bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utility of Clysis for Hydration in Nursing Home Residents
Authors: Hussain Naaz A. , Warshaw Gregg 
Published: April 2015

OBJECTIVES: To determine the utility of hypodermoclysis in the management of dehydration in nursing home residents and to review the recent literature on the use of clysis in older adults.DESIGN: A retrospective chart review.SETTING: Two continuing care retirement community nursing home units in Cincinnati.PARTICIPANTS: Thirty‐six nursing home residents with a mean age of 85 years.MEASUREMENTS: A standard chart auditing form was used to collect demographic and clinical data from the patients' nursing home charts. Clinical outcomes were assessed at 1 week following the cessation of clysis.RESULTS: The study subjects were functionally impaired, with 86% having significant cognitive impairment and 81% totally dependent with transfer. The most common indication for clysis was in association with an infection. Clysis was frequently initiated upon nursing observation of inadequate oral intake before obtaining laboratory results and discontinued upon resumption of adequate oral intake. The use of clysis was associated with the return to clinical/functional baseline in 71% of the cases. In the subset of subjects with pre‐ and post‐clysis measurements of serum sodium and BUN/creatinine ratios, improvement in laboratory values was not significant. The use of clysis was not associated with significant complications, but in nine cases minor local skin reactions were documented.CONCLUSIONS: Hypodermoclysis is a relatively safe and effective procedure in a nursing home. The use of clysis in the nursing home is an alternative to intravenous hydration. The use of clysis for short‐term hydration has the potential to reduce cost and transfers to the hospital. J Am Geriatr Soc 44:969–973, 1996.
Circulatory Responses to Weight Lifting, Walking, and Stair Climbing in Older Males
Authors: Benn Sally J. , McCartney Neil , McKelvie Robert S. 
Published: April 2015

OBJECTIVES: To compare the heart rate and intra‐arterial blood pressure responses during weight lifting, horizontal and uphill walking, and stair climbing in older male subjects.DESIGN: We used intra‐brachial artery catheterization to compare the arterial blood pressure (ABP) and heart rate (HR) responses during 10 repetitions (˜40 s) of single‐arm curl (SAC) and single‐arm overhead military press (SAMP) (70% of the one repetition maximum–1RM); 12 repetitions (˜50 s) of single‐ (SLP) and double‐leg press (DLP) weight‐lifting exercises (80% of 1RM); 10 minutes of horizontal treadmill walking (T10) at 2.5 mph holding a 20‐pound weight in minutes 4 to 6 (T104–6) and 30 pounds in minutes 8 to 10 (T108–10); 4 minutes of treadmill walking (T4) at 3.0 mph up an 8% incline; and 12 flights (192 steps) of stair climbing (STR) at 60 to 65 steps/minute on a Stairmaster 6000 ergometer (˜3 minutes).SETTING: McMaster University, Hamilton, Ontario, Canada.PARTICIPANTS: Seventeen healthy males aged (X̄ ± SE) 64.4 ± 0.6 years.MEASUREMENTS: Continuous intra‐arterial measurements of systolic, diastolic, and mean arterial pressure and heart rate and rate‐pressure product.RESULTS: The peak values of HR, ABP and rate‐pressure product (HR · BPs/1000;(RPP,103)) were not systematically ordered among the various activities. The lowest peak values for all variables were recorded during the initial 4 minutes of horizontal treadmill walking. The STR and T4 walking exercises elicited higher HRs (151 ±3.2 and 121 ± 3.4 bpm) than the weight lifting (range from 100 ± 4.8 (SAC) to 113 ± 3.8 bpm (SAMP)), but the converse was true for diastolic pressure (range from 128 ± 6.3 (SAC) to 151 ± 4.8 mm Hg (SAMP) versus 101 ± 2.5 (T4) to 118 ± 3.4 mm Hg (T108–10) and mean arterial pressure (range from 145 ± 4.5 (SAC) to 158 ± 4.8 mm Hg (SAMP) versus 129 ± 3.4 in T4 to 148 ± 3.8 (T108–10) and 157 ± 4.1 mm Hg (STR)). The peak systolic pressure was greatest in STR (271 ± 9.6 mm Hg) followed by SAMP (261 ± 9.3 mmHg) and T108–10 (244 ± 6.4 mm Hg) and was lowest in SAC (224 ± 10.5 mm Hg) and T104–6 (220 ± 5.7 mm Hg). The peak RPP descended in sequence from STR (41 ± 1.8), SAMP (29.8 ± 1.7), T4 (28.1 ± 1.3), DLP (27.2 ± 1.3), T108–10 (27.1 ± 1.4), SLP (25.4 ± 1.7), T104–6 (22.7 ± 1.2) and SAC (22.0 ± 2.2).CONCLUSION: We concluded that older adults who engage in weight lifting with heavy submaximal loads are exposed to no more peak circulatory stress than that created during a few minutes of inclined walking. Moreover, climbing only three to four flights of stairs at a moderate pace (–50–70 s) elicits peak circulatory demands similar to, but at a much more rapid rate of adjustment than, 10 minutes of horizontal walking at 2.5 mph intermittently carrying a 30‐pound weight or 4 minutes of walking up a moderately steep slope. J Am Geriatr Soc 44:121–125, 1996.
Prevalence of Dementia and Distribution of ApoE Alleles in Japanese Centenarians: An Almost‐Complete Survey in Yamanashi Prefecture, Japan
Authors: Asada Takashi , Yamagata Zentaro , Kinoshita Toru , Kinoshita Akemi , Kariya Tetsuhiko , Asaka Akio , Kakuma Tatsuyuki 
Published: April 2015

OBJECTIVE: To determine the prevalence and types of dementia in centenarians and to examine whether the ApoE 4 allele has significant impact on the development of Alzheimer's disease (AD) in the population.DESIGN: Cross‐sectional study and a 6‐month prospective study.SETTING: Yamanashi Prefecture, JapanPARTICIPANTS: Forty‐seven centenarians participated in the study to determine the prevalence and types of dementia. Thirty‐three of the 47 participated in the study of ApoE genotyping. As controls, 224 demented older adults participated in the genetic study. Their age at onset was <90 years.OUTCOMES: Prevalence of dementia based on DSM‐III‐R; types of dementia based on NINCDS‐ADRDA and ICD‐10; distribution on ApoE alleles in the centenarians and in the controls; and the 6‐month mortality rate of the subjects.MAIN RESULTS: Of 47 centenarians, 70.2% had dementia, and AD accounted for the majority (75.8%) of the dementia cases. The distribution of ApoE alleles in all the subjects and the AD subjects was ε2: 4.6% vs. 0%; ε 3: 90.1 % vs. 94.1%; ε 4: 4.6% vs. 5.9%. The frequency of the ε 4 allele in the AD patients showed a tendency to decrease with increasing age, ranging from 38% for those with an age at onset of <60 years to 22% for those with an age at onset of ranging from 80 to 89 years. The 6‐month mortality rate was 27% (9/33) for the demented centenarians, whereas none of the 14 nondemented centenarians died.CONCLUSION: This almost‐complete survey, conducted in a prefecture of Japan, revealed a high prevalence of dementia in centenarians. The ApoE ε 4 allele does not have an impact on the development of AD in centenarians. J Am Geriatr Soc 44:151–155, 1996.
Evaluation of a Self‐Medication Program
Authors: Pereles L. , Romonko L. , Murzyn T. , Hogan D. , Silvius J. , Stokes E. , Long S. , Fung T. 
Published: April 2015

OBJECTIVE: To determine the effect of an inpatient self‐medication program (SMP) on the ability to self‐medicate, patient medication knowledge, compliance, and patient morale.DESIGN: Randomized controlled clinical trial.POPULATION: One hundred seven consecutive patients admitted to a geriatric assessment and rehabilitation program were randomized to either participate in the SMP or to receive standard care.INTERVENTION: The SMP was a three‐stage program in which patients were given increasing responsibility for the administration of their own medications.MEASUREMENTS: Ability to self‐medicate on discharge from hospital; medication compliance at 1 month; patient medication knowledge; Philadelphia Morale Scale.MAIN RESULTS: Participation in the self‐medication program did not increase the proportion of patients who were able to self‐medicate on discharge from hospital. Compliance was improved by the program. On a proportional basis, the self‐medication group made significantly fewer medication errors than the control group at 1‐month follow‐up (0.045 vs 0.086, P < .001). There were no significant differences in morale or medication knowledge between the SMP and control groups, although both groups made significant gains in knowledge about the names, administration times, and purposes of their medications from admission to follow‐up (P < .001).CONCLUSIONS: A SMP can improve compliance in geriatric patients who are discharged to the community. Participation in a SMP does not improve patients' morale nor does it improve their medication knowledge more than pharmacy counselling alone. Participation in a SMP is unlikely to increase the probability that patients will be able to self‐medicate on discharge. Cognitive factors limit patients' ability to self‐medicate. J Am Geriatr Soc 44:161–165, 1996.
Depression and Disability in Older People with Impaired Vision: A Follow‐Up Study
Authors: Rovner Barry W. , Zisselman Pamela M. , Shmuely‐Dulitzki Yochi 
Published: April 2015

OBJECTIVE: To determine the prevalence of depressive symptoms and their relationship to disability in older low vision patients.DESIGN: Panel study with 2‐year follow‐up.PARTICIPANTS: Community‐residing older people (N = 31).MEASUREMENTS: Geriatric Depression Scale, Community Disability Scale, and Snellen visual acuity.RESULTS: Twelve of 31 patients (38.7%) had GDS scores ≥ 11 at baseline. Two years later, 10 of these 12 patients remained depressed, and three of the 19 (15.8%) previously nondepressed patients had become depressed. Depressed patients tended to be more disabled functionally than nondepressed patients at follow‐up.The correlation of disability with depression and with vision were examined for the entire sample and revealed a strong correlation between disability and depression (r = .40; P = .013) compared with that of disability and vision (r = .34; P = .032) at baseline and at follow‐up: depression (r = .68; P = .001), vision (r = .45; P = .006). There was no significant correlation between depression and vision at baseline (r = .06; P = .383), but there was a trend toward correlation at follow‐up (r = .28; P = .067).CONCLUSION: Depressive symptoms are prevalent and persistent among low vision patients and appear more highly related to disability than is vision. The frequent occurrence of depression and the availability of effective treatment argue for its recognition and treatment as possible ways to reduce disability in older persons with low vision. J Am Geriatr Soc 44:181–184, 1996.
Urinary Incontinence in Rural Older Women: Prevalence, Incidence and Remission
Authors: Nygaard Ingrid E. , Lemke Jon H. 
Published: April 2015

OBJECTIVESTo determine the prevalence, incidence, and remission rates of urinary incontinence in a large group of older women over a 6‐year time span and to assess factors associated with incontinence incidence and remission.DESIGNLongitudinal cohort studySETTINGTwo rural counties in IowaPARTICIPANTS2025 women aged 65 years or older residing in rural Iowa, enrolled in the Iowa 65+ Rural Health Study of EPESE (Establishment of Populations for Epidemiologic Studies of the Elderly) were interviewed in person annually for 6 years; specific responses to queries about urinary incontinence were given at baseline, 3‐, and 6‐year intervals.MEASUREMENTSConditional multivariate logistic regression analysis was done to assess the relationship between incontinence symptoms and various factors previously found to be related to incontinence.RESULTSThe baseline prevalence of urge incontinence was 36.3%, and of stress incontinence it was 40.3%. For urge incontinence, the 3‐year incidence and remission rates between the third and sixth years were 28.5% and 22.1%, respectively. For stress incontinence, the 3‐year incidence and remission rates between years 3 and 6 were 28.6% and 25.1%, respectively. Seventy‐six percent and 84% of women who reported no urge or stress incontinence, respectively, at the baseline interview were continent at both follow‐up interviews. The only significant factors related to changes in incontinence status were age, which was associated with an increased incidence of urge incontinence (OR 1.11, P = .017, 95% CI 1.019–1.203), and improvement in activities of daily living, which was associated with a increased remission of urge incontinence (OR 0.50, P = .015, 95% CI 0.28–0.9)CONCLUSIONIn some older women, urinary incontinence is a dynamic state, with women moving back and forth along a continuum between continence and incontinence. These results are tempered by limitations of the study, which include its questionnaire design and lack of ability to detect potential treatment effect.
Affective Disturbances in Alzheimer's Disease
Authors: Bungener Catherine , Jouvent Roland , Derouesné Christian 
Published: April 2015

OBJECTIVETo evaluate the emotional disturbances in patients with Alzheimer's disease (AD) using both a categorical and a dimensional approach.DESIGNProspective study.SETTINGOutpatient clinic in a neurological department from a general University Teaching Hospital.MEASURESA semi‐structured interview was used to fill in the Hamilton Depression Rating Scale, the Retardation Rating Scale for depression, the Tyrer and Covi scales for anxiety, and the Depressive Mood Scale for emotional disturbances. The cognitive status was assessed by the Mini‐Mental State Examination and the Mattis Dementia Rating Scale.PATIENTSOne hundred eighteen consecutive AD outpatients fitting the criteria for probable or possible AD, according to the National Institute of Neurological and Communication Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, were compared with 34 community‐dwelling healthy older controls and with 20 inpatients meeting the diagnostic criteria for depression according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition‐Revised.RESULTSNo AD patient met the criteria for Major Depressive Episode or Generalized Anxiety Disorder, but 10 (8%) met the criteria for Dysthymic Disorder. AD patients scored significantly higher than the control group but lower than the depressed group for depressive and anxious symptomatology. Depressive symptomatology was correlated negatively to the cognitive status and positively to anxious symptomatology. Two main dimensions in emotional disturbances were described using the Depressive Mood Scale: Emotional Deficit (anhedonia, hypoexpressiveness) and Loss of Control (felt irritability, hyperexpressiveness). Emotional Deficit was correlated positively to the depressive symptomatology and correlated negatively to the cognitive status and the Loss of Control dimension. Loss of Control was correlated positively to the severity of the depressive and anxious symptomatology and weakly to cognitive performance.CONCLUSIONAffective changes were found frequently in AD patients, but no major affective disorder was found. The dimensional approach seems to be more appropriate than the categorical approach to describe the emotional disturbances in these patients.
A Comparison by Payor/Provider Type of the Cost of Dying Among Frail Older Adults
Authors: Experton Bettina , Ozminkowski Ronald J. , Branch Laurence G. , Li Zili 
Published: April 2015

OBJECTIVETo compare expenditures and healthcare service use between decedents (in their last year of life) and survivors, all of whom were frail older people, under three payor/provider types.DESIGNIn‐home interviews were conducted by home care nurses at baseline and at 6‐month intervals for an 18‐month period. Utilization and cost data were collected directly from providers and the Health Care Financing Administration for 12 months immediately before death for decedents and for the first 12 months of follow‐up for survivors.SAMPLEFive hundred seventy‐seven frail older patients of an integrated healthcare system who were receiving physician prescribed home health services, under Medicare fee‐for‐service (FFS), Medicare HMO, or Medicare‐Medicaid coverage. Frailty was defined as the receipt of physician‐prescribed home healthcare services.OUTCOME MEASURESAcute and long‐term healthcare service utilization and expenditures; total healthcare expenditures.RESULTSAfter controlling for baseline differences, significant differences in utilization and expenditures of survivors (n = 450) and decedents (n = 127) were demonstrated. Compared with survivors, frail older decedents were approximately:7 times as likely to have had any hospital admissions3 times as likely to have had one or more emergency room visits8 times as likely to have 30 or more physician visits4 times as likely to have been admitted to a skilled nursing facility and twice as likely to have used home health services after the baseline episode.On average, total expenditures for decedents were 276% higher than for survivors. Total expenditures for Medicaid‐Medicare beneficiaries were 42% higher than expenditures for FFS participants, primarily because of higher hospitalization and emergency room expenditures. There were no differences in utilization and expenditures between HMO enrollees and FFS beneficiaries. Finally, interactions between decedent status and payor/provider were not statistically significant in multivariate analyses.CONCLUSIONDuring the last year of life, frail older people exhibit the same pattern of higher expenditures and service utilization as the general Medicare population. However, differences between decedents' and survivors' healthcare expenditures and resource use did not vary by payor/provider. Thus, cost‐containment strategies should focus on new forms of managing healthcare services beyond those currently practiced within Medicare HMOs, traditional FFS, or Medicare‐Medicaid in California.
Individual Sulfonylureas and Serious Hypoglycemia in Older People
Authors: Shorr Ronald I. , Ray Wayne A. , Daugherty James R. , Griffin Marie R. 
Published: April 2015

OBJECTIVE: To compare the risk of serious hypoglycemia associated with the use of individual sulfonylureas in older people.DESIGN: A retrospective cohort studySETTING: The Tennessee Medicaid ProgramPATIENTS: A total of 13,963 Medicaid enrollees, aged 65 years or older, who were prescribed one of six sulfonylureas from 1985 to 1989.MAIN OUTCOME MEASURE: Hospitalization, emergency room admission, or death associated with neuroglycopenic or autonomic symptoms, myocardial infarction, stroke, or injury, with a concomitant blood glucose determination of less than 2.8 mmol/L (50 mg/dL).RESULTS: We identified 255 persons with a first episode of serious hypoglycemia during 20,715 person‐years of sulfonylurea use. The crude rate (per 1000 person‐years) of serious hypoglycemia was highest in glyburide users, 16.6 (95% confidence interval [CI], 13.2 to 19.9) and lowest among users of tolbutamide, 3.5 (95% CI, 1.2 to 5.9). Users of tolbutamide, tolazamide, and glipizide had lower risks of serious hypoglycemia than users of chlorpropamide, whereas the risk of serious hypoglycemia among glyburide users did not differ from that of chlorpropamide users. Among second generation sulfonylureas, the adjusted relative risk of severe hypoglycemia among glyburide users, compared with glipizide users, was 1.9 (95% CI, 1.2 to 2.9). An increased risk of serious hypoglycemia associated with use of glyburide compared with glipizide occurred in all strata, including those defined by gender, race, nursing home residence, dose, and duration of use.CONCLUSIONS: Significant differences in risk of serious hypoglycemia were observed among users of individual agents. This may be explained by duration, timing, or potency of hypoglycemic action. These data confirm previous findings that chlorpropamide use is associated with high risk of hypoglycemia and indicate that among second generation sulfonylureas, glipizide is less associated with hypoglycemia than is glyburide. More information comparing the effectiveness of glycemic control among individual sulfonylureas is needed to assist prescribers in selecting a specific agent for use in clinical practice.
Cross‐Discipline Disparities in Perceptions of Mental Disorders in a Long‐Term Care Facility
Authors: Podgorski Carol Ann , Tariot Pierre N. , Blazina Linda , Cox Christopher , Leibovici Adrian 
Published: April 2015

OBJECTIVES: This study compared prevalence rates of mental disorders in a single long‐term care facility as perceived by three professional disciplines and compared professionals' perceptions with two standardized measures of psychopathologyDESIGN: Comparison of (1) prospective standardized psychiatric evaluations performed by psychiatrists, (2) chart reviews of mental disorders as documented by primary care physicians, and (3) interviews of nurses.SETTING: The residential health care facility at Monroe Community Hospital in Rochester, New York.PARTICIPANTS: A 20% random sample of adult residents, stratified by ward(n = 80).MEASUREMENTS: Prevalence rates of psychopathology as determined by each data collection method: psychiatric diagnoses as determined by psychiatrists and primary care physicians, the Brief Psychiatric Rating Scale, and the Psychogeriatric Dependency Rating Scale.RESULTS: Prevalence rates of psychopathology ranged from 60 to 91% across discipline‐specific data collection methods. Using psychiatrists' diagnoses as the benchmark, primary care physicians and nurses underestimated the prevalence of mental disorders, particularly organic mental disorders. All disciplines agreed on the presence of personality and developmental disorders. The Brief Psychiatric Rating Scale and Psychogeriatric Dependency Rating Scale validated perceptions of psychopathology by psychiatrists and nurses, but not by primary care physicians' chart diagnoses.CONCLUSION: Disparities in perceptions of mental disorders across disciplines pose a threat to patient care and suggest a need for more reliable incorporation of mental health expertise in the long‐term care setting.
Postural Hypotension and Dizziness in a General Aged Population: A Four‐Year Follow‐Up of the Helsinki Aging Study
Authors: Tilvis Reijo S. , Hakala Suvi‐Marja , Valvanne Jaakko , Erkinjuntti Timo 
Published: April 2015

OBJECTIVE: To evaluate the frequency, risk factors, and prognostic significances of postural hypotension (PH) and dizziness on postural testing (DPT).DESIGN: A prospective cohort study.SETTING: General community, The Helsinki (Finland) Aging Study.SUBJECTS: Persons of three age cohorts (75, 80, and 85 years, n = 569) were chosen randomly and followed for 4 years.MEASURES: Postal questionnaires, structured interview, extensive clinical and laboratory examinations, blood pressure (BP) changes in a postural test using different definitions for PH, history of dizziness, dizziness on testing postural blood pressure reactions (DPT), and date of death during a 4‐year follow‐up.RESULTS: The frequency of a fall in systolic blood pressure greater than 20 mm Hg or a fall in diastolic pressure greater than 10 mm Hg (PH‐I) was 30.3%. Both criteria occurred simultaneously (PH‐II) in 7.5%, and if dizziness on postural testing (DPT) was an additional symptom (PH‐III), the prevalence was 2.6%. The overall prevalence of DPT was 19.7%. PH‐I, PH‐II, and DPT were also frequent among the healthy aged (26.6%, 6.6%, and 17.3%, respectively). The postural change in BP correlated inversely with the initial supine BP levels (systolic r = –.149, P < .001 and diastolic r = –.218, P < .001), but in persons with isolated systolic hypertension PH was rather less frequent (21.9% and 2.3%). DPT was more common in the subjects with heart failure (26.3%, P < .05), impaired exercise tolerance (NYHA III‐IV) (33.7%, P < .05), and PH‐II (37.2%, P < .05) compared with the healthy controls (17.3%). The 1‐year mortality was higher in subjects with than without DPT (7.1% vs 4.8%, P < .05), but the difference was not significant after controlling for age and gender. PH‐I, PH‐II, and PH‐III were not significantly related to 4‐year mortality.CONCLUSIONS: In this study of older people in Helsinki, Finland, asymptomatic hypotensive postural BP reactions and DPT were found frequently among healthy oplder people, and they tended to be increased in people with some diseases. Neither PH nor DPT were of prognostic significance for mortality in this population.