those found in an elevator cage. Lighting intensities inside and outside the cage were varied to create increasing or decreasing luminosity conditions. The effect of adding a cognitive load (counting backwards) was also tested.

DESIGN: A controlled laboratory study.

SETTING: Tests performed in a balance laboratory.

MEASUREMENTS: Sensory and clinical measurements to insure the integrity of the central and peripheral nervous system. Measures of balance were derived from the recordings of the center of foot pressure. These measures included range and speed of the center of foot pressure.

PARTICIPANTS: Eight older, community‐dwelling subjects and nine young subjects participated. A sensorimotor evaluation was used to insure that all older individuals were free from any pathologies affecting postural stability. All participants had a low score (indicating high balance confidence) on the Falls Efficacy Scale and no history of falls.

RESULTS: Older individuals were affected by modification of the stable visual anchor induced by the opening of doors similar to that of an elevator cage. They showed greater ranges of the center of foot pressure (COP) and speed of the COP after than before the opening of the doors. Furthermore, the increased ranges and speed were two to three times greater than that observed for the young subjects. A lighting intensity considered as comfortable for reading inside the elevator affected the overall postural stability of the older participants negatively. Counting backwards also decreased their overall stability.

CONCLUSION: Changing the stable visual anchor, as when exiting an elevator cage, could be a significant risk factor for older persons. Moreover, when combined with a cognitive load or lower lighting intensity inside the elevator cage, the negative effects on the postural stability of older persons are exacerbated. J Am Geriatr Soc 47:235–240, 1999.
Firearm Presence in Households of Patients with Alzheimer's Disease and Related Dementias
Authors: Spangenberg Karen B. , Wagner Mark T. , Hendrix Shirley , Bachman David L.
Published: April 2015

OBJECTIVE: Attention has recently been drawn to the potential dangers of firearm use among patients with dementia. However, little is known about the actual prevalence of firearms in households with demented family members. This study seeks to determine the prevalence and loaded status of firearms in households with a demented family member in a sample of outpatients at a University memory disorders clinic.

DESIGN: Utilizing a cross‐sectional design, subjects underwent a structured NINCDS‐ADRDA criteria comprehensive evaluation to assess dementia and were also administered a questionnaire to assess level of mood disturbance. Family members were administered a behavioral checklist and surveyed about the number and loaded status of firearms in the patient's household.

SETTING: The study took place in an outpatient Medical University memory disorders clinic in the Southern United States.

PATIENTS: Subjects were 106 consecutive outpatients referred for symptoms suggestive of dementia.

MAIN OUTCOME MEASURES: Firearm presence was coded as “present,” “not present,” and “unsure.” In cases where firearms were present, the number and loaded status were collected. Other outcome measures included the Clinical Dementia Rating of each patient, the Yesavage Mood Inventory, and the Revised Memory and Behavior Problems Checklist.

RESULTS: A high prevalence of firearm prevalence in households with demented family members was revealed (60.4%). Gun ownership was equally prevalent in households regardless of the severity of the dementia (chi‐square, P = .426), severity of behavioral disturbance (ANOVA P = .88), or depressive symptoms (ANOVA P = .37). In households with firearms, 44.6% of the families reported that the guns were kept loaded; 38% reported that they did not know whether the guns were loaded. Only 16.9% of the families reported that guns were maintained in an unloaded state.

CONCLUSIONS: This study suggests that many family members living in households in which there are demented patients do not take appropriate action to remove or unload firearms in their households, regardless of the severity of dementia, behavioral disturbance, or depression. These findings suggest that clinicians need to ask families specifically about the presence of firearms and advocate for their removal.
Falls Relate to Vitamin D and Parathyroid Hormone in an Australian Nursing Home and Hostel
Authors: Stein Mark S. , Wark John D. , Scherer Samuel C. , Walton S. Lynette , Chick Patricia , Di Carlantonio Margaret , Zajac Jeffrey D. , Flicker Leon
Published: April 2015

OBJECTIVES: To determine whether falling relates to serum levels of vitamin D and parathyroid hormone.

DESIGN: A cross‐sectional study with retrospective analysis.

SETTING: An aged‐care institution in Melbourne Australia.

PARTICIPANTS: Ambulant nursing home and hostel residents (n = 83).

MEASUREMENTS: Frequency of falling, frequency of going outdoors, use of cane or walker, age, sex, weight, type of accommodation, and duration of residence. Serum concentrations of 25‐hydroxyvitamin D, 1,25‐dihydroxyvitamin D, and parathyroid hormone (PTH). Plasma concentrations of albumin, calcium, phosphate, and creatinine. Use of furo‐semide or non‐benzodiazepine anticonvulsants.

RESULTS: Median age of residents was 84 years. The cohort was vitamin D deficient with a median (interquartile range) 25‐hydroxyvitamin D level of 27 (18–37) nmol/L (one‐third the reference range median), P < .001. The median (interquartile range) PTH of 5.2 (3.8‐7.7) pmol/L exceeded the reference range median, P < .001. Residents who fell (n = 33) had lower serum 25‐hydroxyvitamin D levels than other residents (medians 22 vs 29 nmol/L, P = .02) and higher serum PTH levels (medians 6.2 vs 4.8 pmol/L, P < .01). Sixty residents lived in the hostel (72%), and 41 (49%) walked without any walking aid. In a multiple logistic regression for falling, higher serum PTH remained independently associated with falling, with an odds ratio (95% confidence interval) for falling of 5.6 (1.7–18.5) per unit of the natural logarithm of serum PTH. Other terms in the regression were hostel accommodation, odds ratio .04 (.01‐.25), and ability to walk without aids, odds ratio .07 (.01‐.37).

CONCLUSIONS: In ambulant nursing home and hostel residents, residents who fall have lower serum 25‐hydroxyvitamin D and higher serum parathyroid hormone levels than other residents. The association between falling and serum PTH persists after adjustment for other variables.
Restraint Reduction Reduces Serious Injuries Among Nursing Home Residents
Authors: Neufeld Richard R. , Libow Leslie S. , Foley William J. , Dunbar Joan M. , Cohen Camille , Breuer Brenda
Published: April 2015

OBJECTIVES: To describe how removing physical restraints affected injuries in nursing home settings.

DESIGN: A 2‐year prospective study of an educational intervention for physical restraint reduction.

SETTING: Sixteen diverse nursing homes with 2075 beds in California, Michigan, New York, and North Carolina.

PARTICIPANTS: Study A: 859 residents who were physically restrained at the onset of the intervention on October 1, 1991. Study B: all residents who occupied the 2075 beds in the 16 facilities 3 months before the intervention and 3 months after its completion.

INTERVENTION: Educational program for nursing home staff followed by quarterly site consultations to participating nursing homes.

MAIN OUTCOME MEASURES: Rate of physical restraint use and injuries.

RESULTS: Study A: Serious injuries declined significantly among the 859 residents restrained initially when restraint orders were discontinued (x2 = 6.2, P = .013). Study B: During the intervention period, physical restraint use among the 2075 residents decreased from 41% to 4%, a 90% reduction. The decrease in the percentage of injuries of moderate to serious severity was significant (i.e., 7.5% vs 4.4%, 2‐taii = .0004) as was the rate of moderate and serious injuries combined (Rate Ratio = 1.580, P2‐tail = −0033).

CONCLUSIONS: A substantial decrease in restraint use occurred without an increase in serious injuries. Although minor injuries and falls increased, restraint‐free care is safe when a comprehensive assessment is done and restraint alternatives are used.
Delayed Thrombolytic Treatment of Older Patients with Acute Myocardial Infarction
Authors: McLaughlin Thomas J. , Gurwitz Jerry H. , Willison Donald J. , Gao Xiaoming , Soumerai Stephen B.
Published: April 2015

OBJECTIVE: To determine demographic and clinical factors associated with delayed thrombolysis in patients with acute myocardial infarction.

DESIGN: A retrospective cohort.

SETTING: 37 Minnesota hospitals during the time periods October 1992‐July 1993 and July 1995‐April 1996.

PATIENTS: We reviewed the medical records of 776 older patients aged 65 or older hospitalized with an admission diagnosis of acute myocardial infarction, suspected acute myocardial infarction, or rule‐out acute myocardial infarction, who were treated with a thrombolytic agent.

MEASUREMENT: We used multivariate logistic regression models to examine the association between selected study characteristics and time between hospital presentation and administration of thrombolytic treatment. Early thrombolysis was defined as less than 60 minutes after hospital presentation and late thrombolysis as 60+ minutes.

RESULTS: Of 776 study patients, 57.5% (n = 446) received early thrombolysis. Of the remaining 330 patients receiving late treatment, 12.1% (n = 94) were thrombolyzed more than 2 hours after hospital presentation. After controlling for other factors, the odds of delayed thrombolysis among patients aged 75 or older were 1.48 compared with younger individuals (95% CI, 1.17‐1.88). The odds of delayed thrombolysis among patients with severe comorbidity were 1.46 (95% CI, 1.10— 1.94) compared with individuals without severe comorbidity. Predictors of early thrombolytic treatment included hospital arrival via emergency transport (ORdelay = 0.46; 95% CI, 0.34–0.63) and chest discomfort at admission (ORdelay = 0.40; 95% CI, 0.18–0.86).

CONCLUSIONS: The present study indicates that patients of advanced age and with severe comorbidity are more likely to experience delayed thrombolytic treatment after hospital presentation. These are the patients who suffer the highest morbidity from acute myocardial infarction and for whom expeditious treatment may enhance therapeutic benefit.
An In‐Home Nurse‐Administered Geriatric Assessment for Hypoalbuminemic Older Persons: Development and Preliminary Experience
Authors: Reuben David B. , Effros Rita B. , Hirsch Susan H. , Zhu Xiaoming , Greendale Gail A.
Published: April 2015

BACKGROUND: Although malnutrition in older persons is a common, potentially treatable condition, few data indicate that treatments for this disorder can be effective.

OBJECTIVE: To develop and preliminarily evaluate a two‐component intervention that includes a nurse‐administered, in‐home assessment to identify potentially remediable causes of hypoalbuminemia and protocols to treat these problems.

DESIGN: A pre‐test post‐test case‐series.

SETTING: An academic geriatrics practice.

PARTICIPANTS: Seventeen persons aged 65 and older with serum albumin levels ± 3.8 g/dL; eight of the participants received pre‐and post‐test outcome measures.

INTERVENTION: Nurse‐administered standardized assessment and intervention protocols.

MEASUREMENTS: Serum albumin, Medical Outcome Study (MOS) SF‐36, serum IL‐la and b, TNF a, IL‐6, and lymphocyte markers of immune function.

RESULTS: The assessment took 87 minutes, on average, and generated a mean 4.2 recommendations. Among the eight subjects with pre‐ and post‐test measures, serum albumin increased by 0.2 g/dL (P = .035). Compared with baseline, two T cell markers of immune function demonstrated changes consistent with better function.

CONCLUSIONS: These preliminary data support the potential benefit of a nurse‐administered assessment coupled with protocols to address remediable contributors to hypoalbuminemia.
Predictors of Five‐Year Mortality in Older Canadians: The Canadian Study of Health and Aging
Authors: Østbye Truls , Steenhuis Runa , Wolfson Christina , Walton Ruth , Hill Gerry
Published: April 2015

OBJECTIVE: Based on the Canadian Study of Health and Aging (CSHA), to determine the importance of cognitive status, sociodemographic factors, functional status, and other health related factors as predictors of 5‐year overall mortality in older Canadians.

DESIGN, SETTING AND PARTICIPANTS: Two partially overlapping groups from the Canadian Study of Health and Aging (1991) were identified: (1) older people living in the community (n = 8949) who had a screening interview (larger sample, fewer variables) and (2) older people who underwent an extensive clinical examination (smaller sample, more objective variables; n = 2914). Deaths in the subsequent 5 years were determined from death certificates and interviews with the caregivers. Multivariate logistic regression models, with death within 5 years as the outcome, were developed separately for men and women. Predictor variables were introduced in the following groups: sociodemographic factors, physical and cognitive status, and physical illnesses and life style factors. Parallel models were developed for the screening sample and for the clinical sample.

RESULTS AND DISCUSSION: Five‐year mortality ranged from 10.0% (women aged 65–74 living in the community) to 88.1% (men aged 85 and older living in institutions). Multi–variate models showed that the odds of death within 5 years increased with age. This effect remained after adjustment for all other variables. Odds of death increased with institution‐alization and with increasing cognitive and physical impairment. Although vision and hearing problems and the presence of heart disease, stroke, and diabetes were all strongly related to 5‐year mortality in univariate, unadjusted analyses, their contributions were minimal in the multivariate analyses. Increased Body Mass Index was associated with lower mortality in both univariate and multivariate analyses.

CONCLUSIONS: This population‐based study supported the importance of gender, age, functional status, cognition, and health status in predicting 5‐year mortality, and after accounting for cognitive status, physical status, and specific disease variables, the difference in mortality between older people in the community and in institutions was reduced. Knowledge about survival and prognosis is important not only for the planning of long‐term facilities and home care, but it can also be helpful for clinical decision‐making and for family and caregivers.
Prevalence of Coexistence of Coronary Artery Disease, Ischemic Stroke, and Peripheral Arterial Disease in Older Persons, Mean Age 80 Years, in an Academic Hospital‐Based Geriatrics Practice
Authors: Ness Jose , Aronow Wilbert S.
Published: April 2015

OBJECTIVE: To investigate the prevalence of coronary artery disease (CAD), ischemic stroke, and peripheral arterial disease (PAD), alone and in combination, in older persons.

DESIGN: A retrospective analysis of charts from all older persons seen from April 1, 1998, through December 31, 1998, at an academic hospital‐based geriatrics practice.

SETTING: An academic hospital‐based geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.

PATIENTS: A total of 474 men and 1328 women, mean age 80 ± 9 years (range 60 to 102 years) were included in the study.

MEASUREMENTS AND MAIN RESULTS: Of 1802 persons studied, 612 (34%) had CAD, 351 (19%) had ischemic stroke, 236 (13%) had PAD, and 816 (45%) had either CAD, stroke, or PAD. Three hundred twenty‐eight (18%) of the 1802 persons had CAD alone, 128 (7%) had stroke alone, 50 (3%) had PAD alone, 123 (7%) had CAD + stroke and no PAD, 86 (5%) had CAD + PAD and no stroke, 25 (1%) had PAD + stroke and no CAD, 75 (4%) had CAD + stroke + PAD, and 986 (55%) had no CAD, PAD, or stroke. If CAD was present, coexistent PAD was present in 26% and coexistent stroke in 32% of persons studied. If stroke was present, coexistent CAD was present in 56% and coexistent PAD in 28%. If PAD was present, coexistent CAD was present in 68% and coexistent stroke in 42% of persons studied.

CONCLUSIONS: These data showed that if CAD was present, ischemic stroke was also present in 32% and PAD in 26% of the population. If ischemic stroke was present, CAD was also present in 56% and PAD in 28% of the population. If PAD was present, CAD was also present in 68% and ischemic stroke in 42% of the population.
Improving Morning Care Routines of Nursing Home Residents with Dementia
Authors: Rogers Joan C. , Holm Margo B. , Burgio Louis D. , Granieri Evelyn , Hsu Chuanchieh , Hardin Michael , McDowell B. Joan
Published: April 2015

OBJECTIVES: This study examined the effectiveness of a behavioral rehabilitation intervention for improving the performance of morning care activities of daily living (ADL) of nursing home residents with dementia.

DESIGN: Participants and their caregivers were observed for 5 days each under conditions of Usual Care (naturalistic) and Skill Elicitation (intervention), and for 15 days under Habit Training (intervention follow‐up). Observations involved the ADL categories of DRESSING, OTHER ADL, and NO ADL. A 3 × 3 design (condition X ADL category) was used.

SETTING: Observations occurred in five proprietary nursing homes in Pittsburgh, Pennsylvania.

PARTICIPANTS: The participants were 58 women and 26 men, mean age 82 years (range = 64–97, SD = 6.3), with Probable Alzheimer's disease (AD) (n = 19) and Possible AD (n = 65), with a mean MMSE score of 6.07.

INTERVENTION: Condition 1, Usual Care, was the naturalistic caregiving condition. Condition 2, Skill Elicitation, consisted of an individualized behavioral rehabilitation intervention designed to identify and elicit retained ADL skills. Under Condition 3, Habit Training, the behavioral rehabilitation intervention was continued to reinforce and solidify retained skills and to facilitate further functional gains.

MEASUREMENTS: A computer‐assisted data collection system was used to document in real‐time the assists used by caregivers, the participants' ADL performance, and the participants' responses to caregiving, including disruptive behavior.

RESULTS: Compared with Usual Care, during Skill Elicitation participants increased the proportion of time engaged in nonassisted and assisted dressing significantly and increased their overall participation in ADL, with a concomitant significant decrease in disruptive behavior. These functional gains were demonstrated within 5 days of initiating the behavioral rehabilitation intervention and were maintained for 3 weeks during Habit Training. Physical assists were provided for significantly smaller proportions of a morning care session during Skill Elicitation and Habit Training compared with Usual Care.

CONCLUSIONS: Even very severely cognitively impaired and functionally disabled nursing home residents can respond to a systematically implemented behavioral rehabilitation intervention. Their rapid response to this intervention suggests that it is alleviating excess disabilities brought on by care patterns rather than retraining ADL task performance. Residents with dementia benefit from behavioral rehabilitation by becoming more appropriately involved in their care and being less disruptive. However, behavioral rehabilitative care takes considerably more time than usual care. J Am Geriatr Soc 47:1049–1057, 1999.
Lateral Stability, Sensorimotor Function and Falls in Older People
Authors: Lord Stephen R. , Rogers Mark W. , Howland Amelia , Fitzpatrick Richard
Published: April 2015

AIMS: To design simple tests of lateral stability for assessing balance in older people and to determine whether poor performances in these tests are associated with impaired vision, lower limb sensation, quadriceps strength, simple reaction time, and falling in this group.

DESIGN: A cross‐sectional and retrospective study.

SETTING: Falls and Balance Laboratory, Prince of Wales Medical Research Institute.

PARTICIPANTS: One hundred fifty‐six community‐dwelling men and women aged 63–90 years (mean age 76.5, SD = 5.1).

OUTCOME MEASURES: The maximal lateral sway in a near‐tandem stability test with eyes open and closed and the necessity of taking a protective step in the near‐tandem stability test with eyes closed.

RESULTS: All 156 subjects could complete the near‐tandem stability test with eyes open, but only 99 subjects (63.5%) could undertake the test with eyes closed without taking a protective step. Subjects with a history of falls had increased lateral sway both with eyes open and eyes closed as well as poorer visual acuity, proprioception, and quadriceps strength. Fallers were also significantly more likely to take a protective step when undertaking the near‐tandem stability test with eyes closed. Multiple regression analysis revealed that impaired lower limb proprioception, quadriceps strength, and reaction time were the best predictors of increased maximal sway in the near‐tandem stability test with eyes open. Reduced proprioception and quadriceps strength, in addition to age, were also found to be the best determinants of the necessity of taking a protective step in the near‐tandem stability test with eyes closed.

CONCLUSIONS: The study findings identify simple new tests that are associated with falling in older people and elucidate the relative importance of specific physiological systems in the maintenance of lateral stability. J Am Geriatr Soc 47:1077–1081, 1999.
Non‐Influenza Respiratory Viruses May Overlap and Obscure Influenza Activity
Authors: Drinka Paul J. , Gravenstein Stefan , Krause Peggy , Hanger Elizabeth H. , Barthels Lori , Dissing Margaret , Shult Peter , Schilling Margo
Published: April 2015

OBJECTIVE: To report the number and timing of influenza A isolates, as well as overlapping respiratory viruses. Co‐circulating respiratory viruses may obscure the determination of influenza activity.

DESIGN: Prospective clinical surveillance for the new onset of respiratory illness followed by viral cultures during seven separate influenza seasons.

SETTING: The Wisconsin Veterans Home, a skilled nursing facility for veterans and their spouses.

RESULTS: Influenza A isolates were encountered in greater numbers than non‐influenza A isolates during three seasons. Seasonal variability is striking. In December 1992, we identified a large outbreak of respiratory illness. Influenza type B was cultured from 102 residents. In December 1995, influenza A was cultured from 285 people in Wisconsin. At that time, we identified outbreaks of respiratory illness in two of our four buildings. Based on statewide data, we suspected an influenza outbreak; however, 26 isolates of parainfluenza virus type 1 were cultured with no influenza. The potential importance of culturing at the end of the season was demonstrated in 1991–1992 when an outbreak of respiratory syn‐cytial virus (RSV) overlapped and extended beyond influenza A activity.

CONCLUSIONS: When interpreting new clinical respiratory illnesses as a basis for declaring an outbreak of influenza A, clinicians should realize that co‐circulating respiratory viruses can account for clinical illnesses. Clinicians might utilize healthcare dollars efficiently by performing cultures to focus the timing of influenza A chemoprophylaxis. Cultures could be performed when clinical outbreak criteria are approached to confirm an outbreak. Culturing of new respiratory illness could begin again before the anticipated discontinuation of prophylaxis (approximately 2 weeks). J Am Geriatr Soc 47:1087–1093,1999.
Decision‐Making for Percutaneous Endoscopic Gastrostomy Among Older Adults in a Community Setting
Authors: Callahan Christopher M. , Haag Kathy M. , Buchanan Nancy Nienaber , Nisi Rod
Published: April 2015

OBJECTIVE: To describe clinical decision‐making for percutaneous endoscopic gastrostomy from the perspective of patients, caregivers, and physicians.

DESIGN: A prospective cohort study.

SETTING AND PATIENTS: All patients aged 60 and older receiving percutaneous endoscopic gastrostomies in a defined community over a 16‐month period.

MAIN OUTCOMES MEASURES: Either patients or their surrogate decision‐makers completed a semistructured face‐to‐face interview to map out the information gathering process, expectations, and discussants involved in the decision to proceed with gastrostomy feeding. Physicians completed a written questionnaire to determine their likelihood of recommending percutaneous endoscopic gastrostomy, their involvement in the decision‐making and recommendation process, and sources of perceived pressure in the decision‐making.

RESULTS: We identified 100 patients who received percutaneous endoscopic gastrostomy during the study window and 82 primary care physicians who provided care in the defined community. The most common reasons for the procedure were stroke, neurologic disease, and cancer. Patients or their surrogate decision‐makers reported multiple discussants, incomplete information, and considerable distress in arriving at the decision to proceed with artificial feeding. This distress was usually in the context of an acute and debilitating illness that often overshadowed the decision about artificial feeding. The decision for gastrostomy often appeared to be a “non‐decision” in the sense that decision‐makers perceived few alternatives. Physicians also reported considerable distress in arriving at recommendations to proceed with percutaneous endoscopic gastrostomy, including perceived pressures from families or other healthcare professionals. Physicians have clear patterns of triage for percutaneous endoscopic gastrostomy, but the assumptions underlying these patterns are not well supported by the medical literature.

CONCLUSIONS: Patients, caregivers, and physicians are often compelled to make decisions about long‐term enteral feeding under tragic circumstances and with incomplete information. Decision‐makers typically do not perceive any acceptable alternatives. Because data on these patients' long‐term functional outcomes are lacking, decision‐makers appear to focus primarily on the short‐term safety of the procedure and the potential for improved nutrition. J Am Geriatr Soc 47:1105–1109,1999.
Alcohol Consumption Is Negatively Associated with the Prevalence of Coronary Heart Disease in the New Mexico Elder Health Survey
Authors: Lindeman Robert D. , Romero Linda J. , Allen Andrew S. , Liang Hwa Chi , Baumgartner Richard N. , Koehler Kathleen M. , Garry Philip J.
Published: April 2015

OBJECTIVE: To compare the prevalence of coronary heart disease (CHD) and the effects of various risk factors, including alcohol consumption, on prevalence rates in a randomly selected sample of older Hispanic and non‐Hispanic white (NHW) men and women.

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

PARTICIPANTS: A total of 883 volunteers, mean age 74.1, years were interviewed/examined.

MEASUREMENTS: CHD was identified by interview and electrocardiogram. Risk factors were identified by interview (hypertension, diabetes, medications, smoking, alcohol consumption) and by direct measurements (glucose tolerance, serum lipids, blood pressure, anthropometry).

RESULTS: The age‐adjusted prevalences of CHD were not significantly different when Hispanic men and women were compared with their NHW counterparts. Age‐, ethnicity‐, and gender‐adjusted relative risk of CHD was inversely associated with alcohol consumption (OR. 46; 95% CI,. 28‐.73; P <. 001). Hypertension, diabetes mellitus, and male gender were also significant risk factors; age, anthropometric measurements, smoking, serum lipid concentrations, and level of education were not. HDL cholesterol levels were significantly lower in nondrinkers; other lipid levels were not associated with alcohol consumption. The type of alcoholic beverage was not associated with the prevalence of CHD.

CONCLUSIONS: No significant differences in CHD prevalence existed between Hispanic and NHW participants despite a higher prevalence of diabetes and central obesity in Hispanics. Alcohol consumption was strongly negatively associated with the prevalence of CHD identified in this older, biethnic population.
Measures of Disease Control in Medicare Beneficiaries with Diabetes Mellitus
Authors: Kell Sherron H. , Drass Jan , Bausell R. Barker , Thomas Katherine A. , Osborn Morris A. , Gohdes Dorothy
Published: April 2015

OBJECTIVE: To investigate measures of disease control for Medicare beneficiaries with diabetes and their outpatient care in the fee‐for‐service setting.

DESIGN: Retrospective cohort study.

SETTINGS: Office practices in Alabama, Iowa, and Maryland of 293 primary care physicians (PCPs) who volunteered to participate in the Ambulatory Care Quality Improvement Project.

PARTICIPANTS: A total of 5980 patients with an average age of 75.2 years.

MEASUREMENTS: For an 18‐month period (1/1/94–6/30/ 95), medical records were abstracted for clinical parameters, including up to four blood glucose values; two blood pressure measurements; one total cholesterol value; two serum creatinine values; medication use, including antihypertensives, angiotensin‐ converting enzyme (ACE) inhibitors, and lipid‐lowering agents; and frequency of glycosylated hemoglobin (GHb) determinations.

RESULTS: During the study, 44% of patients received at least one GHb determination, 94% received at least one blood glucose, 68% at least one total serum cholesterol, 74% at least one serum creatinine test, and 97% at least one blood pressure measurement. Ten percent of patients had mean blood glucose levels ≥ 250 mg/dL. Eighty‐five percent had evidence of hypertension. Of this group of hypertensive patients with blood pressure readings available, 70% had blood pressure readings ≥ 140/90 mm Hg, even though there were on medication that could have been prescribed for hypertension. Thirty‐six percent of those who had evidence of hypertension were taking an ACE inhibitor. Thirty‐two percent of those taking lipid‐lowering medication had a total serum cholesterol value ≥ 240 mg/dL. Statistically significant differences were noted for age and gender, with men and patients more than 85 years old generally having better measures of disease control.

CONCLUSIONS: Many older Medicare patients with diabetes did not achieve recommended target levels of blood glucose, blood pressure, and lipids. GHb and serum cholesterol are not being monitored at recommended intervals. Significant opportunities exist to improve diabetes care for this population.
Functional Impairment in Instrumental Activities of Daily Living: An Early Clinical Sign of Dementia?
Authors: Barberger‐Gateau Pascale , Fabrigoule Colette , Helmer Catherine , Rouch Isabelle , Dartigues Jean‐François
Published: April 2015

OBJECTIVE: To estimate the predictive value of four IADLs on 3‐ and 5‐year incident dementia.

DESIGN: Prospective cohort study.

SETTING: A community survey in 37 randomly selected parishes.

SUBJECTS: A random sample of French community dwellers aged 65 and older included in the PAQUID study followed‐up at 3 (1582 subjects) and 5 years (1283 subjects).

MAIN OUTCOME MEASURES: Incidence of dementia at 3 and 5 years, diagnosed by two‐step screening: (1) MMS and DSM‐III‐R; (2) diagnosis of dementia confirmed by a neurologist.

RESULTS: A score summing up the number of dependencies at baseline on four IADLs is a predictor of 3‐year but not of 5‐year incident dementia. Increase in the level of dependence between baseline and 3‐year follow‐up is associated with an increased risk of incident dementia at 5‐year follow‐up.

CONCLUSION: These four IADLs can help to identify older subjects at high risk of dementia who should then undergo neuropsychological testing.
Cognitive Function and Endogenous Sex Hormones in Older Women
Authors: Barrett‐Connor Elizabeth , Goodman‐Gruen Deborah
Published: April 2015

OBJECTIVE: To determine if endogenous hormone levels predict cognitive function in older women.

DESIGN: A longitudinal, population‐based study.

SETTING: Rancho Bernardo, California

PARTICIPANTS: A total of 393 community‐dwelling women aged 55 to 89 years who were not using replacement estrogen.

METHODS: Between 1984 and 1987, sera were collected for measurement of total and bioavailable testosterone, total and bioavailable estradiol, and estrone Between 1988 and 1991, 12 standard neuropsychological tests were administered, including two items from the Blessed Information‐Memory‐Concentration Test, three measures of retrieval from the Buschke‐Fuld Selective Reminding Test, a category fluency test, immediate and delayed recall from the Visual Reproduction Test, the Mini‐Mental State Examination (MMSE) with individual analysis of the Serial 7's and the “World” Backwards components, and the Trail‐Making Test part B (Trails B). The association between the five hormones and the 12 cognitive function tests was tested in age‐ and education‐adjusted analyses using linear regression, partial correlation, quintile and categorical analyses.

RESULTS: Women with better MMSE scores (>23) had significantly higher adjusted mean total and bioavailability testosterone levels (P = .009; P = .02, respectively). Using linear regression, the mean total testosterone was significantly associated with better performance on the World component of the MMSE (b = .12; P = .08). With regard to estrogen, the only statistically significant (P = .02) association was better performance on one test in women with very low levels of estuarial.

CONCLUSIONS: In these older women, higher endogenous estrogen levels were not associated with significantly better performance on any cognitive function test. In contrast, higher levels of testosterone predicted better categorical performance on the MMSE and the World component of the MMSE. These novel findings warrant further research. J Am Geriatr Soc 47:1289–1293, 1999.
Factors Associated with Inconsistent Diagnosis of Dementia Between Physicians and Neuropsychologists
Authors: MacKnight Chris , Graham Janice , Rockwood Kenneth
Published: April 2015

OBJECTIVE: To explore reasons for discrepancy in the diagnosis of cognitive impairment between physicians and neurophysiologists.

DESIGN: Retrospective analysis of national survey data.

SETTING: Canadian Study of Health and Aging Phase 1, a national survey of community‐dwelling and institutionalized older Canadians.

PARTICIPANTS: 1879 subjects who completed all components of a clinical examination.

MEASUREMENTS: Data available to both disciplines (demographic data, functional status, Modified Mini‐Mental State (3MS), schedule H of the Cambridge Mental Disorders of the Elderly Examination (CAMDEX)), results of the physician's history and physical examination, and results of a psychometric test battery. Subjects were classified as No Cognitive Impairment, Cognitive Impairment Not Dementia (CIND), and Dementia, the latter according to the criteria of the Diagnostic and Statistical Manual, 3rd Ed., Revised. Preliminary diagnoses by physicians and neurophysiologists were compared.

RESULTS: In university modeling, higher education increased consistency. Lower scores on the 3MS, depression reported in the CAMDEX, focal neurological signs, and all neuropsychological variables decreased agreement. In multivariate modeling, higher education and identification of long‐term memory impairment by the neurophysiologist increased agreement; lower scores on the 3MS, depression reported on the CAMDEX, and identification of short‐term memory impairment or constructional impairment led to disagreement. When the category of CIND was removed, kappa for agreement increased from 0.51 to 0.92.

CONCLUSIONS: Physicians and neurophysiologists have different, complementary approaches to the diagnosis of dementia, and a consensus approach should be used. The category of CIND requires elucidation. Identification of dementia in subjects with depression or low education is difficult, and new strategies are required. J Am Geriatr Soc 47:1294–1299, 1999.