bluuebunny/crossref_metadata_2025_split huggingface dataset:
MODELS OF GERIATRICS PRACTICE*: Outpatient Geriatric Evaluation and Management
Authors: Reuben David B. , Boult Chad , Boult Lisa , Morishita Lynne , Smith Stanley L. , Kane Robert L. 
Published: April 2015

OBJECTIVE: To describe the development and operation of a practical model of outpatient geriatric evaluation and management (GEM) for high‐risk, community‐dwelling older adults.PARTICIPANTS: Community‐dwelling Medicare beneficiaries age 70 years and older who were medically stable but had a high probability of repeated admission to hospitals (Pra > .40) in the future (n = 248).INTERVENTION: Outpatient GEM.MEASUREMENTS: Demographic, clinical, and use‐of‐hospital characteristics of patients; nature and quantity of GEM services; satisfaction of patients and their established primary physicians.RESULTS: At enrollment, the average patient was 78.7 years old, took 5.0 long‐term prescription medications and was unable to perform 0.5 (of six) activities of daily living (ADL) and 1.4 (of seven) instrumental ADL. Many patients (71.3%) reported hospital days during the previous year. Each of three interdisciplinary teams (geriatrician, gerontological nurse practitioner, nurse and social worker) performed comprehensive assessments and then provided primary care and case management to a case load of 45 to 52 patients. On average, GEM required 6 months, during which patients visited the GEM clinic 7.4 times, had 10.4 active problems addressed, spoke to GEM staff members weekly by telephone, and were referred to two other providers. Most patients (94.4%) completed the GEM program; 66.7% completed advance directives. Satisfaction with GEM was high among the patients and their established primary physicians. The cost of the GEM personnel averaged about $1540 per patient treated.
Reviews of the Geriatric Literature
Authors: Katz Paul R. 
Published: April 2015

Effects of Residence in Alzheimer Disease Special Care Units on Functional Outcomes. Phillips C, Sloane P, Hawes C, et al. Journal of the American Medical Association 278:1340–1344; 1997RATIONALE: To assess the impact of Alzheimer's Special Care Units (SCUs) on the rates at which residents decline in functional status.METHODOLOGY: Utilizing information collected as part of the Minimum Data Set (MDS) in four states (Kansas, Mississippi, Maine, South Dakota), the authors followed functional decline in a group of residents in special care units and compared these findings with traditional care provided in facilities with SCUs as well as non‐SCU facilities. Complete MDS assessments are performed at the time of admission and annually and are followed by quarterly assessment reviews.RESULTS: Residents in SCUs were younger, had more impaired decision‐making abilities, and were less impaired in physical functioning than non‐SCU residents. No statistically significant difference was observed in the amount of decline for residents in SCUs compared with non‐SCU residents in any of the nine outcomes studied (locomotion, transferring, toileting, eating, dressing, summary of activities of daily living (ADLs), urinary and bowel continence, and significant weight loss).CONCLUSION: This study did not demonstrate that residence in a special care unit slowed the rate of decline in functional status or weight.
Acceptability to Patients of a Home Hospital
Authors: Burton Lynda C. , Leff Bruce , Harper Michael , Ghoshtagore Ipsita , Steinwachs Donald A. , Greenough William B. , Burton John R. 
Published: April 2015

OBJECTIVE: To examine the acceptability to older patients of receiving care in the home for acute medical conditions that require hospital level care by current standards.DESIGN: Interviews with patients during hospitalization regarding their views of a hypothetical “home hospital.”PARTICIPANTS: Patients (n = 87) admitted to a community‐based academic medical center with a primary diagnosis of pneumonia, congestive heart failure, or chronic obstructive airway disease, their nurses (n = 111), and resident physicians (67).MEASUREMENTS: A questionnaire was developed to measure several domains of acceptability and expectations for care.RESULTS: A majority of patients agreed that treatment in a home hospital would be more comfortable compared with treatment in a hospital (78.5%), would be less likely to result in an infection (62.5%), and would not be a burden to their family (71.8%). There was less certainty that medical care at home can be as good as in the hospital (56.9%). Nearly three‐quarters (72.3%) of patients would choose home hospital if it were available.CONCLUSION: Patients may be ready to accept home hospital as an alternative for acute care. The acceptability of home hospital to acutely ill older patients is a critical factor in the development of this alternative for care and has the potential for improving satisfaction with care, reducing complications, hastening return to function, and, possibly, of lowering costs of care. J Am Geriatr Soc 46:605–609, 1998.
GERIATRICS IN MANAGED CARE: The Effect of HMO Status on the Outcomes of Home‐Care After Hospitalization in a Medicare Population
Authors: Brummel‐Smith Kenneth , Holtzman Jeremy , Chen Qing , Kane Robert 
Published: April 2015

OBJECTIVE: The literature suggests that Medicare health maintenance organization (HMO) patients may have poorer outcomes with formal home‐health care than do fee‐for‐service (FFS) patients, but it is unclear whether this is related to case‐mix or quality. Our objective was to compare the home‐health care outcomes for HMO and FFS Medicare patients after hospitalization for stroke, COPD, CHF, hip replacement, or hip fracture with fixation or replacement while controlling for site of discharge and other patient characteristics.DESIGN: Patients were identified before hospital discharge with data collected at that time and then prospectively for 1 year.SETTING: Nineteen acute general hospitals in Minneapolis/St. Paul, Minnesota.PATIENTS: All Medicare patients in the above hospitals identified predischarge with stroke, COPD, CHF, hip replacement, or hip fracture with fixation or replacement.MEASURES: Outcome: weighted ADL scale and hospital readmission. Independent factors: site of discharge, HMO status, comorbidity, severity, and demographic factors.RESULTS: A total of 970 subjects were studied, 211 of whom were discharged to home‐care. HMO patients were more likely to be discharged to a nursing home than to home‐care after controlling for other factors (OR = 1.7; P = .015). After controlling for site of discharge and patient characteristics through either propensity scores or regression analysis, there was no statistically significant difference in ADL function at 6 weeks or at 6 months between HMO and FFS patients. Nor was there was a statistically significant difference in hospital readmission rates at 6 weeks and 6 months between HMO and FFS home‐care patients.CONCLUSIONS: The outcomes of Medicare HMO patients discharged to home‐care are not worse than those of FFS patients. J Am Geriatr Soc 46:629–634, 1998.
Aging, Esophageal Motility, and Gastroesophageal Reflux
Authors: Ferriolli E. , Oliveira R. B. , Matsuda N. M. , Braga F. J. H. N. , Dantas R. O. 
Published: April 2015

OBJECTIVES: To compare esophageal motility and gastroesophageal reflux characteristics in young, middle‐aged, and older healthy volunteers.DESIGN: Comparison of conventional esophageal manometry and scintigraphic study of gastroesophageal reflux in volunteers aged 20 to 30 years, 50 to 60 years, and 70 to 80 years.SETTING: Gastroenterology and nuclear medicine laboratories of a tertiary care university hospital.PARTICIPANTS: Forty healthy adult volunteers recruited from the community, 20 aged 20 to 30 years, 10 aged 50 to 60 years, and 10 aged from 70 to 80 years.MEASUREMENTS: Each volunteer underwent conventional esophageal manometry and scintigraphic study of gastroesophageal reflux. Contractile wave amplitude, duration, velocity, and lower esophageal sphincter relaxation duration, as well as the presence of abnormal peristalsis, were correlated with the proportion of volunteers with gastroesophageal reflux and the number and duration of gastroesophageal reflux episodes.RESULTS: Quantitative manometric parameters showed no correlation with gastroesophageal reflux patterns. Abnormal peristalsis was found more frequently in the older volunteers. The number of gastroesophageal reflux episodes per volunteer was similar in the three age groups, but the duration of gastroesophageal reflux episodes was longer in the older volunteers.CONCLUSION: Healthy older persons have impaired clearance of refluxed materials associated with a high incidence of defective esophageal peristalsis. This may explain the higher severity of reflux esophagitis in older people.
Evaluating the Use of Angiotensin‐Converting Enzyme Inhibitors For Older Nursing Home Residents with Chronic Heart Failure
Authors: Forman Daniel E. , Cbander Ravi B. , Lapane Kate L. , Shah Parul , Stoukides John 
Published: April 2015

BACKGROUND: Despite their well noted therapeutic benefits for heart failure (HF), angiotensin‐converting enzyme (ACE) inhibitors may be underprescribed and underdosed among older nursing home patients.OBJECTIVES: To assess the use of ACE inhibitor therapy in older (≤70 years) nursing home residents with systolic heart failure (HF).DESIGN: A cross‐sectional, retrospective analysis.SETTING: Five long‐term care facilities in Providence, Rhode Island.SUBJECTS: Adults aged 70 years or older with left ventricular (LV) ejection fractions ≤40%.MEASUREMENTS: New York Heart Association (NYHA) class, comorbid diseases, and cardiac medications with logistic regression analysis to clarify their bearing on the prescription of ACE inhibitors.RESULTS: Of the 819 nursing home residents who were evaluated, 119 (24 men, 95 women) fulfilled exacting entry criteria, i.e., heart failure signs/symptoms and documented LV systolic dysfunction. Forty‐one of these 119 (35%) older persons were receiving ACE inhibitor therapy, predominantly in doses (≤50 mg captopril/day or ≤5 mg enalapril/day) less than those of proven therapeutic efficacy. Compared with older residents not receiving ACE inhibitors, those receiving ACE inhibitors included fewer with NYHA Class I HF (0 vs 21%, P = .017), more men (58 vs 28%, P ≤ .01), and more people with hypertension (61 vs 35%, P ≤ .01). In contrast, diuretics were prescribed more frequently among those not receiving ACE inhibitors (83 vs 56%, P ≤ .001).CONCLUSIONS: ACE inhibitors are underprescribed and underdosed among elderly nursing home patients carefully screened to include systolic HF and no contraindications to the medication. ACE inhibitors are particularly underused in those elderly with NYHA Class I HF and in those receiving diuretics.
Undertreatment of Hypertension in Older Mexican Americans
Authors: Satish Shiva , Stroup‐Benham Christine A. , Espino David V. , Markides Kyriakos S. , Goodwin James S. 
Published: April 2015

OBJECTIVE: To identify the prevalence of hypertension and factors associated with nontreatment and poor control of hypertension in Mexican Americans aged 65 years and older.DESIGN: A population‐based survey of older Mexican Americans conducted in 1993–1994.SETTING: Subjects residing in five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California.PARTICIPANTS: An area probability sample of 3050 non‐institutionalized Mexican American men and women aged 65 and older took part in a 90‐minute in‐home interview, which included review of all medications taken and two sitting blood pressure measurements.OUTCOME MEASURES: Measured were previous diagnoses of hypertension, current medication for hypertension, and current blood pressure.RESULTS: Sixty‐one percent of older Mexican‐Americans were hypertensive, and 51% of those with hypertension were taking antihypertensive medications. Only 25% of hypertensive subjects (18% of males and 30% of females) were in good blood pressure control (i.e., systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg). In multivariate analyses, factors associated with increased likelihood of treatment included female gender (OR = 1.9), history of heart disease (OR = 2.4), possessing a regular source of health care (OR = 2.7), and having seen a physician two or more times in the previous year (OR = 3.8). These were also independent predictors of good blood pressure control.CONCLUSION: Nontreatment of hypertension is still a major public health concern in older Mexican Americans. We estimate that adequate blood pressure control in this population would prevent approximately 30,000 adverse cardiovascular events over 10 years, affecting approximately 6% of the entire Mexican American older population.
Predicting Hospitalization and Functional Decline in Older Health Plan Enrollees: Are Administrative Data as Accurate as Self‐Report?
Authors: Coleman Eric A. , Wagner Edward H. , Grothaus Louis C. , Hecht Julia , Savarino James , Buchner David M. 
Published: April 2015

OBJECTIVE: To compare the predictive accuracy of two validated indices, one that uses self‐reported variables and a second that uses variables derived from administrative data sources, to predict future hospitalization. To compare the predictive accuracy of these same two indices for predicting future functional decline.DESIGN: A longitudinal cohort study with 4 years of follow‐up.SETTING: A large staff model HMO in western Washington State.PARTICIPANTS: HMO Enrollees 65 years and older (n = 2174) selected at random to participate in a health promotion trial and who completed a baseline questionnaire.MEASUREMENT: Predicted probabilities from the two indices were determined for study participants for each of two outcomes: hospitalization two or more times in 4 years and functional decline in 4 years, measured by Restricted Activity Days. The two indices included similar demographic characteristics, diagnoses, and utilization predictors. The probabilities from each index were entered into a Receiver Operating Characteristic (ROC) curve program to obtain the Area Under the Curve (AUC) for comparison of predictive accuracy.RESULTS: For hospitalization, the AUC of the self‐report and administrative indices were .696 and .694, respectively (difference between curves, P = .828). For functional decline, the AUC of the two indices were .714 and .691, respectively (difference between curves, P = .144).CONCLUSIONS: Compared with a self‐report index, the administrative index affords wider population coverage, freedom from nonresponse bias, lower cost, and similar predictive accuracy. A screening strategy utilizing administrative data sources may thus prove more valuable for identifying high risk older health plan enrollees for population‐based interventions designed to improve their health status.
Thioridazine Dose‐Related Effects on Biomechanical Force Platform Measures of Sway in Young and Old Men
Authors: Liu Yan Juan , Stagni Grazia , Walden Judith G. , Shepherd Alexander M.M. , Lichtenstein Michael J. 
Published: April 2015

OBJECTIVE: Thioridazine (TDZ) is associated with an increased risk of falls. The purpose of this study was to determine whether (1) thioridazine increases Biomechanics Force Platform (BFP) measures of sway in a dose‐related manner, (2) there is a difference in sway between young and old men, (3) there is a correlation between sway and orthostatic changes in BP and HR.DESIGN: Seven younger (aged 20–42) and five older (aged 70–76) healthy male volunteers received, in a randomized order double‐blind design, a single oral dose of 0, 25, and 50 mg of TDZ on three separate days at least 7 days apart and 75 mg on the fourth day of the study. Sway and blood pressure were measured for 24 hours.SETTING: A general clinical research center.MEASUREMENTS: Biomechanics force platform measures of postural sway were measured as the movement of the center of pressure. The elliptical area (EA) and average velocity (AV) were calculated with eyes open and eyes closed. Blood pressure and heart rate were measured for 5 minutes supine and 5 minutes standing.RESULTS: Thioridazine increases BFP sway in a dose‐dependent manner. EA increased from 0.56 (SD = .51) cm2 for placebo to 0.88 (SD = 1.09) cm2 for 75 mg TDZ. AV increased from 1.07 (SD = .27) cm/sec, placebo, to 1.43 (SD = .55) cm/sec, 75 mg TDZ. Older men swayed more than younger men. Changes followed the expected time course for TDZ. EA and AV were associated with HR and BP, e.g., SBP versus ln(EA) and ln(AV) (r = −0.21 and r = −0.22, respectively; P < .0001).CONCLUSIONS: Thioridazine increases validated measures of fall risk dose dependently in young and old men. This may explain the effects of neuroleptic drugs on fall risk in older people.
Atrial Natriuretic Peptide Level Contributes to a Model of Future Mortality in the Oldest Old
Authors: Knight Eric L. , Kiely Dan K. , Fish Loretta C. , Marcantonio Edward R. , Minaker Kenneth L. 
Published: April 2015

OBJECTIVES: To determine if atrial natriuretic peptide (ANP) level is associated with mortality in the oldest old and to develop a comprehensive model of mortality in the oldest old using clinical and laboratory parameters.DESIGN: Prospective cohort study with 7 years of follow‐up.SETTING: A 725‐bed life care facility.PARTICIPANTS: 282 frail older individuals (mean age 88, range 70–102).MEASUREMENTS: Variables measured included age, gender, Charlson Comorbidity Index, functional measurements, weight, blood pressure, and multiple laboratory variables, including ANP. Main outcome measurement was death.RESULTS: Eighty‐four percent (237/282) of subjects died during the 7‐year follow‐up period. On univariate analysis, the risk ratio (RR) for ANP tertile was 1.28. On bivariate analysis, adjusting for the development of congestive heart failure, the RR was 1.22. On multivariate analysis, the following variables were associated with mortality: ANP tertile (RR 1.24), age (RR 1.04), female gender (RR 0.43), Charlson Comorbidity Index score (RR 1.13), mentation score (RR 1.27), BUN/Cr ratio (RR 1.04), albumin level (RR 0.63), and hemoglobin level (RR 0.84).CONCLUSIONS: ANP level and other variables are independent risk factors for mortality in frail individuals. ANP level may indicate homeostatic failure to adapt to fluid volume changes or may reflect subclinical heart disease. ANP level contributes to a multivariate model of mortality in frail older individuals.
Variation in Estimates of Urinary Incontinence Prevalence in the Community: Effects of Differences in Definition, Population Characteristics, and Study Type
Authors: Thom David 
Published: April 2015

OBJECTIVES: Prevalence estimates for urinary incontinence among community‐dwelling adults vary from 2 to 55%. A review of the literature was undertaken to investigate the degree to which differences in definitions of incontinence, age, and gender of the populations studied, response rates, measurement techniques, or location could explain differences in reported prevalences.DESIGN: A literature search was conducted to locate all studies published in English reporting the prevalence of urinary incontinence in a population‐based sample of adults.MEASUREMENT: Information was abstracted for study size, response rate, type of survey, definition of urinary incontinence, and prevalence of incontinence by age group and gender. Prevalence by type of incontinence was also abstracted where available. Stratification was used to obtain prevalence estimates specific for age, gender, and frequency of incontinence. Data were examined for associations between prevalence and survey type, response rate, year, and location of survey.RESULTS: A total of 21 studies met inclusion criteria. Stratification of reported prevalence by frequency, gender, and age substantially reduced the variation in prevalence estimates. For older women, the estimated prevalence of urinary incontinence ranged from 17 to 55% (median = 35%, pooled mean = 34%), and for daily incontinence it ranged from 3 to 17% (median = 14%, pooled mean = 12%). For older men, incontinence prevalence was estimated to be 11 to 34% (median = 17%, pooled mean = 22%), and 2 to 11% reported daily incontinence (median = 4%, pooled mean = 5%). Within studies, the prevalence of any incontinence was 1.3 to 2.0 times greater for older women than for older men. Among middle‐aged and younger adults, prevalence of incontinence ranged from 12 to 42% (median = 28%, pooled mean = 25%) for women and from 3 to 5% (median = 4%, pooled mean = 5%) for men. The ratio of prevalence of any incontinence for women to men in this age group ranged from 4.1 to 4.5. Stress incontinence predominated in younger women, whereas urge and mixed incontinence predominated in older women. There was a tendency for studies using in‐person interviews to report higher prevalences.CONCLUSIONS: An accurate estimate of the prevalence of urinary incontinence depends on specifying the definition of incontinence and the age and gender groups of interest.
Vancomycin‐Resistant Enterococcus faecium in a Long‐Term Care Facility
Authors: Brennen Carole , Wagener Marilyn M. , Muder Robert R. 
Published: April 2015

OBJECTIVE: To describe the epidemiology and natural history of colonization with vancomycin‐resistant Enterococcus faecium (VREF) in a long‐term care facility.DESIGN: All patients in whom VREF was isolated were followed prospectively, with rectal swab cultures at 2‐week intervals, until discharge, death, or clearance of VREF. Clearance was defined as two consecutive negative cultures. In addition, three prevalence surveys were conducted of all patients in residence on one 34‐bed intermediate care ward.SETTING: A 400‐bed, long‐term care Veterans Affairs facility.PARTICIPANTS: Thirty‐six patients colonized with VREF.RESULTS: Vancomycin‐resistant Enterococcus faecium was identified in 24 of the 36 patients at the time of transfer from an acute care facility. Seventeen patients had concomitant methicillin‐resistant Staphylococcus aureus, and seven patients had a recent history of Clostridium difficile‐associated diarrhea. VREF in these patients persisted for a median of 67 days after identification. Treatment of VREF colonization with antimicrobials was associated with prolongation of colonization. Serial surveillance of the 34‐bed ward found stable rates of colonization, with only three documented instances of VREF acquisition. During 2.5 years of surveillance for infection, a single case of bacteremia occurred in a patient in whom colonization with VREF could not be demonstrated by rectal swab culture. No infections occurred in patients colonized with VREF.CONCLUSIONS: Long‐term care patients have protracted carriage of VREF. Most will improve over time; however, receipt of antimicrobial therapy is associated with prolongation of VREF carriage. The risk of VREF infection is low in this population. When there are appropriate contact precautions, patient to patient transmission occurs at a low rate. These observations can be used to design a practical infection control strategy for long‐term care facilities.