bluuebunny/crossref_metadata_2025_split huggingface dataset:
Access to Hospice Programs in End‐Stage Dementia: A National Survey of Hospice Programs
Authors: Hanrahan Patricia , Luchins Daniel J. 
Published: April 2015

OBJECTIVE: Because care of end‐stage dementia is a significant clinical problem for which alternative modes of care are needed, this study examined the extent to which hospice programs served dementia patients.DESIGN: A survey of 1694 hospices with 1184 respondents (70%).PATIENTS: Identifed patients had end‐stage dementia, with no concurrent terminal illness.MEASURE: The proportion of end‐stage dementia patients in hospice was measured.RESULTS: Fewer than 1% of hospice patients had a primary diagnosis of end‐stage dementia, and only 21% of the hospices served such patients. However, 7% of hospice patients had a dementia secondary to another terminal illness, and 56% of the hospices served such patients. For 80% of the hospices, the major problem in serving dementia patients was the difficulty in predicting their survival time. A higher proportion of for‐profit hospices served dementia patients (42%) compared with non‐profit programs (22%) or public programs (15%), P < .001.CONCLUSIONS: A national survey of hospices revealed that few patients with primary dementia are currently treated by these programs, unless they have other terminal illnesses. An inability to predict survival was the major reason offered to explain this phenomenon. The higher percentage of patients with secondary dementia in hospice suggests that dementia per se does not make hospice care unfeasible. Similarly, the high proportion of for‐profit hospices that enrolled patients whose dementia was primary implies the fiscal feasibility of providing hospice care for these patients. Further study is needed concerning the determinants of survival time in end‐stage dementia. J Am Geriatr Soc 43: 56–59, 1995.
Diagnostic and Prognostic Value of Ambulatory Electrographic Monitoring in Older Patients
Authors: Tresch Donald D. 
Published: April 2015

OBJECTIVE: To review the use of ambulatory electrocardiographic monitoring in detecting transient cardiac arrhythmias and myocardial ischemia in older patients and to determine the significance of these findings in predicting future cardiac events.DATA SOURCES: Reports on ambulatory electrocardiographic monitoring's capabilities in the detection and quantification of arrhythmias and myocardial ischemia were identified by multiple searches on the MEDLINE database and citations from relevant articles.STUDY SELECTION: Studies that demonstrated good research methodology were reviewed. Review was limited to studies that used reel‐to‐reel or cassette recorders (not reel‐time monitors).DATA EXTRACTION AND SYNTHESIS: Pertinent data were extracted from the studies, with specific emphasis on studies involving older patients. Prognostic findings were critically analyzed and compared between younger patients and older patients. Differences in prognoses between patients with and without underlying heart disease were assessed.CONCLUSION: Ambulatory electrocardiographic monitoring is a noninvasive procedure that is beneficial in stratifying older patients with heart disease into high and low risk groups for future cardiac events. The presence of complex ventricular arrhythmias or silent myocardial ischemia as documented on 24‐hour monitoring, especially in combination with left ventricular dysfunction or left ventricular hypertrophy, is highly predictive of future cardiac events, including sudden cardiac death and total cardiac mortality. The use of preoperative, intraoperative, and postoperative electrocardiographic monitoring may also be beneficial in stratifying older surgical patients into high and low risks for postoperative cardiac events.
Relationship Between Physical Performance and Self‐Perceived Physical Function
Authors: Cress M. Elaine , Schechtman Kenneth B. , Mulrow Cynthia D. , Fiatarone Maria A. , Gerety Meghan B. , Buchner David M. 
Published: April 2015

OBJECTIVE: The objective of this study was to compare two methods of measuring physical function in subjects with a broad range of abilities and to evaluate the effects of cognitive, social, educational, and age factors on the relationship between the two methods.DESIGN: Multiple regression analysis was used to compare self‐perceived (dependent variables) with performance measures (independent variables). Covariates included age, gender, Mini‐Mental State Exam score, education, living status, and depression score.SETTING: Five community‐dwelling and two nursing home sites.PARTICIPANTS: 417 community‐dwelling subjects and 200 nursing home residents aged 62–98 years.MEASUREMENTS: Self‐perceived physical function was assessed with the physical dimension summary score of the Sickness Impact Profile, which comprises three subscales: ambulation, mobility, and body care and movement. Physical performance was evaluated by self‐selected gait speed, chairstand time, maximal grip strength, and a balance score.RESULTS: Nursing home residents and community‐dwellers were significantly different (P < .0001) in all variables except age and gender. Self‐perceived and performance‐based measures were moderately correlated, with a range from r = −.194 to r = −.625 (P < .05). Gait speed was the strongest independent predictor of self‐perceived physical function in both groups. Symptoms of depression were also an independent predictor of self‐perceived function in nursing home residents; subjects who had such symptoms report more self‐perceived dysfunction than would be predicted based on performance tests.CONCLUSIONS: Self‐selected gait speed is a global indicator of self‐perceived physical function over a broad range of abilities. External determinants (depressive symptoms, cognitive function, marital status, etc.) affect self‐perceived function in both groups, but gait speed is the greatest single predictor of self‐perceived function. In nursing home residents depressive symptomatology is related to self‐perceived function, but gait speed is not.
Predictors of Skilled Nursing Placement in a Multilevel Long‐Term‐Care Facility
Authors: Osterweil Dan , Martin Marla , Sykdulko Karl 
Published: April 2015

OBJECTIVE: To determine if cognitive and functional data gathered before admission to residential care (i.e., board and care) placement can predict nursing home placement.DESIGN: Retrospective study using Cox proportional hazards analysis and pairwise assessment of adjusted relative risk factors to determine which independent variables predicted skilled nursing placement. Subjects were followed for an average of 23.7 months (SD = 18.6 months).SETTING: Multilevel 735‐bed long‐term care facility, Jewish Home for the Aging, Reseda, California.PARTICIPANTS: Of the 248 consecutive residential care admissions studied, 80% were women. Subject's mean age was 84.8 years (SD = 5.0); 67% had no significant cognitive impairment.INDEPENDENT VARIABLES: Categorical variables were classifications with respect to dementia status, incontinence, hearing, and ambulation. Interval variables were number of medications, Katz ADL, and five neuropsychological tests. Demographic variables were gender, age, language of origin, and education.OUTCOME VARIABLE: Time between preadmission testing and the move up to skilled nursing placement.RESULTS: Pairwise assessment of adjusted potential risk factors indicated that cognitive dysfunction, less than perfect Katz ADL performance, and hearing loss were the most important independent risk factors for nursing placement.CONCLUSIONS: The findings remind us to pay careful attention to residents exhibiting even relatively mild cognitive deficits upon admission because these residents are likely to need increased environmental support.
An Epidemiologic Study of Fall‐Related Fractures Among Institutionalized Older People
Authors: Cali Clorinda M. , Kiel Douglas P. 
Published: April 2015

OBJECTIVES: The purpose of this study was to assess the incidence of fall‐related fractures, and the circumstances surrounding these events, during a 5‐year period among all residents of a long‐term care facility.PARTICIPANTS: The study group was composed of residents with radiologically confirmed fractures that were the direct result of a fall occurring between the years 1988 and 1992. This group was 82% female and had a mean age of 89±6 years.DESIGN: The study was designed as a 5‐year retrospective cohort study in a long‐term care institution where annual incidence rates of fracture were assessed.RESULTS: There were 296 fall‐related fractures during the 5‐year period. Annual incidence rates remained fairly constant (72, 86, 84, 70, and 94 per 1000 person‐years, respectively) despite a 54% decline in the use of physical restraints during the 5‐year period. Hip fractures comprised almost 50% of all fractures. Based on incident reports of these fractures, 42% occurred during the day, 55% took place in the bedroom or adjoining bathroom. 67% occurred while the resident was ambulating, and a wet floor was in evidence in 16% of the incidents.CONCLUSION: Fracture incidence in this long‐term care facility has remained stable despite reduced restraint use. The incident reporting system may contribute valuable information to the identification of factors that should receive further attention in studies of risk factors for fracture in the long‐term care setting.
Use of the Minimum Data Set to Rate Incontinence Severity
Authors: Crooks Valerie C. , Schnelle John F. , Ouslander Joseph P. , McNees M. Patrick 
Published: April 2015

OBJECTIVES: To assess the relationship of the MDS incontinence severity ratings to direct measures of incontinence frequency.DESIGN: Two methods of measuring incontinence were compared: the MDS rating as recorded by nursing home (NH) staff and physical checks for wetness performed by research staff.SETTING AND PARTICIPANTS: A total sample of 293 older residents from nine nursing homes located in Iowa, the State of Washington, and the Los Angeles area were assessed once. A subsample of 49 incontinent residents were assessed twice, before and after the implementation of a prompted voiding program.INTERVENTION: This study is a part of a larger study evaluating the use of a computer‐aided incontinence management system (IMS). Incontinent residents were assessed, and, if they met predefined criteria, they were treated with prompted voiding.MEASUREMENTS: Three measures of incontinence were used: the MDS rating recorded by NH staff, physical checks for wetness performed by NH staff while assessing residents for and treating them with prompted voiding, and physical checks for wetness performed independently by research staff.RESULTS: There was a statistically significant correlation (r = .49; P ≤.001) between research staff wet checks and the MDS ratings, but wetness checks performed by NH staff had an insignificant correlation with MDS ratings (r = .003; P < 0.914). There was wide variability within and between NHs in the correlation. For residents who were placed on the prompted voiding program, the pre to post wet rate, as measured by research staff, improved significantly (from 28 to 14%; t = 6.73; df= 48; P < .001), whereas the pre to post MDS ratings did not change significantly (from 1.7 to 2.0; t = −1.42;df=4S;P< .075).CONCLUSIONS: Although the MDS appears to identify incontinent NH residents accurately, its clinical utility may be limited by disagreements between actual wet check data and MDS categorical severity rankings for residents known to be incontinent. The wide variability between direct observational measures of wetness and the MDS scores denoting incontinence severity we observed may limit the potential usefulness of the MDS for detecting changes in incontinence severity. It is possible that more information and instructions are needed for staff completing the MDS if the goal is to discriminate between different levels of incontinence severity and measure changes over time in response to therapeutic interventions.
Utility of Beta‐Blockade Treatment for Older Postinfarction Patients
Authors: Park Kevin C. , Forman Daniel E. , Wei Jeanne Y. 
Published: April 2015

OBJECTIVE: The prevalence of myocardial infarction (MI) in older people is high. Whereas use of beta‐blockers after MI is known to lower MI mortality in younger adults, its efficacy for adults more than 75 years of age remains less clear. We hypothesized that use of beta‐blockers after MI in older adults would improve clinical outcomes.DESIGN: Retrospective cohort study.SETTING: A community‐based, tertiary‐care teaching hospital.METHODS: A total of 1011 consecutive MI patients aged 60 to 89 were admitted to Boston's Beth Israel Hospital between January 1988 and September 1989 and were screened for this study. One hundred eighteen patients met eligibility criteria, of whom 76 received metoprolol, ≥25 mg/day for at least 5 days after their MI. Forty‐two age and clinically matched patients were similarly suitable for beta‐blocker therapy, but it was omitted by their physicians during and after hospitalization. The latter group served as controls.MEASUREMENTS: Mortality, reinfarction, and subsequent hospital admissions were measured.RESULTS: MI patients aged 60 to 89 years who were treated with metoprolol had an age‐adjusted mortality reduction of 76% (RR 0.24; P < .001; 95% CI 0.11–0.54). Multivariate logistic regression analysis showed a 12% mortality reduction (95% CI 0.75–1.00) among older MI patients, attributable to metoprolol therapy. Reinfarction rates were unchanged in patients receiving metoprolol therapy, and subsequent rehospitalizations were significantly increased among the metoprolol patients.CONCLUSIONS: Use of metoprolol significantly reduced mortality in older MI patients. The fact that metoprolol‐treated patients had neither reduced reinfarctions or rehospitalizations may relate to methologic limitations of this study. The mortality data support the hypothesis that older patients benefit from postinfarction beta‐blockade.
The Effects of Strength Conditioning on Older Women's Ability to Perform Daily Tasks
Authors: Hunter Gary R. , Treuth Margarita S. , Weinsier Roland L. , Kekes‐Szabo Tamas , Kell Sherron H. , Roth David L. , Nicholson Christal 
Published: April 2015

OBJECTIVES: The objectives of this study were to determine the effects of a strength‐training program on walking speed and relative muscular stress, as measured by normalized integrated electromyographic (nIEMG) activity, while carrying a box of groceries and standing from a chair.DESIGN: Prospective intervention study.SETTING: Volunteer subjects from the community of Birmingham, Alabama.PARTICIPANTS: Fourteen healthy women aged 60 to 77 years.INTERVENTION: Sixteen weeks of total body strength conditioning.MEASUREMENTS: Before and after 16 weeks of strength conditioning, the following variables were evaluated for all subjects: (1) strength, six isotonic tests and two isometric tests; (2) walking velocity; (3) nIEMG of the biceps while carrying a box of groceries; and (4) nIEMG of the rectus femoris while standing from a chair.MAIN RESULTS: After the strength training program, subjects' isotonic strength increased significantly, an average of 52% on the isotonic tests and 31% on the isometric tests. Walking velocity also increased significantly (18%). nIEMG of the biceps decreased 36% while carrying a box of groceries. Rectus femoris nIEMG decreased 40% while standing and 47% while sitting.CONCLUSIONS: After strength conditioning, healthy older women showed not only substantially increased strength but also improvements in walking velocity and the ability to carry out daily tasks such as rising from a chair and carrying a box of groceries.
Predictors of Nursing Home Placement in Community‐Based Long‐term Care
Authors: Tsuji Ichiro , Whalen Sarah , Finucane Thomas E. 
Published: April 2015

OBJECTIVE: To identify predictors for nursing home placement among a group of frail older patients receiving formal home care services.DESIGN: Retrospective chart review.SETTING: A geographically defined catchment area of southeast Baltimore, Maryland.PATIENTS: A total of 334 homebound patients who started using the Elder Housecall Program (EHP), a multidisciplinary team providing in‐home care and housed at the Johns Hopkins Geriatrics Center, between 1986 and 1989.MEASUREMENTS: Independent variables, based on the chart review, were age, sex, diagnosis, functional status, and caregiver conditions at entry into EHP. Dependent variable was nursing home placement until December 31, 1991.MAIN RESULTS: Cox proportional hazards analysis indicated that significant predictors were diabetes mellitus, bowel incontinence, and three caregiver characteristics: living separate from the patient, having time conflicts because of a job, and being stressed by caregiving.CONCLUSION: Among this group of frail older people, caregiver problems were significant predictors of nursing home placement, but functional disabilities generally were not. These results suggest the need for geriatricians to be alert to the psychosocial aspects of patients and their caregivers.
Does Oxybutynin Add to the Effectiveness of Prompted Voiding For Urinary Incontinence Among Nursing Home Residents? A Placebo‐Controlled Trial
Authors: Ouslander Joseph G. , Schnelle John F. , Uman Gwen , Fingold Susan , Nigam Jennifer Glatler , Tuico Edward , Jensen Barbara Bates 
Published: April 2015

OBJECTIVE: To determine if oxybutynin, a bladder relaxant medication, adds to the effectiveness of prompted voiding (PV) in the management of urinary incontinence among nursing home residents.DESIGN: Randomized, placebo‐controlled, double‐blinded, dose‐adjusted, crossover trial of oxybutynin added along with PV.SETTING: Seven nursing homes in Los Angeles County, California.PARTICIPANTS: Seventy‐five nursing home residents with predominantly urge incontinence, whose incontinence did not respond well to a trial of PV.MAIN OUTCOME MEASURES: The frequency of incontinence, measured as the percentage of hourly (7 AM to 7 PM) physical checks over a 3‐day period at which the resident was found wet.RESULTS: Sixty‐three (84%) of the residents completed the study. Among those completing the trial, the percent of checks wet went from 26.5% to 23.7% on placebo to 20.2% on active drug. These changes were statistically significant but not clinically meaningful. A clinically significant decrease in the frequency of incontinence, which we defined as a relative reduction in the percent of checks wet of >33%, occurred in 20 subjects (32%) while on active drug and in 12 subjects (19%) while on placebo (P = .48 by chi‐square). Twenty‐five subjects (40%) met our “continence criteria” of an average of one or less wet per day while on active drug, and 11 subjects (18%) achieved this goal on placebo (P = .005 by chi‐square).CONCLUSION: Oxybutynin does not add to the clinical effectiveness of PV in the majority of nursing home residents with urge type urinary incontinence. Selected residents may, however, become more responsive to PV while on oxybutynin. Our data are consistent with other studies of bladder relaxant medications in functionally impaired populations. New drugs and/or other interventions are needed for the large number of incontinent nursing home residents who do not respond well to PV.
Treatment of Ventricular Arrhythmias in Older Adults
Authors: Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To review the prognosis and management of ventricular arrhythmias (VA) in persons with and without heart disease with emphasis on older adults.DATA SOURCES: A computer‐assisted search of the English language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.STUDY SELECTION: Studies on the prognosis and management of VA in persons with and without heart disease were screened for review. Studies in older people and recent studies were emphasized.DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving the older persons. Relevant articles were reviewed in depth.DATA SYNTHESIS: Available data about the prognosis and management of VA in persons with and without heart disease, with emphasis on studies involving older people, were summarized.CONCLUSIONS: VA in older persons without heart disease should not be treated with antiarrhythmic drugs. Class I antiarrhythmic drugs should not be used to treat VA in older persons with heart disease. Beta blockers should be used to treat complex VA in older persons with ischemic or nonischemic heart disease if there are no contraindications to beta blocker therapy. The use of amiodarone in treating complex VA should be reserved for life‐threatening ventricular tachyarrhythmias in older persons who cannot tolerate or who do not respond to beta blockers. VA associated with congestive heart failure should be treated with angiotensin converting enzyme inhibitors. If older patients have life‐threatening recurrent ventricular tachycardia or ventricular fibrillation resistant to antiarrhythmic drugs, invasive intervention should be performed. The automatic implantable cardioverter‐defibrillator is recommended in older patients who have medically refractory sustained ventricular tachycardia or ventricular fibrillation.
Long‐Term Survival and Use of Antihypertensive Medications in Older Persons
Authors: Pahor Marco , Guralnik Jack M. , Corti Maria‐Chiara , Foley Daniel J. , Carbonin Pierugo , Havlik Richard J. 
Published: April 2015

OBJECTIVE:To determine whether older persons with hypertension who use specific calcium antagonists and ACE inhibitors have a different risk of mortality than those using β‐blockers.DESIGN:A prospective cohort study continuing from 1988 through 1992.SETTING:Three communities of the Established Populations for Epidemiologic Studies of the Elderly.PARTICIPANTS:Hypertensive participants aged s 71 years (n = 906) who had no evidence of congestive heart failure and who were using either /3‐blockers (n = 515), verapamil (n = 77), diltiazem (n = 92), nifedipine (n = 74), or ACE inhibitors (n = 148). Nifedipine was of the short acting variety.MEASUREMENTS:The main outcome measure was all‐cause mortality. Age, gender, smoking, HDL‐cholesterol, blood pressure, intake of digoxin and diuretics, physical disability, self‐perceived health, and comorbid conditions were examined as confounders.RESULTS:During 3538 person‐years of follow‐up, 188 participants died (53 deaths per 1000 person‐years). Compared with j3‐blockers, after adjusting for age, gender, comorbid conditions and other health‐related factors, the relative risks (95% confidence interval) for mortality associated with use of verapamil, diltiazem, nifedipine, and ACE inhibitors were 0.8 (0.4‐1.4), 1.3 (0.8‐2.1), 1.7 (1.1–2.7), and 0.9 (0.6‐1.4), respectively. The results were unchanged after excluding participants with other potential contraindications to /3‐blockers and after stratifying on coronary heart disease and use of diuretics. Higher doses of nifedipine were associated with higher mortality.CONCLUSION:Compared with /3‐blockers, use of short acting nifedipine was associated with decreased survival in older hypertensive persons. However, selective factors influencing the use of specific drugs in higher risk patients could not be completely discounted, and final conclusions will depend on clinical trials.