bluuebunny/crossref_metadata_2025 huggingface dataset:
Medication Use By Ambulatory Elderly
Authors: Darnell Jeffrey C. , Murray Michael D. , Martz Bill L. , Weinberger Morris
Published: April 2015

The elderly residents of an urban subsidized apartment building were interviewed in their apartments to determine a comprehensive medication profile. The interviews were conducted by doctor of pharmacy candidates, and 155 residents (81.2%) participated. Compliance was similar to rates previously reported (49.3%), and adverse drug reactions were common (29.1%). Other findings included: 1) compliance did not decrease with advancing age; 2) most elderly individuals could open child‐resistant containers (83.4%), read standard container labels (79.7%), and identify teaspoon (97.3%) and tablespoon (88.5%) quantities; 3) inability to open easy‐open (flip‐off) containers decreased compliance (P = .03); 4) men were more compliant than women (68.4 v 42.4%, P = .006) but were taking fewer medications (3.3 per male v 5.0 per female); 5) only 12.6% of respondents thought they were taking too much medication but when they did compliance diminished (P = .003); 6) medications were infrequently shared (5.6% of respondents reported sharing); and 7) only 6.4% of respondents reported medication expense as a concern.
Stage at Diagnosis of Cancer Varies With the Age of the Patient
Authors: Goodwin James S. , Samet Jonathan M. , Key Charles R. , Humble Charles , Kutvirt Daniel , Hunt Curtis
Published: April 2015

The stage of a cancer at diagnosis is multiply determined, theoretically depending on such disparate factors as tumor biology, patient education, and physician behaviors. Data from all Hispanic and non‐Hispanic white residents of New Mexico diagnosed with a malignancy from 1969 through 1982 were analyzed to determine the relationship between the age of the patient and the stage of cancer at the time of diagnosis. Three general patterns were apparent. For cancers of the bladder, breast, cervix, ovary, thyroid, and uterus, and for melanoma, there were significant linear trends for the cancers to be diagnosed at more advanced stages in older patients. For cancers of the lung, pancreas, rectum, and stomach, there were significant linear trends for cancers to be diagnosed at an earlier stage in older patients. For cancers of the colon, kidney, liver, and prostate, there were no significant linear trends in stage at diagnosis versus age of the patient.
Medication Use Characteristics in the Elderly: The Iowa 65+ Rural Health Study
Authors: Helling Dennis K. , Lemke Jon H. , Semla Todd P. , Wallace Robert B. , Lipson David P. , Cornoni‐Huntley Joan
Published: April 2015

Medication use was studied in a rural, elderly population. Household interviews were conducted of 3,467 individuals aged 65 years or older. A total of 9,955 prescription or nonprescription drugs were reported by the respondents. The overall mean number of drugs per respondent was 2.87, while 12% of all respondents were not taking any drugs. Mean prescription and overall drug use increased significantly with increasing age (P < .001), while mean nonprescription drug use was relatively constant across age groups. Significantly more women were prescription and nonprescription drug users. Directions for scheduled daily dosing accounted for 75% of all directions. The majority of prescription and nonprescription drugs had been taken on the previous day. General practitioners accounted for more prescription drugs (39.7%) than any other medical specialty. The most frequently stated purpose was cardiovascular for prescription drugs and musculoskeletal for nonprescription drugs. The three most frequent prescription drug therapeutic categories were cardiovascular (54.7%), central nervous system (CNS) agents (11.4%), and analgesics (9.4%). For nonprescription drugs, the three most frequent therapeutic categories were analgesics (39.6%), vitamins and minerals (32.9%), and laxatives (14.1%). Implications of these findings are discussed.
The Relationship of Knee and Ankle Weakness to Falls in Nursing Home Residents: An Isokinetic Study
Authors: Whipple R. H. , Wolfson L. I. , Amerman P. M.
Published: April 2015

The strength of the knees and ankles of a group of nursing home residents with a history of falls was compared to age‐matched controls. Peak torque (PT) and power (POW) were recorded at two limb velocities (60°/s and 220°s) on a Cybex II Isokinetic dynamometer for four muscle groups: knee extensors, knee flexors, ankle plantar flexors and ankle dorsiflexors. The PT and POW of falters were significantly decreased for all four muscle groups in comparison to controls, with the ankles showing the greatest decrements. Although POW in fullers was significantly lower at the higher velocity in both joints, the decrease was most prominent in the ankles. Dorsiflexion POW production in falters was the most affected of all the motions (7.5 times less than the control value). At the higher, more functional limb velocities, ankle weakness particularly involving the dorsiflexors appears to be an important factor underlying poor balance.
Sundown Syndrome in Institutionalized Elderly
Authors: Evans Lois K.
Published: April 2015

To describe sundown syndrome and determine factors related to its occurrence, 59 demented and 30 nondemented nursing home residents aged 60 years and above were observed in the morning and the evening over two consecutive days using a Confusion Inventory. Physiologic, psychosocial, and environmental data were also recorded. In addition, Pfeiffer's Short Portable Mental Status Questionnaire, the Philadelphia Geriatric Center Morale Scale, Face‐Hand Test, and sensory screening were completed. Among the 89 subjects, 11 were found to be sundowners, a prevalence rate of one in eight in the facility. No clear pattern of behaviors evolved but sundowners were found to increase restless and verbal behavior as evening approached. Sundowners were more likely to be demented, with greater mental impairment and organic involvement than nonsundowners. Among physiologic factors, odor of urine, being awakened frequently on the evening shift, and fewer medical diagnoses were significantly associated with sundowning. Significant psychosocial factors were current room residence of less than one month, more recent admission to the facility, and higher evening levels of confusion. No environmental factors were related.
Use of the Dexamethasone Suppression Test With Depressed and Demented Elderly
Authors: Gierl Ben , Groves Lesley , Lazarus Lawrence W.
Published: April 2015

Although some researchers have suggested that the dexamethasone suppression test (DST) may be useful in differentiating between major depression and dementia in the elderly, recent reports of abnormal DST results in nondepressed, demented elderly have questioned the validity of the test in this population. This study compared the frequency of abnormal DST results in three groups of elderly inpatients: 1) depressed/not demented; 2) demented/not depressed; and 3) depressed and demented. Two geropsychiatrists independently evaluated 33 patients for symptoms of depression and/or dementia and then assigned each patient to one of the three groups. Subjects in the demented/not depressed group had a significantly larger proportion of abnormal DSTs (P < .01), and the mean postdexamethasone, 4 PM blood Cortisol level of the demented/not depressed group was significantly greater than the means of the other two groups (P < .005). In this sample, the DST was more likely to identify dementia than depression. Until further investigations clarify the parameters of DST use in the elderly, the diagnosis of depression and dementia should continue to be determined by sensitive interpretation of clinical findings, history, and other diagnostic tests.
Exercise Conditioning in the Elderly Coronary Patient
Authors: Ades Philip A. , Hanson John S. , Gunther Peter G. S. , Tonino Richard P.
Published: April 2015

We compared conditioning effects of a supervised exercise program in 100 elderly and younger patients with a recent coronary event. Twenty‐one patients were ≥ 62 years of age (mean, 65 years) and 79 were ≤ 61 years of age (mean, 48.7 years). While the elderly patients attained a lower peak exercise intensity on entry and on completion of the exercise protocol, they obtained a similar relative training benefit as the younger patients. Peak exercise intensity increased 68% in each group and sub‐maximal (five METS) heart rate‐blood pressure product decreased 27% in the older patients and 26% in the younger patients. Rate of entry into our program was substantially lower in the elderly patient group, 19% v 57% in younger patients (P < 0.001) despite a similar inhospital recruiting effort. Thus, although elderly coronary patients obtain similar training benefits as younger patients, they are less likely to participate in a program designed to decrease cardiac disability.
Nephrotic Syndrome in the Elderly
Authors: Murphy P. J. , Wright G. , Rai G. S.
Published: April 2015

Study of hospital activity analysis data over a ten‐year period in a district general hospital show that nephrotic syndrome is uncommon in the elderly. The spectrum of histology, however, is no different from the younger adults. The other interesting findings were: 1) diabetic elderly with nephrotic syndrome may have minimal change, therefore should have renal biopsy; and 2) occurrence of sero‐negative lupus nephritis in a 90‐year‐old male and a focal glomerulo‐nephritis in a 75‐year‐old female.
Medications and Diagnoses in Relation to Falls in a Long‐Term Care Facility
Authors: Granek Elisabeth , Baker Susan P. , Abbey Helen , Robinson Elizabeth , Myers Ann H. , Samkoff Judith S. , Klein Lawrence E.
Published: April 2015

The association between falls, drugs, and diagnoses in elderly residents of a long‐term care facility was explored using case‐control methodology. The odds of being a faller rather than a control were significant (P < .01) for those taking antidepressants, sedatives/hypnotics, or vasodilators, and for those with osteoarthritis or depression.

When drug/diagnosis subgroups were examined, these same drug classes and diagnoses had high‐odds ratios in the largest numbers of subgroups. In general, risk of falling appeared to be more strongly associated with drugs than with diagnoses.
Correlates of Depression and Burden for Informal Caregivers of Patients in a Geriatrics Referral Clinic
Authors: Drinka Theresa J. K. , Smith Jane C. , Drinka Paul J.
Published: April 2015

Caregiver burden has been associated with patient dementia. In this study we tested the hypothesis that caregiver burden and depression are related to patient cognitive impairment. We analyzed records of 127 elderly male patients from a Veterans hospital geriatrics referral clinic. The patients and their informal caregivers had been referred to the clinic because the complexity and multiplicity of their problems were beyond the treatment capability of other clinics. There was a high prevalence of dementia (73%) and depression (69%) in these patients according to Diagnostic and Statistical Manual (DSM‐III) criteria.

Quantitative measures of patient dementia and dependency in activities of daily living were not statistically associated with measures of caregiver depression or burden. In contrast, measures of patient depression were significantly correlated with measures of caregiver depression and burden.

We hypothesize that caregivers of chronically ill, elderly men cope better with physical and cognitive incapacity than with affective symptoms. Because caregiver support is the most important factor in maintaining a disabled elder in the community, we suggest evaluating patients and caregivers for depression as part of standard practice in geriatric clinical settings.
Epidemiology of Depression and Dysphoria in an Elderly Hispanic Population Prevalence and Correlates
Authors: Kemp Bryan J. , Staples Frederick , Lopez‐Aqueres Waldo
Published: April 2015

Depression among older minority groups, including Hispanics, has not been well studied. Little is known of the true rates of depression, its correlates or how well it is treated. This research is part of a series examining health status of older Hispanics using the Comprehensive Assessment and Referral Evaluation (CARE). Seven hundred older Hispanics living in Los Angeles County were studied using an area‐probability sampling method. The CARE items were regrouped to reflect Diagnostic and Statistical Manual III criteria for depression and dysphoria. More than 26% were found to have a major depression or dysphoria. These affective disorders were strongly correlated with physical health status. Without physical health complications, the rate was 5.5%. A number of socioeconomic, health behavior, and family variables were related to affective state. Treatment for affective disorder appeared to be very poor for this population. J Am Geriatr Soc 35:920–926, 1987
Major Depression with Melancholia: A Comparison of Middle‐Aged and Elderly Adults
Authors: Blazer Dan , Bachar James R. , Hughes Dana C.
Published: April 2015

Patients admitted to an inpatient psychiatric service were screened to identify middle‐aged (35 to 50 years of age) and elderly (60 years of age and over) patients suffering from a major depressive episode with melancholia. Thirty‐seven subjects (18 middle‐aged and 19 elderly) were identified. Criteria symptoms for depression and symptoms specifically associated with melancholic or endogenous depression did not differ across age groups, with few exceptions. Major depression with melancholia in this hospitalized population was symptomatically similar in the middle‐aged and elderly. The syndrome is therefore relatively common on this inpatient service and should be easily recognized. J Am Geriatr Soc 35:927–932, 1987
Visual Field Limitation in the Patient with Dementia of the Alzheimer's Type
Authors: Steffes Robert , Thralow Joan
Published: April 2015

This paper investigates the existence of a visual field limitation and its effect on the advanced Alzheimer's patient. The data presented was obtained by testing 12 Alzheimer's and 12 control patients. The control patients were demented from causes secondary to reasons other than Alzheimer's disease. The results indicated that patients demented due to Alzheimer's have visual field losses significantly greater than other demented patients. This significant visual loss is of importance in assisting in differential diagnosis, performing patient cares, and planning patient environments.
Gram‐Negative Bacillary Bacteremia in the Elderly: Incidence, Ecology, Etiology, and Mortality
Authors: McCue Jack D.
Published: April 2015

The incidence, ecology, and mortality of gram‐negative bacillary bacteremia in elderly patients were studied in an analysis of 334 episodes over a four‐year‐period in a 489–bed North Carolina community teaching hospital, 135 (40.4%) of which occurred in patients 70 years of age or older. The bacteremia rate per 1000 hospital admissions increased sharply with increasing age. The ecology and in vitro antimicrobial susceptibilities of the bacterial isolates were strongly influenced by community v hospital acquisition, but not by age. Urosepsis was significantly more likely to be the underlying source of hospital‐acquired bacteremia in patients 70 years or older (P< 0.01).

Total bacteremia‐related mortality did not increase with increasing age; in the group of patients aged 70 years or older with nonfatal/ultimately fatal underlying diseases (NF/UFUD), however, mortality was 9.1% compared to 2.9% in the younger age group (P< 0.001). Significantly increased bacteremia‐related mortality was also noted in the older patients with NF/UFUD admitted from nursing homes (P< 0.05) and those not treated with an appropriate antimicrobial agent within 24 hours (P< 0.01). Overall, the older patients with hospital‐acquired bacteremia, neutropenia‐associated infection, those bacteremic from a nonurinary source of infection, and those treated with multiple‐drug regimens had higher mortality (P< 0.05).

Gram‐negative bacteremia is much more common in patients 70 years of age or older and compared with younger patients mortality appears to be significantly increased for the important subgroup of older patients with nonfatal or ultimately fatal underlying diseases.
Severe Disability Related to Cerebral Stroke: Incidence and Risk Factors Observed in a Japanese Community, Hisayama
Authors: Ueda Kazuo , Fujii Ichiro , Kawano Hideo , Hasuo Yutaka , Yanai Toshiro , Kiyohara Yutaka , Wada Junichi , Kato Isao , Omae Teruo , Fujishima Masatoshi
Published: April 2015

To elucidate the incidence of severe disability due to cerebral stroke and its related factors, prospective data of 1,621 Hisayama residents aged 40 and over were examined. Severe disability resulting from stroke was defined as patients who were unable to dress, take care of their toilet needs, and feed themselves without assistance, or who required a wheel chair for ambulation three months after the most recent episode.

During 20 years of follow‐up 255 stroke patients were observed among the sample population. The annual incidence of stroke per thousand was 9.8, and rate of severe disability was 2.8 for men and 6.4 and 2.0 for women, respectively. Of the 74 cases with severe disability, approximately 92% were attributed to cerebral infarction. Related factors to severe disability due to cerebral infarction were recurrent attacks, hypertension, changes in ocular fundi and diabetes mellitus among predispositions and quadriplegia or muscular contraction, and intelligent or mental disorders among inhibiting factors for functional recovery. Furthermore, in 59 autopsy cases with multiple cerebral infarctions, the frequency of disability increased as the number of infarcts increased. Hypertension and diabetes mellitus, as risk factors for cerebral infarction and factors inhibiting postictal functional recovery were discussed.
Prevalence of Anemia and Correlation of Hemoglobin with Age in a Geriatric Screening Clinic Population
Authors: Timiras Mary‐Letitia , Brownstein Harold
Published: April 2015

A retrospective review of 1,024 charts of Geriatric Screening Clinic patients was carried out to evaluate the prevalence of anemia and degree of correlation of aging with changes in hemoglobin (Hgb) level in a healthy, elderly population (age range, 60 to 96 years; mean age, 70 years). Twelve per cent of participants were anemic overall, although there was a sex difference; more males (17.7%) were anemic than females (8.4%). Mean Hgb levels did not change significantly with age group except in males over 85 years of age. Pearson Correlation Coefficients were small for age versus Hgb in females (‐ 0.10) as well as in males (‐ 0.21). Likewise, linear regression slopes were small for females (‐ 0.01) and males (‐ 0.04). Based on this set of data, one would not expect a change in Hgb with advancing age in healthy elderly patients.
Binding the Elderly: A Prospective Study of the Use of Mechanical Restraints in an Acute Care Hospital
Authors: Robbins Laurence J. , Boyko Edward , Lane Judy , Cooper Darcy , Jahnigen Dennis W.
Published: April 2015

Little information exists on the use of mechanical restraints among nonpsychiatric inpatients. This prospective study evaluates their use among consecutive medical and surgical admissions to an acute care hospital. Daily direct observation of patients and hospital record review provided data on potential predictors of restraint, reasons for their application, complications, and outcome. Cox regression analysis was used to calculate relative risk of restraint while adjusting for duration of hospitalization as well as other variables.

Restraints were applied to 37 (17%) of the 222 study patients. Restrained patients were eight times more likely to die during hospitalization (24% v 3%; P < 0.01). Abnormal mental status exam, diagnosis of dementia, surgery, and presence of monitoring and support devices (eg, intravenous lines) were statistically significant independent predictors of restraint. Mechanical restraint is a common occurrence among nonpsychiatric inpatients particularly those with impaired mentation, requirement for surgery, or intensive medical intervention. Identification of medical and surgical patients at risk for restraint may reduce the use of these devices by concentrating surveillance and prevention on this group.
Geriatric Depression and DSM‐III‐R Personality Disorder Criteria
Authors: Abrams Robert C. , Alexopoulos George S. , Young Robert C.
Published: April 2015

The relationship between personality traits and late‐life depression is not well established. The Personality Disorder Examination (PDE), a recently developed structured interview for diagnosing DSM‐III‐R* personality disorders, has provided a methodological advance for studies in this area. The PDE was administered to 36 cognitively intact elderly individuals. The sample consisted of 21 patients who had recovered from depression and 15 normal volunteers. Two of the patients met DSM‐III‐R criteria for personality disorder according to the PDE. The patient group received higher scores on PDE items related to each personality diagnosis (P < .01) except antisocial personality disorder. These preliminary data suggest that elderly patients with a history of major depression have more lifetime personality dysfunction than normal elderly individuals, although no specific pattern could be identified.
Old People in the Emergency Room: Age‐Related Differences in Emergency Department Use and Care
Authors: Baum Stephen A. , Rubenstein Laurence Z.
Published: April 2015

Little is known about how the care received in emergency departments (ED) by the elderly population differs from that received by younger people. We prospectively abstracted ED records of 1620 consecutive patients visiting a large community hospital ED over a 22‐day period in 1984 for demographic and medical variables. Charts of patients presenting with five specific complaints (dyspnea, chest pain, abdominal pain, syncope, and motor vehicle accidents) were also analyzed for process of care variables and, for patients hospitalized, the accuracy of the ED diagnosis.

Older people (ie, those ≥65 years of age) do not seem to be overutilizers of the ED for minor complaints, in fact, they tend to be more acutely ill on presentation than younger people. Older people were more likely to be hospitalized (46% v 10%, P < .001), to arrive by ambulance (35% v 10%, P < .001), and to have an identified source of primary care (95% v 64%, P < .01). Older people stayed longer in the ED than younger people if they were eventually released home but shorter if admitted to the hospital. Test ordering patterns for specific complaints varied by patient age (eg, older patients had more electrocardiograms performed for chest pain and fewer urinalyses for abdominal pain than younger patients). Therapy for specific complaints showed less age effect. Although generally more diagnostic tests were performed on older patients, the ED diagnosis tended to be more accurate for younger patients. Our data indicate that the process of ED care may be substantially different for the elderly population and have implications for future planning and financing of medical care.
Psychological, Social, and Health Consequences of Caring for a Relative with Senile Dementia
Authors: Haley William E. , Levine Ellen G. , Brown S. Lane , Berry Jack W. , Hughes Glenn H.
Published: April 2015

While providing home care for a family member with senile dementia is clearly extremely stressful, there has been little controlled research assessing the specific effects of this stress on caregiver psychological, social, and health functioning. To address this question, 44 primary caregivers of senile dementia patients and 44 matched controls completed a series of questionnaires and interview assessments. Caregivers reported significantly higher levels of depression and negative affect toward their relatives, and lower overall life satisfaction than controls. Caregivers also had significant impairment of their social activities, including visits with friends, vacations, and church attendance when compared with controls. Caregivers expressed less satisfaction with their social networks than did controls, but the groups did not differ in objective size of social network or number of network contacts. Caregivers reported poorer health, more prescription medication use, and higher utilization of health care than controls. Results clearly indicate the serious and wide‐ranging effects of the stress of caregiving, and reinforce the importance of providing comprehensive services for caregiving families.
The Role of Dietary Carbohydrate in the Decreased Glucose Tolerance of the Elderly
Authors: Chen Mei , Halter Jeffrey B. , Porte Daniel
Published: April 2015

In this study we have attempted to evaluate the role of dietary carbohydrate (CHO) in the decreased glucose tolerance of aging. Eighteen healthy young (mean age, 27 ± 1 standard error of the mean) (SEM) and 18 old (71 ± 1 SEM) subjects matched for relative weight and socioeconomic group were studied. Oral glucose tolerance tests were performed while eating ad lib diet and after being given high (85%), medium (45%), and low (20% to 30%) CHO formula diets for at least three days. A three‐ to seven‐day food record was used to determine the major nutrients including CHO and fiber intake in the ad lib diet at home. Our older subjects consumed significantly less total calories and slightly less carbohydrate but there was no difference in dietary fiber, protein, and fat intake. When studies were performed on matched CHO diets, decreased glucose tolerance was present in the older group. However, the mechanism(s) involved may vary with dietary CHO and with age. During the low CHO formula diet and the medium CHO ad lib diet, impaired insulin secretion was prominent in the elderly but was not present in the young. During the high CHO formula diet, insulin response was adequate in both old and young, but decreased glucose tolerance persisted in the older group, suggesting that insulin resistance may be the major contributing factor. We conclude that decreased glucose tolerance in the elderly is modified by CHO intake, but is present even when dietary CHO variability is acutely controlled. The mechanism of this age‐related, decreased glucose tolerance may vary with dietary CHO.
The Use of Mental Health Measures in Nursing Home Research
Authors: Rabins Peter V. , Rovner Barry W. , Larson David B. , Burns Barbara J. , Prescott Carol , Beardsley Robert S.
Published: April 2015

To examine the quality of mental health research in nursing homes, 130 articles published in six geriatric specialty and health care delivery journals were reviewed. Thirty‐nine (30%) articles used a mental health measure. Measures of cognitive function were most common, being used in 32 (25%) of the articles reviewed. Twenty‐three (18%) studies measured abnormal mental experiences and 17 (13%) articles measured behavioral disorder. Many articles used measures or determinations with no established reliability. Twenty‐six of the articles which used a mental health measure also used a measure of activities of daily living or physical function. Retrospective and prospective studies were similar in number. A minority of articles used control groups, random samples, or prepost measures while a majority (64%) identified an outcome measure. We conclude that nursing home research can be improved by the increased use of reliable measures of cognition and abnormal mental experiences and by the development of reliable measures of behavioral disorder. Study design can be improved by identifying a priori hypotheses and by the increased use of random sampling and control/comparison groups.
The Examination of Physicians' Awareness of Dementing Disorders
Authors: Rubin Susan M. , Glasser Michael L. , Werckle Michael A.
Published: April 2015

Despite a significant increase in the amount of research being conducted on the etiology, diagnosis, and treatment of Alzheimer's disease and other dementing disorders, there has been little assessment of the utilization of this new wealth of information by the primary care physician. It was hypothesized that there would be a wide variation in physicians' knowledge of dementing disorders and the procedures used to diagnose these disorders. To quantitate the present status of primary care physicians' knowledge of dementing disorders and to investigate possible relationships between this knowledge and different physician and practice characteristics, 50 general internists and family practitioners from Winnebago County, Illinois, were interviewed regarding their recall of causes of dementia, procedures used in diagnosing these diseases, treatment recommendations, and comfort in making a differential diagnosis.

Results revealed a wide variation in both physicians' familiarity with the causes of dementia as well as the procedures used in making the diagnosis. Although a majority (80%) of the physicians reported some degree of confidence in making a differential diagnosis of dementing disorders, a significant trend was found between physician age and comfort in making the diagnosis, with age being directly correlated with comfort. This was in spite of a significant negative association between physician age and immediate recall of causes of dementia. These data imply that younger physicians are entering the work force with at least better immediate recall of information on dementing disorders, but they have had little opportunity to become comfortable with that knowledge due to a generally smaller geriatric population in their practice. Secondly, despite good recall of specific causes of dementia, younger physicians were no more likely to evaluate patients using mental status testing. In fact, only 42% of physicians mentioned mental status testing as a procedure with only 12% mentioning using any formal mental testing procedure. Although these data reflect favorably on the medical education system's incorporation of geriatric medicine classes in the curriculum, they also imply that dissemination of the information to the present physician population and subsequent use is still problematic.
How Does the Team Approach to Outpatient Geriatric Evaluation Compare with Traditional Care: A Report of a Randomized Controlled Trial
Authors: Williams Mark E. , Williams T. Franklin , Zimmer James G. , Hall W. Jackson , Podgorski Carol A.
Published: April 2015

Although team‐oriented geriatric assessment clinics are growing throughout the country, little documentation exists regarding their clinical efficacy, cost‐effectiveness, or impact on patient functioning and well‐being. This report describes a randomized controlled clinical trial to evaluate the effectiveness of a team‐oriented geriatric assessment approach compared to traditional care. One hundred‐seventeen subjects 65 years of age and over, meeting eligibility criteria to target frail older persons with changing medical and social needs, were randomly assigned to receive a comprehensive geriatric assessment by a multidisciplinary team (treatment) or by one of a panel of community internists who were reimbursed according to their usual and customary fee (controls). Extensive analysis of baseline information failed to identify any significant differences between groups. Over the 1‐year follow‐up period, treatment participants experienced 26 hospital admissions and used 670 hospital days compared with 23 admissions and 1113 days for controls (a 39.8% difference). Annual hospital costs averaged $4297 for treatment subjects and $7018 for controls. Overall institutional costs including hospital and nursing home care revealed an average saving of $2189 per person for treatment subjects compared with controls, a 25% reduction. A small proportion of subjects accounted for this difference. No significant differences were noted in patient or caregiver satisfaction with the evaluation process, functional ability, or health status. These findings suggest that team‐oriented outpatient geriatric assessment provides a promising way to deliver high‐quality, satisfying care to older persons without increasing (and possibly decreasing) health care costs.
The Progression of Personality Changes in Senile Dementia of the Alzheimer's Type
Authors: Rubin Eugene H. , Morris John C. , Berg Leonard
Published: April 2015

Passive, agitated, and self‐centered behavioral changes were noted on initial evaluation in two‐thirds, one‐third, and one‐third, respectively, of subjects with mild senile dementia of the Alzheimer's type (SDAT). Over a 50‐month follow‐up period, the percentage of patients who exhibited agitated and self‐centered behaviors doubled. The percentage of subjects who demonstrated all three behavioral changes increased from 11% at entry to the study (mild SDAT) to over 50% when the dementia had reached a severe stage. The presence of personality changes at a mild stage of dementia did not predispose subjects to more rapid progression to a more advanced stage of illness.
Pneumococcal Bacteremia
Authors: Chang June I. , Mylotte Joseph M.
Published: April 2015

Eighty‐nine episodes of pneumococcal bacteremia were reviewed over a 66‐month period at a Veterans Administration Medical Center. Forty‐one percent of these episodes were nosocomial in origin, and 59% of the patients were elderly (60 years of age or older). Nosocomial infection occurred more often in the elderly (55%) compared to those less than 60 years of age (32%; P <0.05). Within the elderly group, those older than 75 years of age had a higher rate of nosocomial bacteremia than those 60 to 75 years of age (76 versus 44%; P <0.05). The clinical presentation of the elderly and younger groups was not significantly different. All but one patient had serious underlying diseases. Eighty‐three percent of the episodes were due to pneumonia, and penicillin alone was prescribed for only 21% of all cases. The mortality rate directly due to the bacteremia was 22%, while the overall mortality during the hospitalization was 47%. In the elderly, the percentage of deaths due to infection was similar to the younger group, but overall mortality during the hospitalization was significantly higher in the elderly (74 versus 26%; P <0.01). Physicians showed poor recognition of the significance of pneumococcal disease, as demonstrated by inclusion of the diagnosis of pneumococcal infection or bacteremia in only 27% of the discharge summaries and by predischarge vaccination of only 7% (6 of 82) of those without previous pneumococcal vaccination. In conclusion, the rate of nosocomial pneumococcal bacteremia was high in a predominately elderly male population; it may be appropriate to consider a hospital‐based vaccine program in similar populations.
Identifying the Older Person Likely to Require Long‐Term Care Services
Authors: Williams Mark E.
Published: April 2015

The purpose of this study is to determine the accuracy of predictions in identifying older persons who subsequently require long‐term care such as home services or institutionalization. Eighty‐six individuals undergoing geriatric evaluation between May 1983 and April 1984 were evaluated using a series of commonplace tasks such as opening doors, stacking checkers, and copying a simple sentence. Predictions of an individual's use of long‐term care services were made during the initial evaluation and were based on whether the person could complete all the manual tasks and on the amount of time required to do so. Outcomes were determined by telephone interviews by a trained social worker in Dec 1984.

A statistically significant association (P < 0.005) was observed between the predictions and actual outcomes. Analysis of variance confirmed that the mean times for each outcome were different (F = 2.6, P < 0.05).

The results suggest that timing manual performance offers a useful way to prospectively identify older persons at risk of requiring additional long‐term care services.
Daily Sleep Patterns Observed Among Institutionalized Elderly Residents
Authors: Regestein Quentin R. , Morris John
Published: April 2015

The sleep/wake patterns of 16 institutionalized demented women were visually monitored hourly for 14 consecutive days. Individual mean total sleep time varied markedly from 5.0 to 12.1 hours per 24 hours. Unexpectedly, amounts of day sleep and night sleep correlated positively, suggesting a general sleep tendency manifested throughout the 24‐hour day. Consistent individual sleep patterns and high inter‐day correlations were found. A high degree of individuality in the sleep/wake patterns was also found, contrary to expectations that elderly obtain less sleep than others. Night sleep in the institutionalized elderly was not lessened by daytime sleep. Visual monitoring of sleep/wake patterns generated reliable data.
Planning for Decisional Incapacity
Authors: High Dallas M.
Published: April 2015

Practitioners and elderly patients share a common interest in advance planning for future health care decision‐making in the event of decisional incapacity. It is argued that advance directives can: 1) assist the elderly person in maximizing self‐determination; and 2) help physicians in caring for the elderly and their families by removing conflict potential. Furthermore, the author compares the legal and medical understandings of patient self‐determination and the uses of best interest and substituted judgment standards. It is argued that medicine and law differ on the important issues only in degree of emphasis, not in principle. To clarify the issues, a systematic classification of the multiple levels of instruction directives and agent‐proxy decision‐making models is developed. Finally, it is recommended that health care decision‐making for the elderly can be enhanced by encouraging patients to: 1) create as much evidence as possible to affirm their preferences and values; and 2) plan the delegation of decisions by appointing a proxy.
Longitudinal Study of Death and Institutionalization in Patients with Primary Degenerative Dementia
Authors: Knopman David S. , Kitto John , Deinard Susan , Heiring Jessica
Published: April 2015

We studied the outcome of 101 patients with primary degenerative dementia. The patients were outpatients at the time of the initial evaluation, and all had family caregivers. There were substantial differences in mortality and institutionalization between the mild and advanced patients, as defined by scores on mental status examination. Similar differences in those two outcomes were also evident when the patients were stratified by scores on activities of daily living and disruptive behavior assessments. Thus, certain patient characteristics may be of value in predicting risk for institutionalization and death.
Effects of Physical Exercise for Elderly Patients with Physical Impairments
Authors: Thompson Robert F. , Crist Douglas M. , Marsh Marjorie , Rosenthal Mark
Published: April 2015

Exercise is known to preserve many physiological responses in the healthy elderly, yet those with physical impairments are often discouraged from exercising. The authors studied the effects of a closely supervised exercise program designed specifically for elders with health problems and functional limitations. Tests, selected for their relevance to clinical patient management, included the Self Evaluation of Life Function questionnaire, treadmill performance, and tests of autonomic nervous system and neuromotor functions. Ambulatory volunteers, aged 64 to 83 years, with noncardiac health problems, were randomly assigned to a control group (CG; n = 17) or a 16‐week exercise group (EG; 3 hr/wk, n = 18).

Nine of the control and 13 of the exercise subjects completed the study. All EG dropouts were due to illness. EG attendance averaged 87%, and subjects trained at a heart rate (HR) of 103 $pL 5 beats/min (SD) (98% of prescription HR). Though EG test responses showed a tendency to improve, none reached statistical significance. This result was affected by the small number completing the study and the variability inherent in such a sample. Though these impaired elderly subjects enthusiastically and safely participated with high attendance and at an exercise intensity adequate to expect benefit, measurable training effects were not demonstrated.
Health and Function in the Old and Very Old
Authors: Ford Amasa B. , Folmar Steven J. , Salmon Richard B. , Medalie Jack H. , Roy Ann W. , Galazka Sim S.
Published: April 2015

This report advocates conceptual separation and parallel assessment of medically diagnosed health conditions and functional disability in clinical and epidemiological studies of the aged. Data from a study of urban elderly are presented to demonstrate how this can be done and to reexamine the meaning of self‐reported illness and disability.

One hundred thirteen subjects 74 to 95 years old, recruited from a longitudinal study of a representative sample of the elderly population of Cleveland, Ohio, participated in structured interviews and epidemiologically based medical examinations, conducted by a physician‐nurse team at the place of residence. The presence or absence of 11 common chronic conditions was determined according to preestablished criteria, by self‐report and, separately, by medical diagnostic evaluation. Functional disability was estimated by self‐report and by physician‐nurse assessment, using established measures of mobility and activities of daily living.

Results indicate that interview self‐report can provide useful estimates of the prevalence of medical conditions and functional disabilities in elderly populations, although self‐report alone is not a sufficiently sensitive measure to be used for case‐finding or diagnosis.

When functional disabilities are matched against the specific medical conditions that cause them and disease‐specific mortality is also taken into account, a three‐dimensional classification results that has implications for future clinical and survey work with the elderly.
Treatment of the Elderly Brain‐injured Patient Experience in a Traumatic Brain Injury Unit
Authors: Davis Charles S. , Acton Patricia
Published: April 2015

Recovery from traumatic brain injury in the elderly is a subject rarely discussed in the medical literature, and existing data is conflicting. The Traumatic Brain Injury Unit at Gaylord Hospital routinely admits patients over 50 years of age for rehabilitation after significant closed head injury. Of the 26 elderly head‐injured patients reviewed over a four‐year period for this study, 85% eventually returned to a home setting, with more than half independent in activities of daily living. Based on this encouraging data, it is suggested that the older head‐injured patient can recover from severe closed head injury.
Use of the Cornell Scale in Nondemented Patients
Authors: Alexopoulos George S. , Abrams Robert C. , Young Robert C. , Shamoian Charles A.
Published: April 2015

The Cornell scale is a 19‐item clinician‐administered scale of depression that uses information from interviews with both patients and their caregivers. The Cornell scale has been validated in demented patients. In this study, the Cornell scale was psychometically tested in nondemented geriatric subjects by administering it to 15 depressed patients, 15 patients with other psychiatric diagnoses, and 15 normal control subjects. The Cornell scale had high interrater reliability (Cohen's κ = 0.74), internal consistency (Kuder‐Richardson's coefficient = 0.98), and sensitivity, and correlated significantly (Spearman's r = 0.81) with Research Diagnostic Criteria psychiatric diagnoses associated with various intensity of depression. To our knowledge, the Cornell scale is the only depression‐rating instrument that has been validated in both demented and nondemented geriatric subjects.
Age‐related Changes in Regional Cerebral Blood Flow and Brain Volume in Healthy Subjects
Authors: Takeda Shumpei , Matsuzawa Taiju , Matsui Hiroshige
Published: April 2015

Using the xenon‐133 inhalation method, we studied the age‐related decline in regional cerebral blood flow, calculated as the initial slope index (ISI), in neurologically normal subjects without any risk factors for cerebral arteriosclerosis (154 men and 123 women), ranging in age from 19 to 88 years. The decline in the ISI was rapid in younger age groups and gradual in older age groups. The ISI was higher in women than in men older than 40 years. Using computed tomography, we studied the age‐related decline in brain volume index (BVI; 100% X brain volume/cranial cavity volume) in neurologically normal subjects without any risk factors for cerebral arteriosclerosis (92 men and 49 women), ranging in age from 37 to 86 years. The decline in the BVI was gradual in younger age groups and rapid in older age groups. The BVI was higher in women than in men older than 60 years.
Determinants of Total Serum Carotene Concentrations in Institutionalized Elderly
Authors: Kergoat Marie‐Jeanne , Leclerc Bernard S. , PetitClerc Claude , Imbach Andrée
Published: April 2015

The current analysis was designed to examine further the association between total serum carotenoids and a series of preselected variables (dietary intakes, anthropometric parameters, serum cholesterol, vitamin A, transport proteins, and others) using 85 elderly patients.

Simple correlation between serum carotene and carotene intake, as estimated by a three‐day weighed method, was 0.19 (P = 0.08), which was substantially increased (r = 0.29, P = 0.01) after adjustments for a selected set of variables. Standardized coefficients of multivariate regression indicated that the most important predictors of serum carotene were serum cholesterol (β = 0.38), total serum proteins (β = —0.35), and sex (β = 0.34), followed by carotene intake (β = 0.28) and midarm circumference (β= 0.20). These variables accounted for 46% of the variance. Results suggest that serum carotene may be related to protein‐energy status in hospitalized elderly, but further investigation should be directed to serum carotene in undernourished elderly. Nevertheless, total serum proteins could be an important factor in any attempt to correlate carotene intake and blood concentration.
Commonly Used Methods of Estimating Creatinine Clearance Are Inadequate for Elderly Debilitated Nursing Home Patients
Authors: Drusano George L. , Muncie Herbert L. , Hoopes John M. , Damron Dorothy J. , Warren John W.
Published: April 2015

We evaluated the Jelliffe and the Cockcroft and Gault methods of estimating creatinine clearance in elderly nursing home patients (65 years) with chronic indwelling urethral catheters. Although these relationships have been prospectively validated in hospitalized and ambulatory populations previously, we found that they produced poor estimates of creatinine clearance in this patient group. For the Jelliffe method, 11 of 19 estimates were 20% or greater from the measured value; 10 of 11 poor estimates were high. The Cockcroft‐Gault method had 10 of 19 estimates 20% or greater from the measured value with 8 of 10 of the poor estimates being high. An altered relationship between body weight, muscle mass, and daily creatinine production is the most likely explanation for the bias in these creatinine‐clearance estimations. New estimates of the relationships between age, weight, serum creatinine, and creatinine clearance need to be developed for this population.
Clinical Spectrum and Diagnostic Techniques of Coronary Heart Disease in the Elderly
Authors: Coodley Eugene L.
Published: April 2015

Coronary heart disease is a major cause of morbidity and mortality in the older population. The recognition of such disease in the elderly varies in a number of parameters from that noted in younger patients. There are a number of physiologic changes in cardiac function as a result of aging, and they have an important bearing on the recognition of cardiac disease in the elderly.

This review stresses the particular features of coronary disease in the aged and contrasts them with features more readily recognized in younger patients. Changes in the development of angina pectoris, heart failure, and the diagnosis of myocardial infarction vary significantly in the elderly population. The role of diagnostic modalities varies considerably in sensitivity and specificity when comparing younger and older patients. Potential areas for further research are stressed.