bluuebunny/crossref_metadata_2025 huggingface dataset:
Influenza A Virus‐Specific Cytotoxic T Lymphocyte Activity Declines with Advancing Age
Authors: Powers Douglas C.
Published: April 2015

Objective: To investigate whether influenza A‐specific cytotoxic T lymphocyte (CTL) activity is reduced in elderly compared with younger adults.

Design: Case series comparing outcomes in young and elderly cohorts.

Setting: Saint Louis University Division of Geriatric Medicine.

Participants: Healthy adult outpatients and staff members aged <50 (young) or >65 (elderly) years.

Methods: Peripheral blood mononuclear cells were assayed for CTL activity by a 51chromium release assay following 1 week of in vitro stimulation with influenza A/PR/8/34 (H1N1) virus.

Measurements: Percent specific lysis of autologous and allogeneic influenza virus‐infected target cells.

Main Results: Specific lysis of autologous A/PR‐infected targets was significantly lower in elderly compared to young subjects (P < 0.01), and exceeded 10% in a significantly lower proportion of elderly compared with younger subjects (P < 0.05), but was not influenced by a history of vaccination within the preceding 12 months. Cytotoxic effectors were class I human leukocyte antigen (HLA)‐restricted and displayed heterosubtypic cross‐reactivity but were unable to lyse influenza B‐infected targets.

Conclusions: These results demonstrate an age‐related decline of influenza A virus‐specific CTL activity and suggest that CTL responses to inactivated virus vaccine are of short duration.
Rate of Progression and Prognostic Factors in Alzheimer's Disease: A Prospective Study
Authors: Lucca Ugo , Comelli Mario , Tettamanti Mauro , Tiraboschi Pietro , Spagnoli Alberto
Published: April 2015

Objective: To study rate of progression and correlates of cognitive and functional/behavioral deterioration in Alzheimer patients.

Design: A 1‐year multicenter prospective study.

Setting: Outpatients and inpatients at geriatric institutions.

Patients: Fifty‐six patients with a clinical diagnosis of Alzheimer's disease according to DSM‐III criteria of Primary Degenerative Dementia.

Main Outcome Measures: Blessed Dementia Scale (BDS) and Blessed Information‐Memory‐Concentration test (BIMC) measured at baseline, third, sixth, and twelfth month.

Results: The mean annual (±SD) rate of progression of our sample was 3.5 (±3.7) points on the BDS and 2.6 (±4.9) on the BIMC, with a wide range of variability. The level of cognitive impairment (BIMC score) at baseline predicted functional and behavioral deterioration: the better the initial BIMC score, the less the rate of negative change of BDS (r = 0.37, P = 0.006). Furthermore, the younger the patients at the disease onset, the faster the progression of cognitive impairment (r = 0.48, P = 0.0003), with men having a slower rate of progression (P = 0.004) than women.

Conclusions: The present study confirms previous findings showing a wide individual variability in rate of progression of cognitive and functional/behavioral impairment as assessed by BIMC and BDS. The cognitive profile may predict the clinical evolution better than the functional and behavioral status, with patients with an earlier onset and women having a faster deterioration.
The Geriatric “Medical and Public Health” Imperative Revisited
Authors: Siu Albert L. , Beers Mark H. , Morgenstem Hal
Published: April 2015

Attempts to reduce the future demand for institutional care through community services are likely to have limited success. For this reason, health professionals must focus on preventing or ameliorating functional decline in older persons. To focus attention on this aspect of the geriatric imperative, we use an epidemiologic model to estimate the potential impact of existing or potential medical and public health interventions that might decrease the incidence of functional decline. For at least three major causes (stroke, hip fracture, and incontinence) of disability, the potential exists for reducing the incidence and burden of functional disability by a number of mechanisms. For example, treating just half of adults age 65–74 with currently untreated diastolic or isolated systolic hypertension would reduce the incidence of stroke by 2.77% in this age group (or 1,500 fewer cases of stroke annually). The estimates presented indicate the need (1) to better implement those interventions that are known to be efficacious, and (2) to identify and to test new interventions for conditions contributing to functional impairment in the elderly.
Characteristics and Quality of Prescribing by Doctors Practicing in Nursing Homes
Authors: Beers Mark H. , Fingold Susan F. , Ouslander Joseph G. , Reuben David B. , Morgenstern Hal , Beck John C.
Published: April 2015

Objectives: To describe the professional characteristics of doctors practicing in nursing homes and to determine whether those characteristics correlate with quality of prescribing.

Design: A prospective, cohort study.

Participants: 306 physicians practicing in 12 nursing homes in greater Los Angeles.

Measurements: We surveyed doctors about their age, sex, education, credentials, and NH practice. We also determined medication orders for a 1‐month period and evaluated them using explicit criteria for appropriateness developed by an expert panel.

Results: We obtained data from 72% of MDs. Respondents had a mean age of 53 years (29–78) and were 94% male. Fifty‐seven percent trained in internal medicine, 20% graduated outside the US or Canada, 67% were board certified in their declared specialty, and 5% had a certificate of added qualification in geriatrics (CAQ). Sixteen percent spent >10% of their professional time in NHs, and 46% had NH practices that were >20% Medicaid; most did not consult psychiatrists when prescribing psychoactive drugs. Forty percent of residents had at least one inappropriate prescription. The characteristics of doctors associated with the best prescribing quartile were female sex, CAQ, no board certification, and frequent consultation with psychiatrists. The characteristics of doctors in the most inappropriate quartile were older age, graduation from medical school before 1965, graduation from US medical school, small NH practice, and infrequent consultation with psychiatrists.

Conclusions: Although the quality of prescribing in nursing homes is related to some physician characteristics, the relationships are not those most commonly stated.
Disposition of Intramuscular Cefonicid in Elderly Patients
Authors: Karki Shyam D. , Bentley David W. , Luzier Aileen , Taylor Charlene , Morse Gene D.
Published: April 2015

Objective: To examine the disposition of intramuscular (IM) cefonicid in elderly patients with bacterial pneumonia.

Design: Pharmacokinetic study.

Setting: A 620‐bed university‐affiliated long‐term care institution with its own 39‐bed acute care unit.

Patients: Nine consecutive elderly patients with bacterial pneumonia treated with IM cefonicid.

Measurements: Blood samples were collected on the seventh day of therapy over a 24‐hour period and analyzed by high performance liquid chromatography. Pharmacokinetic parameters (volume of distribution, half‐life, and clearance) and protein binding were calculated. Clinical outcome of IM cefonicid therapy was also noted.

Results: The estimated creatinine clearance (Clcr) ranged from 32 to 145 mL/min. Peak cefonicid serum concentrations occurred at 0.5–1.5 hours, with a mean value of 118 ± 41 μ/mL. Cefonicid concentrations declined monoexponentially to 57 ± 16 μg/mL at 12 hours and 28 ± 14 μg/mL at 24 hours. The mean apparent distribution volume was 0.2 ± 0.07 L/kg, and the mean apparent total clearance was 15 ± 12 mL/min. The half‐life ranged from 3.1 to 38 hours. A linear correlation was noted between Clcr and cefonicid clearance (r = 0.99).

Conclusions: Cefonicid absorption was variable among these patients, and the serum half‐life was longer than previous values noted in younger patients with similar degree of renal dysfunction. Pharmacokinetic and clinical outcome data from our study group indicate the potential role of IM cefonicid in treating elderly patients with bacterial pneumonia.
The Effects of Thiazide Diuretics on Calcium Metabolism in the Aged
Authors: Perry Horace M. , Jensen Judy , Kaiser Fran E. , Horowitz Michael , Perry H. Mitchell , Morley John E.
Published: April 2015

Objective: To determine the effects of long‐term use of the thiazide diuretic chlorthalidone on serum bone‐related biochemical variables in older persons.

Design: Cross‐sectional comparison.

Setting: Community‐dwelling subjects who had participated in the Systolic Hypertension in the Elderly (SHEP) program.

Participants: Sixty‐six Caucasians (36 male and 30 female), age range 70 to 89 years, of whom 23 were taking a thiazide diuretic.

Measurements: 25‐hydroxyvitamin D (25OHD), parathyroid hormone, osteocalcin, calcitonin, and serum bioavailable testosterone.

Results: In both groups, there was a high prevalence of low 25 (OHD) levels (30%). Log 25OHD showed a significant inverse relationship to parathyroid hormone (r = .33, P < 0.05). Thiazide users had lower levels of osteocalcin (P < 0.05) and parathyroid hormone levels (P < 0.05) compared with non‐thiazide users. Male thiazide users had decreased bioavailable testosterone levels compared with non‐thiazide users (P < 0.05). Serum osteocalcin was significantly related to bioavailable testosterone in men not on thiazide (r = .43, P < 0.05).

Conclusions: Hypovitaminosis D is a common finding in older individuals with associated elevations in parathyroid hormone. Parathyroid hormone and testosterone concentration (in men) are correlated with serum osteocalcin, a measure of osteoblastic activity. Long‐term thiazide use alters these relationships and produces a biochemical profile suggestive of decreased bone formation. Reduced bioavailable testosterone may also play a role in these biochemical changes.
Serum Thyrotropin and Thyroid Hormone Levels in Elderly and Middle‐Aged Euthyroid Persons
Authors: Hershman Jerome M. , Pekary A. Eugene , Berg Loretta , Solomon David H. , Sawin Clark T.
Published: April 2015

Objective: To determine whether serum thyrotropin (TSH) levels are altered in euthyroid older persons compared with middle‐aged adults.

Design: Serum TSH and thyroid hormone levels were measured in a large group of older persons (>70 years old, n = 216) and their middle‐aged offspring (40–60 years old, n = 211) after excluding those with clinical or historical evidence of thyroid disease or abnormal thyroid function.

Measurements: Serum TSH, thyroxine (T4), free T4 index, estimated free T4, triiodothyronine (T3), estimated free T3, and ferritin levels were measured on the Abbott IMx instrument. Peroxidase and thyroglobulin antibodies were measured by radioimmunoassay using Kronus kits.

Main Results: Overall, serum TSH showed a log‐normal distribution. The geometric mean TSH (mU/L) and 95% confidence limits in the older persons, 1.24 (0.29–5.4), did not differ significantly from that in the middle‐aged, 1.45 (0.54–3.9). The mean TSH in the 264 women, 1.37 (0.34–5.5), was similar to that of the 163 men, 1.30 (0.48–3.5). The mean TSH in older women, 1.21 (0.22–6.6), was slightly but significantly lower than that in middle‐aged women, 1.52 (0.55–4.2). However, when euthyroid women with positive antibodies were excluded, this difference was not significant. Four of the 123 older women had TSH <0.1 mU/L, but none of the men or middle‐aged women had a suppressed serum TSH. The mean TSH in older men, 1.28 (0.43–3.8), was similar to that in middle‐aged men, 1.32 (0.55–3.2). Free T4 was slightly higher in older women than middle‐aged women. There were no significant correlations between TSH and any thyroid hormone level. Serum ferritin, measured as a potential marker for the action of thyroid hormone, did not correlate with any measure of thyroid function. At least one antibody level was >10 U/mL in 14.6% of older women, 15.6% of middle‐aged women, 4.3% of older men, and no middle‐aged men. When those with milder elevations of antibody levels were included (at least one level >1 U/mL), the prevalence was 32% of older women, 43.3% of middle‐aged women, 15% of older men, and 11.4% of middle‐aged men.

Conclusions: Euthyroid older persons have about the same levels of serum TSH as younger ones, although older euthyroid women have a slightly lower serum TSH than middle‐aged women. We recommend that the normal range of serum TSH in the elderly be considered to be the same as that in healthy middle‐aged subjects.
Poisoning in the Elderly: Characterization of Exposures Reported to a Poison Control Center
Authors: Kroner Beverly A. , Scott Robert B. , Waring Evelyn R. , Zanga Joseph R.
Published: April 2015

Objective: To determine the incidence of poison center calls involving the elderly, characterize these poisonings, and compare them with poisonings that occur in people younger than 60 years of age.

Design: Concurrent, observational survey.

Setting: The Virginia Poison Center in Richmond, Virginia.

Participants: All persons 60 years of age and older who were involved in a poison exposure reported to the Virginia Poison Center from October 1, 1991 through March 31, 1992.

Measurements: Incidence, type, route, location, management site, medical outcome of exposures and reasons for these exposures.

Results: Exposures in persons 60 years of age and older accounted for 2.3% of all poison center calls during the 6‐month study period. These calls were most likely to involve women who unintentionally ingested extra doses of medications. The majority of these exposures occurred in the home and resulted in either no effect or minor effects. For those exposures that necessitated an emergency room visit, elderly persons were more likely to be admitted to the hospital than younger persons (P < 0.05).

Conclusions: The majority of poisonings that occur in persons 60 years of age and older are unintentional and may be amenable to poison prevention education.
A Randomized, Controlled Trial of Outpatient Geriatric Evaluation and Management in a Large Public Hospital
Authors: Rubin Craig D. , Sizemore Mark T. , Loftis Paula A. , de Mola Nancy Loret
Published: April 2015

Objective: To study the effect of outpatient geriatric evaluation and management on physical function, mental status, and subjective well‐being.

Design: Prospective randomized controlled trial with a 1‐year study period.

Setting: Large medical school‐affiliated public hospital in an urban community.

Subjects: Patients at least 70 years old admitted to the medicine service were screened, randomized, and completed a 1‐year follow‐up interview.

Interventions: Comprehensive geriatric evaluation and an outpatient care management program.

Main Outcome Measures: Mental status (SPMSQ), ADL (Katz Index), IADL (Five‐Item OARS Scale), Life satisfaction (LSI‐Z), and self‐perception of health status (physical health section of OARS).

Results: No significant differences were found for cognitive status, ADL functioning, life satisfaction, nursing home placement, or mortality. The experimental patients reported significantly higher function in IADL and more favorable self‐perception of health status compared with controls.

Conclusion: Outpatient comprehensive geriatric evaluation and management appears to be a useful model for providing care to medically frail elderly patients.
Oral Disease and Physical Disability in Community‐Dwelling Older Persons
Authors: Jette Alan M. , Feldman Henry A. , Douglass Chester
Published: April 2015

Objective: The aim of this epidemiologic investigation was to determine whether poor oral health in older persons was associated with physical disability.

Design: The study was a cross‐sectional survey involving in‐home interviews and dental examinations of older persons.

Setting: A random sample of 68 cities and towns was selected from the six New England states, with stratification according to population size.

Participants: The study sample consisted of 1,156 community‐dwelling (non‐institutionalized) individuals aged 70 and over, randomly selected from the Medicare beneficiary lists for each city and town.

Measurements: Oral health was assessed by three dichotomous indices: edentulism (no teeth); current caries, including either coronal or root decay; and periodontal disease, as measured by gingival pocket depth. Physical disability was indicated by the subject's self‐report of difficulty in the areas of personal care (eating, bathing, dressing, and using the toilet) and mobility (walking, bed transfer, getting outside), Additional independent variables included age, sex, number of teeth, education, living alone, oral hygiene practices, and time since last dental visit.

Results: We found a direct association between specific areas of physical disability and current caries and edentulism. The risk of poor oral health did not increase with advancing age once the related risk factors were controlled for. Those subjects with mobility disabilities were at increased risk of tooth loss; those with personal care limitations were at increased risk of current caries.

Conclusions: Physical disability should be added to the list of known risk factors for oral disease among the older population. Our findings call attention to the need for health care providers to screen for oral health problems among disabled older persons. Further gerontologic research is needed to identify the mechanisms linking physical disability with oral disease in older persons.
Metabolic and Behavioral Covariates of High‐Density Lipoprotein Cholesterol and Triglyceride Concentrations in Postmenopausal Women
Authors: Laws Ami , King Abby C. , Haskell Williain L. , MD Gerald M. Reaven
Published: April 2015

Objective: To determine predictors of high‐density lipoprotein cholesterol (HDL) and triglyceride (TG) concentrations in postmenopausal women.

Design: Cross‐sectional study.

Setting: Clinical research facility.

Participants: One hundred twenty‐seven healthy, relatively sedentary, postmenopausal women not on estrogen replacement, mean age 57 years.

Measurements: Alcohol intake, cigarette smoking, aerobic fitness (VO2max), body mass index (BMI), percent body fat, waist‐hip ratio, lipids and lipoproteins, fasting plasma glucose (FPG), and insulin (FPI) concentrations.

Results: In univariate analyses, HDL was significantly (P < 0.05) inversely related to BMI, waist‐hip ratio, smoking, FPG, and FPI, and directly related to VO2max and alcohpl intake. Triglycerides were related directly to BMI, waist‐hip ratio, percent body fat, FPG, and FPI, and inversely to VO2max. In stepwise multiple regressions, BMI, waist‐hip ratio, alcohol, smoking, and FPG were significantly associated with HDL (R2 for the model = 0.43). Addition of TG to these models reduced relations of BMI and waist‐hip ratio, but not the other variables, to insignificance. For triglycerides, waist‐hip ratio, alcohol, smoking, FPG, and FPI were significant predictors (R2 = 0.33). VO2max and percent body fat did not contribute to any model.

Conclusions: Obesity, abdominal obesity, smoking, alcohol intake, and measures of carbohydrate metabolism predict HDL and triglyceride concentrations in postmenopausal women.
Physical Activity and Serum Lipids and Lipoproteins in Elderly Women
Authors: Nieman David C. , Warren Beverly J. , O'Donnell Kelley A. , Dotson Ruth G. , Butterworth Diane E. , Henson Dru A.
Published: April 2015

Objective: The relationship between cardiorespiratory exercise and serum lipid and lipoprotein levels was studied in elderly women.

Design: Randomized controlled experimental design with a follow up of 12 weeks; cross‐sectional comparison at baseline.

Setting: Community‐living elders in university exercise facilities.

Participants: Thirty‐two apparently healthy, sedentary elderly Caucasian women, 67 to 85 years of age. Ten highly conditioned elderly women, 65 to 84 years of age, who were active in endurance competitions and had been training for 11.2 ±: 1.2 years, were recruited at baseline for cross‐sectional comparisons.

Interventions: Sedentary subjects were randomized to either a walking or calisthenic group. Intervention groups exercised 30 to 40 minutes, 5 days a week for 12 weeks, with the walking group training at 60% heart rate reserve and the calisthenic group engaging in mild range‐of‐motion and flexibility movements that kept their heart rates close to resting levels.

Measurements: Serum lipids and lipoproteins, maximal aerobic capacity (V̇O2 max), four skinfolds, and dietary intake at baseline and after 5 and 12 weeks.

Results: When the highly conditioned group and combined group of sedentary subjects were compared at baseline, serum high‐density lipoprotein cholesterol (HDL‐C; 1.61 ± 0.14 vs 1.27 ± 0.05 mmol/L, respectively; P = 0.048) and triglycerides (1.29 ± 0.15 vs 2.00 ± 0.15, respectively; P = 0.002), but not total serum cholesterol (5.72 ± 0.36 vs 5.72 ± 0.19 mmol/L, respectively) and low‐density lipoprotein cholesterol (LDL‐C; 3.62 ± 0.36 vs 3.72 ± 0.18 mmol/L, respectively), were significantly different. Twelve weeks of moderate cardiorespiratory exercise improved the VO2max of the sedentary subjects 12.6% but did not result in any change in body weight, energy intake, dietary quality, or any of the serum lipids or lipoproteins.

Conclusion: Highly conditioned and lean elderly women, when compared with their sedentary counterparts, had higher HDL‐C and lower triglycerides, but similar total serum cholesterol and LDL‐C values. However, twelve weeks of moderate cardiorespiratory exercise were not associated with an improvement in serum lipid or lipoprotein profiles in previously sedentary elderly women.
Left Ventricular Diastolic Filling in Elderly Hypertensive Patients
Authors: MD Antonio Nicolino , MD Nicola Ferrara , MD Giancarlo Longobardi , MD Domenico Acanfora , MD Carlo Rengo , MD Franco Rengo
Published: April 2015

Objective: To evaluate the effects of mild to moderate hypertension and of LVH on diastolic filling and other Doppler indices in the elderly.

Design: Survey with a control group.

Subjects: Seventy‐one hypertensives (34 men, 37 women) referred for echocardiograms and 32 age‐ and sex‐matched normotensive volunteers. Thirty‐six of the hypertensives had LVH; 34 did not.

Setting: Echocardiography laboratory.

Measurements: M‐mode, two‐dimensional, and pulsed Doppler echocardiograms. A wide variety of Doppler‐derived indices of diastolic function were assessed.

Results: All Doppler derived indices of left ventricular diastolic filling (peak E, peak A, their ratio, EF slope, time‐velocity integrals, atrial filling fraction, and isovolumic relaxation time) were similar among the three groups.

Conclusion: Elderly mild to moderate hypertensives with or without LVH have LV diastolic filling that is normal for age. The identification of pathological diastolic dysfunction requires comparison to age‐matched controls, since aging, a major factor influencing diastolic filling, can mask the effect of hypertension.
Discussions about Limiting Treatment in a Geriatric Clinic
Authors: Goold Susan Dorr , Arnold Robert M. , Siminoff Laura A.
Published: April 2015

Objective: Obtain detailed information about the frequency and content of discussions about withholding treatment between doctors and elderly outpatients.

Design: Survey.

Setting: Primary care geriatric clinic at an urban university.

Participants: Twelve physicians and one nurse practitioner completed questionnaires for 185/198 (93.4%) patient visits.

Measurements: Questionnaires were completed by physicians after each patient visit during August 1989. Interviews were conducted with physicians who had discussed limiting life‐sustaining treatment with patients.

Results: Ten percent (n = 19) of patients seen had had discussions with their physicians about life‐sustaining treatment. These patients were older and had worse prognoses as estimated by their physicians. Physicians usually raised the issue with the families of demented patients and mentioned dementia, quality of life, prognosis, and the need to make other clinical decisions as motivation for initiating discussions. The majority of patients with poor prognoses, however, had not had discussions about life support.

Conclusions: Despite increasing attention given to end‐of‐life decisions in the medical and lay press, discussions with elderly outpatients about limiting treatment occur rarely. They are more likely when patients are older or have worse prognoses, but age, prognosis, and poor quality of life do not consistently lead physicians to raise the issue.
Seniors' Program for Injury Control and Education
Authors: Hornbrook Mark C. , Stevens Victor J. , Wingfield Darlene J.
Published: April 2015

The Seniors' Program for Injury Control and Education (SPICE) examines the effects of exercise and physical fitness on falls and related injuries among older persons. The design is a two‐group, randomized trial with 2 years of follow‐up. The study is at Northwest Region of Kaiser Permanente (NWKP), a large hospital‐based prepaid group practice HMO in Portland, OR. The participants are 1,323 community‐living persons 65 years or older who are enrolled in NWKP and are at moderate risk of falling. A multifaceted intervention strategy uses a group approach to falls and injury prevention which includes moderate intensity endurance‐building exercise (walking), strength and balance training, home safety improvements, and mental practice. Sessions of 20–25 participants are led by two nurses. Participants set their own realistic goals for exercising to accommodate to differing functional abilities and baseline conditioning. The control group receives usual care from the HMO. Participants report all falls for 2 years after randomization. Outcome measures include health status, physical functioning, falls, and fall‐related medical care use and cost. If SPICE is effective, cost‐effectiveness analysis will examine the relative efficiency of SPICE versus other successful FICSIT interventions. Thus far, recruitment and intervention compliance goals have been met from a population of frail elderly HMO members.
Training Balance and Strength in the Elderly to Improve Function
Authors: Wolfson L. , Whipple R. , Judge J. , Amerman P. , Derby C. , King M.
Published: April 2015

Short‐term exposure to altered sensory input or destabilizing platform movement results in significant improvement in sway control and inhibition of inappropriate motor responses, resulting in improved balance during repetitive testing. In addition, there is recent evidence that strength and function can be increased in both active and frail elderly who participate in strength training programs. Therefore, the hypotheses to be tested are that (1) balance training alone, or (2) strength training alone will each be capable of significantly improving balance, gait, and functional mobility, and that (3) a combined program of balance and strength training will be more effective than either approach alone. These hypotheses will be tested relative to a control group, using a 2 times 2 design (30 subjects per group), in a community‐dwelling elderly at least 75 years of age. Intervention sessions of at least 45 minutes will occur three times per week for 3 months, with 6 months of follow‐up, home‐based Tai Chi training. The primary outcome variable is a basic measure of functional balance, ie, the occurrence of loss of balance during tilts of the support and/or movement of the visual surround.
Acute Autonomic Responses to Postural Change, Valsalva Maneuver, and Paced Breathing in Older Type II Diabetic Men
Authors: Naliboff Bruce D. , Gilmore Stephanie L. , Rosenthal Mark J.
Published: April 2015

Purpose: To examine the effects of advanced age and diabetes on the response to standard tests of cardiovascular reflexes.

Desigin: Group comparison.

Setting: Psychophysiology laboratory, Department of Veterans Affairs Medical Center.

Patients: Sixteen elderly male (67–81 years old) non‐insulin dependent diabetic subjects without hypertension and nine elderly male (63–77 years old) controls.

Main Outcome Measures: Continuous (beat‐by‐beat) measures of heart rate, systolic blood pressure, diastolic blood pressure, and skin conductance were studied during tests of Valsalva maneuver, deep breathing, and postural change from sitting to standing.

Results: In comparison with elderly controls, the diabetic patients showed altered cardiovascular responses in measures of heart rate variability during Valsalva and standing. None of the subjects evidenced frank postural hypotension, but there was a greater fall in diastolic blood pressure immediately after standing for the diabetic patients compared with the controls. There was also a significant relationship between this response and decreased heart rate variability during Valsalva.

Conclusions: Older type II diabetic patients compared with healthy controls had mild cardiovascular abnormalities. These results parallel those of studies comparing younger diabetics and controls.
Reliability of Sampling Urine from Disposable Diapers in Elderly Incontinent Women
Authors: Belmin Joël , Hervias Yvonne , Avellano Eveline , Oudart Odette , Durand Isabelle
Published: April 2015

Objective: To assess the reliability for biochemical and microbiological analysis of urine collection from disposable diapers in elderly women with severe urinary incontinence.

Design: Cross‐sectional comparison of two methods of collection.

Patients and Measurements: Urine was sampled from 52 women inpatients (aged 68–98 years) in a geriatric hospital ward by pressing a diaper which the patient had worn for 3 hours. Just after this collection, another sample was obtained by retrograde catheterization. Both samples were analyzed for sodium, potassium, chloride, proteins, urea, creatinine, calcium, and phosphate and for cell counts, the presence of bacteria, and bacteria culture.

Results: For all the biochemical parameters, the urinary concentrations obtained by the two methods were strongly and significantly correlated. The following differences (mean and range, in mmol/L) were found between the values obtained by the two methods: sodium: 6.05 (−26 to 27), potassium: (−16 to 14), chloride: −1.13 (−24 to 23), urea: 6.85 (−33 to 37), creatinine: 0.24 (−0.95 to 1.45), calcium: −0.22 (−1.27 to 1.70), and phosphate: 2.17 (−2.5 to 13.4). For diagnosis of urinary tract infection, agreement between the two methods was good (kappa = 0.84), and bacteriological agreement was obtained in 25 out of 28 cases (89%). However, for diagnosis of microscopic hematuria, agreement was poor (kappa = 0.50), probably due to the overestimation of the true urinary red cell count in the samples collected by catheterization.

Conclusion: For routine microbiological and biochemical analysis, urine extraction from disposable diapers is a simple and reasonably reliable method of sampling urine from elderly women with severe incontinence.
The Relationship between Age, Gender and Cognitive Performance in the Very Old: The Effect of Selective Survival
Authors: Perls Thomas T. , Morris John N. , Ooi Wee Lock , Lipsitz Lewis A.
Published: April 2015

Objective: To determine the prevalence of cognitive disability as a function of advanced age and gender in elderly nursing home and community‐dwelling populations. Since cognitive dysfunction is associated with increased mortality, we hypothesized that selective survival results in a decreased prevalence of cognitive disability in the oldest old.

Design: Cohort study. An analysis of 6‐month longitudinal data obtained from a national probability sample of older persons in 260 nursing homes (n= 1951) and 2‐year longitudinal data obtained from a sample of community‐dwelling older persons (n= 2947).

Measures: In the nursing home sample, the primary outcome measure was cognitive performance score. In the community sample, cognitive performance was determined using the results of three orientation questions and assessment of decision‐making ability. Cognitive performance and subsequent survival, controlling for various disease states and demographic factors, were examined in three age cohorts of men and women (ages 65–79, 80–89, 90–99).

Results: In the nursing home sample, the cognitive performance of very old men (≥90 years) was better than that of younger men (aged 80–89 years,P< 0.05) and very old women (age ≥90 years,P= 0.001). Among 80–89‐year‐olds with poor cognitive performance, the 6‐month mortality rate was higher in men than in women (38% vs 19%,P= 0.001). However, the mortality rates of men and women with good cognitive performance were not statistically different in any age group. Proportional‐hazards regression analysis demonstrated that poor cognitive performance remained a powerful predictor of death among men aged 80–89 years with a relative risk of 2.7 (95% C1, 1.19–3.17;P= 0.0006) after controlling for covariates. Results from the community sample lent support to our findings: within each age group, mortality rates for men and women with intact cognitive performance were not statistically different. However, in the two older age groups, the mortality rates of subjects with impaired cognitive performance were significantly greater for men than for women (P< 0.01 for both age groups).

Conclusions: Decreased cognitive performance is significantly associated with mortality among elderly men. Survival by men who have relatively intact cognitive function results in a population of oldest men, those aged 90–99 years, with cognitive performance scores better than younger men or similarly‐aged women. The same selective survival phenomenon was not observed among women. Thus, there may be less cognitive disability among very old men than previously expected.
Book Reviews
Authors: McCullough Laurence B.
Published: April 2015

The Erosion of Autonomy in Long‐Term Care. By Charles W. Lidz, Lynn Fischer, and Robert M. Arnold. Oxford, Oxford University Press, 1992. 195 + xiii pages. $37.95.
Cardiopulmonary Resuscitation in Elderly Patients Hospitalized In The 1990s: A Favorable Outcome
Authors: Tresch D. , Heudebert G. , Kutty K. , Ohlert J. , VanBeek K. , Masi A.
Published: April 2015

Objective: To compare the clinical characteristics and survival of elderly and younger hospitalized patients who sustain cardiac arrest and receive cardiopulmonary resuscitation (CPR) in the 1990's and to assess predictors of survival.

Design: Retrospective survey of cardiac arrest database and hospital charts, plus telephone follow‐up.

Setting: 450‐bed acute care teaching hospital.

Study Population: Seventy‐eight hospitalized patients 70 years or older and 73 hospitalized patients under 70 years of age.

Measurements: Survey of cardiac arrest data base, hospital charts, and telephonic follow‐up to allow (1) comparison of clinical characteristics, survival, and long‐term follow‐up between two age groups and (2) univariate and multivariate analysis of predictors of mortality.

Main Results: Pre‐arrest clinical characteristics were not significantly different between the age groups. Prior to arrest the majority of patients were functionally active, and over one‐third were hospitalized for acute coronary artery syndromes. In approximately 85% of the patients, the arrest was witnessed, and 70% of the patients had their cardiac rhythm monitored at onset of the arrest. Survival was not significantly different between the age groups; 26% of the total 151 patients were discharged. No significant difference was noted in pre‐post arrest functional status of survivors. Survival at 1, 2, and 3 years in elderly and younger survivors was 86% versus 80%, 76% versus 67%, and 71% versus 61%, respectively. Multivariate analysis identified the presence of coronary artery disease, admission systolic blood pressure, and functional level to be independent pre‐arrest predictors of mortality. At the time of the arrest, the initial cardiac rhythm and duration of CPR were found to be independent predictors of mortality.

Conclusions: Elderly patients hospitalized in the 1990's who receive CPR have outcomes similar to younger patients who receive CPR. The favorable outcome in the elderly patients may reflect patient selection: the majority of our patients were functionally active prior to hospitalization, without multiple serious illnesses; many were hospitalized for acute coronary artery syndromes; and, in most cases, the arrest was witnessed with the patient's cardiac rhythm monitored at onset of the arrest.
Stature Estimated from Knee Height in Elderly Japanese Americans
Authors: Myers Sally A. , Takiguchi Sharon , Yu Mihae
Published: April 2015

Objective: To validate the use of knee‐height‐to‐stature formulas established on Caucasian subjects to estimate height of Japanese‐Americans, ages 60 to 90 years.

Design: Survey by measurement of a convenience sample.

Subjects: Japanese‐American men and women patients, aged 60 years or older, at The Queen's Medical Center during March and April 1992.

Measurements: Each subject's height (without shoes) was measured in inches by standard height scale and then converted to centimeters. Each subject's knee height was measured using the tool and procedure described by Chumlea et al (Journal of the American Geriatrics Society 1985; 33:116–120).

Results: Statures of Japanese‐American men and women predicted by the regression models developed on the Hawaii sample were significantly different (P < 0.0001) from the heights predicted by the Caucasian regression model developed by Chumlea and associates (1985).

Conclusions: The statistical models specific to elderly Japanese Americans predicted more precise height approximation than models developed on Caucasians.
Alzheimer's Disease and Cumulative Exposure to Anesthesia: A Case‐Control Study
Authors: Bohnen Nicolaas I.L.J. , Warner Mark A. , Kokmen Emre , Beard C. Mary , Kurland Leonard T.
Published: April 2015

Objective: To evaluate prior exposure to general anesthesia as a potential risk factor for Alzheimer's disease (AD).

Design: A retrospective, population‐based, case‐control study.

Setting: The Rochester Epidemiology Resource.

Patients: Cases were all incident cases of AD from 1975 to 1984 who resided for 40 years or more in Olmsted County prior to the onset of their dementia (n = 252). One age‐ and gender‐matched control for each case was selected from all registrations for care at Mayo Clinic during the year of onset in the incident case. The case and control groups each had 252 individuals. Of these, 208 cases and 199 controls had at least one exposure to general anesthesia prior to the year of onset of dementia in the matched AD patient.

Measurements: The cumulative duration of anesthesia and the total number of general anesthetic exposures prior to the age of onset of dementia and the corresponding year in each matched control were ascertained.

Results: There was no significant difference in mean cumulative exposure (in minutes) to general anesthesia (patients vs controls: 188.4 vs 170.5 rninutes, ns). Neither exposure to six or more episodes of general anesthesia (OR = 1.44; 95% CI: 0.77–2.71) nor cumulative exposure to 600 minutes or more of general anesthesia (OR = 1.63; 95% CI: 0.53–5.04) were associated with a significantly increased risk of AD.

Conclusion: It is unlikely that multiple exposures to general anesthesia increase the risk of AD.
A Controlled Trial of Outpatient Geriatric Evaluation and Management
Authors: Boult Chad , Boult Lisa , Murphy Christine , Ebbitt Brenda , Luptak Marilyn , Kane Robert L.
Published: April 2015

Objective: To evaluate the effects of targeted outpatient geriatric evaluation and management (GEM).

Design: Controlled clinical trial. Elderly persons were identified as being at high risk for hospital admission on the basis of their responses to a short, mailed, self‐administered questionnaire. The high‐risk elders who chose to participate in the GEM program were compared to those who continued to receive usual care.

Setting: Outpatient GEM clinic at an urban university hospital.

Subjects: Elderly Medicaid recipients whose probability of repeated hospital admission (Pra) within 4 years was calculated as 40% or greater (Pra ≥ 0.40).

Main Outcome Measures: Mortality, use of institutional services, satisfaction.

Results: Of the 1210 persons who were sent questionnaires, 624 responded (response rate = 51.6%), of whom 154 (24.7%) were deemed to be a high risk for hospitalization. Of these, 43 received GEM (experimental subjects); 111 received usual care (controls). At baseline, the experimental and control groups' demographic and health‐related characteristics did not differ significantly. The average experimental subject was 76.5 years old, had 9.6 significant medical problems, and took 6.7 significant long‐term prescription medications. During the program's first 17 months of follow‐up, the experimental subjects had lower annual rates of mortality (2.9% vs 19.2%, P = 0.03) and emergency room use (0.6 vs 1.0 visits, P = 0.01) than did the controls. The experimental subjects also tended to use nursing homes, but not hospitals, at a lower rate than the controls. All of the experimental subjects rated the program as either excellent (81.0%) or good (19.0%); 100% said they would recommend it to others. Their established primary physicians rated the GEM services as appropriate and helpful.

Conclusion: Targeted outpatient GEM was associated with reduced mortality, reduced use of emergency rooms, and a trend toward reduced use of nursing homes.
Impact of Nutritional Status on Morbidity in a Population of Geriatric Rehabilitation Patients
Authors: Sullivan Dennis H. , Walls Robert C.
Published: April 2015

Objective: The primary objective was to confirm the results of a prior study that demonstrated a strong independent correlation between the severity of protein‐energy undernutrition and the risk of subsequent morbidity in a population of elderly rehabilitation patients. A second objective was to determine whether inadequate in‐hospital nutrient intake is a co‐contributor to the risk of subsequent morbidity.

Design: Cohort study.

Setting: Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital.

Patients: Three hundred fifty randomly selected admissions to the GRU, of whom 99% were male, and 75% were white. The average age of the study patients was 76 years.

Measurements: At admission, each patient completed a comprehensive medical, functional, neuro‐psychological, socioeconomic, and nutritional assessment. While remaining in the hospital, each subject was monitored on a daily basis for the development of complications. Complete calorie counts were obtained at least every other day, and the average pre‐complication daily nutrient intake was expressed as a percent of predicted requirements as determined using the Harris‐Benedict equation.

Results: Of the 96 variables evaluated, the strongest predictor of subsequent complications was the Katz Index of ADL score, followed by serum albumin, usual weight percent, number of prescription medications, presence of renal disease, individual income, the presence of decubiti, dysphagia, and mid‐arm muscle circumference. When all nine of these variables were included in the logistic regression analysis, the final model had a sensitivity of 70%, a specificity of 71%, and an overall predictive accuracy of 71%. When tested using the data from the previous study, the model differentiated the patients who developed a complication from those who had not at a sensitivity of 76.7, a specificity of 76.1, and an overall predictive accuracy of 76.3. There was no difference in the pre‐complication average daily nutrient intake between the complication and the no‐complication groups (79% vs 75% of predicted requirements, P > 0.2).

Conclusions: Protein‐energy undernutrition appears to be a strong independent risk factor for in‐hospital morbidity. However, in‐hospital nutrient intake may not be a significant determinant of risk.
Comparison of Clinical and Biomechanical Measures of Balance and Mobility in Elderly Nursing Home Residents
Authors: Thapa Purushottam B. , Gideon Patricia , Fought Randy L. , Kormicki Maciej , Ray Wayne A.
Published: April 2015

Objective: To compare biomechanics force platform measurements of postural sway with clinical measures of balance and mobility, in frail elderly residents of community nursing homes, in terms of feasibility, correlation with other known risk factors for falls, and intercorrelation with each other.

Design: Cross‐sectional study.

Setting: Twelve Tennessee community nursing homes.

Subjects: Of 1315 residents 360 (≥65) could stand independently (≥10 seconds). Of these eligible subjects, 303 (84%) provided informed consent and were assessed.

Measurements: The biomechanics force platform measurements were postural sway during quiet standing characterized as elliptical area and mean velocity. The clinical measures were functional reach, mobility maneuvers (adapted from Tinetti's Mobility Index), timed chair stands, and 10‐foot walk. Resident characteristics and function were also obtained.

Results: Balance measurements were obtained on most (100% for postural sway to 67% for chair stand) consenting residents and were reliable on test‐retest (intraclass correlation from .56 to .98). Performance in both groups of balance measures deteriorated with increasing musculoskeletal disability. Functional reach and mobility maneuvers correlated with height, and mobility maneuvers with depressive symptoms. Elliptical area correlated with mean velocity of postural sway (Pearson's r = 0.72; P < 0.001), and the clinical measures of balance (functional reach, mobility maneuvers, timed chair stands and walk) were modestly intercorrelated (r from 0.35 to 0.65; all P values ≤0.05). However, the biomechanical measures were not correlated with the clinical measures.

Conclusions: Standard measures of balance were obtained reliably from nursing home residents who could stand independently for ≥10 seconds. However, in this group, further research is needed to determine which measures best predict falls. Further research is also needed to identify predictors of falls in the majority of residents who were too frail to undergo these standard assessments.