bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility of Beta‐Blockade Treatment for Older Postinfarction Patients
Authors: Park Kevin C. , Forman Daniel E. , Wei Jeanne Y.
Published: April 2015

OBJECTIVE: The prevalence of myocardial infarction (MI) in older people is high. Whereas use of beta‐blockers after MI is known to lower MI mortality in younger adults, its efficacy for adults more than 75 years of age remains less clear. We hypothesized that use of beta‐blockers after MI in older adults would improve clinical outcomes.

DESIGN: Retrospective cohort study.

SETTING: A community‐based, tertiary‐care teaching hospital.

METHODS: A total of 1011 consecutive MI patients aged 60 to 89 were admitted to Boston's Beth Israel Hospital between January 1988 and September 1989 and were screened for this study. One hundred eighteen patients met eligibility criteria, of whom 76 received metoprolol, ≥25 mg/day for at least 5 days after their MI. Forty‐two age and clinically matched patients were similarly suitable for beta‐blocker therapy, but it was omitted by their physicians during and after hospitalization. The latter group served as controls.

MEASUREMENTS: Mortality, reinfarction, and subsequent hospital admissions were measured.

RESULTS: MI patients aged 60 to 89 years who were treated with metoprolol had an age‐adjusted mortality reduction of 76% (RR 0.24; P < .001; 95% CI 0.11–0.54). Multivariate logistic regression analysis showed a 12% mortality reduction (95% CI 0.75–1.00) among older MI patients, attributable to metoprolol therapy. Reinfarction rates were unchanged in patients receiving metoprolol therapy, and subsequent rehospitalizations were significantly increased among the metoprolol patients.

CONCLUSIONS: Use of metoprolol significantly reduced mortality in older MI patients. The fact that metoprolol‐treated patients had neither reduced reinfarctions or rehospitalizations may relate to methologic limitations of this study. The mortality data support the hypothesis that older patients benefit from postinfarction beta‐blockade.
The Effects of Strength Conditioning on Older Women's Ability to Perform Daily Tasks
Authors: Hunter Gary R. , Treuth Margarita S. , Weinsier Roland L. , Kekes‐Szabo Tamas , Kell Sherron H. , Roth David L. , Nicholson Christal
Published: April 2015

OBJECTIVES: The objectives of this study were to determine the effects of a strength‐training program on walking speed and relative muscular stress, as measured by normalized integrated electromyographic (nIEMG) activity, while carrying a box of groceries and standing from a chair.

DESIGN: Prospective intervention study.

SETTING: Volunteer subjects from the community of Birmingham, Alabama.

PARTICIPANTS: Fourteen healthy women aged 60 to 77 years.

INTERVENTION: Sixteen weeks of total body strength conditioning.

MEASUREMENTS: Before and after 16 weeks of strength conditioning, the following variables were evaluated for all subjects: (1) strength, six isotonic tests and two isometric tests; (2) walking velocity; (3) nIEMG of the biceps while carrying a box of groceries; and (4) nIEMG of the rectus femoris while standing from a chair.

MAIN RESULTS: After the strength training program, subjects' isotonic strength increased significantly, an average of 52% on the isotonic tests and 31% on the isometric tests. Walking velocity also increased significantly (18%). nIEMG of the biceps decreased 36% while carrying a box of groceries. Rectus femoris nIEMG decreased 40% while standing and 47% while sitting.

CONCLUSIONS: After strength conditioning, healthy older women showed not only substantially increased strength but also improvements in walking velocity and the ability to carry out daily tasks such as rising from a chair and carrying a box of groceries.
Predictors of Nursing Home Placement in Community‐Based Long‐term Care
Authors: Tsuji Ichiro , Whalen Sarah , Finucane Thomas E.
Published: April 2015

OBJECTIVE: To identify predictors for nursing home placement among a group of frail older patients receiving formal home care services.

DESIGN: Retrospective chart review.

SETTING: A geographically defined catchment area of southeast Baltimore, Maryland.

PATIENTS: A total of 334 homebound patients who started using the Elder Housecall Program (EHP), a multidisciplinary team providing in‐home care and housed at the Johns Hopkins Geriatrics Center, between 1986 and 1989.

MEASUREMENTS: Independent variables, based on the chart review, were age, sex, diagnosis, functional status, and caregiver conditions at entry into EHP. Dependent variable was nursing home placement until December 31, 1991.

MAIN RESULTS: Cox proportional hazards analysis indicated that significant predictors were diabetes mellitus, bowel incontinence, and three caregiver characteristics: living separate from the patient, having time conflicts because of a job, and being stressed by caregiving.

CONCLUSION: Among this group of frail older people, caregiver problems were significant predictors of nursing home placement, but functional disabilities generally were not. These results suggest the need for geriatricians to be alert to the psychosocial aspects of patients and their caregivers.
Does Oxybutynin Add to the Effectiveness of Prompted Voiding For Urinary Incontinence Among Nursing Home Residents? A Placebo‐Controlled Trial
Authors: Ouslander Joseph G. , Schnelle John F. , Uman Gwen , Fingold Susan , Nigam Jennifer Glatler , Tuico Edward , Jensen Barbara Bates
Published: April 2015

OBJECTIVE: To determine if oxybutynin, a bladder relaxant medication, adds to the effectiveness of prompted voiding (PV) in the management of urinary incontinence among nursing home residents.

DESIGN: Randomized, placebo‐controlled, double‐blinded, dose‐adjusted, crossover trial of oxybutynin added along with PV.

SETTING: Seven nursing homes in Los Angeles County, California.

PARTICIPANTS: Seventy‐five nursing home residents with predominantly urge incontinence, whose incontinence did not respond well to a trial of PV.

MAIN OUTCOME MEASURES: The frequency of incontinence, measured as the percentage of hourly (7 AM to 7 PM) physical checks over a 3‐day period at which the resident was found wet.

RESULTS: Sixty‐three (84%) of the residents completed the study. Among those completing the trial, the percent of checks wet went from 26.5% to 23.7% on placebo to 20.2% on active drug. These changes were statistically significant but not clinically meaningful. A clinically significant decrease in the frequency of incontinence, which we defined as a relative reduction in the percent of checks wet of >33%, occurred in 20 subjects (32%) while on active drug and in 12 subjects (19%) while on placebo (P = .48 by chi‐square). Twenty‐five subjects (40%) met our “continence criteria” of an average of one or less wet per day while on active drug, and 11 subjects (18%) achieved this goal on placebo (P = .005 by chi‐square).

CONCLUSION: Oxybutynin does not add to the clinical effectiveness of PV in the majority of nursing home residents with urge type urinary incontinence. Selected residents may, however, become more responsive to PV while on oxybutynin. Our data are consistent with other studies of bladder relaxant medications in functionally impaired populations. New drugs and/or other interventions are needed for the large number of incontinent nursing home residents who do not respond well to PV.
Treatment of Ventricular Arrhythmias in Older Adults
Authors: Aronow Wilbert S.
Published: April 2015

OBJECTIVE: To review the prognosis and management of ventricular arrhythmias (VA) in persons with and without heart disease with emphasis on older adults.

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

STUDY SELECTION: Studies on the prognosis and management of VA in persons with and without heart disease were screened for review. Studies in older people and recent studies were emphasized.

DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving the older persons. Relevant articles were reviewed in depth.

DATA SYNTHESIS: Available data about the prognosis and management of VA in persons with and without heart disease, with emphasis on studies involving older people, were summarized.

CONCLUSIONS: VA in older persons without heart disease should not be treated with antiarrhythmic drugs. Class I antiarrhythmic drugs should not be used to treat VA in older persons with heart disease. Beta blockers should be used to treat complex VA in older persons with ischemic or nonischemic heart disease if there are no contraindications to beta blocker therapy. The use of amiodarone in treating complex VA should be reserved for life‐threatening ventricular tachyarrhythmias in older persons who cannot tolerate or who do not respond to beta blockers. VA associated with congestive heart failure should be treated with angiotensin converting enzyme inhibitors. If older patients have life‐threatening recurrent ventricular tachycardia or ventricular fibrillation resistant to antiarrhythmic drugs, invasive intervention should be performed. The automatic implantable cardioverter‐defibrillator is recommended in older patients who have medically refractory sustained ventricular tachycardia or ventricular fibrillation.
Long‐Term Survival and Use of Antihypertensive Medications in Older Persons
Authors: Pahor Marco , Guralnik Jack M. , Corti Maria‐Chiara , Foley Daniel J. , Carbonin Pierugo , Havlik Richard J.
Published: April 2015

OBJECTIVE:To determine whether older persons with hypertension who use specific calcium antagonists and ACE inhibitors have a different risk of mortality than those using β‐blockers.

DESIGN:A prospective cohort study continuing from 1988 through 1992.

SETTING:Three communities of the Established Populations for Epidemiologic Studies of the Elderly.

PARTICIPANTS:Hypertensive participants aged s 71 years (n = 906) who had no evidence of congestive heart failure and who were using either /3‐blockers (n = 515), verapamil (n = 77), diltiazem (n = 92), nifedipine (n = 74), or ACE inhibitors (n = 148). Nifedipine was of the short acting variety.

MEASUREMENTS:The main outcome measure was all‐cause mortality. Age, gender, smoking, HDL‐cholesterol, blood pressure, intake of digoxin and diuretics, physical disability, self‐perceived health, and comorbid conditions were examined as confounders.

RESULTS:During 3538 person‐years of follow‐up, 188 participants died (53 deaths per 1000 person‐years). Compared with j3‐blockers, after adjusting for age, gender, comorbid conditions and other health‐related factors, the relative risks (95% confidence interval) for mortality associated with use of verapamil, diltiazem, nifedipine, and ACE inhibitors were 0.8 (0.4‐1.4), 1.3 (0.8‐2.1), 1.7 (1.1–2.7), and 0.9 (0.6‐1.4), respectively. The results were unchanged after excluding participants with other potential contraindications to /3‐blockers and after stratifying on coronary heart disease and use of diuretics. Higher doses of nifedipine were associated with higher mortality.

CONCLUSION:Compared with /3‐blockers, use of short acting nifedipine was associated with decreased survival in older hypertensive persons. However, selective factors influencing the use of specific drugs in higher risk patients could not be completely discounted, and final conclusions will depend on clinical trials.
SPECT in Dementia: Clinical and Pathological Correlation
Authors: Read Stephen L. , Miller Bruce L. , Mena Ismael , Kim Ronald , Itabashi Hideo , Darby Amy
Published: April 2015

BACKGROUND: The clinical diagnosis of dementia continues to be flawed. Although the diagnosis of Alzheimer's disease (AD) is better than 90% at research centers in highly selected patients, the diagnosis of patients with non‐AD dementias and atypical AD patients is poor. Single photon emission computed tomography (SPECT) is a functional imaging technique touted as a diagnostic technique for the degenerative disorders. However there have been few clinicopathological studies using SPECT.

METHODS: Twenty‐seven consecutive dementia patients were evaluated clinically at a University‐based specialty dementia clinic, and a diagnosis of a specific dementia was made. SPECT imaging was used in helping to select a clinical diagnosis. The correlations between clinical, SPECT and autopsy diagnoses were analyzed.

RESULTS: Single photon emission computed tomography predicted pathologic diagnosis in 25 of 27 patients with dementia (92.6%), compared with clinical diagnosis, which was confirmed in 20/27 (74.1%). Distinct patterns were associated with dementia caused by AD, Fronto‐Temporal Dementia (FTD), and Jakob‐Creutzfeldt Disease (JCD). Vascular insults not seen with computerized tomography (CT) or magnetic resonance imaging (MRI) were found with SPECT. Three different pathologies were found in patients with Par‐kinsonian‐Dementias (PD): Lewy‐Body Variant of AD, Diffuse Lewy‐bodies without plaques, and substantia nigra neu‐ronal loss without plaques or Lewy‐bodies. All showed a temporal‐parietal pattern with SPECT that was similar to AD.

CONCLUSION: SPECT provides useful positive information in dementia, particularly the differentiation of AD, FTD, and JCD. However, it does not distinguish PD from AD.
Effects of Endurance Exercise and Hormone Replacement Therapy on Serum Lipids in Older Women
Authors: Binder Ellen F. , Birge Stanley J. , Kohrt Wendy M.
Published: April 2015

OBJECTIVE: To determine the effects of 11 months of exercise training and hormone replacement therapy (HRT), alone or in combination, on serum lipids and lipoproteins, in postmenopausal women.

DESIGN: Controlled, prospective, 11‐month clinical trial. Healthy postmenopausal women (n = 71, age range 60–72 yrs) were assigned to four groups in a 2 × 2 design (control, exercise, HRT, exercise + HRT).

SETTING: Large, midwestern urban community; subjects were recruited from the community‐at‐large. The exercise program was conducted at a university exercise facility.

INTERVENTIONS: HRT consisted of conjugated estrogens at 0.625 mg/day and trimonthly medroxyprogesterone acetate 5 mg/day for 13 days. Exercise consisted of 2 months of low intensity exercise followed by 9 months of vigorous exercise for 45 min/day, 3 or more days/week, at 65–85% of maximal heart rate.

MEASUREMENTS: Maximal aerobic power (V̇O2max), resting blood pressure, body composition, serum lipids and lipoproteins, and dietary intake at baseline and after 11 months.

MAIN RESULTS: At the end of 11 months, subjects in the exercise group had decreased total cholesterol (TC; P < .01) and LDL‐cholesterol (LDL‐C; P < .05), but there was no change in HDL‐cholesterol (HDL‐C) or triglycerides. Women in the HRT group had decreased LDL‐C (P < .001) and increased HDL‐C (P < .01) and triglycerides (P < .01), but there was no change in TC. Exercise+HRT subjects had decreased TC (P < .05) and LDL‐C (P < .001), and increased HDL‐C (P < .001); exercise prevented the HRT‐related increase in triglycerides.

CONCLUSIONS: Endurance exercise training and HRT have independent and complimentary effects on serum lipid profiles in healthy postmenopausal women. Such effects are likely to reduce the risk of cardiovascular morbidity in this population. J Am Geriatr Soc 44:231–236, 1996.
Hospital Admission Risk Profile (HARP): Identifying Older Patients at Risk for Functional Decline Following Acute Medical Illness and Hospitalization
Authors: Sager Mark A. , Rudberg Mark A. , Jalaluddin Muhammad , Franke Todd , Inouye Sharon K. , Landefeld C. Seth , Siebens Hilary , Winograd Carol H.
Published: April 2015

OBJECTIVES: To develop and validate an instrument for stratifying older patients at the time of hospital admission according to their risk of developing new disabilities in activities of daily living (ADL) following acute medical illness and hospitalization.

DESIGN: Multi‐center prospective cohort study.

SETTING: Four university and two private non‐federal acute care hospitals.

PATIENTS: The development cohort consists of 448 patients and the validation cohort consists of 379 patients who were aged 70 and older and who were hospitalized for acute medical illness between 1989 and 1992.

MEASUREMENTS: All patients were evaluated on hospital admission to identify baseline demographic and functional characteristics and were then assessed at discharge and 3 months after discharge to determine decline in ADL functioning.

RESULTS: Logistic regression analysis identified three patient characteristics that were independent predictors of functional decline in the development cohort: increasing age, lower admission Mini‐Mental Status Exam scores, and lower preadmission IADL function. A scoring system was developed for each predictor variable and patients were assigned to low, intermediate, and high risk categories. The rates of ADL decline at discharge for the low, intermediate, and high risk categories were 17%, 28%, and 56% in the development cohort and 19%, 31%, and 55% in the validation cohort, respectively. Patients in the low risk category were significantly more likely to recover ADL function and to avoid nursing home placement during the 3 months after discharge.

CONCLUSION: Hospital Admission Risk Profile (HARP) is a simple instrument that can be used to identify patients at risk of functional decline following hospitalization. HARP can be used to identify patients who might benefit from comprehensive discharge planning, specialized geriatric care, and experimental interventions designed to prevent/reduce the development of disability in hospitalized older populations. J Am Geriatr Soc 44:251–257, 1996.
Injurious Falls in Nonambulatory Nursing Home Residents: A Comparative Study of Circumstances, Incidence, and Risk Factors
Authors: Thapa Purushottam B. , Brockman Kelly G. , Gideon Patricia , Fought Randy L. , Ray Wayne A.
Published: April 2015

OBJECTIVE: To determine the circumstances of, incidence of, and risk factors for falls resulting in serious injuries in nonambulatory nursing home residents compared with those for ambulatory residents.

DESIGN: Prospective cohort study with 1‐year follow‐up

SETTING: Twelve community nursing homes in Tennessee.

SUBJECTS: A total of 1228 residents, 65 years of age or older, of whom 725 (59%) were nonambulatory and 503 (41%) were ambulatory.

MEASUREMENTS: Baseline data were obtained for potential risk factors for injurious falls. These included demographic characteristics, mental and physical function, vision, hearing, incontinence, and use of mechanical restraints and psychotropic drugs. Data were obtained from direct resident assessment, care provider interview, and the nursing home Minimum Data Set (MDS) (validated in a sample of residents).

OUTCOME: There were 111 first falls resulting in serious injury (head injury with altered consciousness, fracture, joint dislocation or sprain, or sutured laceration) that received medical treatment (hospitalization, emergency room visit, physician visit, or on‐site radiological examination), ascertained from facility incident reports and nursing home charts.

RESULTS: Nonambulatory residents had a substantially greater prevalence of mental and physical impairment. Circumstances of injurious falls in nonambulatory (n = 39 falls) and ambulatory (n = 72 falls) residents differed; those in the former group were more likely to involve equipment (87% vs 45%, P < .0001), occur while seated or during transferring (82% vs 21%, P < .0001), and from a chair/bed level (54% vs 6%, P < .0001). The incidence of injurious falls in nonambulatory residents (6.7 per 100 person‐years) was less than half that in ambulatory residents (17.0 per 100 person‐years, P < .0001). After controlling for other factors, the nonambulatory residents at highest risk were those not bed‐bound and with capacity for independent transfer (incidence density ratio (IDR) = 2.92, 95% CI = 1.07–7.99); the ambulatory residents at highest risk were baseline users of psychotropic drugs (IDR = 2.49, 95% CI = 1.43–4.33).

CONCLUSIONS: In the study cohort, nonambulatory residents had 35% of injurious falls. Because the circumstances and risk factors of these events were substantially different from those for ambulatory residents, separate prevention strategies may be needed for this group. These data suggest that increasing the safety of transferring and of equipment are appropriate targets for interventions. J Am Geriatr Soc 44:273–278, 1996.
Psychotic Symptoms in Parkinson's Disease Patients with Dementia
Authors: Naimark David , Jackson Edward , Rockwell Enid , Jeste Dilip V.
Published: April 2015

OBJECTIVE: To assess the prevalence of psychotic symptoms in a group of patients with Parkinson's disease (PD) and dementia and examine the association of psychotic symptoms with neuropsychiatric problems, the level of distress reported by caregivers, and cognitive and functional impairment.

DESIGN: The psychotic and nonpsychotic patients with PD dementia were compared on a series of demographic, neuropsychiatric, behavioral, caregiver complaint, and cognitive measures.

SETTING: The database from nine university‐based State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTCs).

PARTICIPANTS: 101 patients diagnosed with PD.

RESULTS: A total of 36 of the 101 patients (35.6%) had either hallucinations, delusions, or both. The psychotic patients had significantly more insomnia, confusion, agitation, personality changes, and self‐care problems and were noted by their caregivers to be significantly more unmanageable at home than their nonpsychotic counterparts. On cognitive scales, psychotic patients were significantly more impaired.

CONCLUSION: Many patients with PD and dementia experience psychosis. Psychotic symptoms in PD dementia patients are associated with major behavioral, cognitive, and functional problems. J Am Geriatr Soc 44:296–299, 1996.
Increased Baseline Sway Contributes to Increased Losses of Balance in Older People Following Triazolam
Authors: Robin Deborah W. , Hasan Samer S. , Edeki Timi , Lichtenstein Michael J. , Shiavi Richard G. , Wood Alastair J.J.
Published: April 2015

OBJECTIVE: Although it has been stated frequently that older people are more sensitive to benzodiazepines, the relative roles of impaired baseline performance, impaired elimination, and altered responsiveness have not been defined. We evaluated postural sway and plasma triazolam concentrations after administration of placebo and triazolam 0.375 mg in both young and older healthy subjects.

DESIGN: Double‐blind placebo‐controlled trial.

PARTICIPANTS: Nine young and nine older healthy men.

INTERVENTION: All subjects received triazolam 0.375 mg or placebo on different study days, which were separated by at least 48 hours.

MEASUREMENTS: Postural sway, visual analog scale of drowsiness, and plasma triazolam levels.

RESULTS: The older subjects swayed more during triazolam than did the younger subjects, and this resulted in an increased number of losses of balance. This difference appeared to be caused by greater baseline sway in the older subjects rather than higher concentrations or increased responsiveness. A subset of older people had a much greater number of losses of balance during triazolam than did the rest of the subjects, and these individuals could be identified from their baseline sway.

CONCLUSIONS: In this study, the increase in drug effect seen in the older subjects was of similar magnitude to that of the young, but it resulted in greater postural sway after drug administration than was seen in the young. The higher postural sway and the corresponding increased instability seen in the older subjects may put these older persons at increased risk of drug‐related falls. This study also suggests that it should be possible to develop techniques that will identify individuals at particular risk of drug‐induced postural instability. J Am Geriatr Soc 44:300–304, 1996.
MODELS OF GERIATRICS PRACTICE: A Community Development and Outreach Program in Geriatric Mental Health: Four Years' Experience
Authors: Reuben David B. , Stoke Paul , Kessler Linda , Clair J. Kenneth Le
Published: April 2015

OBJECTIVES: To describe a geriatric mental health outreach program based on a community development model and to review 4 years of experience with this program.

DESIGN: Program model and description of implementation experience.

SETTINGS: A geriatric mental health outreach program of a regional psychiatric hospital, serving a primarily non‐urban area, with offices in the community it serves.

PARTICIPANTS: The program targets community‐dwelling or institutionalized older persons with late‐onset mental health problems and/or behavioral disturbances, persons with long‐standing psychiatric disorders with age‐related changes, and their caregivers.

INTERVENTION: The program is a geriatric mental health outreach and consultation service that emphasizes community development and caregiver education. Program components include an interprofessional consultation team, a specialized information and resource service, educational service initiatives, and an ongoing role in planning and coordination activity in the local health care system.

MEASUREMENTS: Program monitoring, including a patient database and a description of program activities.

RESULTS: Cognitive impairment, behavioral disturbance, physical/medical problems and depression are the most common reasons for referral to the outreach program. Referred patients (mean age 78; 65% female) have usually (almost 90% of cases) been managed at a similar or lower level of care. Program activities have included focused educational initiatives in community and institutional settings and have emphasized the involvement and development of community caregivers and other local resources.

CONCLUSION: The program is a multifaceted effort to make efficient use of scarce specialized resources in a manner that is sensitive and responsive to local circumstances and needs. Experience to date has shown evidence of the feasibility and potential benefits of a comprehensive approach to community development and outreach in geriatric mental health. J Am Geriatr Soc 44:314–320, 1996
Sex Differences in Survival After Myocardial Infarction in Older Adults: A Community‐Based Approach
Authors: Vaccarino Viola , Krumholz Harlan M. , de Leon Carlos F. Mendes , Holford Theodore R. , Seeman Teresa E. , Horwitz Ralph I. , Berkman Lisa F.
Published: April 2015

OBJECTIVE: To determine sex differences in survival after myocardial infarction in older individuals.

DESIGN: Prospective cohort study based on a community sample of older individuals. All patients were followed for 1 year after hospital admission.

SETTING: Two hospitals in New Haven, Connecticut.

PARTICIPANTS: The study included 103 women and 120 men who were participants in the New Haven, CT cohort of the Established Populations for the Epidemiologic Study of the Elderly (EPESE) program and who were diagnosed with myocardial infarction between the inception of the community study in 1982 and December 31, 1992. The mean age of women was 79.3 and of men, 77.3.

MEASUREMENTS: Data on clinical characteristics were abstracted from medical records. Sociodemographic, psychosocial, and physical function information was derived from the EPESE interview preceding the infarction. The main outcome measure was all‐cause mortality, for which three end points were used: early mortality (first 30 days), late mortality (1‐year mortality among survivors of the first 30 days), and overall mortality (1‐year mortality from admission in the whole sample).

RESULTS: Mortality in the first 30 days did not differ significantly in the two sexes. The relative risk (RR) of death in women compared with men was 0.85 (95% confidence interval [CI], 0.49‐1.47) before multivariable adjustment; this was unchanged after adjustment for demographic factors, comorbidity, functional status, psychosocial factors, and clinical severity (RR, 0.85, 95% CI, 0.41‐1.76). Among survivors of 30 days, women were almost two times more likely to survive at 1 year compared with men, both before multivariable adjustment (RR, 0.56,95% CI, 0.31‐1.02) and after controlling for demographic factors, comorbidity, physical function, psychosocial factors, clinical severity on admission, and hospital complications (RR, 0.44; 95% CI, 0.20‐0.99). Analyses involving 1‐year follow‐up from admission for the entire sample yielded intermediate results.

CONCLUSION: There was little difference in mortality in the first 30 days after myocardial infarction between older men and women, but when the early deaths were excluded, women showed an increased survival compared with men in the first year after the myocardial infarction.
Antihypertensive Medication Use Among Recruits for the Trial of Nonpharmacologic Interventions in the Elderly (TONE)
Authors: Espeland Mark A. , Kumanyika Shiriki , Kostis John B. , Algire Jenifer , Applegate William B. , Ettinger Walter , Whelton Paul K. , Bahnson Judy
Published: April 2015

OBJECTIVES: To examine the distribution and correlates of the classes of antihypertensive medications taken by persons aged 60 to 80.

DESIGN: Cross‐sectional screening.

SETTING: Four academic medical centers in the southern and eastern United States.

PARTICIPANTS: Volunteers (N = 2601) entering a clinical trial testing the value of nonpharmacologic approaches to control blood pressure who were either taking one or two (single or combined) medications for the treatment of hypertension and expressed willingness to be withdrawn from these medications according to a standardized protocol

MEASUREMENTS: Medication use, blood pressure, and data from self‐administered questionnaires collected during standardized clinic visits.

RESULTS: Calcium channel blockers (23.9%) were the most frequent single agent antihypertensive medications used by cohort members, followed by diuretics (17.9%) and angiotensin‐converting enzyme (ACE) inhibitors (17.5%). The most common combination agents were composed of diuretics with either calcium channel blockers (5.4%), ACE inhibitors (4.0%), or β‐blockers (3.7%). Women were twice as likely to be taking diuretics, and less likely to be taking ACE inhibitors and β‐blockers, than men. Blacks were more likely to be taking diuretics and calcium channel blockers, and less likely to be taking β‐blockers and ACE inhibitors, than others. These relationships could not be attributed to differences in geographical area, other demographic factors, age, or medical history.

CONCLUSIONS: These usage patterns appear to mirror those in the population of the United States as a whole, which has trended toward greater usage of calcium channel blockers and ACE inhibitors with declining use of diuretics. The distribution of antihypertensive medications among older hypertensives is markedly different between women and men and between black Americans and others.
The Care of Older Persons with Diabetes Mellitus: Families and Primary Care Physicians
Authors: Silliman Rebecca A. , Bhatti Shelah , Khan Amina , Dukes Kimberly A. , Sullivan Lisa M.
Published: April 2015

OBJECTIVES: To determine the extent to which family members participate in the day‐to‐day management of diabetes mellitus in older persons, and in older diabetics' medical encounters, and to identify patient and family member characteristics associated with this participation.

DESIGN: A longitudinal observational study, with baseline data being reported herein.

SETTING: Three primary care practice settings in Seattle, Washington, Boston, Massachusetts, and Indianapolis, Indiana.

PARTICIPANTS: Family members of patients 70 years of age or older participating in the Patient Outcomes Research Team (PORT) Study of type II diabetics.

MAIN OUTCOME MEASUREMENTS: The two dependent variables represent, respectively, the extent of family members' assistance with diabetes‐related care and participation in older diabetics' medical encounters.

RESULTS: The 357 family members enrolled were older (mean age = 66.3 years), were mostly women (76.2%), and were usually the spouses of diabetic patients (71.3%). Between 22% and 50% of family members reported helping with various aspects of diabetes care; 35.6% of family members participated regularly in their diabetic patients' medical encounters. A multiple linear regression model relating family assistance with diabetes‐related care to patient and family member characteristics included four variables: patients' physical function, and the family member's relationship to the patient, assistance with basic activities of daily living (ADLs), and understanding of diabetes management issues (all P < .05). A multiple logistic regression model relating family member participation in the medical encounter to patient and family member characteristics also included four variables: patient age and physical function, and family member assistance with instrumental activities of daily living (IADLs) and with diabetes‐related care (all P < .05).

CONCLUSION: The family members studied frequently assisted older diabetics with diabetes‐specific care; more than one‐third were regular participants in older diabetics' medical encounters. Family member involvement in the day‐to‐day management of diabetes and in the medical encounter was more likely when patients were functionally disabled. Health care systems and physicians need to educate their older patients, and involved family members when patients are frail, about diabetes‐related care issues and support them in their roles in the management of diabetes as well as other chronic diseases. J Am Geriatr Soc 44:1314–1321, 1996.
The Relationship Between Physical Performance Measures and Independence in Instrumental Activities of Daily Living
Authors: Judge James O. , Schechtman Kenneth , Cress Elaine , Group FICSIT
Published: April 2015

OBJECTIVES: Understanding the relationship between physical capacity and functional status is required to design exercise interventions to maintain independent living. This study assessed the importance of physical performance in maintaining independence in Instrumental Activities of Daily Living (IADL).

DESIGN: A pre‐planned meta‐analysis of cross‐sectional data from six sites of the Frailty and Injury: Cooperative Studies of Intervention Trials (FICSIT). Linear regression was used to estimate the relationship between physical performance and IADL.

PARTICIPANTS: 2190 community‐dwelling older subjects.

MEASUREMENTS: IADL was the dependent variable; gait velocity, balance function, grip strength and chair rise time were the predictor variables. Age, gender, education, falls self‐efficacy, and cognitive status were covariates.

RESULTS: Gait velocity, balance function, and grip strength were independently related to IADL deficits, after correcting for covariates. The linear slopes were relatively steep. For gait, a decrease of 0.1 m s−1 was associated with 0.10 (95% CI: 0.17, 0.04) increase in IADL deficits, which is equivalent to 1 ADL deficit in 10 subjects. The linear slopes for hand grip and balance were similar or steeper. In the sites where chair stand time was measured, an increase of 1 second in the time to rise was associated with a 0.14 (0.04, 0.24) increase in IADL deficits. The relationships found in the meta‐analytic analysis were consistent across sites which enrolled subjects with widely varying levels of physical performance.

CONCLUSION: Simple measures of physical performance were strongly associated with IADL independence after correcting for many previously identified predictors of functional status. The data from this meta‐analysis support testing interventions designed to improve physical performance to determine whether improved performance can maintain or improve independence in IADLs. J Am Geriatr Soc 44:1332–1341, 1996.
Good Nutritional Oral Intake Is Associated with Equal Survival in Demented and Nondemented Very Old Patients
Authors: Franzoni Simone , Frisoni Giovanni B. , Boffelli Stefano , Rozzini Renzo , Trabucchi Marco
Published: April 2015

OBJECTIVE: To evaluate the association of oral food intake with survival in very old demented nursing home patients.

DESIGN: A prospective cohort study.

SETTING: A nursing home in northern Italy.

MEASUREMENTS: Anthropometric and laboratory nutritional indicators and nutrient intake were assessed in 33 demented (age 85.7 ± 5.7 years) and 25 nondemented (age 84.9 ±5.7 years) patients. Mortality data were collected over a 28‐month follow‐up period. Association of survival with dementia was estimated by Kaplan‐Meyer analysis and multivariate Cox proportional hazard models.

RESULTS: Nutrient intake and nutritional status were good compared with data in the literature and were similar in demented and nondemented patients, except for smaller triceps skinfold thickness in the demented. The cumulative annual death rate was 0.23 deaths per subject per year, similar in the demented (0.23) and the nondemented (0.22). Unadjusted survival by Kaplan‐Meyer analysis was similar in the two groups, and correction for age, gender, cognition, triceps skinfold thickness, and number of drugs in a Cox model did not alter the relationship.

CONCLUSIONS: Dementia developing in very old age is not necessarily associated with malnutrition and decreased life expectancy. J Am Geriatr Soc 44:1366–1370, 1996.
Restrictive Left Ventricular Filling Patterns in Very Old Patients with Congestive Heart Failure: Clinical Correlates and Prognostic Significance
Authors: Lipsitz Lewis A. , Byrnes Narelle , Hossain Montr , Douglas Pamela , Waksmonski Carol A.
Published: April 2015

OBJECTIVES: In certain younger patients with congestive heart failure (CHF), Doppler/echocardiography has identified a “restrictive” pattern of early diastolic ventricular filling characterized by very rapid early filling and a steep deceleration slope. We asked whether a similar restrictive pattern can be identified in very old patients with CHF, and if so, what are its clinical correlates and prognostic implications.

DESIGN: Retrospective cohort with prospective follow‐up.

SETTING: Academic long‐term care facility

PARTICIPANTS: Thirty‐nine residents with clinical CHF (age 89 ± 5 (SD) years)

MEASUREMENTS: Transmitral Doppler flow, clinical characteristics, recurrent CHF episodes, hospitalizations, and mortality were measured.

RESULTS: Fifteen (38%) of the subjects had restrictive filling patterns, characterized by a ratio of early to late flow (E/A) > 1.00 and 24 (62%) had nonrestrictive patterns. The restrictive pattern was associated with a longer duration of CHF, more angina, and higher rate of symptomatic recurrences of CHF.

CONCLUSION: A restrictive diastolic filling pattern may represent a late stage in the evolution of congestive heart failure when left ventricular filling pressure is markedly increased. The treatment of CHF in older patients may need to account for different patterns of diastolic filling.
Iatrogenic Congestive Heart Failure in Older Adults: Clinical Course and Prognosis
Authors: Rich Michael W. , Shah Atul S. , Vinson Janice M. , Freedland Kenneth E. , Kuru Tunay , Sperry Jane C.
Published: April 2015

OBJECTIVE: To determine the prevalence, risk factors, clinical course, and prognosis of iatrogenic congestive heart failure in older patients.

DESIGN AND SETTING: Prospective observational study at a university teaching hospital.

PARTICIPANTS: A total of 401 patients 70 years of age or older hospitalized with congestive heart failure. The mean age was 80 ± 6 years; 59% were female, and 65% were white.

MEASUREMENTS: Comprehensive data, including an assessment of the etiology and precipitating factors leading to the development of heart failure, were collected at the time of diagnosis. Iatrogenic heart failure was defined as heart failure precipitated by medications or excessive fluid administration, or occurring as a procedural complication. All patients were followed for 1 year, and the primary outcome measure was total mortality.

RESULTS: Using strict criteria, 28 patients (7.0%) were considered to have iatrogenic heart failure. Compared with noniatrogenic patients (n = 373), iatrogenic cases had less severe premorbid cardiac disease but more marked noncardiac disability and longer hospital stays (29 ± 24 vs 13 ± 12 days, P < .001). Hospital mortality was 32% in iatrogenic heart failure patients compared with 9% in noniatrogenic cases (P < .001). Cumulative mortality at 1 year was 68% in iatrogenic patients versus 39% in noniatrogenic patients (P < .01). Using a Cox proportional hazards model, iatrogenic congestive heart failure was associated with a relative mortality risk during follow‐up of 2.5 (95% confidence interval 1.5–4.3) after adjusting for age, sex, prior history of heart failure, New York Heart Association class, diabetes mellitus, systolic blood pressure, hemoglobin, blood urea nitrogen, and serum albumin.

CONCLUSIONS: Frail, debilitated older patients are at increased risk for developing iatrogenic heart failure, even in the absence of clinically evident cardiac disease. In this population, iatrogenic heart failure serves as a marker for poor short‐ and long‐term prognosis, but further study is required to determine the optimal approach to management of these patients.
Patterns of Diagnoses, Comorbidities, and Treatment in Late‐Middle‐Aged and Older Affective Disorder Patients: Comparison of Mental Health and Medical Sectors
Authors: Moos Rudolf H. , Mertens Jennifer R.
Published: April 2015

OBJECTIVE: To compare the diagnoses, psychiatric and medical comorbidities, and prior and current treatment received by late‐middle‐aged and older affective disorder patients in mental health and medical service settings and to identify predictors of these patients' length of inpatient care.

DESIGN: Department of Veterans Affairs (VA) nationwide databases are used to examine the prevalence, diagnoses, and inpatient and outpatient treatment received by affective disorder patients in mental health and medical units in Fiscal Year 1990.

RESULTS: Compared with late‐middle‐aged and older index medical patients (n = 11,701), index mental health patients (n = 9039) were more likely to have affective psychoses and major depressive disorder and less likely to have depressive disorder NOS. Almost 60% of affective disorder patients in mental health settings had comorbid psychiatric diagnoses; this was true of 30% of patients in medical settings. Moreover, more than 80% of affective disorder patients in mental health settings had concomitant medical disorders. Affective disorder patients also had very high rates of prior mental health and medical care. Patients who had more severe affective disorders and comorbid psychiatric and medical diagnoses had longer episodes of inpatient care; in contrast, more intensive prior medical and mental health outpatient care was associated with shorter episodes of inpatient care.

CONCLUSIONS: The findings highlight affective disorder patients' high rates of comorbidity and intensive use of health care resources, emphasize the value of outpatient care in reducing the amount of subsequent inpatient care, and underscore the need for closer integration of mental health and medical care.
1H‐MRS, MRI‐Based Hippocampal Volumetry, and 99mTc‐HMPAO‐SPECT in Normal Aging, Age‐Associated Memory Impairment, and Probable Alzheimer's Disease
Authors: Parnetti Lucilla , Lowenthal David T. , Presciutti Otello , Pelliccioli GianPiero , Palumbo Renato , Gobbi Gianni , Chiarini Pietro , Palumbo Barbara , Tarducci Roberto , Senin Umberto
Published: April 2015

OBJECTIVE: To better understand how to differentiate the “in vivo” normal aging brain from pathological conditions, namely dementia of the Alzheimer type (DAT), by means of magnetic resonance imaging (MRI), single photon emission computerized tomography (SPECT), and proton magnetic resonance spectroscopy (1H‐MRS), to show neuroanatomical, perfusional and neurochemical details, respectively.

DESIGN: 1H‐MRS, MRI‐based hippocampal volumetry and 99mTc‐HMPAO SPECT were performed in healthy older subjects as well as patients suffering from age‐associated memory impairment (AAMI) and dementia of Alzheimer type (DAT).

SUBJECTS AND SETTING: Eighteen subjects were selected from those referred to an outpatient clinic for diagnostic evaluation of cognitive impairment entered the study. Six patients fulfilled NINCDS‐ADRDA diagnostic criteria for DAT, six subjects were affected by AAMI, and six cognitively healthy subjects, selected from among relatives of the patients, were defined as controls.

METHODS: The 1H‐MRS and MRI studies were performed on a 1.5 Tesla NMR‐imaging system equipped with a spectroscopy research package. SPECT scans were performed on a Gamma 11 computer system.

FINDINGS: 1H‐MRS showed significantly lower N‐acetyl‐aspartate concentration in DAT and AAMI compared with controls. Conversely, mean inositol concentration was significantly higher in DAT than in controls, whereas AAMI subjects registered intermediate values. MRI measurements showed significantly reduced volumes of hippocampal formations in DAT and AAMI groups compared with controls. Finally, 99mTc‐HMPAO SPECT showed a significant frontal, temporo‐parietal, and occipital hypoperfusion in DAT patients only.

CONCLUSIONS: These findings support the hypothesis of a continuum among the three conditions studied, or at least between AAMI and DAT, where AAMI seems to be an early, monosymptomatic stage of Alzheimer disease. Accepting this view, it would be questionable to maintain the term “age‐associated memory impairment” as a discrete entity. J Am Geriatr Soc 44:133–138, 1996.
Falls Leading to Femoral Neck Fractures in Lucid Older People
Authors: Nyberg Lars , Gustafson Yngve , Berggren Diana , Brännström Benny , Bucht Gösta
Published: April 2015

OBJECTIVE: To analyze the mechanisms of falls that result in femoral neck fractures among lucid older people.

DESIGN: A cross‐sectional study.

SETTING: An orthopedic university hospital department.

PARTICIPANTS: A consecutive series of 123 lucid patients, 65 years of age or more, who were admitted for femoral neck fractures.

MEASUREMENTS: On admission, the subjects were interviewed about fracture accident characteristics, and falling mechanisms were classified. An arterial blood gas sample was taken from each patient soon after admission. Based on data regarding drug consumption and social and medical characteristics, a fall‐risk index was calculated for each subject.

RESULTS: It was ascertained that 95% of the fractures were caused by falls and <2% were spontaneous. Most accidents (68%) took place indoors, 47% of the falls were classified as extrinsic, 24% as intrinsic, 7% as nonbipedal, and 22% remained unclassified. Almost all outdoor falls were extrinsic; however, intrinsic falls were as common as extrinsic falls indoors (P < .001). Extrinsic fallers presented a significantly lower fall‐risk index score than subjects with fractures caused by intrinsic, nonbipedal, and unclassifiable falls. A large proportion of subjects (24%) were hypoxemic (pO2 < 8 kPa) on admission, and patients who sustained fractures at night had lower oxygen tension than that of daytime fallers (P = .006).

CONCLUSIONS: Accidental falls are the primary cause of femoral neck fractures. Preventive actions should be directed toward intrinsic, as well as extrinsic, risk factors for falls. Hypoxemia might be a risk factor for falls, especially those falls that occur at night. J Am Geriatr Soc 44:156–160, 1996.