bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temporal and Regional Variability in the Surgical Treatment of Cancer Among Older People
Authors: Farrow Diana C. , Hunt William C. , Samet Jonathan M. 
Published: April 2015

OBJECTIVES: Numerous studies have documented that older individuals with cancer have been treated less aggressively than younger individuals. We utilized data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program to assess geographic variation in the effects of age on the surgical treatment of cancer and to examine temporal trends in the treatment of older people between 1973 and 1991.DESIGN: Ecological analyses comparing time trends of treatment in nine regions over a 19‐year period.SETTING: Population‐based data for nine geographic areas of the United States.PARTICIPANTS: Persons with incident cancer of the breast, colon, rectum, lung, ovary, uterus, pancreas, and stomach residing in these regions during the selected years. RESULTS: After age 64, the percentage of patients treated surgically decreased with increasing age for every cancer site studied. Between 1973 and 1991, the likelihood of receiving surgery for cancers of the uterus, colon, rectum, ovary, and breast increased more rapidly among patients ages 65 years and older than among those under age 65. This relative decrease occurred consistently across most geographic areas should For cancers of the lung, stomach, and pancreas, the effect of age of age on the likelihood of receiving surgery did not diminish through the period under study.: CONCLUSIONS: Although older people remain less likely to receive surgical therapy than younger persons, for some important cancer sites the gap between the treatment of older and younger individuals narrowed from 1973 through 1991.
Factors Associated with Institutionalization of Older People in Canada: Testing a Multifactorial Definition of Frailty
Authors: Rockwood Kenneth , Stolee Paul , McDowell Ian 
Published: April 2015

OBJECTIVES: To test a model of frailty by examining factors associated with institutionalization of older people in Canada; to assess whether diagnostic data provided information about risk beyond that provided by data on functional capacity and demographic variables.METHODS: Cross‐sectional study of 1258 institutional subjects and 9113 community‐dwelling older adults from the Canadian Study of Health and Aging.RESULTS: Multiple logistic regression analysis showed that female gender, being unmarried, absence of a caregiver, presence of cognitive impairment (including all types of dementia), functional impairment, diabetes mellitus, stroke, and Parkinson's disease were independently associated with being in a long‐term care facility.CONCLUSION: Frailty appears to be a multidimensional construct, and not simply a synonym for dependence in Activities of Daily Living. Studies of health outcomes in older people should include diagnostic data as well as demographic information and data on functional capacity.
Gender Differences in the Behavioral Manifestations of Alzheimer's Disease
Authors: Ott Brian R. , Tate Charlene A. , Gordon Norman M. , Heindel William C. 
Published: April 2015

OBJECTIVE: To examine the relationship between gender and specific types of behavior problems that occur in patients with Alzheimer's disease.DESIGN: This was an observational study using the Dementia Behavior Disturbance Scale to quantify and define behavioral problems encountered by caregivers. Multiple regressions were used to control for the possible influence of dementia severity as measured by the Mini‐Mental State Examination and the duration of dementia.SETTING: Patients were sampled from the outpatient dementia clinics of Roger Williams Hospital and Miriam Hospital in Providence, Rhode Island.PARTICIPANTS: A total of 125 patients with probable Alzheimer's disease, defined by NINCDS‐ADRDA diagnostic criteria, were included in the study. There were 75 women and 50 men.MAIN OUTCOME MEASURES: Caregivers rated the presence and frequency of 28 different behavior problems from the Dementia Behavior Disturbance Scale. Domains of behavior disturbance were then defined by a factor analysis of the data.RESULTS: Male and female groups were comparable for the demographic variables of age, education, and duration of dementia, as well as severity of depression, degree of cognitive impairment and overall severity of behavior disturbance. Among the six behavior factors that were defined, two were significantly related to gender. One factor, which included apathy and vegetative signs, was related to male gender; a second factor, which included reclusiveness and emotional lability, was related to female gender.CONCLUSIONS: Although overall severity of behavior disturbance in Alzheimer's disease may be related primarily to severity of dementia, significant differences in the types of behaviors manifested exist between males and females with the disease.
MODELS OF GERIATRICS PRACTICE: Decreased Hospital Utilization By Older Adults Attributable to a Home Hospitalization Program
Authors: Reuben David B. , Stessman Jochanan , Ginsberg Gary , Hammerman‐Rozenberg Robert , Friedman Reuven , Ronen David , Israeli Avi , Cohen Aaron 
Published: April 2015

OBJECTIVE: To evaluate the cost effectiveness of a short‐term home health care program for older people, Home Hospitalization (HH), compared with the alternative of regular ambulatory care with general or geriatric hospitalization as necessary.SETTING: Our HH was initiated in November 1991 to serve Jerusalem residents. Program staff included physicians, nurses, and paramedical professionals. Other medical/hospital services were provided nonselectively by the general medical personnel of the various hospitals in Jerusalem.STUDY DESIGN: Patients over the age of 65 were either referred to the HH program (study group; n = 36,500) or to routine medical care (control group; n = 9000) depending on their Sick Fund assignment. Hospital utilization rates per enrollee were studied prospectively and compared both between the two groups and with hospitalization rates in the year before the initiation of the program.RESULTS: During the first 26 months of operation, the HH program cared for 741 older persons for a total of 37,290 days' care at an average daily cost of $30.06 (1992) and $23.64 (1993). Annual general hospitalization rates per person declined in the study group from 2.80 days in the 1991 baseline period to 2.65 days in 1992 and to 2.54 days in 1993. Hospitalization rates in the control group increased from 2.62 in 1991 to 2.70 days/member and 2.71 days/member in 1992 and 1993, respectively. Annual geriatric hospitalization rates declined considerably in the study group from the 1991 baseline of 1.49 to 1.34 (1992) to 1.33 (1993). The control group experienced a small decrease from 1.64 (1991) to 1.58 (1992) and then a rise to 1.68 days per member in 1993.For the 26‐month duration of the program, estimated savings of 20,773 general hospital days ($5.54 million) and 8486 geriatric hospital days ($0.98 million) exceeded its costs ($0.97 million), providing a cost/benefit ratio of 5.7/1. In addition, patient satisfaction was high.CONCLUSION: The HH program provided a cost effective substitute for care in a geriatric or general hospital for Jerusalem's elderly.
Hepatitis B Virus Vaccination for Older Adults
Authors: Bennett Richard G. , Powers Douglas C. , Remsburg Robin E. , Scheve Ann , Clements Mary Lou 
Published: April 2015

OBJECTIVE: To compare in adults more than 50 years old the tolerability and immunogenicity of vaccination with recombinant hepatitis B surface antigen (HBs) compared with vaccination with recombinant hepatitis B protein PreS2+S, and to investigate the safety and immunogenicity of a fourth vaccine dose in poor and non‐responders.DESIGN: Randomized, double‐blind prospective study.SETTING: General clinical research center for outpatient evaluation and vaccination.SUBJECTS: Adults older than age 50 who were in general good health and with no known risk factors for acquiring or serologic evidence of hepatitis B virus infection.INTERVENTION: Subjects were randomized to receive 10 mcg HBs (Recombivax®, Merck, Sharp and Dohme), 12 mcg PreS2+S, or 24 mcg PreS2+S vaccine at 0, 1, and 6 months. Poor and non‐responders (anti‐Hbs < 10 mIU/mL at month 9 and/or 12) were encouraged to receive a fourth vaccine injection.MEASUREMENTS: Diary records of temperature and local and systemic reactions following each vaccination were maintained by all subjects. Anti‐HBs levels were measured by radioimmunoassay before the first injection, at 1, 2, 3, 6, 7, 9, and 12 months after for all subjects, and 1 month after the fourth injection for the group of poor and non‐responders.MAIN RESULTS: Twenty men and nine women (mean age ± SD, 66 ± 8.0 years) were enrolled. Ten subjects received HBs vaccine, nine received 12 mcg PreS2+S vaccine, and 10 received 24 mcg PreS2 + S vaccine. One subject in the HBs group dropped out, and data were analyzed for the remaining 28 subjects. There were no differences in rates of side effects reported by each of the three groups. Overall, minor local adverse reactions occurred in 12 (40%) after at least one of the first three vaccinations. Systemic side effects occurred in five (17%) after the first vaccination, in one after the second, but in none after the third. The 24‐mcg PreS2+S vaccine was not more immunogenic than the HBs vaccine, and the 12‐mcg PreS2+S vaccine was judged inadequate. Nineteen of 22 (86%) poor and non‐responders received a fourth vaccination. Minor local adverse reactions were reported by six (32%), and none reported a systemic side effect. For the 12 subjects receiving a fourth injection of HBs or 24 mcg PreS2 + S vaccine, the proportion of responders 1 month following the fourth injection was greater than for 1 month following the third injection (11 of 12 [92%] versus 12 of 19 [63%], respectively, P < .05).CONCLUSION: For adults more than 50 years of age who have low anti‐HBs levels after three vaccine injections, a fourth injection is well tolerated and results in improved immunogenic response.
Geriatric Targeting Criteria as Predictors of Survival and Health Care Utilization
Authors: Satish Shiva , Winograd Carol Hutner , Chavez Catherine , Bloch Daniel A. 
Published: April 2015

OBJECTIVE: To assess the utility of geriatric targeting criteria in predicting survival and health care utilization in a cohort of hospitalized older veterans.DESIGN: A prospective cohort study assessing geriatric targeting criteria, e.g., polypharmacy, falls, or confusion, with respect to adverse outcomes at 12 months.SETTINGA Tertiary Care VA Medical Center.PATIENTS: 507 acutely hospitalized male veterans aged 65 years or more.MAIN OUTCOME MEASURES: Survival status, nursing home placement, and total hospital days during 12 months following hospital admission.RESULTS: Patients who had a higher number of targeting criteria at admission showed a significantly increasing trend toward death (P ≤ .001), nursing home placement (P ≤ .01), and longer hospital stays (P ≤ .01) at 12 months. In univariate analyses, weight loss (relative hazard 3.8, 95% CI 2.4, 5.9), appetite loss (relative hazard 3.3, 95% CI 1.9, 5.8), depression (relative hazard 2.5, 95% CI 1.4, 4.5), falls (relative hazard 2.2, 95% CI 1.2, 4.1), confusion (relative hazard 2.2, 95% CI 1.2, 4.0), and socioeconomic problems (relative hazard 1.6, 95% CI 1.0, 2.5) predicted death. Polypharmacy (OR 3.4, 95% CI 1.3, 8.8), confusion (OR 4.4, 95% CI 1.5, 13.0), and prolonged bedrest (OR 7.6, 95% CI 1.5, 39.3) predicted nursing home placement. Confusion (Beta 12.0, 95% CI 2.9, 21.3), falls (Beta 14.2, 95% CI 4.2, 24.3), and prolonged bedrest (Beta 22.4, 95% CI 3.9, 41.0) predicted total hospital days. In multivariate analyses, weight loss, depression, and socioeconomic problems predicted death; confusion and polypharmacy predicted nursing home placements; and falls predicted total hospital days.CONCLUSION: This prospective cohort study of hospitalized older veterans demonstrated geriatric targeting criteria as predictors of adverse hospital outcomes. Our findings suggest screening acutely hospitalized patients using chart abstracted geriatric targeting criteria is useful in identifying patients at risk for adverse outcomes of hospitalization. J Am Geriatr Soc 44:914–921, 1996.
Life Values, Resuscitation Preferences, and the Applicability of Living Wills in an Older Population
Authors: Schonwetter Ronald S. , Walker Robert M. , Solomon Marcy , Indurkhya Alka , Robinson Bruce E. 
Published: April 2015

OBJECTIVES: To determine whether life values are related to resuscitation preferences and living will completion in an older population and to assess beliefs about the applicability of living wills.DESIGN: Individual structured interviews.SETTING: An independent retirement community.PARTICIPANTS: One hundred thirty‐two subjects older than 63 years of age.MEASUREMENTS: Resuscitation preferences were elicited in five hypothetical scenarios. Subjects with living wills were asked whether their living will would play a role in the scenarios. Subjects rated the importance of 13 life value statements.RESULTS: The percentage of subjects desiring CPR in each scenario was as follows: current condition (66%); acute illness (33%); terminal disease (8%); functional impairment (8%); and dementia (7%). The percentage of those with a living will who thought their living wills would play a role in the scenarios was as follows: acute illness (84%); terminal disease (93%); functional impairment with intact cognition (66%); and dementia (91%). Factor analysis of the life value statements revealed five meaningful factors: quality of life; capacity/autonomy; family relations; physical comfort; and treatment philosophy. Multiple correlations were found between four of five life value factors and hypothetical resuscitation preferences or the presence of a living will.CONCLUSION: Subjects misinterpreted the applicability of living wills in nonterminal illness scenarios. A relationship between life values and resuscitation preferences was noted, which emphasizes the importance of eliciting and including life values when discussing advance directives. J Am Geriatr Soc 44:954–958, 1996.
Spouse Caregivers' Attitudes Toward Obtaining a Diagnosis of a Dementing Illness
Authors: Connell Cathleen M , Gallant Mary P. 
Published: April 2015

OBJECTIVES: To examine attitudes of spouse caregivers about the process of obtaining a diagnosis of a dementing illness, including perceived benefits and obstacles to obtaining a diagnosis and suggestions for improving the process.DESIGN: A mail survey of spouse caregivers of dementia patients followed by the Michigan Alzheimer's Disease Research Center.PARTICIPANTS: The 233 spouse caregivers of dementia patients who returned a completed questionnaire.RESULTS: More than three‐fourths of the sample rated the following benefits of obtaining a diagnosis as very or extremely important: ruling out other causes of memory or behavior problems, allowing family members to get information about dementia, may qualify my spouse for drug treatment, and will allow me to plan for the future. Primary obstacles included the time required to obtain a diagnosis, the cost of procedures, lack of access to physicians trained to diagnose dementing illnesses, and not receiving a referral from a primary care physician (41.6%, 41.0%, 40.8%, and 24.1 % of the sample, respectively, agreed or strongly agreed that the factor posed a barrier to obtaining a diagnosis). Content analysis of responses to two open‐ended questions identified problematic or stressful aspects of obtaining a diagnosis and suggestions for making the process easier for the patient and family.CONCLUSION: Results suggest the need to provide an orientation to the diagnosis and assessment process for patients and family members, develop a training session for physicians to better prepare them to address the emotional needs of patients and families and to disclose the diagnosis in an informative and compassionate manner, and provide outreach education to primary care physicians to increase knowledge and awareness of dementing illnesses and to increase referrals to community‐based services and health professionals able to address the concerns of family members. J Am Geriatr Soc 44:1003–1009, 1996.
Nocturnal Enuresis in Community‐Dwelling Older Adults
Authors: Burgio Kathryn L. , Locher Julie L. , Ives Diane G. , Hardin J. Michael , Newman Anne B. , Kuller Lewis H. 
Published: April 2015

OBJECTIVE: To investigate the prevalence and characteristics of nocturnal enuresis in community‐dwelling older adults and to identify potential predisposing variables.DESIGN: Interview survey.SETTING: Five rural counties in northwestern Pennsylvania.PARTICIPANTS: Subjects were 3884 community‐dwelling older adults aged 65 to 79 years who volunteered for a health promotion demonstration.MEASUREMENTS: The dependent variable was self‐reported accidental loss of urine during sleep. Independent variables included demographic variables, self‐reported disease history and symptomatology, and standardized screening instruments for depression (CES‐D), dementia (MMSE), and functional status (ADLs).MAIN RESULTS: Prevalence of nocturnal enuresis was 2.1%, and was significantly higher among women (2.9%) compared with men (1.0%; P < .0001). Compared with subjects with daytime incontinence only, those with nocturnal enuresis reported greater severity and impact of incontinence on several parameters. Enuretics were more likely to have received treatment; treatment outcome, however, was significantly less successful. In univariate analyses, enuresis was significantly associated with symptoms of congestive heart failure (CHF), impairment in activities of daily living, depression, and use of sleep medications at least once per week. In stepwise logistic regression modeling, two symptoms of congestive heart failure and regular use of sleep medication entered the model.CONCLUSIONS: Nocturnal enuresis appears to be uncommon among older adults, but it may be associated with i poorer therapeutic outcomes compared with the more common forms of daytime incontinence. The findings are consistent with the hypothesis that daytime fluid accumulation followed at night by mobilization of excess fluid is a contributor to enuresis in older adults. J Am Geriatr Soc 44:139–143, 1996.
Prevalence of Use of Beta Blockers and of Calcium Channel Blockers in Older Patients with Prior Myocardial Infarction at the Time of Admission to a Nursing Home
Authors: Aronow Wilbert S. 
Published: April 2015

OBJECTIVETo investigate the prevalence of beta blocker use and calcium channel blocker use in older patients with prior myocardial infarction at the time of admission to a nursing home.DESIGNIn a prospective study of 500 consecutive patients aged 60 years or older admitted to a nursing home, 202 (40%) had electrocardiographic evidence of Q‐wave myocardial infarction at the time of admission. The prevalence of beta blocker use and of calcium channel blocker use was investigated in these 202 patients with previous myocardial infarction. The prevalence of beta blocker use and of calcium channel blocker use was also investigated in patients with myocardial infarction and abnormal left ventricular (LV) ejection fraction.SETTINGA large long‐term health care facility.PATIENTSThe patients included 344 women and 156 men, mean age 81 ± 8 years (range 60 to 100).MEASUREMENTS AND MAIN RESULTSOf 500 patients, 202 (40%) had Q‐wave myocardial infarction at the time of admission to the nursing home. Seventeen (8%) of these 202 patients with myocardial infarction were receiving beta blockers and 74 (37%) were receiving calcium channel blockers at the time of admission. Of 171 patients with myocardial infarction who had technically adequate measurements of LV ejection fraction, 59 (35%) had an abnormal LV ejection fraction (<50%). Of the 59 patients with previous myocardial infarction and abnormal LV ejection fraction, four (7%) were receiving beta blockers and 19 (32%) were receiving calcium channel blockers at the time of admission.CONCLUSIONSBeta blockers are underutilized, and calcium channel blockers are overutilized in the treatment of older patients with a history of myocardial infarction at the time of admission to a nursing home.
Impact of a 12‐Month Exercise Program on the Physical and Psychological Health of Osteopenic Women
Authors: Bravo Gina , Gauthier Pierre , Roy Pierre‐Michel , Payette Hélène , Gaulin Philippe , Harvey Monique , Péloquin Lucie , Dubois Marie‐France 
Published: April 2015

OBJECTIVE: To describe the effect of a supervised physical activity program on the physical and psychological health of osteopenic women.DESIGN: A randomized controlled trial.SETTING: Sherbrooke, Quebec, Canada.PARTICIPANTS: A total of 124 community‐living postmenopausal women, between 50 and 70 years of age, with low bone mass took part in the study.INTERVENTION: Subjects allocated to the experimental group performed weight‐bearing exercises (walking, stepping up and down from benches), aerobic dancing, and flexibility exercises for 60 minutes, three times a week, over a period of 12 months. All subjects were invited to attend bi‐monthly educational seminars covering topics related to osteoporosis.OUTCOME MEASURES: Spinal and femoral bone mineral density (BMD), functional fitness (flexibility, coordination, agility, strength/endurance, cardiorespiratory endurance), psychological well‐being, back pain intensity, and self‐perceived health.RESULTS: Spinal BMD stabilized in the exercisers while decreasing significantly in the controls (P = .031). No change in femoral BMD was observed in either group (P = .597). Four of the five parameters chosen to evaluate functional fitness, namely flexibility, agility, strength, and endurance, were affected positively by the exercise program (all P < .01). Adjusting for prescores by means of an analysis of covariance revealed a significant difference between the groups in psychological well‐being, which favored the exercisers (P = .012). After 12 months, back pain reported by exercisers was lower than that reported by controls (P = .008). Finally, self‐perceived health increased in the exercise group, whereas no difference was observed in the control group (P = .790).CONCLUSION: These results suggest that after 12 months, exercising can produce a significant increase above initial levels in the functional fitness, well‐being, and self‐perceived health of osteopenic women. Intensity of back pain can also be lowered by exercise. The exercise program succeeded in stabilizing spinal BMD but had no effect on femoral BMD.