bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variability in Mammography Use Among Older Women
Authors: Burns Risa B. , McCarthy Ellen P. , Freund Karen M. , Marwill Sandra L. , Shwartz Michael , Ash Arlene , Moskowitz Mark A. 
Published: April 2015

OBJECTIVE: To determine rates of and explore factors associated with mammography use among older women.DESIGN: Retrospective review of part B (physician) bills submitted to Medicare during 1990.SETTING: Health Care Financing Administration (HCFA) data, including sociodemographic information and part B physician bills for all services delivered to Medicare‐eligible women in 1990.PATIENTS/PARTICIPANTS: Women age 65 or older as of January 1, 1990, residing in one of 10 states with part B coverage through December 31, 1990.MEASUREMENTS AND MAIN RESULTS: The outcome was receipt of a mammogram (yes/no). We explored factors associated with mammography use within three age groups: 65 to 74, 75 to 84, and 85 +. The factors considered were race, state, median income of ZIP Code of residence (from the 1990 US Census, and used to divide the population into quintiles within each state), and number of primary care visits (0, 1, 2, and 3+). Overall, 15% of women had a mammogram: 20% of women age 65 to 74, 12% of women age 75 to 84, and 4% of women age 85 and older. Mammography use was lowest in Oklahoma and highest in Washington. However, in each state the older the age category, the less the mammography use (e.g., 9% vs 5% vs 2% in Oklahoma and 25% vs 16% vs 5% in Washington for women 65–74, 75–84, and 85+, respectively). Mammography use was lower for black than for white women age 65 to 74 (14% vs 21%, P < .001) and 75 to 84 (9% vs 12%, P < .001). Women in each of these two age groups had lower mammography use if they resided in the lowest income quintile and highest if they resided in the highest income quintile (17% vs 23% 65–74, and 10% vs 13% 75–84, P values < .001). Among the oldest women (those 85+), mammography use was low (4%) and varied minimally by race and income (P = .907 and .003, respectively). In all age groups, mammography use was lowest among women who did not have a primary care visit, was greater among women who had at least one visit, and continued to rise with increasing numbers of visits (all P values < .001). For example, among women age 75 to 84, mammography use increased from 5% to 10%, 14%, and 17% for those with 0, 1, 2, and 3+ visits.CONCLUSIONS: We found that mammography use was less for women who were older, of black race, who did not visit a primary care provider, and who lived in areas with lower median income and certain geographic locations (states). Similar factors influenced mammography use in women age 65 to 74, where there is greater consensus as to who should receive a mammogram, and women age 75 to 84, where there is neither consensus nor data. Surprisingly, neither race nor income had much influence on mammography use among women age 85 or older. J Am Geriatr Soc 44:922–926, 1996.
Bacteremic Urinary Tract Infection in Older People
Authors: Ackermann Richard J. , Monroe Patrick W. 
Published: April 2015

OBJECTIVES: To describe patients with bacteremic urinary tract infections, compare characteristics of young and older patients, and suggest appropriate empiric antibiotic therapy for this clinical condition.DESIGN: Case series, with an observation period of 3 years.SETTING: A large southeastern community hospital.PARTICIPANTS: One hundred eighty patients more than 18 years old (101 older than age 65) with urine and blood cultures simultaneously positive for bacterial organisms.MEASUREMENTS: Chart review‐determined demographic characteristics, clinical data, bacterial organism and antibiotic susceptibility, number of medical diagnoses, use of a urinary catheter, admission source, and mortality.RESULTS: The 180 patients experienced bacteremias caused by 183 bacterial organisms. Sixty‐one patients were aged 65 to 79 years, and 40 were 80 years of age or older; 63.9% of patients were female; 62.2% were black. Gram‐negative organisms accounted for 80.3% of bacterial isolates, with Escherichia coli accounting for 54.1% of cases. Gram‐positive organisms accounted for 19.7% of isolates, including Staphylococcus aureus (13.1%) and Enterococcus (5.5%). Older patients had a distribution of Gram‐positive and Gram‐negative organisms similar to that of younger patients. Men and patients with chronic urinary catheters had higher proportions of Gram‐positive organisms and non‐E. coli Gram‐negative rods. Organisms showed excellent susceptibilities to commonly used antibiotics. In‐hospital mortality was 16.1%, with higher mortality in patients with chronic urinary catheters, in patients who were admitted from nursing homes, and when a Gram‐positive organism was identified. Advanced age was not associated with higher mortality.CONCLUSIONS: Concomitant illness and especially the use of urethral catheters, but not advanced age itself, are associated with a higher mortality from bacteremic urinary tract infection. Single agent empiric antimicrobial therapy such as ceftriaxone may be appropriate in older patients with presumed urosepsis, except in catheterized patients or those with other risk factors for Gram‐positive or resistant Gram‐negative infections. J Am Geriatr Soc 44:927–933, 1996.
Free and Protein‐Bound Cobalamin Absorption in Healthy Middle‐aged and Older Subjects
Authors: van Asselt Dieneke Z. , van den Broek Wim J. , Lamers Cornelis B. , Corstens Frans H. , Hoefnagels Willibrord H. 
Published: April 2015

OBJECTIVE: To study free‐ and protein‐bound cobalamin absorption and the correlation with atrophic gastritis in healthy middle‐aged and older subjects.DESIGN: A cross‐sectional study.PARTICIPANTS: Fifty‐two healthy subjects, aged 26 to 87 years, apparently free from conditions known to influence the cobalamin status. Middle‐aged subjects were defined as those younger than 65 years of age (median age 57 years) and older subjects as those 65 years and older (median age 75 years).MEASUREMENTS: Protein‐bound cobalamin absorption was assessed by 48‐hour urinary excretion method following oral administration of scrambled egg yolk, labeled in vivo with 57Co‐cobalamin by injecting a hen with 57Co‐cyanocobalamin. The percentage of 57Co‐cobalamin bound to protein was 65%. Free cobalamin absorption was assessed by 48‐hour urinary excretion method following oral administration of crystalline 57Co‐cyanocobalamin. Plasma cobalamin, folate and fasting plasma gastrin, and pepsinogen A and C concentrations were determined.RESULTS: The median urinary excretion of egg yolk 57Co‐cobalamin in middle‐aged subjects was 12.3% (25th and 75th percentiles 10.5%‐14.5%) compared with 11.7% (25th and 75th percentiles 9.8%‐13.6%) in older subjects (P = .283). The median urinary excretion after administration of free 57Co‐cobalamin in middle‐aged subjects was 25.7% (25th and 75th percentiles 20.6%‐30.7%) compared with 27.9% (25th and 75th percentiles 21.4%‐34.5%) in older subjects (P = .694). Neither egg yolk nor free 57Co‐cobalamin excretion correlated with age.A ratio of pepsinogen A to pepsinogen C less than 1.6, indicating atrophic gastritis, was found in 13 subjects. Within the atrophic gastritis group, 11 subjects had a pepsinogen A concentration greater than or equal to 17 μg/L, indicating mild to moderate atrophic gastritis, and two subjects had a pepsinogen A concentration less than 17 μg/L, indicating severe atrophic gastritis or gastric atrophy. All subjects had normal fasting plasma gastrin concentrations. Free and egg yolk 57Co‐cobalamin excretions were not reduced in the atrophic gastritis group when compared with the non‐atrophic gastritis group.Median plasma cobalamin concentration was not significantly lower in older subjects (P = .205). Nonetheless, plasma cobalamin concentration correlated negatively with age (r = ‐.36; P = .008).CONCLUSIONS: We demonstrated no significant difference in either free or protein‐bound cobalamin absorption between healthy middle‐aged and older adults. In addition, no alteration in cobalamin absorption was found in subjects identified as having mild to moderate atrophic gastritis. Therefore, based on our results, the high prevalence of low cobalamin levels in older people cannot be explained by either the aging process or mild to moderate atrophic gastritis. J Am Geriatr Soc 44:949–953, 1996.
Hand Sensibility of Healthy Older People
Authors: Desrosiers Johanne , Hébert Réjean , Bravo Gina , Dutil Elisabeth 
Published: April 2015

OBJECTIVE: To develop normative data for four hand sensibility modalities in older subjects.DESIGN: Cross‐sectional.SETTING AND PARTICIPANTS: Three hundred and sixty community‐dwelling subjects of both sexes, aged 60 to 94, randomly selected from the electoral list of the city of Sherbrooke, Quebec, Canada.MEASUREMENTS: Touch/pressure threshold (Semmes‐Weinstein monofilaments), static and moving two‐point discrimination (Mackinnon‐Dellon Disk‐Criminator), tactile recognition (Modified Pick‐up test), and thumb kinesthesia.RESULTS: A reduction with age was found in the performance of the study subjects, with the exception of the kinesthesia test. The values obtained in this study are clearly lower than the norms proposed for adults, underlining the importance of using reference values developed for the target clientele.CONCLUSION: The norms will help clinicians to differentiate better between normal and pathological changes in sensibility with age. J Am Geriatr Soc 44:974–978, 1996.
Life‐Sustaining Treatment Decisions by Spouses of Patients with Alzheimer's Disease
Authors: Mezey Mathy , Kluger Malvina , Maislin Greg , Mittelman Mary 
Published: April 2015

OBJECTIVE: To examine the anticipated decisions to consent to or to forgo life‐sustaining treatment by spouses of patients with Alzheimer's disease and to describe the relationship of spouse and patient characteristics to predicted decisions.DESIGN: Prospective quantitative study.SETTING: The Aging and Dementia Research Center (ADRC), part of an Alzheimer's Disease Center Core Grant, at New York University Medical Center.PARTICIPANTS: Fifty spouse caregivers of Alzheimer's disease patients, evaluated at the ADRC, who had a minimum Stage 4 on the Global Deterioration Scale.MEASUREMENTS: Spouses were presented with two conditions (critical illness and irreversible coma) and rated their agreement with, certainty of, and comfort with four treatments (resuscitation, breathing machine, feeding tube, and antibiotics). Data were also obtained as to patients' current quality of life, spouses' standard of decision‐making, and spouse burden.RESULTS: Eighteen of 50 patients had a durable power of attorney for health care, 20 of 50 had a living will, and 26 of 50 had neither. In the face of critical illness, almost equal numbers of spouses would consent to or forgo CPR, 28 of 50 would forgo a breathing machine, 21 of 50 a would forgo a feeding tube, and 5 of 50 would forgo antibiotics. Five of 50 would forgo all four treatments, and 12 of 50 all but antibiotics. Spouses were significantly more likely to forgo treatment in the face of coma than for critical illness (P < .001). Spouses were more certain about decisions related to coma than to critical illness (P < .001), and there was a positive and significant correlation between certainty and comfort (P = .001). Those consenting to treatment were more comfortable than those forgoing treatment (for CPR and antibiotics P = .001). Spouses of patients with Stage 7 AD were more likely to forgo CPR than those with Stages 4 to 6 AD (P < .001). Only two of 50 spouses selected descriptors congruent with a purely substituted judgment standard of decision‐making. An equal number of spouses rated patient quality of life as good, fair, or poor. For critical illness, the poorer the quality of life rating, the more likely the spouses were to forgo feeding tubes (P < .001). There was a trend for highly burdened spouses to consent to treatment.CONCLUSIONS: The results provide evidence that spouses of patients with AD anticipate forgoing life‐sustaining treatments in the face of coma but are less sure about choices for critical illness. Although preliminary in nature, findings suggest that doctors, nurses, and social workers need to provide additional support to spouses choosing to forgo rather than consent to treatment and need to inquire as to what spouses perceive as the factors that are important to them in making a decision. J Am Geriatr Soc 44:144–150, 1996.
Nutritional Assessment: A Primary Component of Multidimensional Geriatric Assessment in the Acute Care Setting
Authors: Incalzi Raffaele Antonelli , Landi Francesco , Cipriani Luca , Bruno Elvira , Pagano Francesco , Gemma Antonella , Capparella Oliviero , Carbonin PierUgo 
Published: April 2015

OBJECTIVE: To test the prognostic role of nutritional variables as a component of geriatric multidimensional assessment and to study the effect of hospitalization on nutritional status.DESIGN: Validation cohort study: multidimensional assessment on admission and at discharge and a weekly nutritional assessment.SETTING: General Medicine and Geriatrics wards in an acute‐care university hospital.PATIENTS: A consecutive sample of 302 patients aged 79 ± 6 years, range 70–96 years.MAIN OUTCOME MEASURES: Mortality, longstay (>29 days), loss of lean body mass as expressed by a negative change in mid‐arm muscle circumference (MAMC).RESULTS: Incidence of mortality, longstay, and decreased MAMC was 6.9%, 24.8%, and 64.2%, respectively. According to logistic regression analysis, mortality was independently predicted by preadmission dependency in at least one Activity of Daily Living (odds ratio = 2.08, confidence limits = 1.19–3.65), clinical diagnosis of malnutrition (OR = 1.89, CL= 1.11–3.21), serum albumin < 3.5 g/dL (OR = 1.82, CL = 1.06–3.14). This predictive model allowed us to recognize 75% of the patients at risk of death by targeting 23% of the population. Longstay was independently predicted by stroke (OR = 1.54, CL = 1.01–2.35), clinical diagnosis of malnutrition (OR = 1.41, CL = 1.04–1.93), and more than five comorbid diseases (OR = 1.39, CL = 1.01–1.94). Dependency in at least one ADL was the only independent predictor of decreased MAMC (OR = 1.71, CL = 1.27–2.30).CONCLUSIONS: Nutrition variables are a cardinal component of multidimensional assessment in the acute‐care setting. Nutritional status deteriorates during the hospital stay, mostly in physically dependent patients. J Am Geriatr Soc 44:166–174, 1996.
Probable Adverse Drug Reactions in a Rural Geriatric Nursing Home Population: A Four‐Year Study
Authors: Cooper James W. 
Published: April 2015

OBJECTIVE: To quantitate probable adverse drug reactions (ADRs) in a geriatric nursing homes population.DESIGN: A repeated measures prospective study.SETTING: Two nursing home populations in rural Georgia.PATIENTS: All 332 residents present for 30 or more days over a 4‐year period.MEASUREMENT: Admission and monthly drug regimen review for each resident, Naranjo algorithm assessment of each ADR, with monthly reports to attending physicians and follow‐up within the next month.RESULTS: There were 444 probable ADRs in 217 of 332 residents (67.4%) during this period. The 217 residents had a mean 1.9 ± 1.3 probable adverse drug reactions (range, 1–9). The ADR group differed statistically from the rest of the population only in the number of drugs per patient (7.8 ± 2.6 vs 3.3 ± 1.3), which was almost twice the number of active problems present in both the ADR (4.0 ± 0.9) and non‐ADR populations (3.8 ± 1.4). The organ systems most commonly involved in the 444 ADRs observed were cardiovascular (188), central nervous system (129), gastrointestinal (82), endocrine (41), immune (17), hematologic (7), pulmonary (6), and renal (5). The drugs most commonly implicated in ADRs were, in decreasing order, diuretics, antipsychotics, anxiolytics, potassium supplements, digoxin, NSAIDs, insulin, theophylline, H2‐receptor antagonists, antiinfectives, anticonvulsants, and thyroid supplements. There were 39 multiple drug ADRs in 34 patients. In decreasing order the drug classes in multiple ADRs were CNS depressants, antihypertensives, potassium‐altering therapy, and NSAIDs. Numerous patients had repetitions of the same ADR, especially with antipsychotics, NSAIDs, and insulin.CONCLUSIONS: ADRs are a common occurrence in a geriatric nursing home population, and may be related to inadequate attention to the patients history as well as to unrealistic therapeutic endpoints. J Am Geriatr Soc 44:194–197, 1996.
Protective Effect of Chronic NSAID Use on Cognitive Decline in Older Persons
Authors: Rozzini Renzo , Ferrucci Luigi , Losonczy Kathy , Havlik Richard J. , Guralnik Jack M. 
Published: April 2015

OBJECTIVETo verify whether chronic use of nonsteroidal anti‐inflammatory drugs (NSAIDs) has a protective effect against cognitive decline in older persons.DESIGNProspective study with a 3‐year observation period.SETTINGThree communities of the Established Populations for Epidemiologic Studies of the Elderly (EPESE).SUBJECTSA population‐based sample of 7671 subjects who received an in‐person interview at the sixth annual follow‐up. Persons with documented NSAID use at the time of the interview and 3 years before were considered chronic users (21%), while all other persons were considered as nonusers.MAIN OUTCOME MEASUREChange over time in cognitive function assessed as the number of correct answers to a 9‐item version of the Short Portable Mental Status Questionnaire (SPMSQ).RESULTSFor every level of SPMSQ score measured at the beginning of the observation period, the mean SPMSQ score after 3 years was higher in chronic NSAID users than in nonusers. Cognitive function at the end of the observation period was significantly higher in chronic NSAID users than in controls, adjusting for initial SPMSQ score and potential confounders. Older age, female gender, education, and history of cerebrovascular disease were also independent predictors of lower SPMSQ score. In the multivariate analysis, the magnitude of the protective effect estimated for NSAID use was comparable to a difference in age of 3.5 years. The percentage of persons who started above a specific SPMSQ score cut‐point and deteriorated below that cut‐point over a 3‐year period was significantly lower in chronic NSAID users than in nonusers (30.2% vs 34.3%, P = .03, for decline below SPMSQ score of 8 and 12.3% vs 14.4% for decline below SPMSQ score of 6, P = .04). After controlling for potential confounders, the relative risk of cognitive declining in chronic NSAID users compared with nonusers was 0.82 (95% Confidence Interval: 0.69–0.98) for a decline below a score of 8, and 0.80 (95% CI: 0.66–0.98) for a decline below a score of 6.CONCLUSIONSThese results support the association between NSAID use and reduction in cognitive decline in older persons. Ultimately, randomized controlled trials must be done to prove a beneficial effect definitively.
Effects of Growth Hormone and Estrogen on T Lymphocytes in Older Women
Authors: Bonello Robert S. , Marcus Robert , Bloch Daniel , Strober Samuel 
Published: April 2015

OBJECTIVETo assess the effect on peripheral blood T lymphocytes of recombinant human growth hormone administered to healthy older women.DESIGNProspective, open study.SETTINGVeterans Administration clinical research unit and community surrounding Palo Alto, California.PARTICIPANTSThirty‐three women were recruited in two age groups: 20 to 40 years (n = 13) and 70 years or older (n = 24). Subjects were healthy, community‐dwelling volunteers.INTERVENTIONSRecombinant human growth hormone at a dose of 0.025 mg/kg body weight/day was administered to the older subjects by daily subcutaneous injection over a 6‐month study period.MAIN OUTCOME MEASURESMean percentage and number of peripheral blood CD45RA+ (“naive”) T cells, mean counts per minute (CPM) of [3H]‐thymidine incorporation following stimulation of peripheral blood mononuclear cells with phytohemaglutinin (T cell proliferation).RESULTSBefore therapy, mean percentage and number of peripheral blood CD45RA+ T cells and T cell proliferative responses were significantly reduced in older compared with younger women. The fraction of older women with CD45RA+ T cell levels or T cell proliferative responses in the young range was significantly decreased in those who were receiving estrogen (1/10) compared with those who were not (9/14). After treatment with growth hormone, there were no significant changes in the mean CD45RA+ T cell levels or proliferative responses of the older women.CONCLUSIONSThe results suggest that T cell changes associated with the age‐related decline in secretion of growth hormone cannot be reversed by growth hormone therapy during the eighth decade.
Treatment of Progressive Supranuclear Palsy with Amitriptyline: Therapeutic and Toxic Effects
Authors: Engel Peter A. 
Published: April 2015

BACKGROUNDProgressive supranuclear palsy (PSP) is a parkinsonian‐like disorder characterized by postural instability, rigidity, bradykinesia, supranuclear ocular palsy, dysarthria, dysphagia, and dementia. There is no satisfactory treatment. Two patients with advanced (PSP) reported here had clinically meaningful improvement in motor function on low dose amitriptyline (AMI) but developed cognitive and behavioral disturbances at higher doses.CASE REPORTSDuring 11 weeks of upward dose titration, a 65‐year‐old man was partially relieved of severe bradykinesia, dysarthria, and dysphagia at an optimal dose of 40 mg bid (plasma AMI 39 ng/mL) such that he could feed himself, swallow easily, and transfer from wheelchair to toilet. Nocturnal confusion and urinary incontinence appeared at 70 mg bid, then resolved at 40 mg bid. Benefits were sustained during the next 14 months. A 77‐year‐old man had substantial relief of severe rigidity, bradykinesia, poor balance, and blepharospasm at 10 mg bid, such that he could feed himself and walk independently. At 40 mg bid (plasma AMI 62 ng/mL) 3 weeks later, he became aggressive, irritable, and increasingly confused. He reverted to his untreated state with drug withdrawal, then improved when AMI was reintroduced at 10 mg bid (plasma AMI 17 ng/mL).CONCLUSIONLow dose AMI may improve severe motor dysfunction in PSP significantly. Dosing must be individualized for optimal response and minimal toxicity.
The Evolution of Psychiatric Symptoms in Alzheimer's Disease: A Natural History Study
Authors: Jost Barbara C. , Grossberg George T. 
Published: April 2015

OBJECTIVETo characterize the natural history of Alzheimer's Disease (AD); in particular, to determine the prevalence and time of onset of psychiatric symptoms.DESIGNRetrospective medical records review.SETTINGRegional brain bank operated by a university hospital.PARTICIPANTSOne hundred randomly selected autopsy‐confirmed AD patients.MEASUREMENTSThe presence of psychiatric symptoms (e.g., anxiety, wandering, agitation) was documented, and the time of onset relative to diagnosis was measured.RESULTSIrritability, agitation, and aggression were documented in 81 patients (81%) an average of 10 months after diagnosis. A total of 72% of patients experienced depression, changes in mood, social withdrawal, and suicidal ideation more than 2 years before diagnosis (26.4 months). Hallucinations, paranoia, accusatory behavior, and delusions were documented around the time of diagnosis (0.1 months after diagnosis) in 45% of patients. Patients with early‐onset disease, more years of formal education, and male gender experienced psychiatric symptoms later, relative to diagnosis, than their counterparts.CONCLUSIONSPsychiatric manifestations of depression may herald a diagnosis of AD, as such behaviors occurred more than 2 years before diagnosis, on average, in this cohort. Psychotic symptoms manifested around the time of diagnosis, perhaps even prompting diagnosis, whereas agitative symptoms occurred in the first year after diagnosis. The evolution of psychiatric symptoms in this cohort differed according to age at onset of disease, years of formal education, and gender.