bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants of Functional Abilities in Dementia
Authors: Hill Robert D. , Bäckman Lars , Fratiglioni Laura 
Published: April 2015

OBJECTIVES: To determine the extent to which selected variables within demographic, psychometric, and memory domains can predict functional abilities in dementia.DESIGN: Hierarchical regression analyses were employed to predict functional abilities, while controlling for disease severity, using the Mini‐Mental State Exam (MMSE).SETTING AND PARTICIPANTS: A total of 2368 inhabitants of Kungsholmen parish in Stockholm, Sweden, aged 75 years of age or older. Eighty‐one subjects with confirmed dementia (MMSE, M = 17.9; SD = 5.26) were selected from the study population. The mean age was 84.5 years (SD = 5.58), and 72% were female.MEASUREMENTS: Participants received a battery of standardized neuropsychological instruments and selected experimental tasks that measured visuospatial ability as well as primary and episodic memory. Self‐care was assessed using the Katz index of activities of daily living (ADL); instrumental activities of daily living (IADL) were assessed through the primary caregiver, who responded to questions related to functional competence of the participant.RESULTS: Hierarchical regression procedures revealed that disease severity was the strongest predictor of ADL and IADL performance. Controlling for disease severity, a measure of visuoperception (Poppelreuter's figures) also made a significant contribution to the explanatory variance in both ADL and IADL function. Beyond disease seve—ity and visuoperception, years of schooling and disease duration were marginally predictive of IADL performance.CONCLUSION: It is possible to predict functional abilities in dementia on the basis of individual difference variables. Multiple variables were initially correlated with ADL and IADL performance; however, after controlling for disease severity, visuoperception was the only predictor of ADL scores. In addition to visuoperception, IADL scores were also marginally predicted by education and disease duration. These findings highlight the importance of peripheral sensory processes in adaptive function in dementia. They also suggest that although many variables may be correlated with functional ability, their explanatory role, particularly with regard to self‐care skills, is diminished in the presence of the disease.
Sexual Function of Men Ages 40 to 79 Years: The Olmsted County Study of Urinary Symptoms and Health Status Among Men
Authors: Panser Laurel A. , Rhodes Thomas , Girman Cynthia J. , Guess Harry A. , Chute Christopher G. , Oesterling Joseph E. , Lieber Michael M. , Jacobsen Steven J. 
Published: April 2015

OBJECTIVES: Knowledge of male sexual function is somewhat limited because of a lack of current population‐based data. This study provides information on sexual function and satisfaction in a population‐based sample of men.METHODS: Men aged 40 to 79 years (n = 2115) were selected randomly from the Olmsted County population for the baseline component of a prospective cohort study (the Olmsted County Study of Urinary Symptoms and Health Status Among Men) during 1989–1990. The men completed a self‐administered questionnaire that included questions about sexual concerns, performance, satisfaction, drive, and erectile dysfunction.RESULTS: For all five sexual parameters queried, the prevalence of problems and dysfunction increased with age. A comparison of men aged 70 to 79 years with men aged 40 to 49 years suggested that older men were more worried about sexual function (46.6% vs 24.9%), had worsened performance compared with a year ago (30.1% vs 10.4%), expressed extreme dissatisfaction with sexual performance (10.7% vs 1.7%), had absent sexual drive (25.9% vs 0.6%), and reported complete erectile dysfunction when sexually stimulated (27.4% vs 0.3%). Logistic regression analyses suggested that sexual dissatisfaction was significantly associated with erectile dysfunction, decreased libido, and the interaction between erectile dysfunction and libido, but not age.CONCLUSIONS: These population‐based cross‐sectional data corroborate the previously reported age‐related decrease in sexual function. The age‐related increase in dissatisfaction could, however, be accounted for primarily by the age‐related increase in erectile dysfunction, decreased libido, and the interaction between erectile dysfunction and decreased libido.
The Use of Medicines with Anticholinergic Effects in Older People: A Population Study in an Urban Area of Sweden
Authors: Fastbom Johan , Claesson Cecilia B. , Cornelius Christel , Thorslund Mats , Winblad Bengt 
Published: April 2015

OBJECTIVE: To investigate the use of medicines with anticholinergic properties among older people in an urban population in Sweden.DESIGN: A cross‐sectional survey.SETTING: Ordinary homes, sheltered accommodations, nursing homes, and geriatric departments.PARTICIPANTS: All residents aged 75 and older in a district of Stockholm, Sweden.MEASUREMENTS: Structured interviews with older persons, their relatives and/or health care personnel; prescription forms; medical records.RESULTS: The overall use of medicines with anticholinergic effects was comparatively low. Doses of these medicines were also generally low. Concurrent use of several such medicines was uncommon. The most prevalent therapeutic/pharmacological group was neuroleptics. In contrast, antidepressants were used by few older people. The prevalence of medicines with anticholinergic effects was highest at institutions, where neuroleptics were frequent and use of low‐potency neuroleptics was not uncommon.CONCLUSION: Our results indicate that the risk of anticholinergic side effects may be quite low in the present population as a whole. However, there may be grounds for revising the therapy in institutions, where the use of neuroleptics was shown to be high and low‐potency neuroleptics, known to have a higher incidence of anticholinergic side effects, were not avoided.
MODELS OF GERIATRICS PRACTICE
Authors: Reuben David B. , Evans Lois K. , Yurkow Johanna , Siegler Eugenia L. 
Published: April 2015

BACKGROUND AND OBJECTIVES: Frail older adults are especially vulnerable in a health system that is fragmented and fails to focus on preservation or restoration of function. The School of Nursing at the University of Pennsylvania, together with the School of Medicine and the Hospital of the University of Pennsylvania, established the Collaborative Assessment and Rehabilitation for Elders (CARE) Program to meet the needs of this population. We used the British Day Hospital as a model because it provides a comprehensive approach to care and a bridge between acute, home‐based, and institutional long‐term care. We have designed our program to provide innovative, interdisciplinary care as well as to be reimbursable under current and future payment structures. This nurse‐managed, collaborative practice seeks to maximize independent functioning, promote health, and enhance quality of life for chronically ill, frail older adults living in the community whose needs are left unmet by existing services. The program was certified as a Comprehensive Outpatient Rehabilitation Facility (CORF) in December 1993 to maximize reimbursement of services through Medicare and other third party payers. With a Gerontological Nurse Practitioner as care manager, clients receive an intensive, individualized, time‐limited program of nursing, rehabilitation, mental health, social, and medical services in one setting several days each week. Additional geriatric services, such as primary care, are available in the same location when needed.SETTING: The program is housed in renovated space devoted to the care of older people. The academic and clinical offices of the University of Pennsylvania's nursing and medical gerontologic and geriatric faculty are in the same building.PARTICIPANTS: We have targeted those persons older than age 65 who have complex health problems and are living at home. Individuals must need multiple services, including at least one rehabilitation therapy, and they must be unsuitable‐for inpatient rehabilitation.DESCRIPTION OF THE POPULATION: In its first 8 months of operation, the program received 97 referrals and admitted 53 clients. Clients were, on average, 78 years of age. Over three‐fourths (77%) were women and 58% were black. The average stay in the program was 6 weeks. FIM scores, which improved a mean of 2.4 points, were found to lack sensitivity to the functional improvements achieved by clients.CONCLUSION: Under existing Medicare and third party reimbursement policies, it is feasible to establish a nurse‐managed comprehensive outpatient rehabilitation program designed to meet the needs of frail older persons. Preliminary data support the beneficial effects of the program as well as the economic feasibility of this approach.
Epidemiology of Injury in People with Alzheimer's Disease
Authors: Oleske Denise M. , Wilson Robert S. , Bernard Bryan A. , Evans Denis A. , Terman Eric W. 
Published: April 2015

BACKGROUND: Previous studies have suggested that the risk of injury is elevated among persons with dementia, but these studies have focused primarily on falls and fractures. This study characterizes all injuries incurred in a large sample of community‐dwelling persons with a specific form of dementia, Alzheimer's disease (AD).SUBJECTS AND METHODS: The sample consisted of 281 community‐dwelling persons diagnosed with AD according to NINCDS/ADRDA guidelines. Information regarding all injuries occurring within the previous 6 months was obtained through a structured interview of a caregiver.RESULTS: The rate of injuries was 58.4 per 100 persons per year. Although falling was the single most common mechanism by which injuries occurred, it accounted for only 43.8% of all injuries. Fractures accounted for 13.7% of injuries. Medical treatment was sought for 52.1% of the injuries. After adjustment for age and gender, the likelihood of injury was significantly associated with cognitive impairment and with ADL limitation, but the independent contribution of these two factors could not be assessed.CONCLUSIONS: The findings suggest that injuries are a significant problem in persons with AD
Accuracy of Rapid Urine Screening Tests Among Incontinent Nursing Home Residents with Asymptomatic Bacteriuria
Authors: Ouslander Joseph G. , Schapira Moises , Fingold Susan , Schnelle John 
Published: April 2015

OBJECTIVE: To determine the accuracy of rapid urine screening tests in detecting bacteriuria among incontinent nursing home residents.SETTING: Six nursing homes.PARTICIPANTS: 214 chronically incontinent, but otherwise asymptomatic, nursing home residents who were enrolled in a clinical intervention trial for urinary incontinence.MEASUREMENTS: 684 urine specimens were collected, the majority (76%) by a clean catch technique and the remainder by in‐and‐out catheterization. Each specimen underwent dipstick testing for nitrite and leukocyte esterase, a rapid, enzyme‐based screening test for bacteriuria, and a quantitative urine culture using standard laboratory techniques.RESULTS: No one screening test or combination of tests had adequate sensitivity and specificity for clinical purposes. However, using all three tests, the sensitivity increases to 97% in females and 92% in males when any one of the tests is positive, and the specificity increases to 95% in females and 97% in males when all three tests are negative. Among nursing home residents suspected of having a symptomatic urinary tract infection, the prevalence of bacteriuria is probably higher than in our study population (e.g., 60–70%, compared with 32%). At these prevalence rates, the positive predictive value of any of the three tests being positive is 93% and higher, and the negative predictive value of all three tests being negative is 80 to 90%.CONCLUSIONS: Our data must be interpreted cautiously because of the specimen collection methods, the definitions we used, and the fact that we studied a population who did not have symptoms of an acute urinary tract infection. In addition, we did not examine the absolute accuracy of the screening tests, but their accuracy as a clinician might use them in a nursing home. Despite these caveats, our data suggest that a combination of these screening tests could be useful in the initial assessment of nursing home residents for bacteriuria, and result in considerable cost savings. Studies are needed to replicate our findings among nursing home residents with symptomatic urinary tract infections.
Posturography and Balance Problems in Older People
Authors: Baloh Robert W. , Spain Sharon , Socotch Tina M. , Jacobson Kathleen M. , Bell Theodore 
Published: April 2015

OBJECTIVE: To determine which measurements and test conditions on posturography are most useful for identifying balance problems in older people.SUBJECTS: Two samples of 70 community‐dwelling older subjects (>75 years). One group (controls) considered their balance normal for their age, and the other (patients) complained of imbalance.MEASUREMENTS: Velocity of sway on static (with and without foam) and dynamic posturography, Tinetti gait and balance score, self‐reported fear of falling, and number and circumstances of falls.RESULTS: Mean sway velocity was significantly increased in patients compared with controls. The greatest difference between patients and controls occurred with measures of anterior‐posterior sway velocity during angular tilt of the platform. Sway velocity was not significantly increased in patients or controls who reported falls compared with those who did not report falls. Even when comparing those who fell as a result of loss of balance with those who fell because of trips or slips, there was no significant difference in sway velocity. By contrast, those who reported fear of falling (patients and controls) had significantly increased sway velocity compared with those who did not report fear of falling.CONCLUSION: On average, velocity of sway (particularly in the anterior‐posterior direction) is higher in older subjects who complain of imbalance compared with age‐matched controls, and the difference is greater with dynamic posturography than with static posturography. However, the posturography data provided little information about the cause of the imbalance and did not correlate with the frequency of reported falls.
Older Community‐Dwelling Adults' Attitudes Toward and Practices of Health Promotion and Advance Planning Activities
Authors: Fried Terri R. , Rosenberg Roberta R. , Lipsitz Lewis A. 
Published: April 2015

OBJECTIVE: To describe the attitudes toward and practice of health prevention and advance planning measures by a group of community‐dwelling older adults and to examine the effect of age on these practices.DESIGN: A descriptive study performed by mail survey.PARTICIPANTS: Members of a research registry who were 65 years of age or older.MEASUREMENTS: By means of a written questionnaire, we asked about knowledge of various health prevention and advance planning topics, including exercise, cholesterol screening, rectal examination, influenza vaccination, sigmoidoscopy, mammography, prostate cancer screening, organ donation, autopsy, health care proxy, and advance directives. Of those who knew about the topic, we asked if the respondent had discussed it with a physician, who initiated the conversation, and if the respondent participated in the activity. We also asked how important the topic was to the respondent.RESULTS: We received 598 completed surveys, a response rate of 83%. Respondents had a mean age of 74 years, were predominately white (96%), and were well educated, with 44% having completed college. The respondents were all knowledgeable about the topics, and, with the exception of sigmoidoscopy, organ donation, and autopsy, more than 70% thought these topics were important. In the case of health screening and prevention activities, a large percentage of respondents reported having discussed the topic with a physician, and a slightly smaller percentage reported regular participation. In the case of health care proxies and advance directives, however, only about one‐half of those who had made these arrangements said they had discussed them with a physician. When discussion did occur, it was much more likely to have been initiated by the respondent. Controlling for level of education, age was inversely associated with the likelihood of a woman reporting she had undergone mammography (P < .05). Age, however, was not associated with decreased frequency of undergoing other screening tests.CONCLUSIONS: Among a group of well educated older adults, reported interest in and compliance with health screening, health promotion, and advance planning activities were high. However, sigmoidoscopy, a relatively more invasive procedure that is generally recommended as a screening tool, is reported less likely to be practiced than prostate cancer screening, a less invasive procedure without such recommendation. Older adults state they are pursuing health care proxies and advance directives, often without the involvement of their physicians. Of the screening tests about which we asked, age was associated only with less frequent practice of mammography.
A Low, ‘Normal’ Score on the Mini‐Mental State Examination Predicts Development of Dementia After Three Years
Authors: Braekhus Anne , Laake Knut , Engedal Knut 
Published: April 2015

OBJECTIVES: To study whether a low, “normal” sumscore (i.e., 24 or higher) on the Mini‐Mental Status Examination (MMSE) near the cutpoint usually employed for identifying persons with cognitive impairment predicts later development of dementia.DESIGN: A prospective study of a random sample of nondemented persons aged 75 years and older, according to DSM‐III criteria, with follow‐ups after 3 and 6 years.PARTICIPANTS: The subjects were 215 persons living at home, mean age 81 years, 81% women. Their mean MMSE sumscore at the start of the study (T0) was 27.9 (range 24–30).MAIN RESULTS: A low MMSE sumscore at T0 was identified as a statistically strongly significant predictor of dementia after 3 years (P < .001), when more than 40% of those with a sumscore of 24 or 25 at T0 had become demented. A similar, although weaker and statistically nonsignificant, trend was observed for the risk after 6 years in relation to MMSE scoring at baseline.CONCLUSION: Persons with a sumscore of 24 or 25 and classified as not suffering from dementia according to the DSM‐III criteria are at high risk of developing dementia within 3 years.
Effect of Hormone Replacement Therapy for Menopause on the Mechanical Properties of Skin
Authors: Piérard Gérald E. , Letawe Caroline , Dowlati Afshin , Piérard‐Franchimont Claudine 
Published: April 2015

OBJECTIVE: To evaluate the effect of hormone replacement therapy (HRT) for menopause on the mechanical properties of the skin in healthy women.DESIGN: A group of 114 women, including 43 nonmenopausal controls, 46 menopausal women with HRT and 25 menopausal women without HRT, participated in the study. Mechanical properties of the skin were measured on the volar forearm using a computerized suction device.SETTING: University medical center. Research laboratory in bioengineering and biometrology.RESULTS: Computerized measurements of skin deformability and viscoelasticity revealed differences between the three groups of women. A steep increase in skin extensibility was evidenced during the perimenopause in untreated women. HRT appeared to limit the age‐related increase in cutaneous extensibility, thereby exerting a preventive effect on skin slackness. No effect of HRT was found on other parameters of skin viscoelasticity.CONCLUSION: HRT has a beneficial effect on some mechanical properties of skin and thus may slow the progress of intrinsic cutaneous aging.
The Reliability and Validity of the Geriatric Depression Rating Scale Administered by Telephone
Authors: Burke William J. , Roccaforte William H. , Wengel Steven P. , Conley Deborah M. , Potter Jane F. 
Published: April 2015

OBJECTIVE: To evaluate prospectively the reliability and validity of the Geriatric Depression Scale administered by telephone (T‐GDS) in patients undergoing outpatient comprehensive geriatric assessment.SUBJECTS: A total of 101 geriatric patients were evaluated in a 1‐year period at the outpatient Geriatric Assessment Center of the University of Nebraska Medical Center.METHODS: The 30‐item GDS was completed by all patients on three occasions: by telephone several days before their assessment, face‐to‐face during their assessment visit, and several days later, again by phone. During their assessment, all patients were evaluated by one of three geriatric psychiatrists who were blind to all GDS results.The test‐retest reliability of the T‐GDS was measured by comparing the results of the two phone interviews. The construct validity of the T‐GDS was estimated by comparing the results of the initial T‐GDS to the GDS obtained during the comprehensive assessment. The criterion validity of the T‐GDS was estimated by comparing the results of the T‐GDS with the clinical diagnosis of depression assigned by the psychiatrists.RESULTS: The individual items of the initial T‐GDS showed substantial concordance with the second T‐GDS (kappa range 0.35–0.7, mean = 0.52), and with the assessment GDS (kappa range 0.29–0.75, mean = 0.52). One item showed evidence of bias when comparing the two T‐GDSs, and two items when comparing the initial T‐GDS to the GDS done during the assessment. The mean number of symptomatic responses was not significantly different for the T‐GDS versus assessment administration but did decline slightly when comparing the two T‐GDSs. ROC curve analyses showed good agreement between the clinical diagnosis and the T‐GDS.CONCLUSION: The GDS appears to maintain its reliability and validity when administered via telephone and thus may be useful for a variety of epidemiological and clinical purposes.