bluuebunny/crossref_metadata_2025_split huggingface dataset:
Follow Up of Patients Referred to a Dementia Service
Authors: REDING MICHAEL J. , HAYCOX JAMES , WIGFORSS KAREN , BRUSH DORETHEA , BLASS JOHN P. 
Published: April 2015

ABSTRACT:Eighty‐five patients referred to a dementia clinic in a prosperous suburban setting were followed for as long as 48 months. Progressive dementia occurred in 55 of the 56 patients in whose cases it was predicted. Three‐year mortality rates were 83 per cent for multi‐infarct dementia, 57 per cent for mixed vascular plus Alzheimer dementia, and 37 per cent for Alzheimer disease. The differences in death rates among the different diagnostic groups support the validity of the clinical distinctions drawn. A subspecialty clinic can accurately identify progressive intellectual impairment in the elderly. The data suggest that patients who have depression complicating organic brain disease are at risk for progressive intellectual impairment, even if not demented when first seen. Intellectual deterioration appears to be a poor prognostic sign in older people.
Management of Hip Fractures in Nursing Home Patients: To Treat or Not to Treat?
Authors: LYON LEONARD J. , NEVINS MICHAEL A. 
Published: April 2015

ABSTRACT:Nursing home patients who sustain hip fractures have a much higher than average complication rate after surgical repair, and few ever walk again. Operation is not necessary to ensure the patient's survival in the postfracture period. The majority of these patients are better off managed without surgery. For patients with little or no chance to walk again, a nonsurgical treatment regimen in the nursing home is safer, more humane, and far less expensive than hospitalization.
Health Experience Learning Program (HELP)
Authors: McDOWELL FLETCHER H. , WATKINS SYLVIA , ALMY THOMAS P. 
Published: April 2015

ABSTRACT:Since 1976, The Burke Rehabilitation Center has employed undergraduate university and college students as nurses' aides. This experience has enabled many students to make a decision or firm up their decision to go on to medical school. It has also been extremely valuable to the institution to have available for employment this intelligent and highly motivated group of individuals. The program has been mutually beneficial for both parties and could easily be adapted for other health care institutions.
Geriatrics: A Selected Up‐to‐date Bibliography
Authors: ROSENTHAL MARK 
Published: April 2015

This is the first annual revision of the Geriatrics Bibliography. Rather than publish only new references, the previous list has been totally revised. Approximately one quarter of the old references have been replaced by more current or more detailed articles. In addition, the bibliography has been expanded to include a number of new topics, with over one hundred more references.In preparing this revised list, many good articles were, of necesssity, excluded. The number of publications pertinent to clinical geriatrics has grown quickly over the past year. Preference, as before, was given to recent publications, since they usually provide a list of the important earlier articles. Most of the references are less than five years old; the exceptions deal with specific issues not covered as well in the subsequent literature. An occasional review article is cited to cover gaps in the geriatric literature or merely to amplify aspects of common diseases that have been widely ignored outside of geriatric medicine.Most of the references selected deal specifically with an elderly patient population. Exceptions include those dealing with diseases remarkably common in the aged but for which no adequate study from a geriatric viewpoint exists, e.g., monoclonal gammopathy, Paget's disease, pulmonary emboli. All studies in geriatrics are confounded by questions of “normal” aging as opposed to the concomitants of aging frequent in our society: inactivity, relative obesity, malnutrition, and psychosocial trauma.The first set of references (I) includes synopses on the causation of aging, the second (II) on the systems known to degenerate with advancing age. The next two topics (III, IV) are clinically related: one deals with the basic distinctions of the geriatric patient and the other with the ancillary services available. As geriatrics is basically a multidisciplinary field, the bulk of the references are cited by pertinent specialty.
Aging in Rodents Fed Restricted Diets*,†
Authors: Weindruch Richard 
Published: April 2015

Section Editor's Note:This is the first article of a new permanent section of the journal, “Geriatric Bioscience.” The Editor and the Section Editor wish to use this section to present “work in progress” and/or state of the art reviews in areas of basic science of relevance to clinicians dealing with geriatric patients. We hope this can he a mechanism to help the clinician keep abreast of new information from the fields of physiology, anatomy, molecular and cell biology, neurobiology, immunology, etc. that are likely to impact upon our care of the geriatric patient now or in the future.We wish to encourage the submission of papers for this section that will summarize recently published work from individual investigators or investigative groups and place it in the perspective of the general state of work in the field. We welcome very broad participation in this series and also solicit the readership's views on topics or work of interest that might be commissioned for this series.Harvey Jay Cohen, MDSection Editor
Alzheimer's Disease: An Annotated Bibliography of Recent Literature
Authors: Busby Jan , Bonelli Andres , Vargas Lillian , Stirna John , Caranasos George 
Published: April 2015

In recent years, Alzheimer's disease has become well known both to the medical profession and to laymen as an increasingly important cause of morbidity and mortality in the elderly. As interest in the disease has grown, so has the scientific literature. In the past four years, over 400 journal articles in the English language alone have been published on various aspects of Alzheimer's disease.Those participating in the Geriatric Medicine Fellowship Program at the Gainesville VA Medical Center have compiled an annotated list of 92 important references on Alzheimer's disease. These are classified into six major groups: General Review, Etiology, Pathophysiology, Diagnosis, Treatment, and Epidemiology.It is important for the practicing physician to be able to quickly find references to recent studies on various aspects of Alzheimer's disease, especially those related to treatment possibilities. Family members of Alzheimer's patients are particularly well informed about this disease and are anxious to learn about the latest research advances from their physicians.
Impact of Medicare Diagnosis‐Related Groups (DRGs) on Nursing Homes in the Portland, Oregon Metropolitan Area
Authors: Lyles Yvonne M. 
Published: April 2015

To evaluate the impact of the Medicare Prospective Payment System (PPS) on nursing homes, resident census and staffing data from 78 Portland, Oregon nursing homes were compiled from annual reports filed with the state. Between fiscal years (FYs) 1983 and 1984, (before and after initiation of the Medicare PPS), there was no significant change in the total number of patient‐days, but there was a 20.5% increase in the total number of deaths and a significant increase in average facility adjusted death rates (P = .004). Between the previous FYs 1982 and 1983, the total number of deaths had risen only 8.3%, and the average facility adjusted death rate had no significant change. Since initiation of diagnosis‐related groups (DRGs), these nursing homes also made sizeable increases in their adjusted full‐time registered nurse employment rate, and reported fewer patients reimbursed by Medicare.These same nursing homes were surveyed in spring, 1985 to determine the impact of Medicare DRGs in more qualitative terms. Of the 51 nursing homes (66%) responding, more than half reported increased severity of illness, shorter length of stay, increased prevalence of clinical problems, and increased use of medical supplies. In addition, more than half of the respondents reported increased frequency of requests for Friday and weekend admissions, admission of patients too sick for the facility, and physician phone consultation.These findings indicate that Portland, Oregon nursing homes experienced increased patient severity of illness, explained at least in part by earlier hospital discharge, following DRGs.
Nutritional Status and Dietary Intake in Institutionalized Patients With Alzheimer's Disease and Multiinfarct Dementia
Authors: Sandman Per‐Olof , Adolfsson Rolf , Nygren Charlotte , Hallmans Goran , Winblad Bengt 
Published: April 2015

Nutritional status, dietary intake, weight change, and mortality were studied in a sample of severely demented, institutionalized patients. Dietary intake was registered during five days in two periods, five weeks apart. A weighing method was used. Nutritional status was assessed by anthropometric measurements (weight for height index, triceps skinfold thickness, arm muscle circumference) and determination of circulating proteins (albumin, transferrin, and prealbumin).Energy and/or protein malnutrition was found in 50% of the patients. The mean dietary intake was sufficient according to energy (2059 kcallday), proteins, vitamins, and minerals. A comparison of patients with or without malnutrition showed no differences in dietary intake, diagnoses, age, length of hospital stay, or duration of illness. However, malnourished patients had had four times as many infectious periods treated by antibiotics as patients with no malnutrition. Thirty‐nine of 44 patients lost weight during their hospital stay. There was no correlation between loss of weight, length of hospital stay, or duration of illness.
Antecedents of Death in the Men of a Veterans Administration Nursing Home
Authors: Rudman Daniel , Mattson Dale E. , Nagraj Hoskote S. , Caindec Norma , Rudman Inge W. , Jackson Daniel L. 
Published: April 2015

This study aims to learn whether the annual clinical and laboratory screening of nursing home residents provides significant information about their chance of dying during the following year.In August 1984, a comprehensive clinical data base was compiled for 176 male residents of this VA nursing home. During the next 14 months, 12 men were discharged to other locations and were dropped from the study; among the remaining 166, who comprised the study group of this report, 24 died. The most common immediate causes of death were infections (67%) and cardiac disorders (25%). Twenty of the deaths occurred after transfer to the acute hospital services.Among the 67 items in the clinical data base (including absence or presence of 17 diagnoses and 16 drugs), eight were significantly correlated with death rate. Age and functional impairment were directly related, and inversely related were the following: body weight as percent of ideal, triceps skin fold, hematocrit, hemoglobin, serum albumin, and serum cholesterol. Multivariate analysis showed cholesterol and hematocrit to be the most informative of the eight mortality predictors and to correlate with death independently of age and functional level.Subgroups defined on the basis of combinations of mortality‐related attributes differed many fold in their death rates. For example, men with cholesterol ≤ 256 mg/dl and hematocrit ≤ 41% died at a rate 42 times the rate of men with values above both thresholds.For each mortality‐related attribute, death rate varied with the level of the attribute. This relationship extended into the generally accepted “normal ranges” for cholesterol, hematocrit, hemoglobin, and albumin.
Prevalence of Thyroid Disorders in Psychogeriatric Inpatients A Possible Relationship of Hypothyroidism with Neurotic Depression but not with Dementia
Authors: Tappy L. , Randin J. P. , Schwed P. , Wertheimer J. , Lemarchand‐Béraud Th. 
Published: April 2015

Thyroid disorders are known to manifest occasionally as isolated psychiatric disorders. In order to determine whether thyroid dysfunctions could play a significant role in the pathogenesis of psychiatric disorders in the elderly, the prevalence of thyroid disorders was compared in a group of psychogeriatric patients and in a group of nonpsychiatric elderly patients.Thyroid function screening was performed in 157 patients consecutively admitted to a psychogeriatric unit, and the prevalence of hypothyroidism was determined in the different groups of psychiatric disorders (senile and multi‐infarct dementia, organic brain syndrome of other etiologies, psychotic depression, neurotic depression, chronic delusional state, acute confusional state, and personality disorder). Thyroid function screening was performed similarly in 104 unselected elderly patients admitted to the medico‐surgical admission unit of the University hospital to assess the prevalence of hypothyroidism in a general, nonpsychiatric, elderly population.Eight patients were diagnosed as hypothyroid based on an elevated basal thyrotropin (TSH) and on thyrotropin‐releasing hormone (TRH) test in the total number of patients, two in the nonpsychiatric and six in the psychiatric group. Three had clinical hypothyroidism, with decreased total and free T4 and T3 plasma levels in addition to increased basal TSH, five had biochemical hypothyroidism, with normal T4 and T3 levels and an excess TSH response to oral TRH. The prevalence of hypothyroidism in the two groups did not differ significantly (1.9% in the nonpsychiatric versus 3.8% in the psychiatric group).The prevalence of hypothyroidism in a subgroup of 88 patients with senile and multi‐infarct dementia was 2.3%. It was not statistically different from that of the general nonpsychiatric geriatric population. The prevalence of hypothyroidism in a subgroup of 27 patients with neurotic depression was 14.8%. It was significantly higher than the prevalence found both in the overall psychogeriatric group and in the general geriatric group.It is concluded that hypothyroidism is not involved in cognitive disorders, but may play a role in the pathogenesis of some depressive disorders in the elderly.
Influenza Vaccination in Community Elderly
Authors: Buchner David M. , Larson Eric B. , White Richard F. 
Published: April 2015

Available strategies to increase influenza vaccination rates in the elderly have not been tested in the private sector where most elderly receive care. We performed a randomized controlled trial of a postcard reminder in three private general internal medicine practices. The observed vaccination rates of 55% in experimental patients (N = 262) and 54% in control patients (N = 278) were similar, though much higher than estimated national rates of 20%. The data indicated that the baseline (control group) vaccination rate was high probably because study participants were exposed to many community vaccination cues, separate from the study cue. That vaccination rates were not higher after additional exposure to the study cue suggests that a “ceiling effect” occurred. Including 70 patients not randomized into the trial because they received flu shots prior to randomization, the vaccination rate in patients who had a clinic visit during autumn months was 75% compared to a rate of 52% in patients not visiting the clinic (P <.0001).Our results suggest that vaccination rates can be considerably higher in the private sector than those reported in the past, and that both vaccination cues and direct patient contact appear important to promote vaccination. This and other studies suggest that traditional cues may have a ceiling effect, yielding vaccination rates no higher than 55 to 65%; further increases in rates will require other approaches.
The Ethics Committee in the Nursing Home Results of a National Survey
Authors: Glasser Gary , Zweibel Nancy R. , Cassel Christine K. 
Published: April 2015

As the complexity, prevalence and visibility of ethical dilemmas in medical care of the elderly have grown, hospitals and nursing homes have attempted to develop mechanisms for responding to these difficult ethical issues. While it is known that many hospitals rely on education and advice provided by an ethics committee, little data exist on the responses of nursing homes, despite the unique nature of ethical issues in a long‐term care setting.The present paper reports findings from a national survey of administrators of 4504 nursing homes in which mechanisms for handling ethical dimensions in patient care were investigated. Results from 29% of respondents reveal that few nursing homes have established ethics committees (2% of the sample) and that committee formation appears positively associated with facility size and religious affiliation. Committees that have been formed engage in policy review (81%), advisory case review (67%) and education (45%). Few committees include patients or their representatives as members, and few have the authority to make binding decisions (26%).While the most effective response to ethical issues in medical decision‐making is being debated, standing committees provide one means to contribute to the quality of decision‐making by patients, their family members and their physicians. However, broader inclusion of patient perspectives and education of members regarding ethical analysis are necessary precursors to effective functioning of ethics committees in long‐term care.
Erectile Failure in the Aged: Evaluation and Treatment
Authors: Mulligan Thomas , Katz P. Gary 
Published: April 2015

With aging, there are changes in both libido and erectile function. Although the majority of aged men remain interested in sex, less than 15% report continued sexual intercourse. The cause of this “libido‐potency gap” is due primarily to erectile failure.Penile erection is dependent upon a complex interaction of the autonomic nervous system, cardiovascular system, and local neurotransmitters such as acetylcholine and vasoactive intestinal polypeptide. Sexual stimulation causes augmented blood flow into the corpora cavernosa, and restricted outflow, resulting in penile rigidity. With aging, there is a decline in gonadal steroids, nerve conduction velocity, and vascular compliance, any of which could interfere with normal erections. When disease is superimposed on the normal changes of aging, erectile function is further impaired.Evaluation of an elderly male with impotence may consist of a detailed drug history and trial of alternate therapy, as in the case of adverse drug reactions. More often, evaluation entails hormonal assays, penile vascular assessment, neurologic assessment, and an evaluation of nocturnal erectile function. Based on the results of these assessments, appropriate treatment alternatives can be chosen. With the availability of multiple treatment options, patients and physicians can now choose from a range of noninvasive or invasive alternatives depending upon the etiology, associated disorders, and preference of the patient.
Pap Smear Screening in Women 65 and Older
Authors: Wheat Mary E. , Mandelblatt Jeanne S. , Kunitz Gretchen 
Published: April 2015

Pap smear screening in women 65 years of age and older is controversial. To assess the need to offer screening in this group, we examined Pap results of women 65 and older whose charts were reviewed as part of a cancer screening study in two San Francisco hospitals. Two hundred thirty women (41%) were 65 years of age or older (mean age, 73). Compared with younger women, they were less likely to have had a Pap smear during the past 3 years (61% versus 72%), less likely to have seen a gynecologist (24% versus 34%), and were more likely to have refused Pap screening (11% versus 5%).Of the 140 women who had Paps, five showed atypia (class 11). None exhibited dysplasia or carcinoma in situ. Those with atypia were all nonwhite. One had had a hysterectomy; two had a history of previously abnormal Paps. Overall, women with a history of abnormal Paps were far more likely to be screened (91% versus 58%). Those who had had a hysterectomy were significantly less likely to be screened (51% versus 68%).These results showed a low rate of cervical dysplasia/ carcinoma in older, low‐income women. Although our sample was small, the low rate of abnormals may reflect the relatively high rate of prior screening in this population. Because older women are not likely to see gynecologists, primary care physicians should continue Pap screening in older women (including those with a history of hysterectomy) until a history of repeated, technically adequate, normal Pap smears is documented.
Antibody Response of an Elderly Population to a Supplemental Dose of Influenza B Vaccine
Authors: Peters Nancy L. , Meiklejohn Gordon , Jahnigen Dennis W. 
Published: April 2015

Recent reports have suggested that the antibody response of elderly persons to standard doses of influenza vaccine is depressed. We examined the effect of an additional threefold dose of influenza B vaccine on the antibody response in elderly, ambulatory veterans.One hundred thirty‐one male subjects aged 70 years and older were randomized to receive one of three influenza vaccine regimens: Group I received standard trivalent influenza vaccine containing 15 micrograms of B/USSR/100/83 in one arm and placebo in the other; Group II received standard trivalent vaccine in one arm and a supplemental dose of 45 micrograms of B/USSR in the other; Group III received the same dose as group II combined in one arm with a placebo in the other.Antibody levels were measured at baseline, 1 month, and 5 months.Nearly 80% of the participants achieved levels of antibody to B/USSR considered protective; seroconversion rates varied from 40% to 61%. No significant differences in antibody response to B/USSR occurred among the vaccine groups, and there were more side effects at higher doses. The higher dose groups did, however, achieve greater antibody levels to the drifted influenza B virus which circulated during the year of the study. Response to the influenza A components of the vaccine, however, may have been blunted in Group III which received a large dose of A and B antigens all at one site.
A Longitudinal Study of Impaired Glucose Tolerance and Diabetes Mellitus in the Aged
Authors: Grobin Wulf 
Published: April 2015

This longitudinal study of glucose tolerance in the residents of a Jewish home for the aged (JHA) is now in its 25th year. Of 1,177 supposedly nondiabetic persons screened on admission from 1965 to 1986, 22.5% had impaired glucose tolerance (IGT), reflecting its undiagnosed prevalence among the Jewish elderly in the community. The incidence of IGT was lower in 1969–1973, when the average age on admission was 77 years, than in 1982–1986, when the average age was 83.5 years. However, aging was not the only factor affecting glucose tolerance (GT). The rise in the residents' age in the last 10 years was not accompanied by an increased rate of deterioration of GT in the annual screenings of 1970–1984, suggesting that there was a delay in the effect of age on IGT and diabetes mellitus (DM). This was attributed mainly to the multimodal antidiabetic regimen (ADR) prevailing in the JHA in those years. Relaxation of this regimen was associated with a marked increase in the incidence of IGT and DM in the screenings of 1985–1987.When 25 newly diagnosed diabetics were put on a diabetic diet, 60% had normal or improved glucose tolerance tests (GTT) one to five years later. By contrast, in over half of the 80 residents whose first GTT did not indicate diabetes and whose diet was not as strictly controlled, the repeat GTT showed deterioration and was diabetic in 31%.Conclusions: Screening led to early diagnosis and institution of antidiabetic measures, probably avoiding or postponing the need for antidiabetic medication with its risk of iatrogenic hypoglycemia. Periodic screening is recommended for older persons because of their high risk for DM.