bluuebunny/crossref_metadata_2025 huggingface dataset:
Fire Fatalities in Older People
Authors: McGwin Gerald , Chapman Victoria , Curtis Jonathan , Rousculp Matthew
Published: April 2015

OBJECTIVE: To compare the epidemiology of fire‐related fatalities among older, middle‐aged, and young people.

DESIGN: Retrospective case series.

SETTING: Alabama, 1992–1997.

PARTICIPANTS: All persons fatally injured in fire‐related incidents in the state of Alabama from 1992 to 1997.

MEASUREMENTS: The State Fire Marshal's Office provided both demographic and autopsy information about the victim. In addition, information regarding the nature and circumstances of the fire was also obtained.

RESULTS: Between 1992 and 1997, there were 674 fire‐related deaths in the state of Alabama. The fire‐related fatality rate was highest among older persons. The fatality rate was particularly high among older black people. The rate of fatal fires caused by heating devices was higher (15.0%) among older people compared with their young and middle‐aged counterparts (6.3% and 4.5%, respectively). Fatalities among older people were least likely (26.0%) to occur if smoke detectors were present, compared with deaths among young and middle‐aged persons (38.3% and 33.5%, respectively). There were fewer smoke detectors present in the fatal fires of older rural black adults and white adults (0.0% and 29.0%, respectively) compared with their urban counterparts (25.0% and 47.0%, respectively). Alcohol was not a factor in fatal fires involving older adults (29.0%) compared with those involving the young (52.0%) and middle‐aged adults (73.9%).

CONCLUSIONS: With the growth of the percentage of older people in the population, the problem of fire‐related deaths in this age group is likely to increase. Interventions focused on this age group are necessary for the state of Alabama to meet the National Health Objectives for the year 2000. J Am Geriatr Soc 47:1307–1311,1999,.
Low Plasma Insulin‐Like Growth Factor‐1 Concentrations Predict Worsening of Insulin‐Mediated Glucose Uptake in Older People
Authors: Paolisso Giuseppe , Tagliamonte Maria Rosaria , Rizzo Maria Rosaria , Carella Carlo , Gambardella Antonio , Barbieri Michelangela , Varricchio Michele
Published: April 2015

OBJECTIVE: The relationship among insulin action, advancing age, and insulin like growth factor‐1 (IGF‐1) is poorly understood. To gain further insight, the predictive role that low plasma IGF‐1 concentration may have on insulin‐ mediated glucose uptake in older persons was investigated.

DESIGN: The study was designed as a longitudinal, observational trial.

PARTICIPANTS: Fifty‐eight healthy aged (73.1 ± 9.4 years) subjects (31 males/27 females) were followed up for 12 months.

MEASUREMENTS: At baseline and at the end of the follow‐up, insulin‐mediated glucose uptake was assessed by eugly‐cemic glucose clamp and plasma total IGF‐1 and IGF‐binding protein 3 (IGF‐BP‐3) in each subject, and concentrations were determined.

RESULTS: At baseline, plasma IGF‐1 concentrations correlated with whole body glucose uptake (WBGD) (r = 0.39, P < .003), insulin‐stimulated glucose oxidation (GOX) (r = 0.35, P < .009), and non‐oxidative glucose metabolism (r = 0.37, P < .007). Such correlations were also independent of age, sex, body fat, and waist/hip ratio. Fasting plasma total IGF‐1 concentrations (84 ± 56 vs 63 ±44 fig/L, P < .040), plasma IGF‐1/IGF‐BP3 molar ratio (0.13 ±0.05 vs 0.10 ±0.03 P < .050), and WBGD (34.8 ±5.0 vs 23.1 ±4.6 /umol/kg × min, P < .010) were more elevated at baseline than at the end of the follow‐up. Low baseline fasting plasma IGF‐1 concentration (RR = 1.5, 95%CI = 1.3‐1.7) and plasma IGF‐l/IGFBP‐3 molar ratio (RR = 1.4, 95% CI = 1.3‐1.8) predicted a decline in WBGD. The predictive role of plasma IGF‐1 on age‐related decline in WBGD was independent of age, sex, body fat, waist/hip ratio, and degree of physical activity (model 1), or of fasting plasma free fatty acid and triglyceride concentrations, LDL/HDL ratio, and basal adjusted respiratory quotient (model 2). Finally, low plasma IGF‐1 concentration predicts a decline in WBGD independent of body fat, free fatty acids, waist/hip ratio, and basal adjusted respiratory quotient (model 3).

CONCLUSION: Our study demonstrates that fasting plasma IGF‐1 concentration may have a modulatory role on insulin action in older people. This finding might prompt an evaluation of the direct effect of IGF‐1 administration on insulin sensitivity in older adults. J Am Geriatr Soc 47:1312–1318, 1999.
The Power of Ageism on Physical Function of Older Persons: Reversibility of Age‐Related Gait Changes
Authors: Hausdorff Jeffrey M. , Levy Becca R. , Wei Jeanne Y.
Published: April 2015

OBJECTIVE: To test the hypothesis that age‐associated changes in physical function, particularly walking performance, are influenced by ageism and that the activation of positive stereotypes of aging can partially reverse these changes.

DESIGN: Randomized intervention study.

SETTING: General community.

PARTICIPANTS: Forty‐seven community‐dwelling men and women (63–82 years old) who walked independently and described themselves as healthy.

INTERVENTION: Thirty‐minute exposure to the subconscious reinforcement of either a positive or negative stereotype of aging while subjects played a computer game.

MEASUREMENTS: Pre‐ and post intervention measures of gait speed and percent swing time (the time spent with one foot in the air during walking). Health and psychosocial status were also evaluated.

RESULTS: Significant increases in walking speed (9% ± 2%; P < .001) and percent swing time (percent change: 1.1% ± 0.4%; P = .023) were observed in subjects who received reinforcement of positive stereotypes of aging. Gait speed and swing time did not change in those who received reinforcement of negative stereotypes of aging. The observed improvements in gait were related to the positive intervention, but were not related to age, gender, health status, or psychosocial status.

CONCLUSIONS: Stereotypes of aging apparently have a powerful impact on the gait of older persons. Interventions designed to enhance perceptions of old age may prove beneficial in helping to improve gait and functional independence among older persons. In the future, positive changes in society's view of aging may also help to reduce and prevent age‐related declines in function and the associated deleterious consequences. J Am Geriatr Soc 47:1346–1349, 1999.
Temporal Arteritis: A Clinical Approach
Authors: Lee Andrew G. , Brazis Paul W.
Published: April 2015

OBJECTIVE: To develop a clinical guide to the evaluation of temporal arteritis.

DESIGN: A Medline English‐language search of the literature from 1966 to 1998, including more than 300 articles about temporal arteritis, was performed to develop a guide to the evaluation of temporal arteritis.

RESULTS: A user‐friendly guide to the evaluation of temporal arteritis was developed based on the following criteria: (1) clinical suspicion, (2) laboratory testing, and (3) temporal artery biopsy.

CONCLUSION: A clinical guide to the evaluation of temporal arteritis may assist clinicians in the care of patients with this condition. J Am Geriatr Soc 47:1364–1370,1999.
The Efficacy of Ginkgo for Elderly People with Dementia and Age‐Associated Memory Impairment: New Results of a Randomized Clinical Trial
Authors: van Dongen Martien C.J.M. , van Rossum Erik , Kessels Alphons G.H. , Sielhorst Hilde J.G. , Knipschild Paul G.
Published: April 2015

OBJECTIVES: To evaluate the efficacy, the dose‐dependence, and the durability of the effect of the ginkgo biloba special extract EGb 761 (ginkgo) in older people with dementia or age‐associated memory impairment.

DESIGN: A 24‐week, randomized, double‐blind, placebo‐controlled, parallel‐group, multicenter trial.

SETTING: Homes for the elderly in the southern part of the Netherlands.

PARTICIPANTS: Older persons with dementia (either Alzheimer's dementia or vascular dementia; mild to moderate degree) or age‐associated memory impairment (AAMI). 214 Participants were recruited from 39 homes for the elderly.

INTERVENTION: The participants were allocated randomly to treatment with EGb 761 (2 tablets per day, total dosage either 240 (high dose) or 160 (usual dose) mg/day) or placebo (0 mg/d). The total intervention period was 24 weeks. After 12 weeks of treatment, the initial ginkgo users were randomized once again to either continued ginkgo treatment or placebo treatment. Initial placebo use was prolonged after 12 weeks.

MEASUREMENTS: Outcomes were assessed after 12 and 24 weeks of intervention. Outcome measures included neuropsychological testing (trail‐making speed (NAI‐ZVT‐G), digit memory span (NAI‐ZN‐G), and verbal learning (NAI‐WL)), clinical assessment (presence and severity of geriatric symptoms (SCAG), depressive mood (GDS), self‐perceived health and memory status (report marks)), and behavioral assessment (self‐reported level of instrumental daily life activities).

RESULTS: An intention‐to‐treat analysis showed no effect on each of the outcome measures for participants who were assigned to ginkgo (n = 79) compared with placebo (n = 44) for the entire 24‐week period. After 12 weeks of treatment, the combined high dose and usual dose ginkgo groups (n = 166) performed slightly better with regard to self‐reported activities of daily life but slightly worse with regard to self‐perceived health status compared with the placebo group (n = 48). No beneficial effects of a higher dose or a prolonged duration of ginkgo treatment were found. We could not detect any subgroup that benefited from ginkgo. Ginkgo use was also not associated with the occurrence of (serious) adverse events.

CONCLUSIONS: The results of our trial suggest that ginkgo is not effective as a treatment for older people with mild to moderate dementia or age‐associated memory impairment. Our results contrast sharply with those of previous ginkgo trials.
Dementia Diagnostic Guidelines: Methodologies, Results, and Implementation Costs
Authors: Beck Cornelia , Cody Marisue , Souder Elaine , Zhang Mingliang , Small Gary W.
Published: April 2015

OBJECTIVE: To facilitate the diagnostic process for dementia. Five guidelines and four consensus statements on specific diagnostic recommendations, specialist referral recommendations, and costs of recommended diagnostic procedures were compared and summarized.

DATA SOURCES AND SELECTION: A MEDLINE search from 1984 to 1999 and queries to experts yielded 14 guidelines and consensus statements that addressed the diagnosis of dementia. Only nine documents which had national or international scopes were reviewed.

METHODS: Comparisons were made on the specific diagnostic criteria for patient history, clinical examination, functional assessment, laboratory tests, neuroimaging, and other diagnostic tests, as well as specialist referral recommendations and costs for the recommended diagnostic procedures. The first three authors reviewed independently each document and completed a table on specific recommendations in each document. To settle disagreements about specific recommendations, they discussed them until they reached a consensus. To interpret the intent of vague statements, they used their best judgment.

RESULTS: The documents differed in content, recommendations, and development methodology. They were based on either expert opinion or scientific evidence, or both. Although the nine documents were nearly unanimous in several recommendations, including assessing the presenting problem, taking a medical history, conducting physical and neurological examinations, and assessing the patient's mental and cognitive status, considerable differences in recommendations were common. Such differences led to large differentials in the estimated costs (range, $190 to $2,001) for recommended diagnostic assessments.

CONCLUSIONS: A systematic approach to diagnostic recommendations for dementia may induce greater consistency among guidelines and consensus statements. The current approach leads to considerable variability in recommendations and estimated costs.
The Role of Routine Laboratory Studies and Neuroimaging in the Diagnosis of Dementia: A Clinicopathological Study
Authors: Massoud Fadi , Devi Gayatri , Moroney Joan T. , Stern Yaakov , Lawton Arlene , Bell Karen , Marder Karen , Mayeux Richard
Published: April 2015

OBJECTIVE: To determine the neuropathological diagnoses of longitudinally followed patients with potentially reversible causes of dementia and to examine the results of the “dementia work‐up,” especially neuroimaging, by comparison with the pathological diagnosis.

DESIGN: A neuropathologic series of 61 consecutive patients, with review of clinical, laboratory, neuroimaging, and pathological results.

RESULTS: Of the 61 patients, forty‐eight (79%) had a clinical diagnosis of probable or possible Alzheimer's disease (AD). Compared with the pathological diagnosis, the sensitivity and specificity of the clinical diagnosis of AD were 96% and 79%, respectively. Of the 61 patients, 9 had abnormal laboratory tests, the correction of which did not improve the subsequent course. These patients were found to have AD8 and frontotemporal dementia1 on pathology. In two patients, neuroimaging was helpful in the clinical diagnoses of frontotemporal dementia and progressive supranuclear palsy (PSP). Neuroimaging revealed cerebrovascular disease in 18 patients, only two of whom were suspected clinically. Pathology confirmed AD in 17 and PSP in 1 of these patients. Sensitivity and specificity for the clinical diagnosis of cerebrovascular disease in comparison with pathology were 6% and 98%, respectively. With the added information from neuroimaging, that sensitivity increased to 59% and specificity decreased to 81%.

CONCLUSIONS: All cases with abnormal laboratory or neuroimaging results had AD or some other neurodegenerative disease on pathology. The “dementia work‐up” did not reveal any reversible causes for dementia in this group of patients. Neuroimaging may have a role, especially in the diagnosis of possible AD with concomitant cerebrovascular disease.
Factors Related to Sleep Disturbance in Older Adults Experiencing Knee Pain or Knee Pain with Radiographic Evidence of Knee Osteoarthritis
Authors: Wilcox Sara , Brenes Gretchen A. , Levine Doug , Sevick Mary Ann , Shumaker Sally A. , Craven Timothy
Published: April 2015

OBJECTIVES: To describe the types and frequencies of sleep complaints and the biopsychosocial factors associated with sleep disturbance in a large community sample of older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis (OA).

DESIGN: Baseline analyses of an observational prospective study.

SETTING AND PARTICIPANTS: Participants were 429 men and women aged 65 years and older experiencing knee pain or knee pain with radiographic evidence of OA enrolled in the Observational Arthritis Study in Seniors (OASIS).

MEASUREMENTS: Demographic variables (age, gender, ethnicity, education), health (X‐rays of knee rated for OA severity, medical conditions, medication use, smoking status, body mass index, self‐rated health), physical functioning (self‐rated physical functioning, physical performance), knee pain, and psychosocial functioning (social support, depression) were measured.

RESULTS: Problems with sleep onset, sleep maintenance, and early morning awakenings occurred at least weekly among 31%, 81%, and 51% of participants, respectively. Bivariate correlates of greater sleep disturbance in those with OA were less education, cardiovascular disease, more arthritic joints, poorer self‐rated health, poorer physical functioning, poorer physical performance, knee pain, depression, and less social support. In regression analyses, each set of variables representing the domains of health, physical functioning, pain, and psychosocial functioning contributed to the prediction of sleep disturbance beyond the demographic set. Finally, in a simultaneous model, white race (trend, P = .06), poorer self‐rated health, poorer physical functioning, and depressive symptoms were predictive of sleep disturbance.

CONCLUSIONS: Sleep disturbance is common in older adults experiencing knee pain or knee pain with radiographic evidence of OA and is best understood through the consideration of demographic, physical health, physical functioning, pain, and psychosocial variables. Interventions that take into account the multidetermined nature of sleep disturbance in knee pain or knee OA are most likely to be successful.
Impact of Depressive Symptoms on Hospitalization Risk in Community‐Dwelling Older Persons
Authors: Huang Benjamin Y. , Cornoni‐Huntley Joan , Hays Judith C. , Huntley Robert R. , Galanos Anthony N. , Blazer Dan G.
Published: April 2015

OBJECTIVE: To determine whether depressive symptoms in older adults are associated with an increased risk for hospitalization.

DESIGN: A 6 month cohort study.

SETTING: Five counties in the northern Piedmont of North Carolina from the Duke University site of the Established Populations for Epidemiological Studies of the Elderly project.

PARTICIPANTS: The sample included 3486 community‐dwelling adults, aged 65 and older.

MEASUREMENTS: Crude risk ratios for the effect of depressive symptoms on 6 month risk for hospitalization were calculated, followed by a multivariable analysis controlling for demographics and health status.

RESULTS: Three hundred participants were hospitalized during the 6 month follow‐up period. The crude risk ratio for the effect of depressive symptoms on hospitalization was 1.95 (95% CI = 1.47–2.58). Subgroup analysis showed significant positive risk ratios for men aged 65 to 74 and ≥75, and women aged 65 to 74. After a multivariable analysis, however, these associations remained significant only among men ≥75 (RR = 3.43; 95% CI = 1.33–8.86).

CONCLUSIONS: Depressive symptoms were independently associated with a more than threefold increased risk for hospitalization among men aged ≥75. This result reflects differences in the effects of depressive symptoms across age and gender groups, and emphasizes that symptoms of depression influence overall health and medical utilization among, at the very least, the oldest subset of men.
Relationships Between Nutritional Markers and the Mini‐Nutritional Assessment in 155 Older Persons
Authors: Vellas Bruno , Guigoz Yves , Baumgartner Marcel , Garry Philip J. , Lauque Sylvie , Albarede Jean‐Louis
Published: April 2015

OBJECTIVE: To investigate the relationships between nutritional status measured by a comprehensive nutritional assessment including anthropometric measurements, nutritional biological markers, evaluation of dietary intake, and the Mini‐Nutritional Assessment (MNA) nutrition screening tool.

DESIGN: A prospective study.

PARTICIPANTS: One hundred fifty‐five older subjects (53 men and 102 women; mean age = 78 years; range = 56–97 years). These participants were hospitalized in a geriatric evaluation unit (n = 105) or free living in the community (n = 50).

MEASUREMENT: Weight, height, knee height, midarm and calf circumferences, triceps and subscapular skinfolds, albumin, transthyretin (prealbumin), transferrin, ceruloplasmin, C‐reactive protein, alpha1‐acid glycoprotein, cholesterol, vitamins A, D, E, B1, B2, B6, B12, folate, copper, zinc, a 3 day food record combined with a food‐frequency questionnaire; the MNA nutritional screening.

RESULTS: The MNA scores have been found to be significantly correlated to nutritional intake (P < .05 for energy, carbohydrates, fiber, calcium, vitamin D, iron, vitamin B6, and vitamin C), anthropometric and biological nutritional parameters (P < .001 for albumin, transthyretin, transferrin, cholesterol, retinol, alpha‐tocopherol, 25‐OH cholecalciferol zinc). An MNA score between 17 and 23.5 can identify those persons with mild malnutrition in which nutrition intervention may be effective.

CONCLUSIONS: The MNA is a practical, noninvasive, and cost‐effective instrument allowing for rapid nutritional evaluation and effective intervention in frail older persons.
Nonspecific Presentation of Pneumonia in Hospitalized Older People: Age Effect or Dementia?
Authors: Johnson Jerry C. , Jayadevappa Ravishankar , Baccash Patricia D. , Taylor Lynne
Published: April 2015

OBJECTIVES: Older adults, when presenting with pneumonia, are often thought to present with nonspecific symptoms instead of more suggestive symptom(s). However, studies designed to determine whether age is associated with nonspecific presentations have yielded contradictory results. Many studies have not distinguished between the effects of preexisting cognitive impairment that results from dementia and the effects of age. The aim of this study is to determine whether there are significant differences in the presentation of pneumonia in demented versus nondemented patients across two age groups. We hypothesized that the nonspecific presentation of pneumonia in older people is due to dementia rather than to chronological age.

DESIGN: We compared retrospectively nonspecific (weakness, decreased appetite, urinary incontinence, falls, and delirium) and specific (cough, sputum production, dyspnea, and chest pain) symptoms of pneumonia in 148 hospitalized adult subjects from two urban, general medical teaching hospitals.

RESULTS: When the subjects with dementia were included in the analysis, two (falls and delirium) of the five nonspecific symptoms were associated with older age and one other symptom (weakness) showed a trend toward statistical significance. However, when we excluded the demented subjects, nonspecific presenting symptoms were similar in old and young adults with the exception of an increased frequency of delirium on presentation. Similarly, when demented subjects were excluded, we found a stronger association of younger age with the classic specific symptoms than were seen when the demented subjects were included.

CONCLUSIONS: We conclude that age differences in the presentation of pneumonia are largely due to the presence of dementia.
Nocturnal Polyuria in Older People: Pathophysiology and Clinical Implications
Authors: Miller Myron
Published: April 2015

OBJECTIVES: To review the physiological changes of aging which affect the systems involved in urine formation and to consider how these changes interact with changes in bladder function, thereby leading to the onset of nocturnal polyuria with associated urinary frequency, nocturia, and incontinence. Based on this information, data are presented on the effectiveness of pharmacological interventions which reduce the rate of urine formation and, thus, can be of benefit in reducing symptoms, especially during the nighttime.

METHODS: Peer‐reviewed journal articles were identified by MEDLINE Search and by review of the literature.

CONCLUSIONS: As a consequence of age‐associated diminished renal concentrating capacity, diminished sodium conserving ability, loss of the circadian rhythm of antidiuretic hormone secretion, decreased secretion of renin‐angiotensin‐aldosterone, and increased secretion of atrial natriuretic hormone, there is an age‐related alteration in the circadian rhythm of water excretion leading to increased nighttime urine production in older people. The interaction of nocturnal polyuria with age‐related diminution in functional bladder volume and detrusor instability results in the symptoms of urinary frequency, nocturia and, in some persons, incontinence. The additional impact of Alzheimer's disease on these physiological and aging changes, as well as on a diminished perception of bladder fullness, leads to an even greater risk of urinary incontinence in these patients. Treatment of nocturnal polyuria with the antidiuretic hormone analog, DDAVP (desmopressin), can result in decreased nocturnal urine production with improvement in symptoms of frequency, nocturia, and incontinence.
The Protective Effect of Social Engagement on Mortality in Long‐Term Care
Authors: Kiely Dan K. , Simon Samuel E. , Jones Richard N. , Morris John N.
Published: April 2015

OBJECTIVES: To examine the effect of social engagement (SE) on mortality in long‐term care.

DESIGN: A retrospective cohort study.

SETTING: A 725‐bed long‐term care facility.

PARTICIPANTS: A total of 927 long‐term care residents who had SE measurements and did not have a serious communication problem.

MEASUREMENTS: Minimum Data Set information including psychosocial items comprising an internally reliable and valid SE scale, and mortality risk factor measurements. Mortality data during the 1721‐day follow‐up period was obtained from facility records.

RESULTS: Life table analyses indicate that higher levels of SE are associated with longer survival (P = .0001). Unadjusted proportional hazards analyses show that residents who did not engage socially were 2.3 times more likely to die during the follow‐up period compared with residents who were the most socially engaged. Multivariate adjusted analyses showed the protective effect of SE on mortality remained even after simultaneously adjusting for mortality risk factors. Residents who did not engage socially were 1.4 times as likely to die during the follow‐up period compared with residents who were the most socially engaged.

CONCLUSIONS: Increased levels of SE were associated with longer survival independent of mortality risk factors. SE may be a modifiable risk factor for death among long‐term care residents. More research is needed to understand psychological factors that may influence residents' desire and ability to engage socially.
The Prognostic Value of Serum Albumin in Healthy Older Persons with Low and High Serum Interleukin‐6 (IL‐6) Levels
Authors: Reuben David B. , Ferrucc Luigi , Wallace Robert , Tracy Russell P. , Corti M. Chiara , Heimovitz Harley , Harris Tamara B.
Published: April 2015

OBJECTIVE: We sought to determine the prognostic value of serum albumin for 4‐year mortality among high‐functioning persons who did or did not have evidence of inflammation as indicated by high interleukin‐6 (IL‐6) levels.

DESIGN: We used a case‐cohort design of healthy, nondisabled older persons who had serum albumin and plasma IL‐6 measured at baseline. Crude and multiply adjusted (for sociodemographics and chronic diseases) proportional hazards models were used to identify the effect of baseline levels of serum albumin level on 4‐year mortality among those with higher and lower levels of IL‐6.

RESULTS: Among subjects without evidence of IL‐6‐mediated inflammation (IL‐6 < 3.20 pg/mL), having a lower (≤4.4 g/dL) albumin level was associated with a multiply adjusted relative risk of 2.1 for 4‐year mortality compared with those with higher albumin. In the presence of inflammation (IL‐6 ≥ 3.20 pg/mL), higher and lower serum albumin levels had similar risks (adjusted relative risks 4.0 and 3.8, respectively) compared with the referent group (higher albumin and low IL‐6).

CONCLUSIONS: High serum albumin has a protective effect in healthy older persons who do not have evidence of cytokine‐mediated inflammation. This protective effect is not conferred in presence of inflammation. The mechanisms by which inflammation eliminates the protective effect of high albumin remain to be determined.
Self‐Reported Walking Ability Predicts Functional Mobility Performance in Frail Older Adults
Authors: Alexander Neil B. , Guire Kenneth E. , Thelen Darryl G. , Ashton‐Miller James A. , Schultz Albert B. , Grunawalt Julie C. , Giordani Bruno
Published: April 2015

OBJECTIVE: To determine how self‐reported physical function relates to performance in each of three mobility domains: walking, stance maintenance, and rising from chairs.

DESIGN: Cross‐sectional analysis of older adults.

SETTING: University‐based laboratory and community‐based congregate housing facilities.

PARTICIPANTS: Two hundred twenty‐one older adults (mean age, 79.9 years; range, 60–102 years) without clinical evidence of dementia (mean Folstein Mini‐Mental State score, 28; range, 24–30).

INTERVENTION AND MAIN OUTCOME MEASURES: We compared the responses of these older adults on a questionnaire battery used by the Established Populations for the Epidemiologic Study of the Elderly (EPESE) project, to performance on mobility tasks of graded difficulty. Responses to the EPESE battery included: (1) whether assistance was required to perform seven Katz activities of daily living (ADL) items, specifically with walking and transferring; (2) three Rosow‐Breslau items, including the ability to walk up stairs and walk a half mile; and (3) five Nagi items, including difficulty stooping, reaching, and lifting objects. The performance measures included the ability to perform, and time taken to perform, tasks in three summary score domains: (1) walking (“Walking,” seven tasks, including walking with an assistive device, turning, stair climbing, tandem walking); (2) stance maintenance (“Stance,” six tasks, including unipedal, bipedal, tandem, and maximum lean); and (3) chair rise (“Chair Rise,” six tasks, including rising from a variety of seat heights with and without the use of hands for assistance).

A total score combines scores in each Walking, Stance, and Chair Rise domain. We also analyzed how cognitive/behavioral factors such as depression and self‐efficacy related to the residuals from the self‐report and performance‐based ANOVA models.

RESULTS: Rosow‐Breslau items have the strongest relationship with the three performance domains, Walking, Stance, and Chair Rise (eta‐squared ranging from 0.21 to 0.44). These three performance domains are as strongly related to one Katz ADL item, walking (eta‐squared ranging from 0.15 to 0.33) as all of the Katz ADL items combined (eta‐squared ranging from 0.21 to 0.35). Tests of problem solving and psychomotor speed, the Trails A and Trails B tests, are significantly correlated with the residuals from the self‐report and performance‐based ANOVA models.

CONCLUSIONS: Compared with the rest of the EPESE self‐report items, self‐report items related to walking (such as Katz walking and Rosow‐Breslau items) are better predictors of functional mobility performance on tasks involving walking, stance maintenance, and rising from chairs. Compared with other self‐report items, self‐reported walking ability may be the best predictor of overall functional mobility.
Assessment of Adherence to Renal Dosing Guidelines in Long‐Term Care Facilities
Authors: Papaioannou Alexandra , Clarke Jo‐Anne , Campbell Glenda , Bédard Michel
Published: April 2015

OBJECTIVE: We determined whether dosing guidelines based on creatinine clearance (Ccr) for renally excreted drugs are being applied when prescribing to long‐term care residents

DESIGN: A cross sectional chart review for the month of May 1999.

PARTICIPANTS: Long‐term care residents more than 65 years of age from four long‐term care facilities in Southern Ontario who were prescribed a medication from a list of renally excreted drugs commonly prescribed in long‐term care facilities.

RESULTS: Approximately one in three prescriptions (34.1%) were considered inappropriate for the calculated Ccr of the residents. Overall, 42.3% of the residents who were prescribed a drug under review received at least one inappropriate prescription based on creatinine clearance. Logistic regression found that age (odds ratio (OR) = 1.06 per year; 95% confidence interval (CI) 1.03–1.09, P = .001), weight (OR = 0.96 per kg; 95% CI 0.94–0.98, P < .001), the total number of prescribed medications (OR = 1.10; 95% CI 1.04–1.17, P = .001), and the number of physicians prescribing in the facility (OR 1.02; 95% CI, 1.003–1.044, P = .03) were predictive for receiving an inappropriate prescription based on Ccr.

CONCLUSIONS: Renal function is often overlooked when prescribing renally excreted drugs to older long‐term care residents. These findings emphasize the need for consideration of Ccr when prescribing such drugs in this population.
Relationship Between Low Blood Pressure and Depressive Symptomatology in Older People
Authors: Stroup‐Benham Christine A. , Markides Kyriakos S. , Black Sandra A. , Goodwin James S.
Published: April 2015

OBJECTIVES: To determine if low blood pressure is associated with a definable constellation of somatic and psychological symptoms in older persons.

DESIGN: A population‐based study.

SETTING: In‐home interviews in five southwestern states.

PARTICIPANTS: A total of 2723 Mexican Americans aged 65 or older not living in institutions.

MEASURES: Blood pressure, Center for Epidemiologic Studies Depression Scale (CES‐D), global self‐rating of health, and self‐esteem.

RESULTS: Bivariate analyses indicate a significant relationship between low blood pressure and increased depressive symptomatology; for example, systolic hypotensive subjects scored a CES‐D mean of 12.07 ± .67 compared to 8.99 ± .95 for normotensives (P < .01). Regression analyses supported these findings when controlling for confounders such as gender, age, and use of antihypertensive medications. Subjects with low blood pressure also scored lower on self‐esteem and global self‐reported health and reported more days waking up feeling tired.

CONCLUSIONS: These data support the existence of a relationship between low blood pressure and higher levels of depressive symptomatology as well as a constellation of somatic and psychosocial symptoms. J Am Geriatr Soc 48: 250–255, 2000.
Coronary Artery Calcification in Older Adults with Minimal Clinical or Subclinical Cardiovascular Disease
Authors: MD Anne B. Newman , Naydeck Barbara , Sutton‐Tyrrell Kim , Edmundowicz Daniel , Gottdiener John , Kuller Lewis H.
Published: April 2015

BACKGROUND: Coronary artery calcification (CAC) reflects the extent of coronary artery atherosclerosis. The extent of coronary artery calcification is not well described in older adults.

OBJECTIVE: To determine the extent of CAC in older adults participating in a large population study of cardiovascular disease (CVD), especially those characterized as having minimal clinical or subclinical cardiovascular disease.

DESIGN: An observational epidemiologic study.

POPULATION: Participants in the Cardiovascular Health Study Cohort, mean age 78 years, who had electron beam computed tomography (EBT) scan of the heart (n = 133); included were 106 persons with no prior evidence of clinical or subclinical CVD.

MEASUREMENTS: Total CAC score was measured using cardiac EBT. Cardiovascular disease and risk factors, as well as carotid ultrasound, electrocardiogram, echocardiogram, and ankle‐arm index, had been measured previously to define subclinical disease. Previous cerebral magnetic resonance imaging was also evaluated.

RESULTS: Overall, the CAC scores were higher in those with clinical cardiovascular disease or evidence of subclinical cardiovascular disease than in those with no evidence of disease. For the 106 participants without evidence of clinical or subclinical disease, the median score was 176, compared with 367 in those with subclinical disease and 923 in those with clinical CVD. Seventeen persons had scores of zero. There was little difference in risk factors across quartiles of CAC in the subgroup of 106 with prior characterization of minimal CVD despite the broad range of CAC scores. There was a higher proportion of those with white matter grade ≥2 by magnetic resonance imaging among those with higher CAC scores (P = .025). Infarct‐like lesions prevalence ranged from 12.5% in the lowest group to 47.1% in the highest CAC group (P = .019).

CONCLUSIONS: Older adults with evidence of clinical or subclinical CVD have higher total CAC scores. Though the extent of coronary artery calcification was lower in those with minimal evidence of CVD, the range was broad and not explained by CVD risk factors. J Am Geriatr Soc 48: 256–263, 2000.
Patterns of Care in the Early Stages of Alzheimer's Disease: Impediments to Timely Diagnosis
Authors: Knopman David , Donohue Jane A. , Gutterman Elane M.
Published: April 2015

OBJECTIVE: Description of factors associated with delay in diagnosis of Alzheimer's disease (AD).

DESIGN: A self‐administered mail questionnaire.

SETTING: Households including someone with AD identified through a nationwide marketing database.

PARTICIPANTS: A total of 1480 caregivers of patients diagnosed with AD

MEASUREMENTS: There were two measures of delay examined through caregiver reports: (1) duration in years from first AD signs until determination of a definite problem, and (2) duration from problem recognition to first physician consultation. Also, caregivers were categorized by time since patient's diagnosis and relationship to patient. Within‐group analyses examined the impact of these characteristics on delay measures.

RESULTS: Mean lag in years from observation of first symptoms to problem recognition for those diagnosed in the past 12 months, the past 13 to 48 months, and the past 49 months or more was, respectively, 1.20, 1.56, and 2.25 (P < .001). The timing of diagnosis also influenced lag from problem recognition to first physician consultation so that subgroups with recent, less recent, and distant diagnosis reported delays in years of .82, .84, and 1.31 (P < .001). Caregiver relationship was not significantly related to these lags. Correct diagnosis of AD was reported by caregivers in only 38% of cases at initial physician consultation.

CONCLUSIONS: These results suggest that both caregivers and physicians lack ready understanding of the difference between memory processes in aging and AD. Ongoing public and professional education is needed to convey the basics of the diagnosis of AD. In addition, routine screening for dementia should be considered to surmount attitudinal and logistical barriers. J Am Geriatr Soc 48: 300–304, 2000.
Hodgkin's Disease Survival by Stage and Age
Authors: Kennedy B.J. , Fremgen Amy M. , Menck Herman R.
Published: April 2015

OBJECTIVE: Prior reports on Hodgkin's disease have suggested a biologic behavior difference between young and old patients. A study of 35,033 patients could confirm that older patients do not do as well as young patients regardless of age.

METHODS: The National Cancer Data Base provided data from U.S. tumor registries on 35,033 patients newly diagnosed with Hodgkin's disease from 1985 through 1994. For analysis the patients were divided into two time periods, 1985–1989 and 1990–1994. The earlier period provided survival data to assess the impact of age and stage.

RESULTS: The overall disease‐specific, 5‐year survival rate for the 1985–1989 period was 84.9%. For stages I and II, it reached almost 90%. For both observed survival based on all deaths and disease‐specific survival, the duration of survival decreased with increasing age. This decrease with age occurred for all stages of the disease.

CONCLUSIONS: The data reflect the actual status of management of Hodgkin's disease in the United States rather than the best attainable results. The decreasing survival with increasing age and in all stages further supports the concept of a difference in biologic behavior of Hodgkin's disease associated with age. J Am Geriatr Soc 48: 315–317, 2000.
Exercise and Older Patients: Guidelines for the Clinician
Authors: Christmas Colleen , Andersen Ross A.
Published: April 2015

“If I'd known I was going to live this long, I'd have taken better care of myself.” Eubie Blake

Sedentary persons who improve their physical fitness are less likely to die of all causes and of cardiovascular disease than are those who remain sedentary. There now exists a wealth of data demonstrating that physical activity and exercise may ameliorate disease and delay decline in function in the geriatric population. We review evidence that exercise can improve body composition, diminish falls, increase strength, reduce depression, reduce arthritis pain, reduce risks for diabetes and coronary artery disease, and improve longevity. However, many healthcare professionals do not feel adequately prepared to design and prescribe exercise programs for their patients. This review provides a basic overview of the benefits of exercise in the geriatric population and guidelines indicating how to prescribe and facilitate adherence to an exercise program. Healthcare providers are strongly encouraged to promote a less sedentary life style for their older patients, which may augment quality of life in these older individuals. J Am Geriatr Soc 48: 318–324, 2000.
Interdisciplinary Geriatric Primary Care Evaluation and Management: Two‐Year Outcomes
Authors: Burns Robert , Nichols Linda O. , Martindale‐Adams Jennifer , Graney Marshall J.
Published: April 2015

BACKGROUND: The long‐term efficacy of interdisciplinary outpatient primary care Geriatric Evaluation and Management (GEM) has not been proven. This article focuses on results obtained during the 2 years of the study.

METHODS: In this 2‐year randomized clinical trial, at the Veterans Affairs Medical Center, Memphis, TN, 128 veterans, age 65 years and older, were randomized to outpatient GEM or usual care (UC). Two‐year follow‐up analyses are based on the 98 surviving individuals. Study outcome measurements included health status, function, and quality of life including affect, cognition, and mortality.

RESULTS: At 2 years, there were positive intervention effects for eight of 11 outcome measures, five of which had attained significance at 1 year. GEM subjects, compared with UC subjects, had significantly greater improvement in health perception (P = .001), smaller increases in numbers of clinic visits (P = .019) and instrumental activities of daily living (IADL) impairments (P = .006), improved social activity (P < .001), greater improvement in Center for Epidemiologic Studies‐Depression (CES‐D) scores (P = .003), general well‐being (P = .001), life satisfaction (P < .001), and Mini‐Mental State Exam (MMSE) scores (P = .025). There were no significant treatment effects in activities of daily living (ADL) scores (P = .386), number of hospitalizations (P = .377), or mortality (P = .155).

CONCLUSIONS: These findings suggest that a primary care approach that combines an initial interdisciplinary comprehensive assessment with long‐term, interdisciplinary outpatient management may improve outcomes for targeted older adults significantly. Findings suggest further that outcomes may continue to improve over time and that the GEM care model provides an effective way to manage health care of older adults. J Am Geriatr Soc 48: 8–13, 2000.
The Influence of Patient Age on Primary Care Resident Physician‐Patient Interaction
Authors: Callahan Edward J. , Bertakis Klea D. , Azari Rahman , Robbins John A. , Helms L. Jay , Chang Dong W.
Published: April 2015

OBJECTIVES: To explore resident physician‐patient interaction in primary care to address issues relevant to quality of care for older people.

DESIGN: A sample of 509 new, adult, nonpregnant patients was assigned to the care of second‐ and third‐year residents in primary care clinics. Care was compared for three subgroups of patients: older patients (65 years or older; n = 45), those aged 18 to 44 years (n = 320), and those aged 45 to 64 years (n = 144).

SETTING: Observations were made at the family medicine and general internal medicine clinics at the University of California, Davis.

MEASUREMENTS: Self‐report by means of the Medical Outcomes Study Short Form‐36 (MOS SF‐36) was used to determine patient demographics and patient health status. Two measures of satisfaction were obtained gauging reaction to medical care in general and to the videotaped visit specifically. Videotapes were coded for content using the Davis Observation Code.

RESULTS: Self‐reported health status of older persons was poorer than that of younger groups as measured by the MOS SF‐36. Differences in demographics were explored and then controlled, along with physical health status in subsequent analyses. Supporting prior studies, this study found that older patients had more return visits and reported higher levels of satisfaction than did younger comparison groups. Contrary to prior literature, older patients were found to have longer visits than did younger cohorts. The physician‐patient interaction was significantly different in many areas between these three groups. Whereas older patients experienced more chatting in their visits, they were given less counseling, asked fewer questions, had less discussion about their families and their use of substances, were asked to change their health behavior habits less often, and were given less health education. For older patients, more of each visit was spent checking on compliance with earlier treatment and developing treatment plans.

CONCLUSIONS: These results provide a new and more detailed view of how resident physician‐patient interaction differs between older and younger groups and raise important issues on whether quality of care needs for this population are being adequately addressed, particularly regarding mental health issues. J Am Geriatr Soc 48: 30–35, 2000.
Measures of Postural Stability Are Not Predictors of Recovery from Large Postural Disturbances in Healthy Older Adults
Authors: Owings Tammy M. , Pavol Michael J. , Foley Kevin T. , Grabiner Mark D.
Published: April 2015

OBJECTIVES: To determine, in healthy older adults, the relationship between postural steadiness, stability limits, and the ability to recover balance from three postural disturbances requiring anteriorly directed stepping responses.

DESIGN: Analysis of multiple motor tasks in a cross‐sectional sample of healthy older adults.

SETTING: A biomechanics research laboratory.

PARTICIPANTS: Fifty women and 29 men aged 65 or older, all healthy, living in the community, participated in this study. Subjects were examined by a geriatrician to identify the presence of exclusionary factors.

MEASUREMENTS: Anterior‐posterior and medial‐lateral excursion distances of the center of pressure during quiet standing (postural steadiness), static leaning (static stability limits), and dynamic swaying (dynamic stability limits) were determined from ground reaction forces measured by a strain gauge forceplate. Within the same group of subjects, the maximum angle of forward lean from which a subject could recover with a single step, the ability to recover balance in response to an accelerated support surface, and the ability to recover balance after being tripped were determined.

RESULTS: Recovery from the three types of postural disturbances were found to be statistically independent. The postural steadiness and the stability limit variables were only weakly correlated. Postural steadiness and stability limits were not related to the maximum recoverable angle of lean. The average medial‐lateral center of pressure speed during the postural steadiness test was significantly slower for those who failed to recover after tripping than for the subjects who recovered successfully. However, a logistic regression model failed to achieve statistical significance, suggesting that the difference may not be functionally important. The anterior‐posterior static stability limits were significantly larger for subjects who recovered successfully than for those who failed to recover during the accelerated support surface test. Although logistic regression suggested that a reduced anterior‐posterior stability limit represents a risk factor for failure to recover during this task, only nine of 28 failures could be properly classified, thus diminishing the functional importance of this finding.

CONCLUSIONS: Because recovery following postural disturbances could not generally be predicted from measures of postural stability, these findings suggest that these measures of postural stability are of limited utility in identifying potential anteriorly directed fallers in healthy older adults. J Am Geriatr Soc 48: 42–50, 2000.