bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlates of Kyphosis in Older Women
Authors: Ensrud Kristine E. , Black Dennis M. , Harris Fran , Ettinger Bruce , Cummings Steven R. ,   For the Fracture Intervention Trial Research Group
Published: April 2015

OBJECTIVE: To determine the association between kyphosis (degree of forward curvature of the thoracic spine) and measures of spinal osteoporosis (height loss and vertebral fractures) and chronic back pain and disability in older women.DESIGN: A cross‐sectional study.SETTING: Eleven clinical centers in the United States.PARTICIPANTS: A total of 6439 community‐dwelling osteoporotic women aged 55–80 enrolled in the Fracture Intervention Trial (FIT), a multicenter clinical trial of alendronate.MEASUREMENTS: Thoracic curvature was measured at baseline using a Debreuner Kyphometer. Height loss was determined by subtracting current height measured with a Harpenden stadiometer from self‐reported height at age 25. Vertebral fractures were defined by morphometry and semiquantitative reading of lateral thoracic and lumbar spine radiographs, and chronic back pain and back‐related disability were assessed by questionnaire.RESULTS: After adjustment for age, a 15° increase in kyphosis was associated with losing more than 4 cm of height (OR, 1.88; 95% CI, 1.79–2.03) and having a vertebral fracture (OR, 1.57; 95% CI, 1.46–1.69). Kyphosis was more strongly related to thoracic fractures than to lumbar fractures, and kyphosis was most prominent in women with multiple thoracic wedge fractures. Kyphosis was also associated with upper back pain (OR per 15° increase, 1.62; 95% CI 1.47–1.79) and middle back pain (OR per 15° increase, 1.24; 95% CI 1.12–1.36), but it was not related to lower back pain (OR per 15° increase, 0.98; 95% CI 0.90–1.05). Women with greater degrees of kyphosis were only slightly more likely to report back‐ related disability (OR per 15° increase, 1.18; 95% CI 1.03–1.35) and poorer health status (OR per 15° increase, 1.19; 95% CI 1.03–1.37).CONCLUSIONS: Older women with greater degrees of kyphosis are likely to have other manifestations of spinal osteoporosis such as height loss and thoracic fractures and to suffer chronic upper and middle back pain. Measurement of kyphosis may be useful in assessing the severity of spinal osteoporosis.
Older Medicare Enrolees' Choices for Insured Services
Authors: Danis Marion , Biddle Andrea K. , Henderson Gail , Garrett Joanne M. , DeVellis Robert F. 
Published: April 2015

OBJECTIVES: The Medicare Trust Fund is expected to be bankrupt in the next decade, thus threatening the viability of the Medicare Program. We have ascertained what Medicare enrollees' priorities for insured services would be, and why, if it were fiscally necessary to limit Medicare benefits to maintain the viability of the Program.DESIGN: A cross‐sectional survey using anonymous, in‐person interviews and an innovative instrument to elicit choices.SETTING: General Internal Medicine outpatient clinic at a university teaching hospital.PARTICIPANTS: One hundred five adults, 65 years of age and older, who had primary care physician visits between July and September 1995.MEASUREMENTS: Desire to personally select insurance benefits, insurance benefit choices, and the reasons for selection or rejection of benefits.RESULTS: Subjects of various educational and economic backgrounds were able to carry out the selection process with relative ease, and four‐fifths of respondents preferred to make their own choices about insured services. The most frequently selected services were hospitalization, outpatient care, prescription drugs, eye care, and home care, in descending order. Subjects selected 52 different combinations of services. Only 2% of respondents picked the current Medicare service package. The reasons given for selection varied by service; cost and current or anticipated need for a service were the most frequently cited forces driving the choices made.CONCLUSION: These data suggest that Medicare enrollees prefer some element of choice about their health insurance coverage. Their choices vary widely and differ from the current Medicare package.
Clinical Correlates of Low Blood Pressure in Very Old People: The Importance of Cognitive Impairment
Authors: Guo Zhenchao , Viitanen Matti , Winblad Bengt 
Published: April 2015

OBJECTIVE: To identify the medical conditions associated with low blood pressure in very old people.DESIGN: A population‐based, cross‐sectional study.SETTING: Two neighboring communities in Stockholm, Sweden.SUBJECTS: Participants were 319 male and 1070 female participants, with the mean age of 85.0 years (SD = 5.8).MEASUREMENTS: Blood pressure recording, pulse rate counting, and Mini‐Mental State Examination (MMSE) were conducted by trained nurses. Information on illness condition and activities of daily living (ADL) status was self‐reported or gathered from proxy respondents. The computerized inpatient register system was also used for collecting the data of illness condition. Systolic pressure less than 130 mm Hg and diastolic pressure less than 70 mm Hg were defined as low systolic and diastolic pressure, respectively. MMSE score less than 24 was considered to indicate cognitive impairment.MAIN RESULTS: In multiple logistic regression analyses, low systolic pressure was related to slower pulse rate (≤60 per minute), heart failure, ADL limitation, and cognitive impairment, and low diastolic pressure was related to increasing age, slower pulse rate, cardiac dysrhythmia, ADL limitation, and cognitive impairment. People with diabetes mellitus were less likely to be in the low systolic pressure group. 34.9% of the prevalence of low systolic pressure, and 17.9% of the prevalence of low diastolic pressure was associated with cognitive impairment.CONCLUSIONS: Low blood pressure in the very old may be associated with poor functional status, cardiac insufficiency and, more importantly, cognitive impairment. It would be expected that low blood pressure is associated with increased mortality in this age group.
The “Common Cold” in Frail Older Persons: Impact of Rhinovirus and Coronavirus in a Senior Daycare Center
Authors: Falsey Ann R. , McCann Robert M. , Hall William J. , Criddle Mary M. , Formica Maria A. , Wycoff Dennis , Kolassa John E. 
Published: April 2015

OBJECTIVE: To evaluate the incidence and impact of rhino‐virus and Coronavirus infections in older persons attending daycare.DESIGN: Prospective descriptive study.SETTING: Three senior daycare centers in Rochester, New York.PATIENTS: Frail older persons and staff members of the daycare centers who developed signs or symptoms of an acute respiratory illnessMEASUREMENTS: Demographic, medical, and physical findings were recorded on subjects at baseline and during respiratory illness. Nasopharyngeal specimens for viral culture as well as acute and convalescent sera for Coronavirus 229E enzyme immunoassay (EIA) were obtained for all illnesses.RESULTS: During the 44 months of study, 352 older persons experienced 522 illnesses. Thirty‐five (7%) of 522 cultures were positive for rhinovirus and 37 (8%) of 451 serologies were positive for Coronavirus 229E infection. The clinical syndromes associated with rhinovirus and Coronavirus infection were similar and characterized by nasal congestion, cough, and constitutional symptoms. No patient died or was hospitalized, but approximately 50% had evidence of lower respiratory tract involvement. The average illness lasted 14 days. During the same period, 113 staff developed 338 respiratory illnesses. Eight percent were identified as Coronavirus and 9% as rhinovirus. Cough, sputum production, and constitutional symptoms were significantly more common among older persons.CONCLUSIONS: Rhinovirus and Coronavirus 229E are common causes of moderately debilitating acute respiratory illnesses among older persons attending daycare.
The Relation Between Antioxidants and Memory Performance in the Old and Very Old
Authors: Perrig Walter J. , Perrig Pasqualina , Stähelin Hannes B. 
Published: April 2015

OBJECTIVES: Aging processes, and among them brain aging, are thought to be associated with free radical action. It is hypothesized that plasma antioxidant vitamin levels correlate with cognitive performance in healthy older subjects.DESIGN: Longitudinal and cross‐sectional comparisons.SETTING: The city of Basle, considered representative of the older urban population in Switzerland.PARTICIPANTS: A total of 442 subjects aged 65 to 94 years (mean: 75 years; 312 male, 132 female) was selected from a random sample.MEASUREMENTS: In 1993, participants were tested for memory, and plasma vitamin levels were measured for the three antioxidants α‐tocopherol, ascorbic acid, and β‐caro‐tene. These vitamin parameters, measured previously in 1971 in the same sample, were integrated in our analyses. In addition, plasma cholesterol, ferritin, and systolic blood pressure were taken into account. Memory variables were priming, working‐memory, free recall, recognition and the WAIS‐R vocabulary test (semantic memory).RESULTS: Correlations showed significant stability of the plasma antioxidants over the time lag of 22 years (a‐tocopherol: r = .47, P ≥ .001; β‐carotene: r = .43, P < .001; ascorbic acid: r = .22, P < .001). Free recall, recognition, and vocabulary (but not priming and working‐memory) correlated significantly with ascorbic acid and β‐carotene in the cross‐sectional 1993 data as well as in the longitudinal 1971–1993 analysis. These two antioxidants remained significant predictors, especially of semantic memory, after controlling for possible confounding variables like age, education, and gender using multiple regression analyses and ANOVAs.CONCLUSION: Among people aged 65 and older, higher ascorbic acid and β‐carotene plasma level are associated with better memory performance. These results indicate the important role played by antioxidants in brain aging and may have implications for prevention of progressive cognitive impairments.
One‐Leg Balance Is an Important Predictor of Injurious Falls in Older Persons
Authors: Vellas Bruno J. , Wayne Sharon J. , Romero Linda , Baumgartner Richard N. , Rubenstein Laurence Z. , Garry Philip J. 
Published: April 2015

OBJECTIVE: To test the hypothesis that one‐leg balance is a significant predictor of falls and injurious falls.DESIGN: Analysis of data from a longitudinal cohort study.SUBJECTS: Healthy, community‐living volunteers older than age 60 enrolled in the Albuquerque Falls Study and followed for 3 years (N = 316; mean age 73 years).MAIN OUTCOME MEASURES: Falls and injurious falls detected via reports every other month.INDEPENDENT VARIABLES: Baseline measures of demographics, history, physical examination, Iowa Self Assessment Inventory, balance and gait assesessment, and one‐leg balance (ability to stand unassisted for 5 seconds on one leg).RESULTS: At baseline, 84.5% of subjects could perform one‐leg balance. (Impairment was associated with older age and gait abnormalities.) Over the 3‐year follow‐up, 71% experienced a fall and 22% an injurious fall. The only independent significant predictor of all falls using logistic regression was age greater than 73. However, impaired one‐leg balance was the only significant independent predictor of injurious falls (relative risk: 2.13; 95% CI: 1.04, 4.34; P = .03).CONCLUSION: One‐leg balance appears to be a significant and easy‐to‐administer predictor of injurious falls, but not of all falls. In our study, it was the strongest individual predictor. However, no single factor seems to be accurate enough to be relied on as a sole predictor of fall risk or fall injury risk because so many diverse factors are involved in falling.
Chronic Medical Conditions and Risk of Fall Injury Events at Home in Older Adults
Authors: Herndon James G. , Helmick Charles G. , Sattin Richard W. , Stevens Judy A. , DeVito Carolee , Wingo Phyllis A. 
Published: April 2015

OBJECTIVE: To evaluate the association between selected chronic medical conditions (CMCs) and fall injury events at home among community‐dwelling older persons.DESIGN: Population‐based case‐control study.SETTING: The general community.PARTICIPANTS: Persons aged 65 and older living at home, excluding those using a wheelchair; 467 cases and 691 control subjects were studied.MEASUREMENTS: The main independent variables were self‐reported histories of 10 CMCs: diabetes, high blood pressure, anemia, heart attack, Parkinson's disease, stroke, emphysema, cancer (other than skin), cataracts, and glaucoma.RESULTS: The final multivariate model included variables for age, sex, body mass, dependency in activities of daily living, current exercise (three or more times per week), mental status scores, and three CMCs. Persons with a history of stroke or anemia had an increased risk of a fall injury event: for stroke the adjusted odds ratio (aOR) equalled 1.7 (95% confidence interval (CI), 1.0–3.0); for anemia the aOR equalled 1.5 (95% CI, 1.0–2.2). Those with a history of high blood pressure had decreased risk (aOR = .7, 95% CI 0.5–0.9).CONCLUSIONS: Persons 65 and older with a self‐reported history of anemia or stroke are at increased risk of a fall injury event in the home, whereas those with a self‐reported history of high blood pressure are at decreased risk.
Surrogate and Physician Understanding of Patients' Preferences for Living Permanently in a Nursing Home
Authors: Mattimore Thomas J. , Wenger Neil S. , Desbiens Norman A. , Teno Joan M. , Hamel Mary Beth , Liu Honghu , Califf Robert , Connors Alfred F. , Lynn Joanne , Oye Robert K. 
Published: April 2015

OBJECTIVE: To evaluate patients' willingness to live permanently in a nursing home and surrogate and physician understanding of that preference.DESIGN: Evaluation of cross‐sectional interview data from a cohort study.SETTING: Five academic medical centers.PARTICIPANTS: Seriously ill hospitalized adults enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).MEASUREMENTS: Patients' willingness to live permanently in a nursing home was measured on a 5‐point scale ranging from “very willing” to “rather die.” Ordinal logistic regression was used to identify patient demographic and clinical characteristics associated with this preference. Surrogate and physician perceptions of patient preferences were compared with patients' responses, and factors associated independently with surrogate and physician understanding of patient preference were identified.RESULTS: Of 9105 patients, 3262 (36%) provided responses to the study question: 7% were “very willing” to live permanently in a nursing home, 19% “somewhat willing,” 11% “somewhat unwilling,” 26% “very unwilling,” and 30% would “rather die.” Older age was associated independently with less willingness to live permanently in a nursing home (odds ratio [OR]= .90 per decade; 95% confidence interval [CI]: 0.85, 0.96). Patients with more education (OR = 1.03 per year; 95% CI:1.00,1.05) and more disabilities (OR = 1.05 per disability; 95% CI:1.01,1.09), and black patients (OR = 1.46 compared with white patients; 95% 0:1.20,1.76) were more willing to live in a nursing home. Surrogates understood 61% of patients' nursing home preferences but identified only 35% of patients who were willing to live permanently in a nursing home. Physicians identified 18% of patients willing to live permanently in a nursing home.CONCLUSION: Patient attitudes about living permanently in a nursing home can be elicited, cannot be reliably predicted from demographic and clinical variables, and are frequently misunderstood by surrogates and physicians. Elicitation of patient preferences regarding permanent nursing home placement should be explored before patients become unable to participate in decision making in order to enhance the concordance of patient preference with the way they spend the end of their lives.
Incidence of Anemia in Older People: An Epidemiologic Study in a Well Defined Population
Authors: Anía Basilio J. , Suman Vera J. , Fairbanks Virgil F. , Rademacher Diana M. , III L. Joseph Melton 
Published: April 2015

OBJECTIVE: To assess the incidence and clinical spectrum of anemia among older people.DESIGN: Inception cohort assembled and followed by medical records linkage until death or last clinical contact through January 1994.SETTING: Population‐based study in Olmsted County, Minnesota.PARTICIPANTS: All 618 Olmsted County men and women aged 65 years or more with anemia by World Health Organization criteria that was first recognized in 1986.MEASUREMENTS: Age‐ and sex‐adjusted incidence rates, corrected for prevalent anemia, and survival estimates using the Kaplan‐Meier method, with calculation of standardized mortality ratios for specific causes of death.RESULTS: The corrected annual incidence of anemia rose with age, and rates were higher in men (90.3 per 1000; 95% CI, 79.2–101.4) than women (69.1 per 1000; 95% CI, 62.3–75.8). In 465 cases (75%), anemia was detected in conjunction with a hospitalization, but admission was due to anemia in only 57 instances. Half of the cases were caused by blood loss, two‐thirds of these as a result of surgery. The cause of anemia was uncertain in 102 cases (16%). One‐third of the patients were transfused with a median of 3 units each. Overall survival was worse than expected but was better among those with anemia caused by blood loss. Mortality attributable to malignancy, mental disorders, circulatory and respiratory diseases, ill‐defined conditions, and injuries was significantly increased among these older patients with anemia.CONCLUSIONS: The incidence of anemia among older people is 4 to 6 times greater than that suspected clinically, rises with age, and is higher in men than in women. The apparent cause in half the cases is blood loss. Even mild anemia is associated with reduced survival, especially during the first year, but this could relate to underlying comorbid conditions.
Factors Predicting Fractures During Falling Impacts Among Home‐Dwelling Older Adults
Authors: Luukinen Heikki , Koski Keijo , Laippala Pekka , MD Sirkka‐Liisa Kivelä 
Published: April 2015

OBJECTIVE: To investigate the predictors of fractures during falling impacts among home‐dwelling older adults.DESIGN: A case‐control study within a prospective, population‐based survey.SETTING: Five rural municipalities in northern Finland.PARTICIPANTS: The study population consisted of all home‐dwelling persons aged 70 or older living in these five municipalities (n = 790 (85%)). The cases for this study were those with fracture, using the first fracture (n = 82) in the analyses, during a follow‐up period of 4 years. Controls (n = 82) were selected from among the persons who suffered soft tissue injuries; matching was by age, sex, and location of the first injury during the period.MEASUREMENTS: During a 4‐year follow‐up period, all falls in the population were recorded using fall diaries, telephone interviews, and information from medical records. Risk factors for fractures during the 4‐year follow‐up were determined according to the number and severity of previous falls, circumstances and place of falls, disease history, use of medicines, symptoms, clinical examinations and tests, nutritional status, functional abilities and social and health behavior. Cross‐tabulations for categorial variables, paired t tests for the means of continuous variables, and conditional logistic regression analysis were performed.RESULTS: According to the bivariate analyses, the risk factors for falls resulting in a fracture were frequent fear of falling, abnormal heel‐shin test, reduced knee extension strength, reduced grip strength, poor distance visual acuity, low supine pulse rate, inability to carry a 5‐kg load 100 meters, not doing heavy outdoor work, and no habitual exercise. A limited amount of social participation was associated negatively with fracturing. Conditional logistic regression analysis showed that the risk factors for fracture‐causing falls were frequent fear of falling (OR 2.50; CI 1.11–5.65), reduced knee extension strength (OR 3.38; CI 1.00–11.4), and poor distance visual acuity (OR 3.45; CI 1.13–10.6), whereas limited social participation (OR 0.29; CI 0.11–0.79) protected against the occurrence of fractures.CONCLUSION: Impaired perception, muscle strength, and psychological and social functioning may influence fracture risk during injurious fall impacts. Studies with larger sample sizes are needed to confirm this and to examine the circumstances and mechanisms contributing to the fracture risk during falls via these risk factors. J Am Geriatr Soc 45:1302–1309, 1997.
Mammography Underutilization Among Older Women in Connecticut
Authors: Preston Jeanette A. , Scinto Jeanne D. , Ni Weijia , Wang Yun , Galusha Deron , Schulz Allyson F. , Petrillo Marcia K. 
Published: April 2015

OBJECTIVES: The primary goals were to examine mammography use rates among older women in Connecticut and to determine if there was significant variation among different areas and racial groups in the state. The secondary goal was to examine what impact the initiation of Medicare reimbursement for mammography screening has had on mammography use.DESIGN: Statewide use rates were determined by retrospective Medicare Part B mammography claims analysis. Small area analysis methodology (SAA) was used to identify mammography rates for 23 hospital service areas (HSAs), representing all of the catchment areas for Connecticut's acute care hospitals.PARTICIPANTS: Female Medicare beneficiaries 65 years and older with Part B coverage residing in Connecticut during the study period.MEASUREMENTS: The main outcome (the use of at least one mammogram) was calculated for the calendar years 1991, 1992, and 1993. Mean annual use rates in 1993 were generated for the 23 HSAs and the different racial groups in Connecticut. To examine the effect that Medicare reimbursement for screening mammograms has had on mammography use, rates were calculated for women who met Medicare reimbursement criteria in 1991 through 1993. The rates in 1992 and 1993 were then compared with those in 1991, when the reimbursement program was first initiated.MAIN RESULTS: The mean statewide annual rates among women aged 65 years and older were 23.4% (1991), 24.5% (1992), and 24.9% (1993). The mammography use rates among black women 65 years and older were significantly lower than their white peers in 1991 (18.8% black vs 23.8% white, P .001), 1992 (20.6% vs 24.7%, P <.001), and 1993 (22.0% vs 25.1%, P < .001). Significant variation was identified among hospital service areas (HSAs) within the state for each time interval studied. The use rates among women aged 65 years and older who were eligible for Medicare screening mammography reimbursement increased significantly from 14.6% in 1991, when Medicare reimbursement for screening mammograms was first initiated, to 18.9% in 1992 (P < .001). The rates in 1993 (17.4%) also increased from the baseline year 1991 (P < .001). However, the observed increases since 1991 have been limited in magnitude.CONCLUSIONS: Low mammography use persists among older women in Connecticut and, in particular, among older black women. The initiation of Medicare reimbursement for screening mammograms in 1991 has had some impact on mammography use although its effects are still limited. Through the use of small area analysis methodology, significant underutilization of mammography in localized areas of the state was identified. These findings have facilitated local outreach interventions. Additional research is needed to understand if health service barriers are contributing to the local variation in rates observed in this study. J Am Geriatr Soc 45:1310–1314, 1997.