bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of DHEAS on Influenza Vaccination in Aging Adults
Authors: Degelau John , Guay David , Hallgren Helen 
Published: April 2015

OBJECTIVE: To determine whether simultaneous administration of dehydroepiandrosterone sulfate (DHEAS) exhibits adjuvant activity in the immune response of aging humans by supplementing influenza vaccination with the maximum single dose of DHEAS that could be practically injected subcutaneously (approximately 7.5 mg).DESIGN: A randomized, double‐blind, placebo‐controlled trial of DHEAS injection with 1993–94 and 1994–95 influenza vaccine in older subjects. In addition, initial safety, tolerability, and control testing with 1993–94 influenza vaccine was conducted in young subjects.SETTING: An urban primary care geriatrics clinic.PARTICIPANTS: Seventy‐eight older adult volunteers (mean age 78.61 ± 3.43 years, range 73–90 years) and 20 younger controls (<40 years, means age 32.76 ± 5.39 years) were recruited from clinic and community advertising. Subjects were free of disease or medication known to affect immune function.MEASUREMENTS: Immune responses to vaccine at 0, 2, and 4 weeks were measured by vaccine antigen‐induced lymphoproliferation in peripheral blood mononuclear cells (PBMC) and serum antibody response by hemagglutination inhibition (HI).RESULTS: The maximum DHEAS dose that could be practically administered subcutaneously was 7.5 mg. Baseline DHEAS levels were significantly lower in older adults (52.1 vs 236.4 μg/dL, P < .001). The 1993 old adult DHEAS group HI response tended to be higher for the H3N2 Beijing antigen but not for the H1N1 or B antigen. In subjects with HI titers less then 1:40 for the H3N2 Beijing antigen (n = 29), the post‐vaccination titer response tended to be higher among the 16 subjects who received DHEAS (P = .06). The peak response for the H3N2 antigen was associated with the initial DHEAS serum concentration in the DHEAS and placebo groups (R2 =.22, P = .04 and R2 = .21, P = .06, respectively). No significant differences were found for antibody responses to the H1N1 and B antigens or vaccine‐antigen induced lymphoproliferation.CONCLUSION: A one‐time supplemental dose of DHEAS with influenza vaccination appeared to enhance the specific HI antibody response to the 1993–94 H3N2 antigen in a small group of older adults. These findings were limited to those with lower prevaccination titers and lower DHEAS concentrations. Although clinical implications of these findings for influenza vaccine are uncertain, these results suggest additional detailed immunologic investigations on the role of DHEAS in the aging human immune response are warranted.
Use of Digoxin, Diuretics, Beta Blockers, Angiotensin‐Converting Enzyme Inhibitors, and Calcium Channel Blockers in Older Patients in an Academic Hospital‐Based Geriatrics Practice
Authors: Fishkind Deborah , Paris Barbara E. C. , Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To investigate the prevalence of and indications for digoxin use and the prevalence of beta blocker and calcium channel blocker use in older patients with pevious myocardial infarction or coronary artery disease (CAD), and the prevalence of use of diuretics, beta blockers, angiotensin‐converting enzyme (ACE) inhibitors, and calcium channel blockers in older patients with hypertension in an academic hospital‐based geriatrics practice.DESIGN: A retrospective analysis of charts from 528 unselected older patients, seen from June 1995 through July 1996 at an academic hospital‐based geriatrics practice, was performed to investigate the prevalence of digoxin use and indications for digoxin use, the prevalence of beta blocker and calcium channel blocker use in older patients with previous myocardial infarction or coronary artery disease (CAD), and the prevalence of use of diuretics, beta blockers, angiotensin‐converting enzyme (ACE) inhibitors, and calcium channel blockers in older patients with hypertension.SETTING: An academic hospital‐based, primary care geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.PATIENTS: A total of 416 women and 112 men, mean age 81 ± 8 years (range 58 to 101), were included in the study.MEASUREMENTS AND MAIN RESULTS: Ninety‐two of the 528 patients (17%) were taking digoxin. Recorded indications for digoxin were atrial fibrillation with or without congestive heart failure (CHF) in 39% of patients, CHF with sinus rhythm and abnormal left ventricular ejection fraction (LVEF) in 18% of patients, a clinical assessment of CHF with sinus rhythm and no recorded measurement of LVEF in 20% of patients, paroxysmal atrial fibrillation in 14% of patients, and coronary artery disease (CAD) in 9% of patients. Of 121 patients with previous myocardial infarction, 23 (19%) were prescribed beta blockers, and 54 (45%) were taking calcium channel blockers. Of 173 patients with CAD, 41 (24%) were treated with beta blockers, and 79 (46%) were taking calcium channel blockers. LVEF was not recorded in the charts of 90 of 121 patients (74%) with prior myocardial infarction and of 125 of 173 patients (72%) with CAD. Of 480 older patients with hypertension, 154 (37%) were treated with diuretics, 55 (13%) were treated with beta blockers, 160 (38%) were treated with ACE inhibitors, and 197 (47%) were treated with calcium channel blockers.CONCLUSIONS: In 528 older patients seen in an academic hospital‐based geriatrics practice, the prevalence of digoxin use was 19%. Appropriate indications for digoxin were documented clearly in the charts of 53 of 92 patients (57%). Calcium channel blockers were used more often than beta blockers in patients with previous myocardial infarction or CAD. Calcium channel blockers were the most frequently used antihypertensive drugs.
Determinants of Initiation and Suboptimal Use of Anti‐ulcer Medication: A Study of the Quebec Older Population
Authors: Moride Yola , Melnychuk David , Monette Johanne , Abenhaim Lucien 
Published: April 2015

OBJECTIVES: To describe the use of anti‐ulcer medication in the Quebec older population; to examine determinants of initiation, suboptimal use, and switches between products.DESIGN: Population‐based retrospective cohort study.SETTING: Universal health program for older adults in Quebec.PARTICIPANTS: 5000 users and 5000 non‐users of antiulcer medications were selected randomly. Use was defined as the presence in the 1991 prescription database of an antiulcer prescription. Among users, 1697 (34%) were new users and were considered as the exposure group. Subjects were followed for 365 days after inclusion.MEASUREMENTS: Measured were patient's age, gender, prescribed duration of anti‐ulcer medication, concomitant medications, and gastrointestinal diagnostic procedures.RESULTS: A total of 17% of new users had unusually short courses; 18% were long‐term users. There was no difference in duration for omeprazole compared with other anti‐ulcer medications. First‐time use of NSAIDs was the strongest predictor of initiation of anti‐ulcer medication (odds ratio = 3.21; 95% CI, 2.66–3.88). Twenty‐six percent of users switched brands. Only 9.5% of new users underwent a diagnostic procedure before initiation of therapy, and 49% of long‐term users ever underwent such procedure.CONCLUSION: Despite a relatively homogeneous recommended duration of therapy, patterns of use of anti‐ulcer medication among older people are highly variable, and treatment is often not accompanied by a diagnostic procedure.
Dental Status, Quality of Life, and Mortality in an Older Community Population: A Multivariate Approach
Authors: Appollonio Ildebrando , Carabellese Corrado , Frattola Alessandra , Trabucchi Marco 
Published: April 2015

OBJECTIVE: To evaluate the relationships between a functional measure of dental status (FDS), several variables belonging to a quality of life (QOL) profile, and mortality in an older community population.DESIGN: Cross‐sectional analysis for FDS and QOL; 10‐year prospective study for mortality.SETTING: The historical and central district of the city of Brescia, northern ItalyPARTICIPANTS: The entire cohort of 70 to 75‐year‐old people living in the above‐mentioned district (n = 1303): 1201 subjects were eligible for interview at baseline; 11 refused the physical examination; 52 were lost to follow‐up; data are presented for the remaining sample of 1137 subjects.MEASUREMENTS: FDS examination was used to classify the subjects into three groups: naturally adequate (ADS) (25.2%), naturally inadequate (IDS) (14.3%) dental status, and denture wearers (DW) (60.4%). Various QOL domains were assessed: mood level, cognitive status, instrumental activities of daily living (IADL), social relationships, indexes of somatic health, and health behaviors. The demographic and socioeconomic parameters were used as covariates.RESULTS: Univariate analysis showed that both the ADS and the DW groups had a better QOL profile than the IDS group. Multiple logistic regression indicated that ADS and DW conditions were predicted independently by better educational and financial conditions, higher social relationships and a better IADL level in comparison with IDS. Moreover, compared with IDS, DS was a significant predictor of a better level at the SELF, IADL, and HCU scales whereas DW predicted only a better IADL level.Crude survival analysis showed that ADS was associated with a lower mortality risk compared with both DW and IDS, which did not differ from each other. FDS also remained a significant and independent predictor of mortality in a more general Cox's regression model.CONCLUSIONS: Within this cohort of 70 to 75‐year‐old urban residents, FDS is associated with several QOL domains and with long‐term survival. A hierarchy of reciprocal relationships exists among these parameters. The present study provides a basis for encouraging more extensive use of dentures. Longitudinal studies using oral health outcomes are warranted before clinical recommendations can be made. J Am Geriatr Soc 45:1315–1323, 1997.
Factors Associated with Cognitive Impairment Among Older Italian Inpatients
Authors: Cattin Luigi , Bordin Paolo , Fonda Maurizio , Adamo Claudia , Barbone Fabio , Bovenzi Massimo , Manto Andrea , Pedone Claudio , Pahor Marco ,   Gruppo Italiano di Farmacovigilanza nell'Anziano (G. I. F.A.)
Published: April 2015

OBJECTIVE: To examine the association of cognitive impairment with educational, demographic, and nutritional variables in older hospitalized people.DESIGN: Survey of older patients admitted consecutively to a hospital during two 2‐month periods in 1993.SETTING: Patients admitted for general medical care at 35 hospitals participating in the GIFA study throughout Italy.PARTICIPANTS: A total of 3628 patients aged 65 or older were studied.MEASUREMENTS: The Hodkinson Abbreviated Mental Test (HAMT) was used as a screening method to assess the patients' basic cognitive function. Multiple logistic regression was used to examine the association between cognitive impairment and demographic, educational or nutritional variables.RESULTS: Twenty‐nine percent of older inpatients were classified as having cognitive impairment, with similar distribution of HAMT score found in both genders. Educational attainment has a highly significant inverse relationship with cognitive impairment (highest education: OR 0.32; 95% CI 0.20–0.52). Moreover, cognitive impairment decreased with increasing body mass index (3rd tertile: OR 0.69; 95% CI: 0.51–0.93), cholesterol serum level (highest values: OR 0.59; 95% CI 0.37–0.93), circulating lymphocytes (highest values: OR 0.55; 95% CI 0.45–0.69), and serum albumin (highest values: OR 0.60; 95% CI 0.47–0.76), with a gradient of influence for each variable.CONCLUSIONS: Educational attainment affects cognitive function in older inpatients. The strong association between cognitive impairment and nutritional variables suggests that every effort to improve nutritional status is needed in approaching cognitive impairment in older patients. J Am Geriatr Soc 45:1324–1330, 1997.
Clinical Trial Participant Satisfaction: Survey of SHEP Enrollees
Authors: Schron Eleanor B. , Wassertheil‐Smoller Sylvia , Pressel Sara ,   Behalf of the SHEP Cooperative Research Group
Published: April 2015

OBJECTIVE: The purpose of this study was to determine older persons' reasons for joining a clinical trial, and to provide data that could be useful in planning and carrying out clinical trials in older and minority populations.DESIGN: A survey.PARTICIPANTS: The sample included 4281 men and women 60 years of age or older who were randomized to the Systolic Hypertension in the Elderly Program (SHEP).MEASUREMENTS: A 10‐item satisfaction/attitude questionnaire was designed to evaluate (1) what personal benefits people expect from participation in this trial, (2) motivation for joining, and (3) satisfaction with clinic staff and operations. Each question had a response category asking for a measure of agreement, satisfaction, or importance.RESULTS: The most important reasons for joining the clinical trial were to contribute to science (96%), improve the health of others (96%), and improve their own health (93%). Free medical care and social aspects were less important reasons to join. There were no differences by treatment assignment, but differences in reasons for joining SHEP by age, race, gender, and education were observed.CONCLUSION: Older adults were enthusiastic about clinical trial participation. Recruitment, participant management strategies, and allocation of resources should consider the needs of specific patient groups. J Am Geriatr Soc 45:934–938, 1997.
Alzheimer's Disease and Driving: Prediction and Assessment of Driving Performance
Authors: Fox Gillian K. , Bowden Stephen C. , Bashford Guy M. , Smith Dennis S. 
Published: April 2015

OBJECTIVES: To examine driving competence in a group of drivers diagnosed with probable Alzheimer's Disease (AD) in terms of a standardized open road evaluation and expert judgments. To examine the validity of a standardized medical examination, including administration of the Mini‐Mental Status Exam (MMSE), and a standardized neuropsychological assessment as predictors of open road driving performance.DESIGN: A prospective investigation with consecutively referred subjects.SETTING: Coorabel Driver Assessment Centre, Royal Rehabilitation Centre Sydney, Australia.PARTICIPANTS: Nineteen subjects with a diagnosis of probable AD.MEASUREMENTS: A standardized clinical medical examination, a standardized neuropsychological assessment, and a standardized open road driving evaluation. The driving evaluation provided a correct driving actions score. The outcome measure was the expert judges' rating of overall driving competence, which was termed the final on‐road result.RESULTS: Seven subjects passed the on‐road driving evaluation, and 12 failed. MMSE was found to be a significant predictor of final on‐road result. The physician's prediction, the neuropsychology test scores, and the neuropsychologist's prediction were not found to be significantly associated with the final on‐road result. The on‐road driving evaluation was a reliable test.CONCLUSION: Inasmuch as all subjects except one were still driving and all wished to continue to drive, it is important to note that 63.2% of subjects failed the on‐road evaluation. Conversely, 36.8% were judged safe to drive, suggesting that AD diagnosis alone may be insufficient criteria for cessation of driving. A standardized road test may be the only appropriate means of determining driving competence in people diagnosed with AD.
Preadipocyte Function and Aging: Links Between Age‐Related Changes in Cell Dynamics and Altered Fat Tissue Function
Authors: Kirkland James L. , Dobson Deborah E. 
Published: April 2015

OBJECTIVE: To review recent findings about changes with age in the replication and differentiation of preadipocytes, the progenitor cells in fat tissue that are capable of differentiating into fat cells, and to examine possible links between these alterations and age‐related changes in fat tissue function.DESIGN: A survey and analysis of recent literature concerning changes in preadipocyte and fat cell function with age.CONCLUSIONS: Intrinsic aging changes in fat cells and preadipocytes as well as in factors extrinsic to fat tissue (such as food intake and absorption and hormonal status) contribute to age‐related alterations in fat tissue function and cellularity. Changes with age in preadipocyte number, replicative potential, and capacity for differentiation, which may be linked to aging changes in fat cell size, number, and function, have been identified. The decline in preadipocyte capacity for differentiation and the associated decline in fat cell lipogenic capacity may be particularly important in contributing to the decrease in fat mass and alterations in fat tissue function that occur between middle‐ and old age. These declines result from blunting of the changes in gene expression that occur during preadipocyte differentiation and may, in turn, be related to altered regulation of particular transcription factors that control the preadipocyte differentiation program and maintenance of fat cell function.
Association of the Resident Assessment Instrument (RAI) with Changes in Function, Cognition, and Psychosocial Status
Authors: Phillips Charles D. , Morris John N. , Hawes Catherine , Fries Brant E. , Mor Vincent , Nennstiel Marianne , Iannacchione Vincent 
Published: April 2015

OBJECTIVE: To evaluate the impact of the Resident Assessment Instrument (RAI) on changes in nursing home residents' functional status, cognitive status, and psychosocial well‐being.DESIGN: A quasi‐experiment involving the collection of longitudinal data on two cohorts of nursing home residents. One cohort was assessed before the implementation of the RAI, and the other was assessed after the implementation of the new assessment process.SETTING AND PARTICIPANTS: Over 2000 nursing home residents in 267 nursing homes located in 10 geographic areas were assessed during the pre‐RAI period. In the post‐RAI period, 2000 new residents in 254 of the same facilities were assessed.INTERVENTION: RAI implementation began in October 1990 and continued until October 1991. The RAI includes a structured, multidimensional resident assessment and problem identification system designed to form the basis for residents' care plans.MEASUREMENTS: All residents were assessed at baseline and at 6 months using the Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS) and its protocols. All data were collected by research nurses employed and trained by the research team.RESULTS: Implementation of the RAI significantly reduced the rate of decline in seven of the nine outcomes under consideration. Reductions in improvement were also observed in all outcomes. In activities of daily living, social engagement, and cognitive function, the reduced decline far outweighed any reductions in improvement. In mood problems, problem behaviors, and understanding others, however, reductions in improvement were greater than any reductions in decline. Changes in the rates of decline and improvement were not uniform across all residents.CONCLUSION: The RAI may have improved the quality of care of nursing home residents by reducing overall rates of decline in important areas of resident function. However, this innovation may have generated trade‐offs in that it may have reduced improvement rates in some areas of function. The system's implementation also seems to have focused staff's attention on the needs and strengths of specific subpopulations of residents. Revisions of the RAI must assist staff in generalizing their efforts to all residents and to increasing improvement rates, especially in areas related to mood and behavior.
A Commitment to Change: Revision of HCFA's RAI
Authors: Morris John N. , Nonemaker Sue , Murphy Katharine , Hawes Catherine , Fries Brant E. , Mor Vincent , Phillips Charles 
Published: April 2015

OBJECTIVE: To describe the reliability of new assessment items and their clinical utility as judged by experienced nurse assessors, based on the results from the field test of Version 2.0 of the Resident Assessment Instrument (RAI).DESIGN: Independent dual assessment of residents of nursing facilities by staff nurses using a draft of Version 2.0 of the minimum data set (MDS).SETTING AND PARTICIPANTS: A total of 187 randomly selected residents from 21 nursing homes in seven states volunteered to test Version 2.0 of the MDS.MEASUREMENT: The full array of MDS assessment items included measures in the following areas: Background information, cognitive patterns, communication/hearing, vision, mood and behavior, psychosocial well‐being, physical functioning and structural problems, continence, disease diagnoses, health condition, oral/nutritional status, dental status, skin condition, activity pursuit patterns, medications, special treatments and procedures, and discharge potential and overall status.RESULTS: Evaluative data address issues of MDS item utility and reliability. For new items, almost all achieved a reasonably high‐weighted Kappa interrater reliability; revised items also surpassed earlier items, and with the updated training materials, even the non‐changed items had higher average reliability levels. Based on the success of the field test and the positive response of the industry, Version 2.0 of the RAI has been adopted, and HCFA has initiated a more long‐range process to update further the RAI when necessary.CONCLUSION: Findings support the reliability and clinical utility of the new and revised assessment items incorporated by HCFA in Version 2.0 of the MDS.