bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cognitive Reserve and Postoperative Delirium in Older Adults
Authors: Tow Amanda , Holtzer Roee , Wang Cuiling , Sharan Alok , Kim Sun Jin , Gladstein Aharon , Blum Yossef , Verghese Joe 
Published: June 2016

ObjectivesTo examine the role of cognitive reserve in reducing delirium incidence and severity in older adults undergoing surgery.DesignProspective cohort study.SettingHospital.ParticipantsOlder adults (mean age 71.2, 65% women) undergoing elective orthopedic surgery (N = 142).MeasurementsIncidence (Confusion Assessment Method) and severity (Memorial Delirium Assessment Scale) of postoperative delirium were the primary outcomes. Predictors included early‐ (literacy) and late‐life (cognitive activities) proxies for cognitive reserve.ResultsForty‐five participants (32%) developed delirium. Greater participation in cognitive activity was associated with lower incidence (odds ratio = 0.92 corresponding to increase of 1 activity per week, 95% confidence interval (CI) = 0.86–0.98, P = .006) and severity (B = −0.06, 95% CI = −0.11 to −0.01, P = .02) of delirium after adjustment for age, sex, medical illnesses, and baseline cognition. Greater literacy was not associated with lower delirium incidence or severity. Of individual leisure activities, reading books, using electronic mail, singing, and computer games were associated with lower dementia incidence and severity.ConclusionGreater late‐life cognitive reserve was associated with lower delirium incidence and severity in older adults undergoing surgery. Interventions to enhance cognitive reserve by initiating or increasing participation in cognitive activities may be explored as a delirium prophylaxis strategy.
Validation of the interRAI Pressure Ulcer Risk Scale in Acute Care Hospitals
Authors: Xie Haiyan , Peel Nancye M. , Hirdes John P. , Poss Jeff W. , Gray Leonard C. 
Published: June 2016

ObjectivesTo validate the Pressure Ulcer Risk Scale (PURS) to screen for pressure ulcer (PU) outcomes in the acute hospital setting.DesignSecondary data analysis was undertaken using a combined dataset from three prospective cohort studies.SettingGeneral medical, surgical, and orthopedic wards in 11 hospitals in two states of Australia.ParticipantsIndividuals aged 70 and older admitted to the hospital for longer than 48 hours from July 2005 to May 2010 (N = 1418). Individuals in coronary or intensive care units, palliative care, or transferred out of the ward within 24 hours were excluded.MeasurementsTrained nurses used the international Resident Assessment Instrument (interRAI) Acute Care (AC) assessment tool to collect data at admission and discharge. Adverse outcomes were documented on daily ward visits. The PURS was calculated from interRAI items, and its association with PU outcomes was tested using the c‐statistic (area under the receiver operator characteristic curve).ResultsComplete data were available for 1,371 (96.7%) participants, 85 of whom (6.2%) had a PU at admission. Of the 1,286 without PUs at admission, 42 (3.3%) developed a new PU during their hospital stay. The association between PURS and outcomes had a c‐statistic of 0.81 (standard error (SE) 0.02) for prevalent ulcers at admission and 0.70 (SE 0.04) for incidence of new PUs.ConclusionWhen derived from the interRAI AC tool, the PURS demonstrated good to strong ability to screen for PU outcome in acute care. Assessment burden is reduced without loss of fidelity by integrating the risk scale into an existing assessment system.
Improving Prospective Memory in Healthy Older Adults and Individuals with Very Mild Alzheimer's Disease
Authors: Shelton Jill Talley , Lee Ji Hae , Scullin Michael K. , Rose Nathan S. , Rendell Peter G. , McDaniel Mark A. 
Published: June 2016

ObjectivesTo test the utility of a memory‐encoding strategy for improving prospective memory (PM), the ability to remember to execute future goals (e.g., remembering to take medications), which plays an important role in independent living in healthy older adults and those with very mild Alzheimer's disease (AD).DesignParticipants were randomly assigned to an encoding strategy condition or a standard encoding condition.SettingA longitudinal study conducted at an Alzheimer's disease research center. Testing took place at the center and in a university testing room.ParticipantsHealthy older adults (Clinical Dementia Rating (CDR) = 0.0, n = 38) and those classified as being in the very mild stage of AD (CDR = 0.5, n = 34).InterventionA simple strategy (“If I see Cue X, then I will perform Intention Y”) was used to strengthen PM encoding and reduce the probability of forgetting to execute one's future plans.MeasurementsPM was assessed using Virtual Week, a laboratory task that requires the simulation of common PM tasks (the types of tasks performed in everyday life), such as taking one's medication at breakfast.ResultsThe encoding strategy significantly reduced PM failures in healthy older adults and those with very mild AD and was effective regardless of the individual's episodic memory ability.ConclusionThis encoding strategy was successful in reducing PM errors in healthy older adults and those with mild AD with a range of memory abilities.
Prevalence and Incidence of Frailty in Community‐Dwelling Older People: Beijing Longitudinal Study of Aging II
Authors: Zheng Zheng , Guan Shaochen , Ding Hui , Wang Zhihui , Zhang Jin , Zhao Jing , Ma Jinghong , Chan Piu 
Published: June 2016

ObjectivesTo estimate the prevalence and incidence of frailty and evaluate the effect of frailty on adverse outcomes in Chinese elderly adults.DesignSecondary analysis of prospective cohort study.SettingCommunity in Beijing, China.ParticipantsIndividuals aged 55 and older (N = 10,039).MeasurementsA Frailty Index (FI) was derived from 34 items using Rockwood's cumulative deficits method. A FI of 0.25 or greater indicated frailty. The clinical outcome was evaluated using a composite variable of any of the following adverse events: falls, hospitalization, activity of daily living disability, and death.ResultsThe overall crude prevalence of frailty was 12.3% (95% confidence interval (CI) = 11.7–13.0%), and the standardized prevalence was 9.1% (95% CI = 8.6–9.7%). The crude incidence was 13.0% (95% CI = 12.2–13.9%), and the standardized incidence 10.8% (95% CI = 10.0–11.6%). Prevalence and incidence were significantly greater with age (P for trend < .001) and greater in women (P < .001) and urban residents (P < .001). Participants with lower education and having three or more diseases and taking four or more medications daily were more likely to develop frailty over follow‐up (all P < .05). After adjusting for age, number of diseases, and smoking at baseline, the risk of any adverse event in 1 year in the frail group was 58% higher than in the nonfrail group (adjusted odds ratio = 1.58, 95% CI = 1.30–1.93, P < .001).ConclusionA feasible FI that can be used in routine medical evaluation in a primary care setting was developed, and a 12.3% prevalence and a 13% incidence of frailty was demonstrated in community‐dwelling Chinese older adults. Frailty is more common for urban and female residents in the oldest old group. Being frail significantly predicts geriatric adverse outcomes, indicating the importance of early screening and intervention in frail individuals in primary care.
“If You Don't Know, All of a Sudden, They're Gone”: Caregiver Perspectives About Prognostic Communication for Disabled Elderly Adults
Authors: Cagle John G. , McClymont Keelan M. , Thai Julie N. , Smith Alexander K. 
Published: June 2016

ObjectivesTo describe preferences and experiences of caregivers of disabled older adults regarding being included in patient‐clinician discussions about life expectancy.DesignQualitative interview study.SettingCaregivers were recruited from a Program of All‐Inclusive Care for the Elderly (PACE), caregiver support groups and an advertisement on a nationwide caregiver advocacy group website.ParticipantsActive and bereaved caregivers whose primary language was either English or Cantonese who had provided care within the last 5 years to a disabled adult aged 65 and older (N = 42, 79% female, 60% white, average age 54).MeasurementsSemistructured telephone interviews were conducted with caregivers who were asked about experiences and preferences related to clinician communication about life expectancy, including preferences for and attitudes toward being included in discussions about life expectancy, how such information should be delivered, and how clinicians should address concerns about uncertainty and hope. Responses were analyzed qualitatively using constant comparison until thematic saturation was reached.ResultsTwenty‐six percent of caregivers had been involved in a conversation with a clinician about life expectancy, even though 79% expressed a preference to have such a discussion. According to caregivers, clinician concerns about taking away hope or the uncertainty of prognostic information should not deter them from bringing up the topic of life expectancy. Thematic analysis suggested several approaches that may facilitate prognosis communication: establishing a relationship with the caregiver and care recipient; delivering the prognosis in clear, plain language; and responding to emotion with empathy.ConclusionCaregivers reported a preference for being included in conversations about a care recipient's life expectancy.
Telemedicine for Specialist Geriatric Care in Small Rural Hospitals: Preliminary Data
Authors: Gray Leonard C. , Fatehi Farhad , Martin‐Khan Melinda , Peel Nancye M. , Smith Anthony C. 
Published: June 2016

Small rural hospitals admit and manage older adults who, in city hospitals, would usually be offered geriatrician‐supported comprehensive geriatric assessment and coordinated subacute care if required. Distance and diseconomies of scale prohibit access to the conventional in‐person approach. A telegeriatric service model involving a geriatrician consulting remotely using wireless, mobile, high‐definition videoconferencing; a trained host nurse at the rural site; structured geriatric assessment configured on a web‐based clinical decision support system; routine weekly virtual rounds; and support from a local multidisciplinary team was established to overcome these barriers. This was a prospective observational study to examine the feasibility and sustainability of the model. Patient characteristics were recorded using the interRAI Acute Care assessment system. Usage patterns were derived from health service data sets and a service statistics database. Patients had characteristics that are consistent with characteristics of individuals typically referred for geriatric assessment. Overall, 53% of patients had cognitive impairment, 75% had limitations with activities of daily living, and the average Frailty Index was 0.44 ± 0.12. Stable patterns of consultation occurred within 6 months of start‐up and continued uninterrupted for the remainder of the 24‐month observation period. The estimated overall rate of initial consultation was 1.83 cases per occupied bed per year and 2.66 review cases per occupied bed per year. The findings indicate that the model was feasible and was sustained throughout and beyond the study period. This telegeriatric service model appears suitable for use in small rural hospitals.
A New Standard in Dementia Knowledge Measurement: Comparative Validation of the Dementia Knowledge Assessment Scale and the Alzheimer's Disease Knowledge Scale
Authors: Annear Michael J. , Eccleston Claire E. , McInerney Frances J. , Elliott Kate‐Ellen J. , Toye Christine M. , Tranter Bruce K. , Robinson Andrew L. 
Published: June 2016

ObjectivesTo compare the psychometric performance of the Dementia Knowledge Assessment Scale (DKAS) and the Alzheimer's Disease Knowledge Scale (ADKS) when administered to a large international cohort before and after online dementia education.DesignComparative psychometric analysis with pre‐ and posteducation scale responses.SettingThe setting for this research encompassed 7,909 individuals from 124 countries who completed the 9‐week Understanding Dementia Massive Open Online Course (MOOC).ParticipantsVolunteer respondents who completed the DKAS and ADKS before (n = 3,649) and after (n = 878) completion of the Understanding Dementia MOOC.MeasurementsAssessment and comparison of the DKAS and ADKS included evaluation of scale development procedures, interscale correlations, response distribution, internal consistency, and construct validity.ResultsThe DKAS had superior internal consistency, wider response distribution with less ceiling effect, and better discrimination between pre‐ and posteducation scores and occupational cohorts than the ADKS.ConclusionThe 27‐item DKAS is a reliable and preliminarily valid measure of dementia knowledge that is psychometrically and conceptually sound, overcomes limitations of existing instruments, and can be administered to diverse cohorts to measure baseline understanding and knowledge change.
Discussions About Driving Between Older Adults and Primary Care Providers
Authors: Betz Marian E. , Kanani Halinganji , Juarez‐Colunga Elizabeth , Schwartz Robert 
Published: June 2016

ObjectivesTo estimate how many older adults discuss driving with a primary care provider during a calendar year and to describe discussion triggers.DesignObservational retrospective medical record review.SettingThree primary care clinics (geriatric, hospital‐based general internal medicine (GIM), community‐based GIM) affiliated with a tertiary care hospital.ParticipantsRandom sample of 240 older (aged ≥65) adults with one or more primary care visits in 2014 (January 1 to December 31).MeasurementsStandardized chart abstraction of participant demographic characteristics, medical diagnoses, and presence and context of discussions about driving. Provider factors (obtained from clinic administrators) included sex and average amount worked per week.ResultsParticipants who visited the geriatric clinic were oldest, had more medical diagnoses, and had a median of 4 visits in 2014 (vs 3 visits in GIM clinics). Documented discussions about driving occurred with a greater proportion of participants in the geriatric (n = 22, 28%, 95% confidence interval (CI) = 18–39%) and GIM hospital (n = 15, 19%, 95% CI = 11–29%) clinics than the GIM community clinic (n = 6, 7.5%, 95% CI = 2.8–16%). Medical diagnoses that might affect driving were prevalent but not associated with frequency of documented discussions. In multivariable analysis, participants were more likely to have one or more documented driving discussions in 2014 if they went to the geriatric clinic or had a primary care provider younger than 45 or who worked fewer than six half‐day clinics per week.ConclusionOver 1 year, a minority of older adults had a documented discussion about driving with a primary care provider, with differences according to clinic and provider characteristics. Strategies to support routine and preparatory conversations about driving should incorporate these findings and might vary among clinic settings.
Comparison of Effect of Two Exercise Programs on Activities of Daily Living in Individuals with Dementia: A 9‐Week Randomized, Controlled Trial
Authors: Bossers Willem J. R. , van der Woude Lucas H. V. , Boersma Froukje , Hortobágyi Tibor , Scherder Erik J. A. , van Heuvelen Marieke J. G. 
Published: June 2016

ObjectivesTo compare the effects of two exercise programs on proxy‐ and performance‐based measures of activities of daily living (ADLs) and to explore potential motor and cognitive mediators underlying ADL improvements in individuals with dementia.DesignA parallel, three‐group, single‐blind, randomized, controlled trial.SettingPsychogeriatric wards.ParticipantsIndividuals with dementia (mean age 85.6 ± 5.1).InterventionsEach 9‐week intervention consisted of thirty‐six 30‐minute sessions. A combined group (n = 35) participated in two strength and two walking sessions, an aerobic group (n = 35) participated in four walking sessions, and a social control group (n = 35) participated in four nonexercise social visits per week. The social group was used as a reference for the mediation analysis, which was performed in the combined and aerobic groups.MeasurementsADLs were assessed using the Katz index (proxy‐reported ADL performance), Erlangen‐ADL test (E‐ADL) (instrumental ADL performance), and 7‐item Physical Performance Test (PPT‐7) (physical ADL performance).ResultsThere was a group effect for Katz index (P = .02), E‐ADL (P < .001), and PPT‐7 (P = .003). Differences from baseline to after the intervention were similar in the combined and aerobic groups. Exercise‐induced changes in global cognition mediated changes in Katz index (95% confidence interval (CI) = 0.05–0.41), leg muscle strength mediated changes in E‐ADL (95% CI = 0.03–0.43), and leg muscle strength (95% CI = 0.01–0.36) and walking endurance (95% CI = 0.01–0.43) mediated changes in PPT‐7 only in the combined group.ConclusionPhysical exercise can improve ADL levels in individuals with dementia, but improvements are small and seem independent of exercise type. Additional analyses suggest that combined aerobic and strength exercise may be more effective than aerobic‐only exercise to effectively target ADL dysfunction in individuals with dementia. Future research is warranted to justify these exercise‐specific findings.
Antipsychotic Drugs and Risk of Hip Fracture in People Aged 60 and Older in Norway
Authors: Bakken Marit S. , Schjøtt Jan , Engeland Anders , Engesæter Lars B. , Ruths Sabine 
Published: June 2016

ObjectivesTo examine associations between exposure to various subgroups of antipsychotic drugs and risk of hip fracture in older adults.DesignNationwide cohort study.SettingNorway, 2005–2010.ParticipantsEveryone living in Norway born before 1945 (N = 906,422).MeasurementsInformation was obtained on all prescriptions of antipsychotic drugs dispensed from 2004 to 2010 (Norwegian Prescription Database) and data on all primary hip fractures from 2005 to 2010 (Norwegian Hip Fracture Registry). Incidence rates of hip fracture during person‐time exposed and unexposed to antipsychotic drugs were compared by calculating the standardized incidence ratio (SIR).ResultsThirty‐nine thousand nine hundred thirty‐eight (4.4%) participants experienced a primary hip fracture. Greater risk of hip fracture was associated with exposure to any antipsychotic (SIR = 2.1, 95% confidence interval (CI) = 1.9–2.1), first‐generation antipsychotics (SIR = 2.0, 95% CI = 1.8–2.2), second‐generation antipsychotics (SIR = 2.2, 95% CI = 1.9–2.4), prolactin‐sparing antipsychotics (SIR = 2.4, 95% CI = 1.8–3.1) and prolactin‐elevating antipsychotics (SIR = 2.0, 95% CI = 1.9–2.2).ConclusionIn people aged 60 and older in Norway, those who took an antipsychotic drug had twice the risk of sustaining a hip fracture during exposure than during nonexposure. Although confounding by indication, comorbidity, or other drugs used cannot be excluded, this association is relevant for clinical practice because hip fracture and antipsychotic drug use are prevalent in vulnerable older individuals. Clinical studies examining mechanisms or causality of the observed association between antipsychotic drug use and excess risk of hip fracture are needed.
Effects of Disease Burden and Functional Adaptation on Morbidity and Mortality on Older Adults
Authors: Sanders Jason L. , Arnold Alice M. , Hirsch Calvin H. , Thielke Stephen M. , Kim Dae , Mukamal Kenneth J. , Kizer Jorge R. , Ix Joachim H. , Kaplan Robert C. , Kritchevsky Stephen B. , Newman Anne B. 
Published: June 2016

ObjectivesTo ascertain whether older adults with extensive disease but relative vigor (adapters) shorten the period at the end of life in which they live with morbidity (compress morbidity).DesignProspective, community‐based cohort study in four U.S. cities.SettingCardiovascular Health Study.ParticipantsIndividuals aged 65 and older.MeasurementsParticipants were categorized into three groups according to extent of disease (assessed noninvasively), vigor, and frailty (expected agers (n = 3,528, extent of disease similar to vigor and frailty—reference group), adapters (n = 882, higher disease but vigorous), and prematurely frail (n = 855, lower disease but frail)) and compared according to years of able life (YAL), years of self‐reported healthy life (YHL), and mortality using multivariable regression and survival analysis.ResultsAfter adjustment, adapters had 0.97 (95% confidence interval (CI) = 0.60–1.33) more YAL and 0.54 (95% CI = 0.19–0.90) more YHL than expected agers, and those who were prematurely frail had −0.99 (95% CI = −1.36 to −0.62) fewer YAL and −0.53 (95% CI = −0.89 to −0.17) fewer YHL than expected agers. Adapters had 0.9 more and prematurely frail had 1.5 fewer years of total life than expected agers (P < .001). Adapters spent 55% of their remaining life able and healthy, those who were prematurely frail spent 37%, and of expected agers spent 47% (P < .001).ConclusionDespite similar levels of disease burden, older adults who were more vigorous appeared to compress morbidity and live longer. Older adults with higher frailty lengthened morbidity and had greater mortality. Adaptive factors may compress morbidity and decrease mortality.
A New Method of Identifying Characteristics of Needing Help to Take Medications in an Older Representative Community‐Dwelling Population: The Older Adults Medication Assist Scale
Authors: Jamerson Brenda D. , Fillenbaum Gerda G. , Sloane Richard , Morey Miriam C. 
Published: June 2016

ObjectivesTo determine the sociodemographic characteristics, health conditions, and cognitive and functional status associated with baseline prevalence and new need for help taking medication 3 years later and to construct a brief scale indicative of need for help taking medications.DesignRetrospective cross‐sectional and 3‐year longitudinal study.SettingFive‐county area in north–central Piedmont, North Carolina.ParticipantsRepresentative community‐dwelling sample of black and white individuals aged 65 and older (N = 4,136).MeasurementsInformation was obtained in person in participants' homes using structured questionnaires. Health conditions included sensory impairment and self‐report of physician‐diagnosed conditions. Cognitive status was assessed using the 10‐item Short Portable Mental Status Questionnaire. Functional status was assessed using the three‐item Rosow‐Breslau scale, the five‐item Katz activity of daily living scale, and a modified six‐item Older Americans Resources and Services instrumental activities of daily living scale.ResultsCharacteristics associated with need for help taking medications were aged 80 and older, being male, living with others, having four or more chronic conditions, and impaired cognitive or functional status (c‐statistic 0.94, 77.1% sensitivity, 87.9% specificity). Predictors of new need for help with medications 3 years later included aged 75 and older at baseline, being male, and impaired cognitive and functional status (c‐statistic 0.75).ConclusionThis brief scale can help identify persons needing help with medications and could be useful in assisting clinicians with medication management.