bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary Care of Long‐Stay Nursing Home Residents: Approaches of Three Health Maintenance Organizations
Authors: Reuben David B. , Schnelle John F. , Buchanan Joan L. , Kington Raynard S. , Zellman Gail L. , Farley Donna O. , Hirsch Susan H. , Ouslander Joseph G. 
Published: April 2015

OBJECTIVE: To describe the innovative programs of three health maintenance organizations (HMOs) for providing primary care for long‐stay nursing home (NH) residents and to compare this care with that of fee‐for‐service (FFS) residents at the same NHs.DESIGN: Cross‐sectional interviews and case‐studies, including retrospective chart reviews for 1 year.SETTING: The programs were based in 20 community‐based nursing homes in three regions (East, West, Far West).PARTICIPANTS: Administrative and professional staff of HMOs in three regions and 20 NHs; 215 HMO and 187 FFS residents at these homes were studied. MAIN OUTCOME MEASURES: Emergency department (ED) and hospital utilization.RESULTS: All HMO programs utilized nurse practitioner/physician's assistants (NP/PA), but the structural configuration of physicians' (MD) practices differed substantially. At nursing homes within each region, all three HMO programs provided more total (MD plus NP/PA) visits per month than did FFS care (2.0 vs 1.1, 1.3 vs .6, and 1.4 vs .8 visits per month; all P < .05). The HMO that provided the most total visits had a significantly lower percentage of residents transferred to EDs (6% vs 16%, P = .048), fewer ED visits per resident (0.1 vs .4 per year, P = .027), and fewer hospitalizations per resident (0.1 vs .5 per year, P = .038) than FFS residents; these differences remained significant in multivariate analyses. However, the other two programs did not achieve the same benefits on healthcare utilization.CONCLUSIONS: HMO programs for NH residents provide more primary care and have the potential to reduce ED and hospital use compared with FFS care. However, not all programs have been associated with decreased ED and hospital utilization, perhaps because of differences in structure or implementation problems. J Am Geriatr Soc 47:131–138, 1999.
Use of Primary Care Teams by HMOS for Care of Long‐Stay Nursing Home Residents
Authors: Farley Donna O. , Zellman Gail , Ouslander Joseph G. , Reuben David B. 
Published: April 2015

OBJECTIVE: To characterize the use of formal primary care programs by health maintenance organizations (HMOs) for their members who are long‐stay residents of nursing homes.DESIGN: Using mail survey techniques, 34 Medicare risk‐contracting HMOs with the largest Medicare beneficiary enrollments were asked to complete a written questionnaire. HMOs were asked how they evaluate care in nursing home settings and whether they operate a formal primary care program for members who are long‐stay nursing home residents. Those reporting they had programs were asked about the program features, participation in the program, roles performed by clinical practitioners, and clinical caseloads. Surveys were completed by 21 (61.8%) of the HMOs.PARTICIPANTS: HMO management personnel who know the primary care programs the HMOs operate in affiliated nursing homes.MEASUREMENTS: Descriptive summaries of the HMOs' responses to the survey questions were generated. For HMOs with primary care programs, caseloads of physicians and nurse practitioners were estimated using survey data reported by the HMOs.RESULTS: Eight (38.1%) of the responding HMOs operate formal primary care programs in affiliated nursing homes. HMOs with programs consider more factors than non‐program HMOs in evaluating care for nursing home residents. Reasons cited most frequently for not having a program are costs and too few nursing home residents. The most common primary care program features are designated physicians and use of physician extenders.CONCLUSIONS: Survey findings point to the potential importance of formal HMO primary care programs for long‐term nursing home residents, which may expand with growth in the older population and Medicare‐managed care. Program adoption, however, may depend on sufficient resident participation to be financially feasible. J Am Geriatr Soc 47:139–144, 1999.
Gender Differences in Cognitive Function with Age: The Rancho Bernardo Study
Authors: Barrett‐Connor Elizabeth , Kritz‐Silverstein Donna 
Published: April 2015

BACKGROUND: Estrogen deficiency has been proposed as a cause of memory loss in postmenopausal women. If true, men should have less memory loss with age than women. The present study is designed to examine the postulated effect of estrogen on memory by studying the effect of gender on the age‐related decline in cognitive function.METHODS: Cross‐sectional study of 800 women and 551 men aged 65 to 95 years, members of the community‐based Rancho Bernardo Study (begun in 1972 and 1974) who completed the Beck Depression Inventory in 1984–1987 and 12 standardized tests of cognitive function in 1988–1991. All participants were white, middle to upper‐middle class, relatively well educated, and ambulatory. At all visits, use of estrogen therapy was ascertained and validated.RESULTS: Test performance worsened with age in both sexes, with similar patterns in men compared with women who were current, past, or never users of estrogen. Betweengender comparisons of the slope for age on each cognitive function test after adjustment for education, depressed mood, and estrogen use (in women) indicated that men had a significantly steeper decrement with age than women on the Buschke total recall and long‐term memory tests (P <.001), on the immediate and delayed recall tasks of the visual reproduction tests (P < .01 and .05, respectively), and on category fluency (P < .05). Similar results were obtained when gender comparisons included only women who had never used estrogen.CONCLUSION: These weak or absent gender differences in decline in cognitive function with age do not support the thesis that estrogen deficiency is associated with a decline in cognitive function in postmenopausal women. J Am Geriatr Soc 47:159–164, 1999.
Medication Adherence in Rheumatoid Arthritis Patients: Older Is Wiser
Authors: Park Denise C. , Hertzog Christopher , Leventhal Howard , Morrell Roger W. , Leventhal Elaine , Birchmore Daniel , Martin Mike , Bennett Joan 
Published: April 2015

OBJECTIVES: To create a profile of individuals nonadherent to their medications in an age‐stratified sample (ages 34–84) of community‐dwelling rheumatoid arthritis patients. The relative contributions of age, cognitive function, disability, emotional state, lifestyle, and beliefs about illness to nonadherence were assessed.DESIGN: A direct observation approach was used in conjunction with structural equation modeling. All participants were administered a preliminary assessment battery. Medications were then transferred to vials with microelectronic caps that recorded medication events for all medications for the next 4 weeks.PARTICIPANTS AND SETTING: A volunteer sample of 121 community‐dwelling rheumatoid arthritis (RA) patients were recruited from newspaper ads, posters, and via informal physician contact from private rheumatology practices in Atlanta and Athens, Georgia. Written verification of the RA diagnosis and a disease severity rating were obtained from personal physicians before patients were enrolled in the study. Patients were tested in a private physician's office, and their medication adherence was monitored electronically for a month in their every‐day work and home settings.MEASUREMENTS AND RESULTS: Structural equation modeling techniques were used to develop a model of adherence behavior. Cognitive and psychosocial measures were used to construct latent variables to predict adherence errors. The model of medication adherence explained 39% of the variance in adherence errors. The model demonstrated that older adults made the fewest adherence errors, and middle‐aged adults made the most. A busy lifestyle, age, and cognitive deficits predicted nonadherence, whereas coping with arthritis‐related moods predicted adherence. Illness severity, medication load, and physical function did not predict adherence errors. Omission of medication accounted for nearly all errors.CONCLUSION: Despite strong evidence for normal, age‐related cognitive decline in this sample, older adults had sufficient cognitive function to manage medications. A busy lifestyle and middle age were more determinant of who was at risk of nonadherence than beliefs about medication or illness. Thus, practicing physicians should not assume that older adults have insufficient cognitive resources to manage medications and that they will be the most likely to make adherence errors. Very busy middle‐aged adults seem to be at the greatest risk of managing medications improperly. J Am Geriatr Soc 47:172–183, 1999.
Risk of a New Benzodiazepine Prescription in Relation to Recent Hospitalization
Authors: Grad Roland , Tamblyn Robyn , Holbrook Anne M , Hurley Jerry , Feightner John , Gayton David 
Published: April 2015

OBJECTIVE: To determine if recent hospital admission was associated with new outpatient prescribing of benzodiazepines among community‐dwelling older people.DESIGN: Nested case‐control study using administrative data sets of the provincial health insurance board.SETTING: Province of Quebec.PARTICIPANTS: Cases were 4127 community‐dwelling older people who were newly dispensed a benzodiazepine during an 8‐month period in 1990. Controls were 16,486 community‐dwelling older people who were dispensed any drug (except a benzodiazepine) on the same day as the case‐defining index prescription.EXPOSURE AND OUTCOME MEASURES: Admission to an acute care hospital within a 30‐day period before a new dispensing of a benzodiazepine. Other variables measured were patient age, gender, number of ambulatory physician visits, healthcare region, Chronic Disease Score (CDS), and use of drugs for depression and psychosis.RESULTS: Cases were more than three times as likely as controls to have been hospitalized in the 30‐day period before the index date (adjusted odds ratio (OR) 3.09; 95% CI, 2.78‐3.45). The use of prescription drugs for physical health problems modified this association in that cases who used more medication were also more likely to receive a new benzodiazepine prescription following a recent hospital admission (adjusted OR 4.09; 95% CI, 3.59‐4.65 when the CDS was equal to 5 vs adjusted OR 1.96; 95% CI, 1.66‐2.31 when the CDS was equal to 0).CONCLUSIONS: Recent hospitalization confers an increased risk of a new outpatient benzodiazepine prescription among community‐dwelling older people in Quebec. Those who use more medication, and who may be more vulnerable to drug‐related adverse events, are more likely to be newly dispensed a benzodiazepine following a recent, acute‐care hospital admission. J Am Geriatr Soc 47:184–188, 1999.
Prevalence and Risks of Dementia in the Japanese Population: RERF's Adult Health Study Hiroshima Subjects
Authors: Yamada Michiko , Sasaki Hideo , Mimori Yasuyo , Kasagi Fumiyoshi , Sudoh Shinji , Ikeda Junko , Hosoda Yutaka , Nakamura Shigenobu , Kodama Kazunori 
Published: April 2015

OBJECTIVES: To study the prevalence rate of dementia and its subtypes in Japan and to investigate the relationship of risk factors, such as demographic features and disease history, to the prevalence of Alzheimer's disease or vascular dementia.DESIGN: A prevalence study within a longitudinal cohort study.SETTING: The original Adult Health Study (AHS) cohort consisted of atomic‐bomb survivors and their controls selected from residents in Hiroshima and Nagasaki using the 1950 national census supplementary schedules and the Atomic Bomb Survivors Survey. Since 1958, the AHS subjects have been followed through biennial medical examinations.PARTICIPANTS: Subjects were 637 men and 1585 women aged 60 years or older in the AHS cohort. Forty‐eight subjects resided in hospitals and institutions.MEASUREMENTS: In addition to the biennial medical examinations ongoing since 1958, a screening test for cognitive impairment (CASI) was conducted by trained nurses between September 1992 and September 1996. The prevalence of dementia and its subtypes was assessed in 343 subjects suspected to have dementia and in 272 subjects with high CASI scores who were selected randomly.RESULTS: The prevalence of dementia based on DSM III/R criteria, using neurological examination, the IQCODE, and CDR ≥ 1, was 7.2%. The prevalence of Alzheimer's disease was 2.0% in men and 3.8% in women, and the prevalence of vascular dementia was 2.0% in men and 1.8% in women. The relationship of risk factors to Alzheimer's disease or vascular dementia was investigated by the multivariate logistic linear regression analysis. Odds ratios of Alzheimer's disease for age (in 10‐year increments), attained education (in 3‐year increments), history of head trauma, and history of cancer are 6.3, 0.6, 7.4, and 0.3, respectively. Odds ratios of vascular dementia for age, history of stroke, and history of hypertension are 2.0, 35.7, and 4.0, respectively. Neither type of dementia showed any significant effect of sex or radiation exposure.CONCLUSION: This study is the first study of Japanese dementia rates carried out with a protocol similar enough to that of a US study to allow meaningful comparisons. The prevalence rates demonstrated are more similar to US rates than were found in many previous reports in Japan. J Am Geriatr Soc 47:189–195, 1999.
Misclassification and Selection Bias When Identifying Alzheimer's Disease Solely from Medicare Claims Records
Authors: Newcomer Robert , Clay Ted , Luxenberg Jay S. , Miller Robert H. 
Published: April 2015

BACKGROUND: Medicare claims as the basis for health condition adjustments is becoming a method of choice in capitation reimbursement. A recent study has found that claims‐based beneficiary classification for Alzheimer's disease produces lower prevalence estimates and higher average costs than previous healthcare cost studies in this population. These sets of studies differ in data sources, period length, and in their specification of dementia.OBJECTIVES: Participants in the Medicare Alzheimer's Disease Demonstration (MADDE) provide a sample of persons known to have some form of dementia. This group is used to test the adequacy of claims data for identifying eligible cases and any bias in expenditure differences between those flagged or not flagged by a claim in a given period.DESIGN: A prospective cohort design using up to 36 months of claims data.SETTING: The demonstration enrolled 4166 participants in treatment, and 3942 in a control group in eight communities across the US. Cases were combined in this analysis.PARTICIPANTS: Persons with available Medicare Part A & B claims data: those receiving care under fee for service reimbursement were used in the analysis. A total of 5379 MADDE cases received fee for service care during 1991 and 1992, the period of primary interest in the analysis.MEASUREMENT: Client health and functional status interviews and Medicare Part A & B claims.RESULTS: Less than 20% of MADDE participants were classified with Dementia of the Alzheimer type (DAT) from a single year of claims although 68% had a DAT diagnosis from a referring physician. Annualized expenditures were 1.7 times higher among those with DAT from claims compared with those known otherwise to have dementia but who had not been identified with this condition from Medicare claims.CONCLUSION: Underclassification of dementia from claims records can be partially remedied by increasing the period during which claims are compiled, but additional diagnostic sources will likely be needed to increase prevalence counts closer to 100% of true cases. Risk adjustment based on a single year of reported claims expenditures may overpay providers, at least in the short term, because payment incentives will likely increase prevalence reporting. J Am Geriatr Soc 47:215–219, 1999.
Aging and Postural Control: Postural Perturbations Caused by Changing the Visual Anchor
Authors: Simoneau Martin , Teasdale Normand , Bourdin Christophe , Bard Chantal , Fleury Michelle , Nougier Vincent 
Published: April 2015

OBJECTIVE: To determine the effect of modifying the stable visual anchor on the postural stability of older individuals. The visual anchor was changed by opening doors similar to those found in an elevator cage. Lighting intensities inside and outside the cage were varied to create increasing or decreasing luminosity conditions. The effect of adding a cognitive load (counting backwards) was also tested.DESIGN: A controlled laboratory study.SETTING: Tests performed in a balance laboratory.MEASUREMENTS: Sensory and clinical measurements to insure the integrity of the central and peripheral nervous system. Measures of balance were derived from the recordings of the center of foot pressure. These measures included range and speed of the center of foot pressure.PARTICIPANTS: Eight older, community‐dwelling subjects and nine young subjects participated. A sensorimotor evaluation was used to insure that all older individuals were free from any pathologies affecting postural stability. All participants had a low score (indicating high balance confidence) on the Falls Efficacy Scale and no history of falls.RESULTS: Older individuals were affected by modification of the stable visual anchor induced by the opening of doors similar to that of an elevator cage. They showed greater ranges of the center of foot pressure (COP) and speed of the COP after than before the opening of the doors. Furthermore, the increased ranges and speed were two to three times greater than that observed for the young subjects. A lighting intensity considered as comfortable for reading inside the elevator affected the overall postural stability of the older participants negatively. Counting backwards also decreased their overall stability.CONCLUSION: Changing the stable visual anchor, as when exiting an elevator cage, could be a significant risk factor for older persons. Moreover, when combined with a cognitive load or lower lighting intensity inside the elevator cage, the negative effects on the postural stability of older persons are exacerbated. J Am Geriatr Soc 47:235–240, 1999.
Firearm Presence in Households of Patients with Alzheimer's Disease and Related Dementias
Authors: Spangenberg Karen B. , Wagner Mark T. , Hendrix Shirley , Bachman David L. 
Published: April 2015

OBJECTIVE: Attention has recently been drawn to the potential dangers of firearm use among patients with dementia. However, little is known about the actual prevalence of firearms in households with demented family members. This study seeks to determine the prevalence and loaded status of firearms in households with a demented family member in a sample of outpatients at a University memory disorders clinic.DESIGN: Utilizing a cross‐sectional design, subjects underwent a structured NINCDS‐ADRDA criteria comprehensive evaluation to assess dementia and were also administered a questionnaire to assess level of mood disturbance. Family members were administered a behavioral checklist and surveyed about the number and loaded status of firearms in the patient's household.SETTING: The study took place in an outpatient Medical University memory disorders clinic in the Southern United States.PATIENTS: Subjects were 106 consecutive outpatients referred for symptoms suggestive of dementia.MAIN OUTCOME MEASURES: Firearm presence was coded as “present,” “not present,” and “unsure.” In cases where firearms were present, the number and loaded status were collected. Other outcome measures included the Clinical Dementia Rating of each patient, the Yesavage Mood Inventory, and the Revised Memory and Behavior Problems Checklist.RESULTS: A high prevalence of firearm prevalence in households with demented family members was revealed (60.4%). Gun ownership was equally prevalent in households regardless of the severity of the dementia (chi‐square, P = .426), severity of behavioral disturbance (ANOVA P = .88), or depressive symptoms (ANOVA P = .37). In households with firearms, 44.6% of the families reported that the guns were kept loaded; 38% reported that they did not know whether the guns were loaded. Only 16.9% of the families reported that guns were maintained in an unloaded state.CONCLUSIONS: This study suggests that many family members living in households in which there are demented patients do not take appropriate action to remove or unload firearms in their households, regardless of the severity of dementia, behavioral disturbance, or depression. These findings suggest that clinicians need to ask families specifically about the presence of firearms and advocate for their removal.
Falls Relate to Vitamin D and Parathyroid Hormone in an Australian Nursing Home and Hostel
Authors: Stein Mark S. , Wark John D. , Scherer Samuel C. , Walton S. Lynette , Chick Patricia , Di Carlantonio Margaret , Zajac Jeffrey D. , Flicker Leon 
Published: April 2015

OBJECTIVES: To determine whether falling relates to serum levels of vitamin D and parathyroid hormone.DESIGN: A cross‐sectional study with retrospective analysis.SETTING: An aged‐care institution in Melbourne Australia.PARTICIPANTS: Ambulant nursing home and hostel residents (n = 83).MEASUREMENTS: Frequency of falling, frequency of going outdoors, use of cane or walker, age, sex, weight, type of accommodation, and duration of residence. Serum concentrations of 25‐hydroxyvitamin D, 1,25‐dihydroxyvitamin D, and parathyroid hormone (PTH). Plasma concentrations of albumin, calcium, phosphate, and creatinine. Use of furo‐semide or non‐benzodiazepine anticonvulsants.RESULTS: Median age of residents was 84 years. The cohort was vitamin D deficient with a median (interquartile range) 25‐hydroxyvitamin D level of 27 (18–37) nmol/L (one‐third the reference range median), P < .001. The median (interquartile range) PTH of 5.2 (3.8‐7.7) pmol/L exceeded the reference range median, P < .001. Residents who fell (n = 33) had lower serum 25‐hydroxyvitamin D levels than other residents (medians 22 vs 29 nmol/L, P = .02) and higher serum PTH levels (medians 6.2 vs 4.8 pmol/L, P < .01). Sixty residents lived in the hostel (72%), and 41 (49%) walked without any walking aid. In a multiple logistic regression for falling, higher serum PTH remained independently associated with falling, with an odds ratio (95% confidence interval) for falling of 5.6 (1.7–18.5) per unit of the natural logarithm of serum PTH. Other terms in the regression were hostel accommodation, odds ratio .04 (.01‐.25), and ability to walk without aids, odds ratio .07 (.01‐.37).CONCLUSIONS: In ambulant nursing home and hostel residents, residents who fall have lower serum 25‐hydroxyvitamin D and higher serum parathyroid hormone levels than other residents. The association between falling and serum PTH persists after adjustment for other variables.