bluuebunny/crossref_metadata_2025_split huggingface dataset:
Viral Hepatitis in Older Adults
Authors: Marcus Esther‐Lee , Tur‐Kaspa Ran 
Published: April 2015

The objective of this paper is to review the epidemiology, manifestations, therapy, and prevention of viral hepatitis in older people and to discuss issues of prevention and management.In developed countries a significant portion of the adult population is not immune to Hepatitis A virus (HAV). Morbidity and mortality from HAV infection increases with age. A safe and effective hepatitis A vaccine is available and health authorities should consider immunization early in life and for healthy adults as well as for potential high risk groups such as nursing home residents.Acute hepatitis due to Hepatitis B virus (HBV)is rare in older people and is usually a mild disease. Most older patients with chronic HBV infection who suffer from advanced liver disease have no evidence of ongoing viral replication. Therefore, they are not candidates for interferon therapy. Those with evidence of ongoing viral replication and compensated liver disease should be offered interferon or be included in clinical trials with new antiviral drugs such as lamivudine. Since the response rate to hepatitis B vaccination decreases with age, developing vaccines with greater immunogenicity is crucial.Hepatitis C virus (HCV) is the most frequent cause of acute viral hepatitis in older people. Acute hepatitis C is usually a mild disease in this age group. Because many older patients with chronic HCV infection have compensated liver disease, they could benefit from antiviral therapy. In light of the low response rate to interferon in older patients with chronic hepatitis C and the side effects of the drug, interferon therapy should be reserved for those with the best chance of response. “Combination” antiviral therapy should be on trial for older patients with chronic HCV infection who do not respond to interferon.The recently discovered RNA virus, Hepatitis G (HGV), has been associated with liver disease in older people. It's role in the pathogenesis of liver injury remains to be elucidated.
A Geriatric Consultation Team in the Emergency Department
Authors: Gold Susan , Bergman Howard 
Published: April 2015

BACKGROUND: The proportion and absolute number of older patients presenting to emergency departments (EDs) are increasing. Older ED patients tend to have multiple medical and psychosocial problems that make their care in the ED problematic. Despite this, there have been no previous descriptions of geriatric ED consultative services.SETTING: The Sir Mortimer B. Davis Jewish General Hospital is a 628‐bed tertiary care McGill University teaching hospital. It serves a population of about 160,000, of which 23% are aged 65 and older. In response to the special needs of this group, the Division of Geriatric Medicine at the Jewish General Hospital has developed, among its clinical and teaching services, an ED consultation team.PROGRAM DESCRIPTION: The consultation team is composed of a geriatrician, a full‐time nurse clinician, and part‐time physical and occupational therapists. Consultations are received from referring, primarily ED physicians and encompass all aspects of medical and psychosocial issues. Geriatric assessment is geared toward decision making for rapid disposition: discharge home or admission to acute geriatrics ward or other services. Thus, the service functions as a gatekeeper for admission to the acute geriatrics ward, as well as coordinating geriatric follow‐up both in‐hospital (for patients admitted to other services) and in the community (for patients discharged home), via the outpatient geriatric clinic, home visits, or linkage to other community resources.
Effects of a Restraint Reduction Intervention and OBRA '87 Regulations on Psychoactive Drug Use in Nursing Homes
Authors: Siegler Eugenia L. , Capezuti Elizabeth , Maislin Greg , Baumgarten Mona , Evans Lois , Strumpf Neville 
Published: April 2015

OBJECTIVES: To describe the changes in psychoactive drug use in nursing homes after implementation of physical restraint reduction interventions and mandates of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87).METHODS:A secondary analysis was conducted using data from a controlled clinical trial that took place in three nursing homes: a control home, one that received an educational intervention, and one that received an educational/consultation intervention. All three homes were influenced by the OBRA mandates. Complete pre‐ and 6 months' post‐intervention data on use of psychoactive drugs and physical restraints were available for 446 resident subjects. Changes were first analyzed with the resident subject as the unit of analysis and then using the nursing home ward (n = 16) as the unit of analysis.RESULTS: While physical restraint use declined in the home that received the educational/consultation intervention, neither neuroleptic nor benzodiazepine use increased in any of the homes after the interventions. The percentage of residents taking neuroleptics declined in the control home (18.6% to 11.3%, P = .014). Benzodiazepine use, which was more prevalent than described previously in the literature, declined in all three homes (P < .001). Of those residents whose physical restraints were discontinued, only 2% were started on neuroleptics. When the effect of OBRA mandates on appropriateness of neuroleptic use was examined, the percentage of residents on neuroleptics who lacked an OBRA‐approved indication declined from 21.3% to 14.6% in the total sample, and from 39.9% to 8% in the control home.CONCLUSIONS: Interventions to reduce physical restraint did not lead to an increase in psychoactive drug use; further, reduction in both can occur simultaneously. OBRA mandates regarding psychoactive drug use were not uniformly effective, but appear, at minimum, to have increased awareness of the indications for neuroleptics.
Deaths Caused by Bedrails
Authors: Parker Kara , Miles Steven H. 
Published: April 2015

OBJECTIVES: To determine how bedrails cause death in order to suggest clinical and ergonomic changes to prevent such deaths and to promote research to improve the use and design of bed systems.DESIGN: A review of reports of adult deaths and injuries from bedrails contained in the United States Consumer Product Safety Commission Death Certificate File and its Reported Incidents File and its National Injury Information Clearinghouse Accident Investigations from 1993 to 1996. Deaths involving the use of vest restraints were excluded. We reconstructed, reenacted, and have graphically depicted major patterns of deaths. A review of the literature to 1966 was also done.RESULTS: The 74 deaths described are categorized into three types: (1) 70% were entrapments between the mattress and a rail so that the face was pressed against the mattress, (2) 18% were entrapment and compression of the neck within the rails, and (3) 12% were deaths caused by being trapped by the rails after sliding partially off the bed and having the neck flexed or the chest compressed.CONCLUSIONS: Deaths from bedrails are underrecognized and preventable clinical events that can occur in any medical setting. Preventing these events will require a unified redesign of the relationships between rails, mattresses, and beds, which are now often assembled and used as separate products. Clinicians can prevent many of these deaths by using bedrails much more judiciously, confirming the proper relationships between beds, rails and mattresses, and using alarms.
Reduced Systemic Arterial Compliance Is Associated with Left Ventricular Hypertrophy and Diastolic Dysfunction in Older People
Authors: Rajkumar Chakravarthi , Cameron James D. , Christophidis Nicholas , Jennings Garry L. , Dart Anthony M. 
Published: April 2015

OBJECTIVES: To study the relationship between left ventricular diastolic function and systemic arterial compliance in the older population.DESIGN: Cross‐sectional survey.PARTICIPANTS: A total of 67 older volunteer participants (aged 67 ± 5.4 years).MEASUREMENTS: Systemic arterial compliance (SAC) was measured using applanation tonometry and aortic velocimetry, and diastolic function was assessed using Doppler filling. Left ventricular mass was determined echocardiographically.RESULTS: There were significant univariate correlations between diastolic filling, as measured by E/A ratio, systemic arterial compliance (0.34, P < .01), and left ventricular mass (‐0.41, P < .001). In multiple regression analysis, using diastolic filling as the dependent variable and heart rate, age, left ventricular mass corrected for body surface area, systolic and diastolic blood pressures, and arterial compliance as independent variables, the major determinants of diastolic filling were heart rate, left ventricular mass, and diastolic blood pressure. Arterial compliance did not make a significant independent contribution.CONCLUSION: This study demonstrates a positive relationship between diastolic filling and arterial compliance in the older population. However, in multiple regression analysis, heart rate, diastolic blood pressure, and left ventricular mass were the independent predictors of diastolic filling (E/A), whereas arterial compliance was not. These findings imply that therapeutic modulation of aortic stiffness would not, of itself, contribute to improvement in diastolic function.
Glucose Metabolism in Older Adults: A Study Including Subjects More Than 80 Years of Age
Authors: Garcia Gloria V. , Freeman Rosario V. , Supiano Mark A. , Smith Maria J. , Galecki Andrzej T. , Halter Jeffrey B. 
Published: April 2015

OBJECTIVE: This study was undertaken to understand the dynamics of glucose metabolism in healthy non‐diabetic subjects older than age 80 (old‐old) compared with subjects aged 61 to 79 (young‐old), as well as to compare healthy older subjects with impaired glucose tolerance (IGT) with older subjects with normal glucose tolerance (NGT).DESIGN: A cross sectional, observational study.SETTING: A university hospital clinical research center.PARTICIPANTS: There were 28 community‐dwelling adults, 10 older than age 80 and 18 aged 61 to 79. Thirteen of these people had NGT and 15 had IGT. Subjects were not taking any medication that interfered with glucose tolerance.MEASUREMENTS: Status of glucose tolerance was determined by an oral glucose tolerance test categorized as NGT or IGT according to WHO criteria. Insulin sensitivity (SI and glucose effectiveness (SG) were assessed using a tolbutamide‐assisted intravenous glucose tolerance test (IVGTT). The data were analyzed using the Minmod modeling program. Glucose tolerance (Kg) and the acute insulin response to glucose (AIRg) were calculated from the IVGTT.RESULTS: There were no significant differences between the young‐old and old‐old in body mass index or in plasma glucose, insulin, or C‐peptide levels in the fasting state or during the OGTT. Values for Kg, SI SG, and AIRg from the IVGTT were similar in the two age groups. When the subjects were classified by glucose tolerance status, the subjects with NGT had age, gender, and body mass index similar to the subjects with IGT. Older people with IGT had a lower Kg and tended to have higher fasting glucose and similar fasting insulin compared with people with NGT. IGT subjects had lower S] and tended to have lower SG. The AIRg in IGT subjects tended to be low rather than high when compared with older people with NGT.CONCLUSION: Otherwise healthy adults more than 80 years of age have measures of glucose metabolism similar to people aged 61 to 79. The presence of IGT in older adults is associated with insulin resistance, regardless of patient age. We hypothesize that the lack of pancreatic islet compensation for insulin resistance may contribute to impaired glucose tolerance in older adults.
The Burden of Parkinson's Disease on Society, Family, and the Individual
Authors: Whetten‐Goldstein Kathryn , Sloan Frank , Kulas Elizabeth , Cutson Toni , Schenkman Margaret 
Published: April 2015

OBJECTIVE: To examine the burden of Parkinson's Disease (PD) on society, family, and the individual.SETTING: In‐home interviews in Central North Carolina.DESIGN: A cross‐sectional, descriptive study.PARTICIPANTS: A total of 109 people with PD.MEASURES: Standard instruments used to assess income, health status, health‐related costs, and household activities.SAMPLE: The sample was weighted toward individuals who were within the first 5 years of post‐PD diagnosis.RESULTS: The total per capita societal burden was approximately $6000 per year, the greatest single element of which was compensation for earnings loss for those less than age 65. Government insurance covered 85% of our sample. The largest components of family burden were the burden of providing informal caregiving and that of earnings loss. Spouses providing informal care did so a mean of 22 hours per week. Compared with a random sample of older people, our respondents spent much less time on house and yard work.CONCLUSION: The direct costs of the disease reflect a small portion of the burden. The hidden costs, in the form of lost wages, informal care, and changing roles are substantial. Their magnitude is even more important when we consider that the family generally lives on a fixed income, and the caregiver is an older aged spouse. Medical practitioners will best be able to intervene if they look holistically at the patient with this disease. When treating symptoms themselves, practitioners need to be aware of the high level of pain, fatigue, and depression associated with PD, even in the early stages. The results demonstrate clearly that family relationships are affected early, indicating the importance of providing early referrals to services such as home health, social workers/counseling, and well as PD support groups.
Comparison of Subcutaneous and Intravenous Administration of a Solution of Aminoacids in Older Patients
Authors: Ferry Monique , Leverve Xavier , MD Thierry Constans 
Published: April 2015

OBJECTIVE: To compare the plasma amino acid (AA) concentrations obtained by the infusion of an AA solution (660 mOsm/L, pH 7) using the subcutaneous (SC) with that using the intravenous (IV) route in older patients.DESIGN: A prospective, randomized, cross‐over study.SETTING: A hospital geriatric ward.PARTICIPANTS: Six patients with a mean age of 84 years.MEASUREMENTS: The infusion of the AA solution (IV or SC) lasted 6 hours. Blood was sampled at 0,2,4,6, 8,10,14, 18, and 24 hours from the start of the infusion to determine plasma AA level by the phenyl‐isothiocyanate method.RESULTS: Compared with baseline values, plasma AA concentrations increased to a significantly higher level from the second to the tenth hour and from the second to the fourteenth hour during IV and SC infusions, respectively. Plasma AA levels did not differ between the two routes. SC infusion was well tolerated.CONCLUSION: Assuming that nutritional sufficiency is the desired result of plasma AA infusion, we conclude the SC route is well tolerated and offers the possibility of nitrogen supplementation for older patients over short periods of time, when oral protein intake is transiently insufficient or impossible, as a way to limit, but not to treat, protein‐energy malnutrition.
Underutilization of Beta‐Blockers in Older Patients With Prior Myocardial Infarction or Coronary Artery Disease in an Academic, Hospital‐Based Geriatrics Practice
Authors: Mendelson Gad , Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To investigate the prevalence of beta‐blocker use in older persons with prior myocardial infarction (MI) or coronary artery disease (CAD) without contraindications to beta‐blockers in an academic hospital‐based geriatrics practice.DESIGN: A retrospective analysis of charts from all older patients seen during January 1996 through March 1997 at an academic, hospital‐based geriatrics practice was performed to investigate the prevalence of beta‐blocker use in older patients with prior MI or CAD without contraindications to beta blockers.SETTING: An academic, hospital‐based, primary care geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.PATIENTS: One hundred thirty‐nine women and 84 men, mean age 82 ± 8 years (range 67 to 96), were included in the study.MEASUREMENTS AND MAIN RESULTS: Of 233 patients with CAD, 53 patients (23%) were receiving beta‐blockers. Of 180 patients with CAD not receiving beta‐blockers, 34 patients (19%) had contraindications to beta‐blockers. Of 199 patients with CAD without contraindications to beta‐blockers, 53 patients (27%) were receiving beta blockers. Of 162 patients with prior MI, 38 patients (23%) were receiving beta‐blockers. Of 124 patients with prior MI not receiving beta‐blockers, 19 patients (15%) had contraindications to beta‐blockers. Of 143 patients with prior MI without contraindications to beta‐blockers, 38 patients (27%) were receiving beta‐blockers.CONCLUSIONS: There is marked underutilization of beta‐blockers in treating older patients with prior MI or CAD in an academic, hospital‐based geriatrics practice. J Am Geriatr Soc 45:1360–1361, 1997.
The Soluble Interleukin‐2 Receptor Predicts Mortality in Older Hospitalized Men
Authors: Rosenthal Amy J. , McMurtry Cynthia T. , Sanders Karen M. , Jacobs Mary , Thompson David , Adler Robert A. 
Published: April 2015

BACKGROUND: There is an inverse relationship between the soluble interleukin‐2 receptor (sIL‐2R) and serum albumin, cholesterol, transferrin, prealbumin, and hemoglobin. Inasmuch as low serum albumin and cholesterol have been associated with excess mortality, we hypothesized that elevated sIL‐2R would predict mortality in older adults.OBJECTIVE: To determine if elevated sIL‐2R predicts mortality in patients on a geriatric rehabilitation unit.DESIGN: Prospective cohort.SETTING: University‐affiliated VA medical center.PARTICIPANTS: Seventy‐two male patients aged greater than 60 years admitted to a geriatric rehabilitation unit. Patients with severe hepatic or renal disease were excluded.MEASUREMENTS: We measured serum albumin, prealbumin, cholesterol, transferrin, hemoglobin, body mass index (BMI), C‐reactive protein (CRP), and sIL‐2R upon admission. Subjects were followed for 1 year.RESULTS: Low serum albumin, prealbumin, and hemoglobin and high sIL‐2R and CRP predicted 1‐year mortality on univariate analysis. When these predictors were included as covariates in a Cox regression model, only sIL‐2R was a significant independent predictor of mortality (P = .043). Multiple linear regression with the above covariates revealed that only sIL‐2R predicted time to death at (P = .003).CONCLUSIONS: High sIL‐2R and CRP and low albumin, prealbumin, and hemoglobin predicted mortality using univariate analysis on a rehabilitation unit. However, with multivariate analysis, sIL‐2R was the sole predictor of mortality. J Am Geriatr Soc 45:1362–1364, 1997.
Geriatric Rehabilitation: State of the Art
Authors: Hoenig Helen , Nusbaum Neil , Brummel‐Smith Kenneth 
Published: April 2015

OBJECTIVES: To provide a clinically useful conceptual framework for the evaluation and treatment of disability in older persons, to review the rehabilitation of common conditions affecting function in older persons, and to discuss the effects of the ongoing changes in the healthcare system on geriatric rehabilitation.METHODS: MedLine search and review of relevant texts for information on (1) geriatric disability and its treatment, (2) recent high quality research, guidelines, and review articles relevant to the rehabilitation of conditions commonly causing geriatric disability, (3) effects of recent changes in the healthcare system on geriatric rehabilitation.RESULTS: Several pertinent models for geriatric disability were identified. These are explicated, along with information on the epidemiology of geriatric disability and its causes and relevant clinical applications. Rehabilitation is reviewed for musculoskeletal disorders, stroke and peripheral vascular disease, amputation, cardiopulmonary disorders, hip fracture, and deconditioning. Changes in the healthcare system appear to be affecting geriatric rehabilitation, especially the advent of managed care; relevant articles and opinions are reviewed, along with strategies to accommodate these changes.CONCLUSIONS: Our understanding of the causes of disability in the older population has improved significantly over the last decade. There has also been noteworthy progress in our knowledge about the effects of selected rehabilitation interventions, especially exercise‐related interventions. However, the cost‐effectiveness of many rehabilitative interventions remains unclear, particularly for differing patient groups across the continuum of care. More research will be needed to evaluate the effects of managed care on rehabilitation outcomes in older persons. J Am Geriatr Soc 45:1371–1381, 1997.
Predictors of Decline in Manual Performance in Older Adults
Authors: Hughes Susan , Gibbs James , Dunlop Dorothy , Edelman Perry , Singer Ruth , Chang Rowland W. 
Published: April 2015

OBJECTIVE: To determine factors that predict decline in manual performance using a multivariate model of determinants of functional limitation.DESIGN: Longitudinal observational study.SETTINGS: Ambulatory general medicine clinics, residences of homebound individuals, and a continuing care retirement community.PARTICIPANTS: Subjects were 485 persons more than 60 years of age and included continuing care retirement community (CCRC) residents (n = 215), chronically homebound older persons (n = 65), and ambulatory older adults (n = 205). Mean age at baseline was 78 years.MEASUREMENT: Independent variables included demographics, physician measures of upper‐extremity joint impairment, comorbidities derived from physical examination and chart abstract, self‐assessed arthritis pain, depression, and anxiety. The major dependent variable was 2‐year decline in timed manual performance below a threshold associated with need for long‐term care services.RESULTS: The proportion of subjects who exceed a Timed Manual Performance Test threshold of 350 seconds increased slowly from baseline through Year 4 for all age groups but rose rapidly from Year 4 to Year 6 for the oldest group (>85 years at baseline). Using a discrete survival model, we found that age, education, grip strength, and psychological status predicted crossing the manual performance threshold within a 2‐year period.CONCLUSIONS: The findings, coupled with earlier findings that upper extremity joint impairment predicted both grip strength and manual performance, suggest that joint impairment may be an important risk factor for future functional limitation. Since diminished hand function has been shown to predict dependency, development and testing of interventions to maintain or restore upper extremity joint function and reduce pain would appear to be a high research priority.