bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Hepatitis B Surface Antigen, Hepatitis C Antibody, and HIV‐1 Antibody among Residents of a Long‐Term‐Care Facility
Authors: Simor A. E. , Gordon M. , Bishai F. R. 
Published: April 2015

ObjectiveTo determine the prevalence of hepatitis B antigen (HBsAg), antibody to hepatitis C virus (anti‐HCV), and antibody to human immunodeficiency virus (anti‐HIV) among residents of a long‐term care facility.DesignAnonymous unlinked serosurvey.SettingAccredited university‐affiliated long‐term‐care facility in Toronto with 300 chronic‐care hospital patients, 350 nursing home residents, and 200 residents of a senior citizens' apartment complex.InterventionsSera from left‐over blood samples obtained from residents in November 1990 were tested for HBsAg, anti‐HCV, and anti‐HIV using standard methods.ResultsA total of 508 sera were tested. The number (%) positive for HBsAg, anti‐HCV, and anti‐HIV, respectively were: 3(0.6%), 7(1.4%), and 0(0%).ConclusionsThis is the first report defining rates of infection with bloodborne infective agents among residents of a long‐term care facility. These results support the use of hepatitis B vaccine for medical and nursing staff and the implementation of universal precautions in long‐term care facilities.
State Regulations Governing Infection Control Issues in Long‐Term Care
Authors: Crossley Kent , Nelson Lara , Irvine Patrick 
Published: April 2015

ObjectiveTo examine states' regulations governing infections and infection control in long‐term‐care institutions.DesignCollection and examination of relevant documents from all of the states, the District of Columbia, the Joint Commission on Accreditation of Health Care Organizations, and Medicare/Medicaid.Main Outcome MeasuresRules governing (1) admissions of patients with infections, (2) tuberculin testing of residents, (3) employee health, (4) use of immunizations, (5) human immunodeficiency virus (HIV)‐infected patients, and (6) infection control were compared.ResultsThere were wide variations in states' policies in each of these areas and many were inconsistent with current scientific knowledge.ConclusionUniform federal standards for long‐term care would probably provide a better and more economical way to ensure quality of care in these institutions.
Protein‐Energy Malnutrition in Elderly Medical Patients
Authors: Constans T. , Bacq Y. , Bréchot J.‐F. , Guilmot J.‐L. , Choutet P. , Lamisse F. 
Published: April 2015

Study ObjectiveTo evaluate (1) the prevalence of protein‐energy malnutrition in elderly patients; (2) the changes in nutritional status during the hospital stay; and (3) (main objective) the relationship between simple nutritional parameters and short‐term in‐hospital mortality.DesignProspective time series at admission and on the 15th day of hospitalization.SettingMedical care unit in a teaching hospital.ParticipantsConsecutive sample of 324 hospitalized patients ≥70 years (86.4% of eligible patients). Norms of measurements were obtained from a referred sample of healthy control subjects (26 males and 36 females).Main Outcome MeasuresMid‐arm circumference, triceps skinfold thickness, serum albumin, prealbumin, and retinol‐binding protein levels were measured in patients at admission and on the 15th day.Results(1) Prevalence of PEM was 30% in male and 41% in female patients. (2) Both mid‐arm circumference and serum albumin level decreased over the first 15 days of hospital stay (53 patients, paired t test, P < 0.05). Triceps skinfold thickness did not change. (3) A step‐wise discriminant‐function analysis determined the utility of the parameters at admission as predictors of in‐hospital mortality before the 15th day. Mid‐arm circumference, triceps skinfold thickness, albumin, and prealbumin levels, as well as age, are predictors of in‐hospital mortality, with 73% sensitivity, 69% specificity, and 70% of correctly classified patients of both sexes.ConclusionsParameters used are predictors for short‐term in‐hospital mortality of elderly patients hospitalized in an acute medical unit. The lean body mass is preferentially mobilized for energy during hospitalization.
Empowerment of the Older Patient? A Randomized, Controlled Trial To Increase Discussion and Use of Advance Directives
Authors: Sachs Greg A. , Stocking Carol B. , Miles Steven H. 
Published: April 2015

ObjectiveTo see if an educational intervention directed at older outpatients would lead to increased use or discussion of advance directives and to characterize patients' reasons for not obtaining advance directives.DesignRandomized, controlled trial of an educational intervention versus usual care.SettingOutpatient geriatrics clinic of a university hospital.PatientsOne hundred and thirty‐one non‐demented patients over the age of 65 who did not have an advance directive documented in their record at the start of the study. Forty‐eight patients were in the trial arm and 83 in the control.Main Outcome MeasuresAll patients had their charts re‐examined 6 months after enrollment to look for the presence of a living will, a durable power of attorney for health care, or a physician's note describing a discussion of advance directives. Trial patients were also re‐interviewed to examine their reasons for not executing an advance directive.Main ResultsSix months after the intervention, only seven of the 48 trial subjects (15%) had an advance directive or note describing discussion of advance directives in their charts compared to eight of the 83 controls (10%) (P > 0.05). When asked to give reasons for not obtaining an advance directive, many patients' responses pointed to procrastination as a significant barrier.ConclusionsPromoting advance directive use is a complicated task. Barriers other than information and access to documents appear to be involved and need to be addressed in future efforts.
The Effect of Age on Driving Skills
Authors: Carr David , Jackson Thomas Wayne , Madden David J. , Cohen Harvey Jay 
Published: April 2015

ObjectiveTo assess the effect of age on driving skills independent of the limitations related to disease or dementia.DesignProspective comparison of driving skills across three age groups.SettingA university‐based research study of student and university‐affiliated volunteers.ParticipantsHealthy elderly (age 65+), teen‐age (age 18–19), and young adult drivers (age 25–35). Twenty subjects in each age group were recruited after meeting entry criteria for the study.Main Outcome MeasuresTotal error count and score on the Miller Road Test, a standardized road test developed by the Division of Bus and Traffic Safety in North Carolina.ResultsThe elderly were found to have fewer errors than either of the two younger groups of drivers (P= 0.0013). Specific driving skills were judged to be either superior or unchanged in the elderly subjects in comparison to their younger counterparts.ConclusionsRoad test skills appear to be well preserved in the healthy elderly population. More road test studies are needed on elderly individuals with mental and physical impairments to determine if road tests can play a role in identifying the driver at high risk for a crash.
The Clock Test: A Sensitive Measure To Differentiate Normal Elderly from Those with Alzheimer Disease
Authors: Tuokko H. , Hadjistavropoulos T. , Miller J. A. , Beattie B. L. 
Published: April 2015

ObjectiveTo examine the clinical utility of the Clock Test for identifying dementia.DesignGroup comparisons.SettingA hospital‐based out‐patient diagnostic clinic.PatientsVolunteer sample of elderly individuals (normal elderly, NE, n = 62) and a referred sample of probable Alzheimer Disease (AD, n = 58) patients meeting NINCDS‐ADRDA criteria.Main Outcome MeasureThe Clock Test is composed of three components: Clock Drawing, Clock Setting, and Clock Reading. A detailed scoring system for qualitative as well as quantitative evaluation of Clock Drawing errors was used. Five time settings, varying in level of complexity, were used to evaluate Clock Setting and Clock Reading.ResultsThe groups differed significantly on Clock Drawing, Clock Setting, and Clock Reading (P < 0.001). On Clock Drawing, the AD group made significantly more errors of omission and misplacement of numbers than the NE group (P < 0.001). Using cut‐off scores derived to maximize separation between the groups to define deficits in performance, the sensitivity and specificity for the diagnosis of AD of Clock Drawing, Clock Setting, and Clock Reading were 92% and 86%, 87% and 97%, 92% and 85%, respectively. Using a criterion of deficits on two or more of the three components, sensitivity and specificity increased to 94% and 93%, respectively.ConclusionsDeficits on clock drawing in AD may be reflective of a generalized disturbance in the conceptualization of time rather than constructional apraxia, per se. The functionally relevant components of Clock Setting and Clock Reading combined with Clock Drawing make the Clock Test particularly useful as a screening and research tool for AD.
Comparing Proxy and Patients' Perceptions of Patients' Functional Status: Results from an Outpatient Geriatric Clinic
Authors: Weinberger Morris , Samsa Gregory P. , Schmader Kenneth , Greenberg Stanley M. , Carr David B. , Wildman Diane S. 
Published: April 2015

ObjectiveTo compare ratings of patients referred for geriatric evaluation and their proxies with respect to patients' ability to perform activities of daily living.DesignRetrospective chart audit.SettingUniversity‐based Outpatient Geriatric Clinic.PatientsElderly medicine patients referred to a university‐based outpatient geriatrics clinic for the first time.Main Outcome MeasuresModified Katz Physical Activities of Daily Living (PADL) and Instrumental Activities of Daily Living (IADL).ResultsWith regard to PADLs, patients were generally rated as independent by both patients (91%) and proxies (87%); for IADLs, ratings of independence by both patients (68%) and proxies (51%) were significantly lower. Concordance between patient and proxy ratings was significantly (P<0.001) greater for PADLs (92%) than for IADLs (82%). When disagreement occurred, patients consistently rated themselves as more independent than their proxies, especially for IADLs. Moreover, concordance between patients and proxies regarding IADLs was significantly (P<0.001) worse for patients who had scores below 24 on the Folstein Mini‐Mental State Examination (72%) compared with those scoring 24 or higher (95%).ConclusionsPatient and proxy ratings were concordant when rating patients' ability to perform PADLs. Moreover, concordance was extremely high on IADLs when patients' Folstein scores were 24 or higher. Concordance with respect to IADLs was relatively poor only among patients with Folstein scores below 24. In that case, patients had a more optimistic view of their independence, compared with their proxies.
An Outbreak of Influenza A (H3N2) in a Well Immunized Nursing Home Population
Authors: Coles F. Bruce , Balzano Gregory J. , Morse Dale L. 
Published: April 2015

ObjectiveTo describe the epidemiologic features of an outbreak of influenza A that occurred in a skilled nursing home although over 90 percent of the resident population had previously received influenza vaccine.DesignRetrospective cohort study.SettingSkilled nursing home facility in western New York State.PatientsNursing home residents and patient‐care staff.Main Outcome MeasureIncidence of influenza‐like illness among vaccinated versus unvaccinated nursing home residents and staff.ResultsThirty‐seven of 124 residents (attack rate = 30%) and 18 of 146 staff (attack rate = 12%) had an influenza‐like illness. Staff illness began 16 days prior to onset among residents. Six cases of pneumonia and three influenza‐related deaths occurred, all among the vaccinated residents. Ninety percent of the nursing home residents and 10% of the staff received the influenza vaccine prior to the outbreak. The calculated vaccine efficacies were minus 21% and plus 45% for residents and staff, respectively.ConclusionWhile antigenic drift of the circulating influenza virus was the major factor in the apparent vaccine failure, the observed poor staff immunization rate (10%) and absence of surveillance which precluded the use of amantadine chemoprophylaxis suggest that the use of these strategies may be of importance in controlling influenza outbreaks in nursing homes.
Suicide Attempts in Elderly Psychiatric Inpatients
Authors: Lyness Jeffrey M. , Conwell Yeates , Nelson J. Craig 
Published: April 2015

ObjectiveTo describe the psychopathological characteristics of elderly suicide attempters admitted to an inpatient psychiatric unit.DesignRetrospective chart review.PatientsAll 168 patients age 60 years and over treated on the adult psychiatric inpatient unit of Yale‐New Haven Hospital from 1979 to 1984. Twenty‐five made a suicide attempt.Main Outcome MeasuresPresence and severity of suicide attempts were rated and compared with demographic, clinical, and functional data.Results(1) Eighty percent of the attempters had a major depressive syndrome; (2) among patients with affective disorders, presence of an attempt was significantly associated with a later age of onset; (3) patients who had made more severe attempts were more likely to be diagnosed as psychotic depression, although this trend was not significant; (4) substance abuse and dementia were uncommon diagnoses; (5) symptomatic and functional outcome of hospitalization was as favorable for the attempters as for the entire elderly cohort.ConclusionsAffective illness, especially late‐onset major depression, was the major association with suicide attempts.
Postprandial Cholecystokinin Secretion in Elderly with Protein‐Energy Undernutrition
Authors: Berthélemy Philippe , Bouisson Michèle , Vellas Bruno , Moreau Jacques , Nicole‐Vaysse  , Albarede Jean Louis , Ribet André 
Published: April 2015

ObjectiveMalnutrition is currently observed in aged people, and cholecystokinin is an important peripheral satiety signal. The aim of this study was to examine the effect of aging and protein‐energy malnutrition on postprandial cholecystokinin (CCK) release.DesignNon‐randomized, cross‐sectional comparison by age group.SettingGastroenterology section of a teaching hospital.ParticipantsTwenty‐one human volunteers divided into three groups: young healthy subjects (Group 1: mean 29 years, n = 7), aged healthy subjects (Group 2, mean 80 years, n = 7), and aged subjects with an important degree of malnutrition (Group 3, mean 84.6 years, n = 7).InterventionEach subject ingested a standardized liquid meal after an overnight fast.Main Outcome MeasuresPlasma cholecystokinin was measured using a sensitive bioassay before and after the ingestion of the liquid meal.ResultsBasal cholecystokinin levels were similar (0.9 to 1 pm equivalent CCK‐8) in the three groups. Postprandial levels were significantly increased over basal (P < 0.05). The maximal cholecystokinin value was lower in Group 1 (3.5 ± 0.8 pm equivalent CCK‐8) and Group 2 (3.3 ± 0.77 pm equivalent CCK‐8) than in Group 3 (8.3 ± 2 pm equivalent CCK‐8) (P < 0.05). Integrated plasma cholecystokinin was also similar in Group 1 (171 ± 38 pm · 60 min), (P < 0.05).ConclusionThe increase of postprandial maximal levels of cholecystokinin is more related to malnutrition than to aging.
Attitudes toward Discussing Life‐Sustaining Treatments in Extended Care Facility Patients
Authors: Lurie Nicole , Pheley Alfred M. , Miles Steven H. , Bannick‐Mohrland Susan 
Published: April 2015

Objective: To determine nursing home residents' attitudes toward discussing life‐sustaining treatment plans with their physicians and the factors associated with these attitudes.Objective: Random‐sample, interviewer‐administered survey.Setting: Forty‐one nursing homes in which some residents were cared for by house‐staff physicians of the Hennepin County (Minnesota) Medical Center Extended Care Department.Patients: Random sample of 150 nursing home residents receiving primary care from Extended Care Department physicians, 131 (87%) of whom completed the interview.Results: Older individuals were less likely to have spoken with physicians and family members about treatment plans (P < 0.05), and to have felt that they had more say than necessary in their treatment (P < 0.05). Only 19 (14.5%) residents had formal treatment plan discussions about limiting life‐sustaining treatment. Although perceived current health status did not differ between residents with and without treatment plans, those residents who had discussions about advance directives were more likely to report health improvement over the past 6 months (P < 0.05). Residents with formal advance directives were, on average, 8.4 years younger than those without them (P < 0.05).Conclusions: Younger patients are more likely to have had discussions about life‐sustaining treatment and are also more frequently involved in plan development. Preferences for level of involvement should be considered during advance directive planning, and it should be recognized that these preferences may vary with age. Future research should evaluate whether this age relationship is a true age or a cohort effect. J Am Geriatr Soc 40:1205–1208, 1992
A Prospective Evaluation of the Geriatric Depression Scale in an Outpatient Geriatric Assessment Center
Authors: Burke William J. , Nitcher Rodney L. , Roccaforte William H. , Wengel Steven P. 
Published: April 2015

Objective: To prospectively evaluate the Geriatric Depression Scale (GDS) in cognitively intact and impaired patients undergoing outpatient geriatric assessment.Subjects: One hundred ninety‐four geriatric patients evaluated in a 1‐year period.Setting: The outpatient Geriatric Assessment Center of the University of Nebraska Medical Center.Measurements: The 30‐item GDS was completed by all patients. The patients were then evaluated by one of three geriatric psychiatrists who were blind to the GDS results. The prospective clinical diagnosis of major depression was compared to the GDS results. Patients were categorized as cognitively impaired or intact on the basis of the Mini‐Mental State Examination. Data were analyzed using ROC curves. An optimal cutoff was identified which was the total score on the GDS with the highest combined sensitivity and specificity.Results: ROC curve analyses showed good agreement between the clinical diagnosis and the GDS in both cognitively intact and impaired subjects. Cognitively intact, euthymic patients reported a mean of 8.4 symptoms, while cognitively impaired, euthymic patients, reported a mean of 8.7. Cognitively intact, depressed patients reported a mean of 14.7 symptoms, while cognitively impaired, depressed patients reported a mean of 15.0.Conclusions: This study provides further evidence that the GDS is as accurate a screening test for depression in cognitively impaired as in intact patients. J Am Geriatr Soc 40:1227–1230, 1992
The Influence of Treatment Descriptions on Advance Medical Directive Decisions
Authors: Malloy Timothy R. , Wigton Robert S. , Meeske Jessica , Tape Thomas G. 
Published: April 2015

Objective: To determine whether the wording of the descriptions of life‐sustaining interventions would affect the choices elderly patients make when completing advance directives.Methods: Survey.Setting: General community in Omaha, Nebraska.Patients: Two hundred one community‐dwelling elderly were selected from a population‐based sample.Main Outcome Measures: Subjects were asked whether they would accept or reject three life‐sustaining interventions: cardiopulmonary resuscitation, mechanical ventilation, or tube feeding in three separate hypothetical case scenarios. The three life‐sustaining interventions were each described positively, negatively, and exactly as they are worded in a widely used advance directive. Subjects reviewed each scenario three times with three different descriptions of the three interventions.Results: For the three interventions presented in three scenarios, subjects opted for the intervention 12 percent of the time when it was presented negatively, 18 percent of the time when it was phrased as in an advance directive already in use and 30 percent of the time it was phrased positively. One hundred fifty‐five of the 201 subjects (77 percent) changed their minds at least once when given the same scenario but a different description of the intervention. Of these 155, 33 percent changed decisions one to three times, 33 percent changed decisions four to seven times, and another 34 percent changed decisions eight to seventeen times based solely on the description of the intervention.Conclusion: The decisions patients make about whether to accept or reject life‐sustaining treatments are affected by the descriptions of the treatments. These findings emphasize the critical importance of doctor‐patient consultation when patients execute advance directives. J Am Geriatr Soc 40:1255–1260, 1992
Community‐Acquired Bacteremia in the Elderly: A Prospective Study of 121 Cases
Authors: Whitelaw David A. , Rayner Brian L. , Willcox Paul A. 
Published: April 2015

Objective: To describe community‐acquired bacteremia in the elderly and correlate clinical and laboratory findings with outcome.Design: Prospective study of consecutive cases.Setting: Large community‐based teaching hospital.Patients: One hundred and twenty‐one elderly patients aged 65 to 89 years, seen between February 1, 1986 and January 31, 1988.Main Outcome Measures: Bacteriological cultures, symptoms and signs, laboratory findings, and mortality.Results: Gram‐negative organisms accounted for 65 (54%) cases and Gram‐positive organisms for 47 (39%) cases, while nine (7%) cases were polymicrobial. E. coli (39%), Klebsiella sp. (8%), S. pneumoniae (14%), and S. aureus (12%) were the most commonly isolated organisms. The overall mortality was 38%. A poor prognosis was associated with confusion as a presenting symptom (P < 0.0003), hypotension (P < 0.0003), and inappropriate or delayed treatment (P < 0.02). A good prognosis was associated with E. coli as the pathogen (P < 0.0003) and prompt, appropriate antibiotic therapy.Conclusion: Community‐acquired bacteremia in the elderly has a high mortality rate. Early recognition and prompt, appropriate treatment are critical in reducing the mortality. J Am Geriatr Soc 40:996–1000, 1992
Mammography and Papanicolaou Smear Use by Elderly Poor Black Women
Authors: Mandelblatt Jeanne , Traxler Maryann , Lakin Patricia , Kanetsky Peter , Kao Richard ,   Harlem Study Team
Published: April 2015

Objective: To describe factors related to the use of mammography and Papanicolaou smears in low‐income women aged 65 or more years to guide development of future interventions.Design: A cross‐sectional survey.Setting and Patients: Elderly Black women attending a public hospital medical clinic.Measurements: Information obtained in a face‐to‐face interview of a random sample of patients.Results: Four‐hundred and forty‐five women (94%) consented to be interviewed; 74% reported a mammogram, and 85% reported a Papanicolaou smear in the past, although these early‐detection tests were not obtained with any regularity after age 65. Concordance between self‐reported screening use and blind chart review was more than 90%. The major reasons for non‐use of both screening tests were that a physician hadn't recommended them or that the women didn't know they needed them. Levels of knowledge about breast and cervix cancer were low; 68% believed bumping or bruising the breast caused cancer, and only 25% knew that cancer risk increased with advancing age. In logistic regression models, health status, provider type, perceived benefit, life satisfaction, and knowledge of test intervals were each significantly associated with mammogram use. Age, health status, education, perceived susceptibility and benefit, life satisfaction, and knowledge of test intervals were independently related to Pap use (P < .05).Conclusion: This study illustrates that elderly, poor, minority women who are regular health‐care users do use mammography and Pap smear screening services. Incorporating screening into routine primary care and physician and patient education could enhance the use of early cancer detection procedures in this age group. J Am Geriatr Soc 40:1001–1007, 1992