bluuebunny/crossref_metadata_2025_split huggingface dataset:
Final‐Year‐of‐Life Pacemaker Recipients
Authors: Hefflin Brockton J. 
Published: April 2015

BACKGROUND: Older persons who have initial cardiac pacemakers implanted during their final year of life have not been characterized as a group, which makes it difficult to evaluate the suitability of some of their health services utilizations.OBJECTIVE: To help determine how prudently pacemakers are used in this group, we assessed its pacemaker candidates from the perspective of health and ability to perform physical activities of daily living.DESIGN: A retrospective, population‐based, cross‐sectional study.SETTING: The 1993 National Mortality Followback Survey.PARTICIPANTS: An estimated 1,647,955 persons aged 65 years or older who died in the US in 1993.MEASUREMENTS: Demographic and cause‐of‐death frequencies obtained by analyzing age, sex, race, and underlying cause‐of‐death variables in the survey. For persons who had initial pacemakers implanted during their last year of life, we determined the percent of persons, within 10‐year age groups, who had no difficulty at any time during their final year of life performing 11 specific physical activities of daily living (e.g., climbing stairs, preparing meals, bathing). These data were obtained from negative responses to questions that asked if the decedents, at any time during their last year of life, had difficulty performing the specific activities.RESULTS: Of the estimated 78,941 persons aged 65 years or older with a pacemaker who died in the US in 1993, 14,158 (18%) had their first pacemaker implanted during their last year of life. Estimated median survival of the final‐year‐of‐life recipients of pacemakers after pacemaker implantation was 5 months. Compared with the general older population that died in 1993, the final‐year‐of‐life recipients of pacemakers group had higher percentages of persons who died of acute disorders (49% vs 19%) and who lived alone in a private home (47% vs 20%), and a lower percentage of persons with Alzheimer's disease (1% vs 7%). The age‐stratified means of the percentages of final‐year‐of‐life recipients of pacemakers who had no difficulty performing each physical activity of daily living were all greater than 50.CONCLUSION: Our results suggest that older persons who had initial pacemakers implanted during their final year of life and who died in 1993 were not terminally ill, inactive pacemaker candidates, in general, but relatively independent, physically functional candidates who frequently died abruptly. The physical, mental, and life expectancy factors recommended for consideration by expert guidelines for the implantation of cardiac pacemakers were generally applied to persons in this subgroup.
High Levels of Hopelessness Persist in Geriatric Patients with Remitted Depression and a History of Attempted Suicide
Authors: Szanto Katalin , Reynolds Charles F. , Conwell Yeates , Begley Amy E. , Houck Patricia 
Published: April 2015

OBJECTIVE: To determine whether a high level of hopelessness after treatment of a depressive episode is an indicator of a history of lifetime suicide attempts in older people.DESIGN: Groups of suicide attempters, suicidal ideators, and nonsuicidal patients were compared via analysis of variance with respect to levels of hopelessness, depression, anxiety, and global functioning before and after treatment of depression.SETTING: An outpatient research clinic providing two treatment protocols of late‐life mood disorders.PARTICIPANTS: A total of 107 consecutive outpatients (mean age 67) with major depression who responded to treatment.MEASUREMENTS: Levels of hopelessness, severity of depression, anxiety, and global functioning were compared across the three groups at the beginning of treatment and at remission.RESULTS: After remission there were no differences between the three groups in depression severity, anxiety, and global functioning. Hopelessness remained significantly higher in the attempter group than among ideators or nonsuicidal patients.CONCLUSIONS: Suicide attempts, the most important risk factor for subsequent suicide, are associated with persistent, high levels of hopelessness following remission of depression in late‐life patients. These findings suggest that treatments designed specifically to lower hopelessness (such as cognitive, behavioral or interpersonal therapy) may be effective in reducing suicide risk.
Underutilization of Warfarin in Older Persons with Chronic Nonvalvular Atrial Fibrillation at High Risk for Developing Stroke
Authors: Mendelson Gad , Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To investigate the prevalence of the use of warfarin to maintain an international normalized ratio (INR) between 2.0 and 3.0 in older persons with chronic nonvalvular atrial fibrillation (AF), and without contraindications to warfarin, who are at high risk for developing new thromboembolic (TE) stroke.DESIGN: A retrospective analysis of charts from all older persons seen during 1997 at an academic hospital‐based geriatrics practice.SETTING: An academic hospital‐based geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.PATIENTS: Three hundred eighty men and 1183 women, mean age 80 ± 8 years (range 59 to 103 years), were included in the study.MEASUREMENTS AND MAIN RESULTS: Of 1563 persons studied, 141 (9%) had chronic nonvalvular AF. Of 141 persons with AF, 127 (90%) were at high risk for developing TE stroke because they had either a previous thromboembolism, congestive heart failure, or echocardiographic evidence of abnormal left ventricular systolic function; a systolic blood pressure >160 mm Hg; or they were women older than 75 years of age. Of the 127 persons with AF at high risk for developing TE stroke, three (2%) had contraindications to warfarin. Of the 124 persons with AF at high risk for developing TE stroke and no contraindications to warfarin, 61 (49%) were treated with warfarin to maintain an INR between 2.0 and 3.0, and 45 (36%) were treated with 325 mg aspirin daily. Of 14 persons with AF at low risk for developing TE stroke, one (7%) was treated with warfarin to maintain an INR between 2.0 and 3.0, and six (43%) were treated with 325 mg aspirin daily.CONCLUSIONS: Warfarin is underutilized as a treatment to maintain an INR between 2.0 and 3.0 in older persons with chronic nonvalvular AF at high risk for developing TE stroke.
The Experience of Living‐Dying in a Nursing Home: Self‐Reports of Black and White Older Adults
Authors: Engle Veronica F. , Fox‐Hill Emily , Graney Marshall J. 
Published: April 2015

PURPOSE: The purpose of this study was to describe and compare the experiences, needs, priorities, and concerns reported by black and white nursing home residents during the living‐dying interval. The living‐dying interval is defined as the time between the knowledge of one's impending death and death itself.DESIGN: This qualitative study was part of a larger ethnographic project. Residents participated in from one to four individual, in‐depth, semi‐structured, audiotaped interviews.SETTING: Residents lived in two large county‐financed nursing homes that have historically provided care to indigent black and white older adults.PARTICIPANTS: Purposive sampling was used to identify eight black and five white residents with terminal cancer diagnoses who could serve as rich resources about the experience of living‐dying in a nursing home.MEASURES: Residents were asked open‐ended questions about how things have been and what would make things better; what comforts them and would make them more comfortable; what dying means to them; and what things are important for nursing staff to know.RESULTS: Verbatim transcripts of the interviews were coded using QRS NUD‐IST software. Codes were placed in categories, categories were reviewed for common and different concepts, themes, and patterns, and a conceptual model was developed. The model identified six care needs: (1) day‐today living; (2) inadequate pain relief for black residents; (3) difficulty chewing and swallowing; (4) importance of religious activities; (5) giving care to others; and (6) appreciation of respectful and prompt care. Residents validated all components of the conceptual model.CONCLUSION: Black and white terminally ill residents focused on the quality of living rather than on dying, and black residents may be undertreated for pain. Important care needs for pain and religion are not routinely addressed by the Minimum Data Set (MDS) and Resident Assessment Protocol (RAP) triggers.
Elder‐Proxy Agreement Concerning the Functional Status and Medical History of the Older Person: The Impact of Caregiver Burden and Depressive Symptomatology
Authors: Long Kristie , Sudha S. , Mutran Elizabeth J. 
Published: April 2015

OBJECTIVES: To examine the influence of caregiver burden and depressive symptomatology on elder‐proxy response concordance regarding the older person's functional status and medical history.DESIGN: Cross‐sectional study via telephone interviews.SETTING: Community‐dwelling older people and caregivers in North Carolina.PARTICIPANTS: 340 matched pairs of frail persons aged 65 and older and their respective caregivers.MEASUREMENTS: Multidimensional Functional Assessment: The OARS methodologyRESULTS: Percent agreement on the ADL items ranged from 97.6% on personal hygiene to 99.7% for toileting, with moderate kappa coefficients. IADL percent agreement ranged from 71.5 to 93.7%, with fair to moderate kappa coefficients. Agreement among the medical history items ranged from 76.3 to 98.5% (κ = .138–.831). Response bias for the IADL composite measure is influenced marginally by caregiver burden (F[259] = 1.751. P = .098). Five of the individual IADL bias items are influenced significantly by burden. such that an increase in burden results in a greater likelihood that the caregiver will overstate disability compared with the rating by the older person. Response bias on the ADL scale was increased among persons who experienced more caregiver burden (OR = 1.096, 95% CI = 1.000, 1.192) and those who spent more hours providing care (OR = 1.012, 95% CI = 1.001, 1.024). Additionally, black caregivers were more likely than white caregivers to disagree with the older people on the ADL scale (OR = 2.73, 95% CI = 1.642, 3.809). A composite of the medical history items is influenced by the relationship of the caregiver to the older person; bias is more likely among adult children ((F[227] = 1.56, P = .081).CONCLUSION: Elder‐proxy concordance is highest among ADL items, followed by medical history items and IADL items. Caregiver depressive symptomotology had no significant impact on elder‐proxy response concordance on any of the three outcomes of interest: IADL and medical history bias and ADL disagreement. However, caregiver burden was marginally predictive of bias on the total ADL and IADL scales. Additionally, increased burden was significantly predictive of bias on five of the seven individual items of the IADL scale, suggesting that the more burden a caregiver feels, the greater likelihood that s/he will overstate the older person's disability compared with self‐report. These findings suggest that clinicians and researchers who use proxy reports to determine treatment regimens and complete data collection efforts may do so with confidence on ADL individual items and medical history items when the older person's frailty is marginal. However, caregiver burden may result in misleading representation of the older person's functional status, specifically in regard to IADL items.
Outbreak of Pneumonia in a Long‐term Care Facility: Antecedent Human Parainfluenza Virus 1 Infection May Predispose to Bacterial Pneumonia
Authors: Fiore Anthony E. , Iverson Chris , Messmer Trudy , Erdman Dean , Lett Susan M. , Talkington Deborah F. , Anderson Larry J. , Fields Barry , Carlone George M. , Breiman Robert F. , Cetron Martin S. 
Published: April 2015

OBJECTIVES: To determine the causes of an outbreak of lobar pneumonia.DESIGN: Matched (1:2) case‐control study.SETTING: A 70‐bed chronic care facility for older people.PARTICIPANTS: Residents of the facility.RESULTS: Ten residents developed pneumonia over a 10‐day period. Two residents died. One case‐patient had Streptococcus pneumoniae bacteremia; another had polymerase chain reaction evidence of S. pneumoniae infection. No other etiologic agent was identified. Only four of 10 case‐patients had received routine diagnostic cultures of blood or sputum before the administration of antibiotics. Symptoms of upper respiratory illness (URI) among residents before the pneumonia outbreak corresponded with elevation of antibodies to human parainfluenza virus 1 (HPIV1). In a matched case‐control study, six of 10 case‐patients, compared with five of 20 controls, had symptoms of URI during the preceding month (matched odds ratio (MOR) = 4.5, 95% CI = 0.8–33). Nine case‐patients had serum available, and five of these had both serologic evidence of recent HPIV1 infection and recent URI, compared with two of 18 controls (MOR = 9.0, 95% CI = 1.2–208). Only three residents had documentation of pneumococcal vaccination.CONCLUSIONS: Noninfluenza viral infections may play a role in the pathogenesis of some bacterial pneumonias. S. pneumoniae was the cause of at least two pneumonias; lack of preantibiotic cultures may have interfered with isolation of S. pneumoniae in others. Recent HPIV1 infection was epidemiologically linked to subsequently developing pneumonia. Spread of HPIV1 in the facility may have contributed to increased susceptibility to S. pneumoniae and, potentially, to other bacterial pathogens.
Improving the Utility of Urine Flow Rate to Exclude Outlet Obstruction in Men with Voiding Symptoms
Authors: DuBeau Catherine E. , Yalla Subbarao V. , Resnick Neil M. 
Published: April 2015

OBJECTIVES: Many older men with voiding symptoms do not have bladder outlet obstruction (BOO) but have conditions amenable to medical treatment. If primary care providers could reliably exclude men who have BOO, then they could initiate appropriate evaluation and treatment in a substantial proportion of the remainder. Urine flow rate, although widely used, is insufficiently sensitive to exclude BOO reliably. We investigated whether the decline in flow rate with age could be utilized to improve the utility of flow rate for excluding BOO in symptomatic men, especially when combined with knowledge of the patient's postvoiding residual volume (PVR).DESIGN: Prospective study using two patient cohorts.SETTINGS: A Veterans Affairs urology clinic serving community‐dwelling and institutionalized healthy older men.PARTICIPANTS: 111 men with voiding symptoms (mean age 72.4 ± 9.2 years).MEASUREMENTS: Maximum urine flow rate, measured with standard flowmeter, and PVR, measured by catheterization. BOO was determined by multichannel videourodynamic testing.RESULTS: The sensitivity of flowrate for BOO increased significantly with age (P = .0001) and did not appear to be confounded by comorbid conditions. An algorithm incorporating age, flow rate, and PVR had a sensitivity of 90%, specificity of 43%, and accuracy of 74% in screening for BOO. The algorithm's sensitivity was better than that of flow rate alone (55%); its sensitivity was also similar to a “refer all” strategy (100%) but had improved specificity (41% vs 0%).CONCLUSIONS: Flow rate alone is insufficiently sensitive as a screening test to exclude BOO, but a simple diagnostic algorithm using age, flowrate, and PVR was more sensitive and accurate. This algorithm allows primary care evaluation and initial management of men with voiding symptoms while potentially reducing unnecessary referrals and costs.
Compliance with PASARR Recommendations for Medicaid Recipients in Nursing Homes
Authors: Snowden Mark , Piacitelli John , Koepsell Tom 
Published: April 2015

OBJECTIVE: To determine the rate of compliance with placement and mental health recommendations of the preadmission screening and annual resident review (PASARR) program.DESIGN: A retrospective observational study using PASARR screening forms to identify recommendations of inpatient psychiatric care for people needing more care than nursing homes provide, alternate disposition for individuals needing less than nursing home level care, and recommendations for new mental health services when needed but not provided. Service use as indicated in Medicaid billing data during the following year was used to determine receipt of service.PARTICIPANTS: All Washington state Medicaid recipients screened from 1992 through 1993.MAIN OUTCOME MEASUREMENTS: Compliance rates for placement and service recommendations.RESULTS: Inpatient psychiatric care was recommended for four of the 523 Medicaid recipients (0.8%), all of whom received it. Screeners recommended alternate dispositions in 131 (25%) subjects, and compliance occurred in 29% of these. Recommendations for new services were made in 310 (59%) cases. Compliance rates averaged 35%, ranging from 73% for medication recommendations to 7% for consultation. Depressed individuals were less likely to receive recommended services.CONCLUSIONS: Many individuals needed additional mental health services but did not receive them, and a significant minority of patients could have been given an alternate disposition but rarely were.
An Evaluation of Antiepileptic Drug Therapy In Nursing Facilities
Authors: Schacbter Steven C. , Cramer Gena W. , Thompson Gregory D. , Chaponis Robert J. , Mendelson Marilyn A. , Lawborne Larry 
Published: April 2015

OBJECTIVES: To describe the prescribing and use of anti‐epileptic drug (AED) therapy in nursing facility residents.DESIGN: A retrospective, multicenter drug use evaluation.SETTING: A total of 85 nursing facilities (average size, 119 beds) in five states.PARTICIPANTS: 1132 residents of the total 10,168 residents screened were prescribed at least one AEDMEASURES: Demographic information, primary indication for AED, comorbid conditions, prescribing physician's specialty, concomitant medications, and AED dosage regimen information were collected. Laboratory tests obtained in the most recent 6 months and seizure occurrence and seizure‐related diagnostic assessments made in the most recent 3 months were also recorded.RESULTS: Of 1132 residents receiving AED therapy, 892 (78.8%) were prescribed AED therapy for a seizure‐related diagnosis although 86% of seizure types were unspecified. Another 215 residents (19.0%) were prescribed AEDs for nonseizure diagnoses, and 25 (2.2%) had no indication for AED therapy. AEDs most frequently prescribed were phenytoin (56.8%), carbamazepine (23.0%), phenobarbital (15.6%), and valproic acid (13.1%). For residents with a seizure diagnosis, the most frequently prescribed monotherapy agents were phenytoin (52.0%), carbamazepine (12.2%), and phenobarbitol (7.1%). Almost 25% of residents with a seizure diagnosis took a combination of AEDs; more than 50% of all combinations included phenobarbital. About 9% of residents with a seizure diagnosis had one or more documented seizures during a 3‐month review period.CONCLUSION: Among the substantial percentage of residents treated with AEDs, the lack of diagnosis of seizure type has serious implications for the choice of AED therapy. Opportunities exist for prescribing physicians, consultant pharmacists, and nursing staff to improve the medical management of nursing facility residents with seizures and of others receiving AEDs.
The Prognostic Value of Sensory Impairment in Older Persons
Authors: Reuben David B. , Mui Silbey , Damesyn Mark , Moore Alison A. , Greendale Gail A. 
Published: April 2015

OBJECTIVESTo determine the relationships between visual and hearing impairment and subsequent functional dependence and mortality among community‐dwelling older persons.DESIGNA Prospective, cohort study.SETTINGCommunity‐based.PARTICIPANTSA total of 5444 men and women aged 55 to 74 years at baseline.MEASUREMENTSSelf‐reported and measured visual impairment, self‐reported and measured hearing impairment, self‐reported and measured combined sensory impairment, 10‐year mortality, and dependency in activities of daily living (ADL), instrumental ADL (IADL), and Rosow‐Breslau (RB) function.RESULTSIn multiply‐adjusted models, adjusting for length of follow‐up, socio‐demographic characteristics, and chronic conditions, only measured visual impairment was predictive of mortality. Measured visual impairment was also predictive of 10‐year ADL and IADL dependence; measured hearing impairment was predictive of RB dependence. Self‐reported visual impairment predicted functional impairment on all scales at 10 years, although self‐reported hearing impairment predicted only subsequent RB dependence. Measured combined impairment was associated with the highest risk of 10‐year functional dependence.CONCLUSIONSSensory impairment is predictive of subsequent functional impairment in older persons.
Lifelong Treatment with Oral DHEA Sulfate Does Not Preserve Immune Function, Prevent Disease, or Improve Survival in Genetically Heterogeneous Mice
Authors: Miller Richard A. , Chrisp Clarence 
Published: April 2015

OBJECTIVESTo determine whether lifelong exposure to dehydroepiandrosterone sulfate extends the lifespan or retards immune senescence in mice.DESIGNDouble‐blind, placebo‐controlled intervention trial.SETTINGA specific pathogen‐free rodent vivarium.PARTICIPANTS120 mice bred as a cross between CB6F1 females and C3D2F1 males.INTERVENTIONDHEAS at 100 μg/mL in drinking water from weaning until death.MEASUREMENTAge at death, cause of death, antibody production after erythrocyte immunization, and T cell subset profiles in peripheral blood at ages 8 and 18 months.RESULTSDHEAS ingestion did not lead to a significant increase in mean or maximal longevity: the 95% confidence interval for DHEAS effect on mean lifespan ranged from +35 days to −80 days. There were no significant effects of DHEAS on incidence of lethal illnesses, except for a trend toward higher levels of mammary adenocarcinoma in DHEAS‐treated females and mouse urinary syndrome in DHEAS‐treated males. DHEAS treatment did not improve the ability of middle‐aged mice to produce antibody to a foreign particulate antigen, and it did not alter the proportions of age‐sensitive T cell subsets in middle‐aged animals.CONCLUSIONAlthough differences among species in pharmacokinetics complicate interpretation of studies in which DHEA or DHEAS is administered to rodents, our data provide no support for the idea that chronic exposure to this steroid retards immune senescence or prevents late life illness.