bluuebunny/crossref_metadata_2025 huggingface dataset:
Local Treatment of Pressure Sores in the Elderly: Amino Acid Copolymer Membrane Versus Hydrocolloid Dressing
Authors: Honde Chantal , Derks Christian , Tudor David
Published: April 2015

OBJECTIVE: To compare the clinical effectiveness and wound management properties of a copolymer membrane, Inerpan (Synthelabo), and a hydrocolloid dressing, Corn‐feel (Coloplast), in the treatment of decubitus ulcers in the elderly.

DESIGN: Open, randomized, multicentric French study, with two parallel groups of patients.

PATIENTS: 168 in‐patients aged more 65 years (mean age: 82 years) suffering from grade II to grade IV (in the Shea classification) pressure sores.

TRIAL PERIOD: Either 8 weeks or until the ulcer healed, whichever occurred first.

MEASUREMENTS: In addition to a complete physical examination, patients were evaluated at baseline for nutritional status and risk factors. The wounds were described, their depth scored, and the areas traced at Weeks 0, 1,2, 4, 6, and 8. The number of dressings used was recorded.

RESULTS: Thirty‐one Inerpan‐treated patients and 23 Comfeel‐treated patients achieved healing (P = 0.089), with respective median healing times of 32 and 38 days. Healing times were compared using survival curves (in the whole population) adjusted for ulcer depth effect and showed a significant difference in favor of Inerpan (P = 0.044 and 0.014). Progress of healing (percentage of ulcer healed) was calculated in the two groups. Clinically assessed the treatment performance scored at the completion of the study showed better results with Inerpan (F < 0.05). Both groups were similar in terms of granulation/exudation scores, surrounding skin, and ease of care.

CONCLUSION: It is concluded that Inerpan is easy to use, safeguards the healing process, and is of particular value in the management of pressure sores.
Prognosis‐Based Futility Guidelines: Does Anyone Win?
Authors: Teno Joan M. , Murphy Donald , Lynn Joanne , Tosteson Anna , Desbiens Norman , Connors Alfred F. , Hatnel Mary Beth , Wu Albert , Phillips Russell , Wenger Neil , Harrell Frank , Knaus William A. ,   The SUPPORT Investigators
Published: April 2015

OBJECTIVE: Advocates for health care reform and others claim that significant savings could be achieved if “futile” care were eliminated. Our objective was to provide an initial estimate of the effects of a public policy that would preclude futile life‐sustaining treatments, defined as those employed despite ≤1% chance of surviving for 2 months.

DESIGN: Simulation using data from an observational cohort study.

SETTING: Five academic medical centers.

PATIENTS: Seriously ill hospitalized adults enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT).

METHODS: We examined the impact of prognosis‐based futility guidelines on survival and hospital length of stay on a cohort of seriously ill adults. We calculated the number of days of hospitalization that would not be used if, on the third study day, life‐sustaining treatment had been stopped or not initiated for subjects with estimated 2‐month survival probability of ≤1%.

RESULTS: Of the 4301 patients, 115 (2.7%) had an estimated chance of 2‐month survival of ≤1%. All but one of these 115 subjects died within 6 months. Almost 86% died within 5 days of prognosis. At the time of death, 92 subjects (80.0%) had had no attempt at resuscitation; 35 (30.4%) had had a life‐sustaining mechanical ventilator withdrawn. A Do‐Not‐Resuscitate order was written either before (n = 61) or within 5 days (n = 18) of reaching this prognosis for 68.6% of the patients. These 115 subjects had total hospital charges of $8.8 million. By forgoing or withdrawing life sustaining treatment in accord with a strict 1% futility guideline, 199 of 1,688 hospital days (10.8%) would be forgone, with estimated savings of $1.2 million in hospital charges. Nearly 75% of the savings in hospital days would have resulted from stopping treatment for 12 patients, six of whom were under 51 years old, and one of whom lived 10 months.

CONCLUSIONS: Patients at a high risk of dying can be identified prospectively. Implementation of a strict, prognosis‐based futility guideline on the third day of a serious illness would result in modest savings.
Nutrition and Function: Is There a Relationship Between Body Mass Index and the Functional Capabilities of Community‐Dwelling Elderly?
Authors: Galanos Anthony N. , Pieper Carl F. , Cornoni‐Huntley Joan C. , Bales Connie W. , Fillenbaum Gerda G.
Published: April 2015

Objective: To determine if there is a relationship between body mass index and the ability to perform the usual activities of living in a sample of community‐dwelling elderly.

Design: Secondary data analysis of The National Health and Nutrition Examination Survey‐I Epidemiologic Follow‐up Study (1982–1984). Follow‐up home interview of a population‐based sample originally interviewed between 1971 and 1975 in the National Health and Nutrition Examination Survey‐I (NHANES‐I).

Participants: Survivors of the original NHANES‐I cohort who were 65 years of age or older and who were living at home at the time of the second interview (n = 3061). Excluded were those who could not be found, refused participation, or were institutionalized (n = 220), and those without complete height and weight data (n = 194).

Main Outcome Measure: Functional status as measured by a 26‐item battery.

Results: Bivariate analysis revealed a greater risk for functional impairment for subjects with a low body mass index or a high body mass index. The greater the extreme of body mass index (either higher or lower), the greater the risk for functional impairment. Logistic regression analysis indicated that both high and low body mass index continued to be significantly related to functional status when 22 other potential confounders were included in the model.

Conclusion: The body mass index is related to the functional capabilities of community‐dwelling elderly. The inclusion of this simple measurement in the comprehensive assessment of community‐dwelling elderly is supported.
Arginine Vasopressin and Osmolality in the Elderly
Authors: Johnson Anthony G. , Crawford Georgina A. , Kelly Dianne , Nguyen Tuan V. , Gyory Akos Z.
Published: April 2015

Objectives: To evaluate the influence of age on plasma arginine vasopressin (AVP) concentrations and the relationship between plasma AVP and serum osmolality in younger and older subjects, and in the elderly, to assess the effect of gender on plasma AVP concentration and to determine the impact of prostaglandin blockade on renal responsiveness to AVP.

Design: Cross‐sectional study; randomized, double‐blind, crossover, placebo‐controlled study.

Setting: The Renal Laboratory, Royal North Shore Hospital (younger adults) and Clinical Room, St Vincents Hospital (elderly subjects).

Participants: 45 younger adults (35 ± 9 years) and 41 elderly subjects (29 males, 12 females; 78 ± 3 years). All subjects were healthy and non‐institutionalized. The elderly subjects were screened to exclude significant pathology (clinical assessment, multiple investigations).

Intervention: Blood samples were drawn from all younger and elderly subjects. The elderly subjects were randomly allocated indomethacin or placebo for 1 month. Following a 1 to 2‐week washout, the alternative was administered for a further 1 month.

Main Outcome Measures: Plasma AVP and serum osmolality and plasma AVP, serum, and urine osmolality at baseline were measured on indomethacin and placebo.

Results: In the elderly subjects, baseline plasma AVP concentration was significantly higher than in the younger subjects studied (4.7 ± 0.7 vs 2.1 ± 0.2 pg/mL respectively; P = 0.0003). Plasma AVP was strongly correlated with serum osmolality in the younger subjects (r = 0.76, P = 0.0001) but not in the elderly cohort (r = –0.18, P = 0.26). No difference was found between the sexes in plasma AVP (P = 0.89), and indomethacin treatment did not alter the plasma AVP/urine osmolality ratio (P = 0.85) in the elderly subjects. In addition, changes in plasma AVP with indomethacin therapy did not correlate with changes in serum osmolality (r = 0.16, P = 0.09).

Conclusions: Aging is accompanied by an increase in plasma AVP concentrations. In healthy, elderly subjects, plasma AVP is not dependent on serum osmolality and is not influenced by gender. Indomethacin has no effect on the renal responsiveness to plasma AVP.
Comparison of Static and Dynamic Posturography in Young and Older Normal People
Authors: Baloh Robert W. , Fife Terry D. , Zwerling Lisa , Socotch Tina , Jacobson Kathleen , Bell Theodore , Beykirch Karl
Published: April 2015

Objective: To measure sway velocity during static and dynamic posturography in “normal’ older people and to determine which tests best distinguish young from older subjects.

Subjects: A sample of 30 young (18–39 years) and 82 community‐dwelling older (>75 years) subjects who reported normal balance underwent a battery of balance tests.

Measurements: Velocity and frequency of sway, Tinetti gait and balance score, self‐reported fear of falling and number of falls.

Results: Mean sway velocity and the ratio of high to low frequency sway velocity were significantly increased in older subjects compared with younger subjects for static and dynamic tests with eyes open and with eyes closed. Measures of anterior‐posterior sway velocity during angular tilt of the platform with eyes closed best distinguished young from older subjects (almost three‐fourths of older subjects had values greater than 2 standard deviations from the young normal mean). Older subjects who reported falls in the past year did not have a significantly higher sway velocity on static or dynamic tests compared with those who did not report falls. However, subjects who reported a fear of falling had significantly higher sway velocity on dynamic tests with eyes closed compared to those who did not report a fear of falling.

Conclusions: On average, velocity of sway is higher in older subjects compared with younger subjects, and the difference between young and old is greater with dynamic posturography than with static posturography.
The Effects of the Presence of a Third Person on the Physician‐Older Patient Medical Interview
Authors: Greene Michele G. , Majerovitz S. Deborah , Adelman Ronald D. , Rizzo Connie
Published: April 2015

Objective: To compare communication in triadic (three‐person) and dyadic (two‐person) older patient medical interviews and to determine the influence of the presence of a third person on the physician‐older patient relationship.

Design: Matched sample of dyadic and triadic audiotaped outpatient medical visits. Audiotapes were coded with the Multi‐dimensional Interaction Analysis (MDIA) system.

Setting: Hospital‐based medical primary care group practice in a major urban teaching institution.

Participants: Patients 60 years and older who were making their first visit to study physicians. In a sample of 96 audiotaped initial medical visits, 15 encounters involved three persons. These 15 cases were matched with 15 dyadic interviews for gender and race of the patient and for gender and race of the physician.

Main Outcome Measures: Content, interactional processes, and specific language and communication behaviors of older patients, physicians, and third persons in the medical encounter, as measured by the MDIA system.

Results: The specific content and the quality of interactional processes of physicians were not affected by the presence of a third person. However, older patients raised fewer topics in all content areas (medical, personal habits, psychosocial, and physician‐patient relationship) in triads than in dyads. Overall, patients were less responsive (ie, the quality of their questioning, informing, and supportiveness was poorer) on patient‐raised topics in triads than in dyads. Patients were rated as less assertive and expressive, and there was less joint decision‐making and shared laughter in triads than in dyads. Patients were frequently excluded from conversations in visits in which a third person was present.

Conclusions: The presence of a third person in the medical encounter changes the interactional dynamics of older patient medical interviews and may influence the development of a trusting and effective physician‐older patient relationship.
Associations of Physical Activity with Performance‐Based and Self‐Reported Physical Functioning in Older Men: The Honolulu Heart Program
Authors: Young Deborah Rohm , Masaki Kamal H. , Curb J. David
Published: April 2015

OBJECTIVE: To examine the association of self‐reported physical activity with performance‐based and self‐reported physical functioning measured 3 to 5 years later.

DESIGN: A population‐based, longitudinal study.

SETTING: The island of Oahu, Hawaii.

PARTICIPANTS: Subjects were 3640 Japanese‐American men older than 70 years of age.

MEASUREMENTS: Estimated daily energy expenditure evaluated from self‐reported engagement in a variety of activities determined from a mail survey in 1988; physical functioning status determined from both self‐report and performance‐based measures 3 to 5 years later. The effect of physical activity on physical functioning scores was determined through multiple logistic regression and analysis of covariance techniques for subjects who had chronic diseases as well as those in a healthy subsample.

RESULTS: For the healthy subsample, those who were highly active in 1988 were more likely to have optimal function for the basic activities of daily living score (odds ratio 2.3; confidence interval (CI) 1.1 to 4.9), home management skills score (odds ratio 1.5; CI 1.1 to 2.1), and physical endurance‐type tasks score (odds ratio 1.7; CI 1.2 to 2.4) than subjects classified as low active. A significant linear trend was found additionally across physical activity level for time to walk 10 feet and grip strength (P values < .001). Similar results were found for subjects with chronic diseases; however, most of the benefit of physical activity for this subsample occurred for subjects who were at least physically active at a moderate level.

CONCLUSION: Engaging in physical activity is predictive of a high level of physical functioning in older men with and without chronic diseases. Participation in at least moderate physical activity may be sufficient to maintain
MODELS OF GERIATRIC PRACTICE: Progress Toward a Restraint‐Free Environment in a Large Academic Nursing Facility
Authors: Reuben David B. , Levine Jeffrey M. , Marchello Vincent , Totolos Elizabeth
Published: April 2015

OBJECTIVE: To review the implementation and evolution of a successful physical restraint reduction program in a large nursing facility.

INTERVENTION AND MEASUREMENTS: An initiative to reduce physical restraint began in March of 1990 with formation of a Restraint Review Committee (RRC), which developed and guided a program of inservice education, policy change, and procedural innovation. Progress was measured by monthly prevalence surveys of restraint use, both unit‐specific and facility‐wide.

PATIENTS AND SETTING: The study took place in an 816‐bed not‐for‐profit nursing facility with academic affiliation and closed medical staff. Mean age of residents was 85.5; 74% were female and 26% male.

RESULTS: Physical restraint prevalence in our facility was reduced from 39% to 4% over 3 years, with marked decrease in variation among nursing units. Prevalence initially decreased to 20% after policy modifications and inservice education programs. Further innovations in procedure and policy resulted in continued reduction of physical restraint to 4%. The facility‐wide rate of falls and accident‐related injuries did not change over the 3‐year period. Decrease in physical restraint was not accompanied by a change in the percentage of residents prescribed psychotropic medications such as benzodiazepines and neuroleptics.

CONCLUSIONS: In response to the mandate to provide a least‐restrictive environment, our institution has developed a successful system resulting in a dramatic reduction in physical restraint use. Changes in institutional culture and barriers to change are discussed, as well as issues of cost and generalizability. J Am Geriatr Soc 43:914–918, 1995.
Late Physical and Functional Effects of Osteoporotic Fracture in Women: The Rancho Bernardo Study
Authors: Greendale Gail A , Barrett‐Connor Elizabeth , Ingles Sue , Haile Robert
Published: April 2015

OBJECTIVE:To examine the associations between osteoporotic fractures and difficulty performing selected physical and functional activities.

DESIGN:Cross sectional analysis of a cohort study.

SETTING:Geographically defined cohort located in Rancho Bernardo, California.

PARTICIPANTS:Community‐dwelling women aged 55 and older who participated in a study of osteoporosis between 1988–1991. Eighty percent of eligible women participated in the study.

MAIN OUTCOME MEASURES:Self‐reported difficulty performing seven physical activities and four functional tasks.

RESULTS:The mean age of the 1010 women was 72.6 years. A total of 160 first minimal trauma fractures occurred between 1972 and 1991, including 62 wrist, 29 rib, 25 hip, and 23 spine fractures. The mean time since fracture was 6.7 years (range, 1 to 17 years). In multiply adjusted analyses, having experienced any osteoporotic fracture was significantly associated with a 1.7 to 3.0‐fold increase in difficulty bending, lifting, reaching, walking, climbing stairs, and descending stairs. Any fracture was significantly associated with 1.9 to 6.7 times more difficulty in dressing, cooking, shopping, and performing heavy housework. Compared with the relative odds of physical limitation associated with any osteoporotic fracture, hip fractures were more strongly associated with difficulty walking (OR 3.6) and descending stairs (OR 4.1), whereas spine fractures demonstrated a stronger association with difficulty bending (OR 3.1), lifting (OR 3.4), and descending stairs (OR 4.2).

CONCLUSIONS:Among older women, remote osteoporotic fracture at any site is associated with an approximate doubling of the risk of physical limitations and an even higher risk of functional limitations. Although this cross‐sectional analysis cannot secure the direction of the association, the specificity of the effect of particular fractures on discrete activities supports causality.
Comparing the Performance of Health Status Measures for Healthy Older Adults
Authors: Andresen Elena M. , Patrick Donald L. , Carter William B. , Malmgren Judith A.
Published: April 2015

OBJECTIVES: The specific goals of the study were to compare three health status measures among older adults for their correlations with similar scales and to examine whether extreme (positive) health states might lead to measurement problems. We also report on practical administration and response problems among older adults.

DESIGN: Eligible and randomly selected health plan enrollees aged 65 and older were sent a baseline survey about their health. A random sample of persons who returned this survey was recruited to participate in the comparative study. Additional questionnaires were completed by mail and telephone interviews. Measures were repeated at a 1‐year follow‐up mailing.

SETTING: This study was conducted at Group Health Cooperative (GHC) of Puget Sound, a large prepaid health maintenance organization.

PARTICIPANTS: Subjects were 200 of the 283 older adults selected (68.2% response). Mean age was 72.5 years.

MEASUREMENTS: The primary measures were the Sickness Impact Profile (SIP), the Quality of Well‐being Scale (QWB), and three scales of the Medical Outcomes Study Short‐Form 36 (SF‐36). Also included were a stress scale, the Positive Affect Scale, and the Chronic Disease Score (CDS) computed from the automated pharmacy data.

RESULTS: SIP scores showed a very strong skew toward low (good health) scores with a mean of 3.4% (±SD 4.4). The QWB scores ranged from .50 to .90 (mean .73 ± .09). For the MOS SF‐36 scales, scores of 100 (good health) were common for both of the physical health scales but not for general health. Analyses showed the SIP, QWB, and MOS SF‐36 scales were moderately to strongly correlated with similar measurement scales and with the independent measure of chronic disease and psychosocial health. Scales repeated at 1 year were highly correlated: intraclass correlation coefficients between baseline and 1 year ranged from an r = .51 to .73.

CONCLUSIONS: Our results suggest that the SIP is not a useful tool for rating healthy, community‐dwelling older adults. Two MOS SF‐36 measures used in this study showed some tendency for “ceiling” measurement effects. The QWB demonstrated an acceptable distribution of scale scores; however, it is the most complex of the three measures to administer. Among the broad range of older adults, no one tool appears to apply to every situation.
Heart Failure with Normal Systolic Function: A Common Disorder in Older People
Authors: Tresch Donald D. , McGough Martin F.
Published: April 2015

OBJECTIVE: To review the incidence, pathophysiology, significance, diagnosis, and treatment of heart failure with normal systolic function in older patients

DATA SOURCE: Scientific reports of diastolic ventricular dysfunction in both the general population and the geriatric population were identified from repeated searches of the MEDLINE database and citations from appropriate articles.

STUDY SELECTION: Studies were included only if they demonstrated proper methodology, were from a reputable source, and were published in a peer‐reviewed journal.

DATA EXTRACTION AND SYNTHESIS: Relevant data were obtained from the articles, with special importance placed on studies designed to examine older patients exclusively or as part of a subgroup in a larger study. Emphasis was placed on data pertaining to the pathophysiology, prognosis, and diagnosis of patients with diastolic dysfunction compared with normals and patients with systolic dysfunction as an etiology of heart failure. Therapeutic interventions were selected for the presence of prospective data with concrete end points such as mortality, functional class, exercise capacity, and regression of left ventricular hypertrophy.

CONCLUSION: Diastolic ventricular dysfunction is a significant problem in older people, with at least 40% of older heart failure patients having diastolic dysfunction as the etiology of their heart failure. The pathophysiology of diastolic dysfunction is varied but usually involves impaired left ventricular relaxation and/or increased ventricular stiffness, each partially related to normal aging changes, as well as underlying cardiovascular diseases. The significance of heart failure caused by diastolic dysfunction is great, with increased morbidity and mortality compared with other cardiac diseases that have the same preserved systolic function. Diagnosis of diastolic dysfunction can be clinically difficult and often requires further testing to determine if diastolic dysfunction is present. At this time, no therapy specifically treats diastolic dysfunction, but several medications, such as diuretics, calcium channel blockers, beta blockers, and angiotension‐converting enzyme inhibitors, offer symptomatic relief and may prevent progression of the disorder.
The Impact of Nursing Home Transfer Policies At the End of Life on a Public Acute Care Hospital
Authors: Smith Wally R. , Kellerman Arthur , Brown James S.
Published: April 2015

OBJECTIVES: To determine whether nursing homes transferred their terminal care patients to one public hospital, and if so, the impact of these transfers on nursing home and hospital mortality rates.

DESIGN: A retrospective cohort study using both Medicare claims and hospital data to construct a mortality prediction model, as well as a cross‐sectional descriptive comparison of state nursing home mortality rates.

SETTING: A public hospital, one of 32 hospitals designated as overall mortality outliers for each of the first three Medicare mortality reports.

PARTICIPANTS: Patients (n = 1235) included in the index hospital's 1988 Medicare mortality report; nursing homes (n = 289) included in state data on 1988 nursing home mortality rates.

MEASUREMENTS AND RESULTS: Patients transferred from nursing homes to the index hospital were nearly twice as likely to die as the hospital's other Medicare patients in univariate (P = .0001) as well as multivariate analysis (OR = 1.68, 95% CI = 1.17–2.40). Terminal care admissions accounted for 33.9% of deaths from nursing homes but only 16.2% of other deaths (P = .009). The 1988 death/discharge rate at one of two nursing homes responsible for nearly all transfers was 15.2%, less than half the state average. Yet it contributed 59.3% of nursing home deaths and 22.7% of terminal care patients to the hospital. The hospital's 20.0% 1988 Medicare mortality rate was just above the expected range.

CONCLUSIONS: Two nursing homes transferred terminal care to a single hospital. This resulted in a lower‐than‐average mortality rate for one of the nursing homes and a higher‐than‐expected Medicare mortality for the hospital. Without these end‐of‐life transfers, the hospital's Medicare mortality rate would have been within the expected range.
Involuntary Weight Loss in Older Outpatients: Incidence and Clinical Significance
Authors: Wallace Jeffrey I. , Schwartz Robert S. , LaCroix Andrea Z. , Uhlmann Richard F. , Pearlman Robert A.
Published: April 2015

OBJECTIVES: To describe the incidence, anthropometric parameters, and clinical significance of weight loss in older outpatients.

DESIGN: Four‐year prospective cohort study.

SETTING: University‐affiliated Veterans Affairs Medical Center.

PATIENTS: Two hundred forty‐seven community‐dwelling male veterans 65 years of age or older.

MEASUREMENTS: Anthropometrics (weight, height, skinfolds, and circumferences), health status measures (Sickness Impact Profile scores, health care utilization, self‐reported ratings of health), and bloodwork (cholesterol, albumin, others) were obtained at baseline and followed annually for 2 years. Outcome measures (hospitalization, nursing home placement, and mortality rates) were followed for a minimum of 2 years after any identified weight change.

MAIN RESULTS: The mean annual percentage weight change for the study population was −0.5% (SD: ± 4.0%; range: −17% to +25%). Four percent annual weight loss was determined to be the optimal cutpoint for defining clinically important involuntary weight loss using ROC curve analysis. The annual incidence of this degree of involuntary weight loss was 13.1%. At baseline, involuntary weight losers were similar to nonweight losers in age (73.9 ± 7.9 vs 73.3 ± 6.7 years), body mass index (26.8 ± 3.9 vs 26.9 ± 4.1 kg/m2), and all other anthropometric, health status, and laboratory measures. Relative to nonweight losers, involuntary weight losers had significantly (P ≤ .05) greater decrements in central skinfold and circumference measures (subscapular skinfolds, −2.9 vs −0.4 mm; suprailiac skinfolds, −4.2 vs −0.2 mm; and waist to hip ratio, −.01 vs + .00). Both groups had significant decreases in their triceps skinfolds (an estimate of peripheral subcutaneous fat), whereas arm muscle area and albumin levels did not decline significantly in either group. Over a 2‐year follow‐up period, mortality rates were substantially higher (RR = 2.43; 95% CI = 1.34–4.41) among involuntary weight losers (28%) than among nonweight losers (11%). Of interest, a similar increase in 2‐year mortality (36%) was also observed among subjects with voluntary weight loss (by dieting). Survival analyses adjusting for differences between weight losers and nonweight losers in baseline age, BMI, tobacco use, and other health status and laboratory measures yielded similar results.

CONCLUSIONS: These results indicate that involuntary weight loss occurred frequently (13.1% annual incidence) in this population of older veteran outpatients. When involuntary weight loss occurred, the predominant anthropometric changes were decrements in measures of centrally distributed fat (trunkal skinfolds and circumferences). Finally, involuntary weight loss greater than 4% of body weight appears to be clinically important as an independent predictor of increased mortality.
Drug Utilization in the Old Old and How it Relates to Self‐Perceived Health and All‐Cause Mortality: Results from the Bronx Aging Study
Authors: Hershman Dawn L. , Simonoff Paul A. , Frishman William H. , Paston Francine , Aronson Miriam K.
Published: April 2015

OBJECTIVE: To characterize medication use in a “well” very old population and relate the quantity and type of medication use to 10‐year mortality.

DESIGN AND SUBJECTS: A longitudinal, 10‐year, follow‐up study involving 488 healthy, community‐dwelling volunteers aged 75 to 85 years. The subjects underwent a detailed baseline evaluation and annual assessments that included comprehensive physical exams, laboratory and diagnostic tests, and related interviews. Prescription and nonprescription drug use was determined by self report, confirmation through hospital records, and reports by subjects and significant others.

RESULTS: At study baseline, the mean number of prescription and nonprescription medications used was 2.3 and 1.5, respectively. Female subjects (n = 315), those older than 80 years, or those who reported themselves to be in fair or poor health on initial health self‐report were found to show significantly increased use of prescription medications. The most commonly used classes of medications were cardiovascular drugs and analgesics. Subjects who were consuming a greater number of prescription and nonprescription medications did not have higher mortality rates. After correcting for differences in cardiovascular health status between users and nonusers, only digoxin approached significance as an independent predictor of death (P < .08).

CONCLUSION: This study confirmed that medication use in an ambulatory, old old population is not excessive. The oldest subjects in the cohort consumed more medications than did the younger subjects. Women used more prescription drugs than men. Increased medication use was associated with worse ratings on health self report. Medication use alone, however, was not a predictor of 10‐year mortality in this population. Questions are raised about the inappropriate prescription of digoxin in older subjects.
Predictive Validity of a Questionnaire That Identifies Older Persons at Risk for Hospital Admission
Authors: Pacala James T. , Boult Chad , Boult Lisa
Published: April 2015

OBJECTIVE: To determine the predictive validity of a mailed questionnaire designed to measure older adults' risk of repeated hospitalization.

DESIGN: Prospective cohort study.

SETTING: Ramsey County, Minnesota.

PARTICIPANTS: Medicaid recipients aged 70 and older who completed the questionnaire.

MEASUREMENTS: Responses were used to calculate the subjects' probability of repeated admission (Pra) to hospitals within 4 years. Subjects were classified as low‐risk (Pra < 0.5) or high risk (Pra ≥ 0.5). One year later, Medicaid claims data were analyzed to determine the subjects' actual use of hospitals.

RESULTS: One‐fifth of the respondents (20.6%) were classified as high‐risk at baseline. During the following year, the high‐risk subjects used hospitals at approximately twice the rate of the low‐risk subjects (4.5 vs 2.4 days/person‐year, P = .009).

CONCLUSIONS: The instrument, which was previously found to be valid in a national sample of Medicare beneficiaries, appears to be valid also in a local sample of Medicaid beneficiaries. Older adults at risk of heavy hospital use can be identified prospectively through their responses to this brief, mailed, self‐administered questionnaire. The instrument may be useful in targeting older persons for interventions designed to prevent the need for hospital care.
ADL Dependence and Medical Conditions in Chinese Older Persons: A Population‐Based Survey in Shanghai, China
Authors: Chen Peijun , Yu Elena S.H. , Zhang Mingyuan , Liu William T. , Hill Robert , Katzman Robert
Published: April 2015

OBJECTIVE: To describe the prevalence of activities of daily living (ADL) dependence and medical conditions and the relationship between illnesses and ADL performance in the older population of Shanghai, China.

DESIGN: Probability sample survey of community residents.

SETTING: The Jing An district of Shanghai, China. The interviews were carried out at the homes of the older persons.

PARTICIPANTS: There were 3763 noninstitutionalized elders screened, 3745 of whom completed the interview.

MEASUREMENTS: The dependent variables were the five basic ADL items: eating, dressing, transferring, toileting, and bathing. The independent variables were dementia and 19 self‐reported medical conditions, along with age, gender and education level.

MAIN RESULTS: Of those in Shanghai aged 65 and older, 8.28% (6.52% of males, 9.17% of females) were functionally dependent in one or more ADLs. The most prevalent self‐reported illness was cardiovascular disease, including hypertension (29.12%) and heart disease (26.65%). ADL performance was associated with dementia and a number of medical conditions in univariate analysis. The best predictors of functional dependence in both age groups (65–74 years; 75 years and older), based on the multiple logistic regression analysis and after controlling for age, gender, and education, were stroke, dementia, Parkinson's disease, diabetes, and emphysema

CONCLUSIONS: The authors have successfully applied five ADL items selected and culturally adapted from Older Americans Resources and Services to the study of older Chinese. A consistent and reliable estimate of functional dependence among older persons is obtained. The prevalence of dementia and many self‐reported illness, as well as the ADL status by medical condition, are reported. The findings reveal certain patterns of relationship between illness conditions and ADL performance. J Am Geriatr Soc 43:378–383, 1995.
Foot Pain and Disability in Older Persons: An Epidemiologic Survey
Authors: Benvenuti Francesco , Ferrucci Luigi , Guralnik Jack Michael , Gangemi Salvatore , Baroni Alberto
Published: April 2015

OBJECTIVE: To investigate the prevalence of foot pain in older people and its association with pathological conditions of the feet and with disability in basic and instrumental activities of daily living.

DESIGN: Cross‐sectional survey of a community‐dwelling older population.

PARTICIPANTS: A total of 459 subjects, 73% of the population aged 65 years and older living in Dicomano, Florence, Italy.

MEASUREMENTS: A standardized medical examination was performed by a geriatrician to collect information on the presence of pain, specific problems of the feet, gait, and several indicators of physical health status. Disability in basic and instrumental activities of daily living was evaluated by self‐report.

RESULTS: The prevalence of foot pain was very high, especially in subjects affected by calluses or corns, hallux deformities, hammer toes, pes planus, and edema and among those who complained of difficulty in looking after the basic needs of the feet. Patients with foot pain needed a greater number of steps and longer time to walk the same distance. Foot pain was associated with a higher prevalence of disability in instrumental activities of daily living, particularly those related to standing and ambulation capacities, but it was not related to higher prevalence of disability in basic activities of daily living.

CONCLUSIONS: Foot pain is associated with specific conditions of the feet and disability in instrumental activities of daily living. Adequate assessment and treatment of foot problems may prevent foot pain and potentially reduce risk of disability. This hypothesis needs to be tested in longitudinal studies and specific intervention trials.
Cost of Pressure Ulcer Prevention in Long‐Term Care
Authors: Xakellis George C. , Frantz Rita , Lewis Anne
Published: April 2015

OBJECTIVE: To describe the total cost of pressure ulcer prevention, component costs of each intervention, and the relationship of costs to subjects' risk level.

DESIGN: 3‐month cohort trial.

SETTING: A 600‐bed, state‐supported, long‐term care facility.

PATIENTS: A total of 539 war veterans, 83% of whom were male; mean age was 73 years.

MAIN OUTCOME MEASURES: Cost to facility for using each of four preventive interventions: turning, pressure‐reducing mattresses, chair cushions, miscellaneous preventive devices.

RESULTS: Sixty‐eight percent of subjects received a preventive intervention. Total 3‐month facility cost of prevention was $132,114, and 97% of the cost was consumed by 30% of the subjects. Turning was the most expensive component, accounting for $99,567. The daily cost of turning for subjects who received it was $8.83 ± 1.66. Cost increased with subject risk level. Low cost devices were instituted for lower risk subjects, whereas high cost interventions (turning) were reserved for the highest risk subjects.

CONCLUSIONS: This long‐term care facility expended substantial resources on prevention, and most resources (97%) were expended on less than half (30%) of subjects. Turning was, by far, the most expensive intervention, and the nursing staff reserved it for highest risk subjects. Strategies that substitute moderately priced mattresses for frequent turning may decrease the cost of prevention, as long as mattress cost is less than the daily turning costs it replaces. Future research to define the optimum combinations of preventive interventions for patients of various risk levels is needed.
The Changing Epidemiology of Human Immunodeficiency Virus Infection in Older Persons
Authors: Gordon Steven M. , Thompson Sumner
Published: April 2015

OBJECTIVE: To describe the epidemiology of human immunodeficiency virus (HIV) infection diagnosed in persons aged 60 years and older at a large urban county hospital.

DESIGN: Retrospective chart review of patients, aged 60 years and older, diagnosed with HIV infection, among 6,493 patients identified with positive EIA‐HIV tests performed at Grady Memorial Hospital between January 1, 1985 and July 1, 1992.

RESULTS: A total of 32 HIV‐infected elderly patients, including 27 men and five women, with a mean age of 64.8 years (range, 60–83 years) were identified. Among the 27 men, HIV risk factors included: homosexual/bisexual (10 patients); injection drug users (IDU) (5); transfusion‐associated (2); heterosexual (2); eight patients had no HIV risk factor identified. Among the five women, only one had an identified risk factor (blood transfusion). HIV testing of 47% (15/32) elderly patients was performed after a diagnosis of an AIDS‐defining opportunistic infection. Among 24 elderly patients who presented to a physician with signs or symptoms of HIV infection, testing for HIV was often delayed (median 3.1 months, range: 1–10 months). Eleven patients underwent work‐ups to rule out a malignancy, and three patients were initially diagnosed with organic brain syndrome. Ten of the 32 patients (31%) had a history of syphilis, and 90% (19/21) of patients tested were found to be immune to hepatitis B.

CONCLUSION: The majority of HIV‐infected patients 60 years or older acquired their infection through sexual intercourse or IDU. The diagnosis of HIV infection in the elderly was usually not considered by clinicians until late in the course of infection, despite a high prevalence of prior sexually transmitted diseases (STDs). Our data indicate that clinicians who take care of elderly patients should do a complete sexual history and offer sexual education. HIV testing and counseling should be considered for all individuals with a history of recent STDs or reporting behaviors putting them at risk for HIV infection.
Measuring Physical Function in Community‐Dwelling Older Persons: A Comparison of Self‐Administered, Interviewer‐Administered, and Performance‐Based Measures
Authors: Reuben David B. , Valle Laura A. , Hays Ron D. , Siu Albert L.
Published: April 2015

PURPOSE: To compare two self‐administered, one interviewer‐administered, and one performance‐based measure of physical function in community‐based older persons.

METHODS: Eighty‐three subjects were recruited from meal sites, senior recreation centers, and senior housing units for a comprehensive geriatric assessment program. At the time of screening, study participants self‐administered the Functional Status Questionnaire (FSQ) and were administered the Katz Activities of Daily Living (ADL) and the Older Americans Resources and Services Instrumental Activities of Daily Living (OARS‐IADL) instruments by interview. Participants also completed the Physical Performance Test (PPT) and were given the Medical Outcomes Study SF‐36 to self‐administer on site or at home and return by mail.

RESULTS: All 83 subjects completed FSQ, Katz ADL, OARS‐IADL, and PPT; 72 returned SF‐36 forms. Correlations between the two self‐administered physical function measures (FSQ and SF‐36) were higher than between self‐administered and interviewer‐assessed (ADL and OARS‐IADL) or performance‐based (PPT) measures. When assessed for construct validity, the self‐administered, OARS, and PPT measures had comparable correlations with role limitations as a result of physical health problems, but relationships between physical functional status measures and other SF‐36 measures of health were inconsistent.

CONCLUSION: The relationships between commonly used self‐administered, interviewer‐administered, and performance‐based measures of physical function were inconsistent and weak, suggesting that these instruments are not measuring the same construct.
Acute Respiratory Illness in Older Community Residents
Authors: Hodder Sally L. , Ford Amasa B. , FitzGibbon Paula A. , Jones Paul K. , Kumar Mary Lou , Mortimer Edward A.
Published: April 2015

OBJECTIVE: To describe the 3‐year incidence of acute respiratory illness in a population of noninstitutionalized elderly persons.

DESIGN: Cohort analytic study with an observation period of 3 years.

SETTING: Large midwestern urban community.

SUBJECTS: 574 noninstitutionalized persons aged 65 years and older, of whom 349 were living independently, 110 were in congregate settings, and 115 were living independently and regularly caring for small children.

METHODS: Subjects were interviewed and examined by nurse practitioners at intake and every 4 months. Acute illness and convalescent visits were made when illnesses were reported by participants.

MAIN OUTCOME MEASURES: The incidence of acute respiratory illness was used to test the hypothesis that elderly persons taking care of children have the highest incidence, congregate‐dwellers intermediate incidence, and those living independently the lowest incidence.

RESULTS: The average incidence of acute respiratory illness was 2.5 per 100 person months, comparable to rates reported in the National Health Survey. The incidence of respiratory illness was significantly greater in subjects living in congregate settings or regularly caring for young children. Similarly, greater proportions of persons in the congregate and child‐care groups reported at least one episode of illness (P < .05). A more detailed analysis of exposure shows that acute respiratory illness was significantly more common in subjects who had contact with children (P < .05). This risk was definitely present during the months November through February, and probably also during July through October, but was not observed for March through June.

CONCLUSIONS: Elderly persons living in the community experience low rates of acute upper respiratory illness. Contact with children increases their risk of developing such illnesses during certain seasons of the year.
Acute Respiratory Tract Infection in Daycare Centers for Older Persons
Authors: Falsey Ann R. , McCann Robert M. , Hall William J. , Tanner Martin A. , Criddle Mary M. , Formica Maria A. , Irvine Carrie S. , Kolassa John E. , Barker William H. , Treanor John J.
Published: April 2015

OBJECTIVE: To evaluate the rate of specific pathogens and clinical syndromes associated with acute respiratory tract infections (ARTI) in frail older persons attending daycare.

DESIGN: Prospective descriptive study, without intervention.

SETTING: Two sites of a senior daycare program providing all‐inclusive care for the older persons in Rochester, New York.

PARTICIPANTS: Staff members and participants of the daycare.

MEASUREMENTS: Demographic, medical, and physical findings were collected from older subjects at baseline and while ill with respiratory illnesses. Nasopharyngeal specimens for viral and Chlamydia culture and sputum for bacterial culture were obtained from subjects when ill. Acute and convalescent sera were also collected with each illness and examined for viral, chlamydial, and mycoplasma infection.

MAIN RESULTS: One hundred sixty‐five illnesses were documented in 165 older daycare participants as well as 113 illnesses among 67 staff members during the 15‐month study. The rate of ARTI in the elderly group was 10.8 per 100 person months. The most common etiologies in both the staff and elderly participants were respiratory syncytial virus (RSV), Influenza A, and coronavirus. The etiologies of illnesses in the staff compared with those in elderly group were similar except that bacterial infections were significantly more common among the elderly (7% vs. 0, P = 0.05). Multiple pathogens were found to cocirculate within centers, and no clear outbreak of a predominant organism was noted. Cough and nasal congestion characterized most illnesses. The elderly experienced significantly more cough, dyspnea, and sputum production than did the staff. There were 10 hospitalizations related to respiratory infections and four deaths during the acute illness among the elderly group and none in staff.

CONCLUSIONS: Acute respiratory infections are a common occurrence in both the staff and participants of a senior daycare center and are the cause of substantial morbidity in frail older persons.
The Sessing Scale for Assessment of Pressure Ulcer Healing
Authors: Ferrell Bruce A. , Artinian Barbara M. , Sessing Daphne
Published: April 2015

OBJECTIVE: To describe a new observational scale, the Sessing scale, for measuring the progression of pressure ulcers.

CRITERION STANDARDS: Changes in Shea stage and the diameter of healing pressure ulcers.

SUBJECTS: A cohort of 84 nursing home residents with pressure ulcers.

RESULTS: There were strong relationships between changes in healing as measured by the Sessing Scale and those measured by the Shea Scale (Spearman's r = 0.90; P < .0001), and between changes in the Sessing scale compared with changes in ulcer diameter (Spearman's r = 0.64; P < .001). Test‐retest reliability was good (Kappa = 0.84) in a sample of 50 subjects.

CONCLUSION: The Sessing scale is a simple, easy to use, observational instrument with validity and reliability for the assessment of progression of pressure ulcers in a clinical or research setting. Findings indicate that the Sessing scale, with its description of granulation tissue, infection, drainage, necrosis, and eschar, measures an important domain of wound healing that is independent and perhaps as important to clinicians and researchers as either Shea stage or ulcer size.