bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of an Influenza Hemagglutinin‐Diphtheria Toxoid Conjugate Vaccine in Elderly Nursing Home Subjects During an Influenza Outbreak
Authors: Gravenstein Stefan , Drinka Paul , Duthie Edmund H. , Miller Barbara A. , Brown C. Susan , Hensley Michael , Circo Richard , Langer Elizabeth , Ershler William B. 
Published: April 2015

ObjectiveTo compare the efficacy of an influenza hemagglutinin‐diphtheria toxoid conjugate vaccine with the commercially available influenza hemagglutinin‐subunit vaccine in preventing influenza in older adults living in a nursing home.DesignA prospective, randomized, double‐blind vaccine trial with 5 months of follow‐up after vaccination.SettingFourteen Wisconsin nursing homes.ParticipantsNursing home residents at least 65 years old who were able to give informed consent and were free of malignancy and not receiving immunosuppressive therapy.InterventionsParticipants received, by intramuscular injection, 0.5 mL of a trivalent influenza vaccine containing 15 μg each of A/Leningrad/360/86 (H3N2), A/Taiwan/1/86 (H1N1), and B/Ann Arbor/1/86 (HA) or 0.5 mL of an influenza vaccine containing the same antigens conjugated to diphtheria toxoid (HA‐D).MeasurementsBlood was obtained pre‐ and 1 month post‐vaccination to assess for any vaccine‐induced antibody titer change. Clinical surveillance for respiratory illness was performed twice weekly for 5 months. A record was kept of all signs and symptoms of new respiratory illness, and a viral culture and acute and convalescent sera were obtained.Results204 participants received HA and 204 received HAD. Both groups had similar baseline antibody levels to all influenza antigens. HA‐D recipients seroconverted more frequently based on serum neutralizing activity (P < 0.05), had a greater increase in geometric mean titer (GMT), and sustained the increase in antibody titer longer than HA recipients. Vaccine hemagglutinin recall was greater in a subset of HA‐D recipients as measured by lymphocyte proliferative assays (P < 0.05). During an outbreak of influenza A (H3N2 A/Shanghai/11/87‐like and A/Victoria/7/87‐like), fewer HA‐D (29/195) than HA (43/204) recipients had laboratory‐confirmed infection (P = 0.053), and, of these, fewer HA‐D‐treated subjects had lower respiratory tract involvement (5/29 HA‐D and 17/43 HA) (P = 0.022).ConclusionsHA‐D was more immunogenic in institutionalized elderly recipients and produced greater protection from influenza infection. Superior protection may be due to HAD's ability to stimulate and recruit antigen‐presenting cells, thus enabling the recipient to achieve and maintain functional antibody titers.
Increasing the Recognition of Delirium in Elderly Patients
Authors: Rockwood Kenneth , Cosway Sylvia , Stolee Paul , Kydd David , Carver Daniel , Jarrett Pamela , O'Brien Brian 
Published: April 2015

ObjectiveTo determine if an educational intervention aimed at house staff will increase knowledge about and recognition of delirium.DesignBefore/after study, with blinding of participants to the intent of the study.SettingUniversity hospital in Halifax, Nova Scotia.PatientsOne hundred eighty‐seven control patients, seen as consecutive admissions of elderly patients (65+ years) to the General Medicine services of the Victoria General Hospital prior to the educational intervention, and 247 patients seen thereafter.InterventionEducational intervention at grand rounds, housestaff rounds, sign‐in rounds, and bedside teaching.MeasurementsRecognition of delirium in the admitting history or progress notes, Confusion Assessment Method (CAM) as recorded by nurses, diagnosis of delirium by independent study physicians using DSM‐IIIR criteria and the Trzepacz Delirium Symptom Rating Scale.ResultsPrior to the intervention, delirium or acute confusion was diagnosed in 3% of patients; after the intervention, delirium or acute confusion was diagnosed in 9% of patients (P < 0.01). Other abnormalities in mental state were noted in 8.5% of admissions prior to the intervention, and 15.6% of admissions after the intervention. After the intervention there was a significant difference in the proportion of patients in whom a mental status questionnaire had been carried out and in whom there was formal comment on various aspects of the mental state. The nursing CAM had a sensitivity of 0.68 and a specificity of 0.97.ConclusionsA simple educational intervention aimed at house staff appears to be effective in changing house staff behavior. Improved recognition of delirium may lead to better patient outcomes.
Effects of Antipsychotic Withdrawal in Elderly Nursing Home Residents
Authors: Thapa Purushottam B. , Meador Keith G. , Gideon Patricia , Fought Randy L. , Ray Wayne A. 
Published: April 2015

ObjectiveTo study the effects of antipsychotic withdrawal in elderly nursing home residents.DesignLongitudinal prospective study. Setting: 12 community nursing homes that participated in a randomized controlled trial of an educational program designed to reduce antipsychotic use.Subjects271 residents receiving antipsychotics at baseline and remaining in the home for approximately 6 months thereafter. These were placed into two groups: those with continued use of antipsychotics at follow‐up (n = 207) and those with drug discontinued (n = 64).MeasurementsChange between baseline and follow‐up for several standard measurements. These included behavior problems, as reported by both regular care providers (Nursing Home Behavior Problem Scale) or a blinded study rater (items from the Brief Psychiatric Rating Scale), observer‐rated psychiatric symptoms (subset of the Brief Psychiatric Rating Scale), and other standard tests of function (Activities of Daily Living, Mini‐Mental State Examination, Geriatric Depression Scale, and Abnormal Involuntary Movements Scale).ResultsThe frequency of behavior problems did not increase in residents with antipsychotics discontinued. For these residents, observer‐rated psychiatric symptoms decreased by 21% (P = 0.003), which resulted from a 27% decrease in adverse affective symptoms (P = 0.0002). Residents with drug discontinued had no deterioration in any of the measures of function.ConclusionIn this sample, nursing home residents whose antipsychotics were discontinued had significantly improved affect and no discernable adverse effects.
Functional Status of Mexican American Nursing Home Residents
Authors: Chiodo Laura K. , Kanten Deanna N. , Gerety Meghan B. , Mulrow Cynthia D. , Cornell John E. 
Published: April 2015

ObjectiveTo compare sociodemographic characteristics, physical function, and cognition of Mexican American and non‐Hispanic white nursing home residents.Design and SettingCross‐sectional survey of residents in eight proprietary nursing homes and one Veterans Affairs nursing home in San Antonio, Texas.SubjectsResidents with lengths of stay greater than or equal to 90 days.MeasurementsSociodemographic characteristics, residence prior to admission, and dependency in activities of daily living (ADL) were abstracted from the medical record. The Folstein Mini‐Mental State Examination (MMSE) was administered in the resident's self‐selected language to a subset of residents.Main ResultsThere were 1160 participants, 261 Mexican American (23%) and 899 non‐Hispanic white residents (77%). Mexican Americans were younger (77.1 vs 80.7 years), more often men (44% vs 30%), less educated (6.2 vs 10.8 years), and more often dependent on Medicaid funding (66% vs 40%) than non‐Hispanic whites. Mexican Americans were less independent in feeding (34% vs 49%), transfers (18% vs 30%), toileting (19% vs 29%), and dressing (12% vs 19%). Mean MMSE scores were different in Mexican Americans and non‐Hispanic whites (8.93 vs 11.85), and this difference remained significant after adjustment for age and education (P = 0.04). ADL function was strongly associated with MMSE (P = 0.0001) and less strongly associated with ethnicity (P = 0.056) in multiple regression analysis.ConclusionsThis study provides the strongest evidence to date that Mexican American nursing home residents are more cognitively and functionally impaired than non‐Hispanic white residents. Further studies should explore whether medical conditions, selection and referral patterns or cultural factors explain functional differences between Mexican American and non‐Hispanic white nursing home residents.
Predicting Falls: The Role of Mobility and Nonphysical Factors
Authors: Studenski Stephanie , Duncan Pamela W. , Chandler Julie , Samsa Greg , Prescott Barbara , Hogue Carol , Bearon Lucille B. 
Published: April 2015

ObjectiveOur purpose was to test a four‐domain predictive model of recurrent falls developed for this study. In this model, limited mobility is considered a necessary but not sufficient element in risk of recurrent falls. Three other domains, attitudinal, social, and environmental, are proposed to influence fall risk only in persons with impaired mobility.DesignProspective cohort study.SettingVeterans Affairs Ambulatory Care Service serving rural and urban central North Carolina.SubjectsMale Veterans aged 70 or older (n = 306) were monitored prospectively for falls. At baseline, 159 screened as high‐risk mobility status and 147 as low‐risk mobility status.MeasurementsThe primary outcome was recurrent falls. The mobility screen used for risk assignment defined immobile as unable to sit without support for 60 seconds, mobile and stable as meeting criteria for normal ambulation and stair climbing, and mobile but unstable as those who met neither of the above criteria. The high‐risk subjects were further assessed in their homes for mobility in more detail, attitude toward risk, social supports, and environmental status. Other data included demographics, functional status, diagnoses, and medications.ResultsRecurrent falls occurred in 37 (23.3%) high‐risk subjects and seven (4.8%) low‐risk subjects (relative risk = 4.8, confidence interval 2.5 to 9.6, P < 0.001). Within the high‐risk group, the probability of recurrent falls was significantly affected by degree of impaired mobility (P < 0.001), attitude toward risk (P = 0.005), and environment score (P = 0.03).ConclusionsA simple mobility screen can identify elders at increased risk for recurrent falls. Risk within this group is further modified by risk‐taking behavior and environment.
The Effects of Changing Prompted Voiding Schedules in the Treatment of Incontinence in Nursing Home Residents
Authors: Burgio Louis D. , McCormick Kathleen A. , Scheve Ann S. , Engel Bernard T. , Hawkins Andre , Leahy Eileen 
Published: April 2015

ObjectiveTo determine the effects of different prompted voiding schedules on urinary incontinence on a continence unit (CU) and the maintenance of benefits on normal nursing units.DesignMultiphase study with both intra‐and inter‐subject comparisons.ParticipantsSubjects were 41 consenting incontinent nursing home residents. Based on clinical criteria, subjects were assigned to one of four treatment groups that varied as to the schedule of prompted voiding received.MeasurementThe study used chart review, Katz ADL, and MMSE. Urologic status, self‐initiated toileting, urine volumes voided, and incontinence assessed by pad/pants checks were measured by research nurses. Baseline pad check data were collected on residents' normal nursing units. Residents were transferred to the CU where baseline measurement was repeated, and the effects of different prompted voiding schedules were then assessed. Indigenous staff were trained to use prompted voiding, and nurse supervisors were instructed in special procedures for enhancing maintenance of the intervention. Residents were returned to their normal units and the maintenance of improvements in continence status was assessed at 2 weeks and 3 months post‐cU discharge.ResultsOne of the four groups showed significant improvement on the CU in response to the 2‐Hour schedule; two groups improved on the less intensive 3‐Hour schedule (P < 0.05). Two groups maintained this improvement on their normal nursing units (P < 0.05); one group showed a non‐significant trend toward improvement. Self‐initiated toileting decreased (P < 0.05) and volume voids in an appropriate receptacle increased (P < 0.05) during training.ConclusionsPrompted voiding is an effective treatment for urinary incontinence, and a less intensive 3‐Hour schedule may be superior to the standard 2‐Hour schedule for some residents. These improvements in dryness can be maintained by normal nursing home staff if formal staff management procedures are utilized by nurse supervisors.
Cobalamin Levels Are Not Reduced in Alzheimer's Disease: Results from a Population‐Based Study
Authors: Basun Hans , Fratiglioni Laura , Winblad Bengt 
Published: April 2015

Objective: To determine whether there is a relationship between serum cobalamin levels, normal aging, and Alzheimer's Disease (AD).Design: Cross‐sectional survey.Setting: A district (Kungsholmen) in Stockholm, Sweden.Participants: Population‐based cohort of 545 subjects aged more than 74 years. The sample was selected on the basis of evidence of cognitive impairment from all inhabitants in an area of Stockholm (2368 individuals), both living at home or in institutions.Measurements: Serum cobalamin levels and diagnostic evaluation for a diagnosis of dementia and type of dementia.Results: The serum cobalamin levels in non‐demented individuals decreased 5.5 pmol/L with an increase of 1 year of age (regression coefficient = −5.53; P < 0.0001). However, the regression coefficient was 0.21 (P = 0.91) in demented people and 2.57 (P = 0.32) in AD subjects. There was no difference between serum cobalamin levels in demented, AD, and non‐demented subjects, except for the oldest ages where demented people and AD sufferers showed higher values. AD patients still living in their own homes had significantly lower cobalamin concentrations compared with institutionalized AD sufferers. The prevalence rate of cobalamin deficiency was 15.5% (95% CI = 11.5–19.5) in normal aging and 18.1% (95% CI = 10.3–25.9) in AD.Conclusions: These data suggest that serum cobalamin levels decrease in normal aging, but not in dementia or AD. A lower cobalamin concentration observed in AD sufferers still living in their own homes compared with institutionalized persons with AD seemed to be related to but not fully explained by eating habits. Patients with AD living in their own homes are at risk of developing cobalamin deficiency, and monitoring of serum cobalamin concentrations might be useful in this group.
Diabetic Control and Progression of Retinopathy in Elderly Patients: Five‐Year Follow‐up Study
Authors: Morisaki Nobuhiro , Watanabe Satoe , Kobayashi Junji , Kanzaki Tetsuto , Takahashi Kazuo , Yokote Koutaro , Tezuka Mariko , Tashiro Jun , Inadera Hidekuni , Saito Yasushi , Yoshida Sho , Shigemura Kentaro 
Published: April 2015

Objective: To assess whether control of diabetes mellitus is as important in the elderly as in young and middle‐aged diabetic patients in terms of progression of retinopathy.Design: A 5‐year longitudinal cohort study.Setting: Outpatient diabetic clinic.Patients: One hundred fourteen non‐insulin‐dependent diabetic patients (30 males, 84 females) ≥ 60 years of age.Measurements: Retinopathy was checked at the beginning and end of the follow‐up period. During the 5‐year follow‐up period, demographic variables, body mass index, HbA***1c, blood pressure, and plasma lipids were monitored. Retinopathy was classified as follows: grade 0, no lesion; grade 1, non‐proliferative retinopathy; grade 2, pre‐proliferative retinopathy; grade 3, proliferative retinopathy. Progression of retinopathy during the 5‐year follow‐up was defined as an increase in its grade.Results: At the start of the study, 13% of the patients already had retinopathy, all of grade 1. The 5‐year follow‐up study showed that progression of retinopathy was 23.6% in all cases, 22.2% in those with grade 0 initially, and 33.3% in those with grade 1 initially. The progression rates of retinopathy as a function of the mean HbA***1c during the follow‐up were as follows: lower than 7%, 2%; 7–8%, 20%; 8–9%, 40%; more than 9%, 61%. Multiple logistic regression analysis showed that, of the parameters examined, only HbA***1c was a significant risk factor for progression of retinopathy.Conclusions: Control of diabetes mellitus is the most important factor associated with prevention of progression of retinopathy in elderly patients.
Small Intestinal Bacterial Overgrowth—An Incidental Finding?
Authors: Mahon M. Mac , Lynch M. , Mullins E. , O'Moore R.R. , Walsh J.B. , Keane C.T. , Coakley D. 
Published: April 2015

Objectives: To assess the prevalence of typical clinical features and need for treatment of small intestinal bacterial overgrowth (SIBO) in the elderly.Design: Random selection of patients, regardless of their nutritional status.Setting: Acute admissions ward in the Dept. of Medicine for the Elderly.Patients: Thirty elderly patients between 68 and 90 years of age.Measurements: Active clinical problems, including the presence of recent weight loss and diarrhea, were recorded. Routine blood tests, including serum vitamin B12, red cell folate, albumin and calcium, and qualitative small bowel bacteriology results, were analyzed. The effect of age on all variables was studied.Results: Twenty of the 30 small bowel aspirates had proven SIBO, and strict anaerobes were isolated in 15. The mean blood test values did not differ significantly between culture‐positive and culture‐negative patients. There was no significant correlation between those variables and the total bacterial counts. Of the 20 proven SIBO cases, eight had anemia, five had hypoalbuminemia, five had diarrhea, four complained of recent weight loss, and none had B12 deficiency. Alternative causes other than SIBO were identified for many of these abnormalities. Advancing age correlated significantly with rising counts of small bowel strict anaerobes.Conclusions: These data suggest that age may be a predisposing factor in the development of anaerobic overgrowth but that SIBO is a benign entity in the elderly. Contrary to previous recommendations, treatment of this condition is not routinely indicated.
Breast Irradiation in the Older Woman: A Toxicity Study
Authors: Wyckoff Jennifer , Greenberg Harvey , Sanderson Roger , Wallach Paul , Balducci Lodovico 
Published: April 2015

Objective: To establish the tolerance of breast irradiation by women aged 65 and older.Design: Retrospective chart review.Patients and Setting: Women undergoing partial mastectomy and postoperative radiation therapy at the H. Lee Moffitt Cancer Center and Research Institute between 1986 and 1990. Of 163 women eligible for the study, 100 were under age 65, and 63 were aged 65–78.Measurements: Comparison of total treatment dose, treatment duration, number of treatment interruptions, incidence of cutaneous, mucosal, and hematological toxicity between women aged 65 and older and women younger than age 65.Main Results: All study measurements were comparable among younger and older women: total radiation dose (P = 0.5); treatment interruptions (P = 0.063); treatment duration (P = 0.78); cutaneous toxicity (P = 0.37); anemia (P = 0.83); leukopenia (P = 0.07), and thrombocytopenia (P = 0.94). There was no mucosal toxicity, nor higher than grade 2 hematological or cutaneous toxicity. The incidence and severity of toxicity was not higher for women aged 70 and older.Conclusions: Postoperative breast irradiation is well tolerated by older women. Age is not a contraindication to breast preservation.
Surrogate Decision‐Makers' Satisfaction with the Placement of Feeding Tubes in Elderly Patients
Authors: McNabney Matthew K. , Beers Mark H. , Siebens Hilary 
Published: April 2015

Objective: To assess the satisfaction of surrogate decisionmakers with the decision to place feeding tubes in elderly patients with impaired decision‐making capacity.Design: Inception cohort followed for 5 weeks.Setting: Four hospitals in the greater Los Angeles area.Participants: Fifty‐eight surrogate decision‐makers for elderly patients (over 60) who recently received a first‐time percutaneous endoscopic gastrostomy. Participants were identified through the endoscopy departments at the four hospitals.Measurements: We surveyed surrogates by telephone within 5 days of placement for background data and after 5 weeks of use to assess satisfaction with the decision. The main outcome variables at follow‐up were: surrogate satisfaction; whether the surrogate would repeat the decision; whether the surrogate had considered removal of the tube; and surrogates' perception of patients preference for the tube.Results: After 5 weeks of use, 84% of surrogates stated that they would repeat the decision. Fifty‐nine percent of surrogates described themselves as satisfied with the decision, and 17% were dissatisfied. Only 10% had considered removing the tube. After 5 weeks of use, 36% of surrogates felt that the patient would prefer the tube, and 31% felt they would not.Conclusions: Most surrogates we studied would repeat the decision to have a feeding tube after experiencing its effects for 5 weeks. However, almost one‐third felt the patient would not want the tube. Physicians and surrogates may need to place greater emphasis on patients' wishes before placing feeding tubes and when reassessing their benefit to the patient after being placed.
Suicide Over 60: The San Diego Study
Authors: Carney Susanne S. , Rich Charles L. , Burke Patricia A. , Fowler Richard C. 
Published: April 2015

Objectives: To see if selected clinical factors characterize suicides over the age of 60 differently from younger suicides and to ascertain if those factors characterize female and male suicides over the age of 60 differently.Design: A group of consecutive suicides aged 60–88 was compared with groups of consecutive suicides aged 31–59 and 16–30. The female suicides aged 60–88 were also compared with the male suicides in that age group. Data were gathered from a variety of informants using a structured interview format.Setting: The sample was gathered in San Diego County, California, between November, 1981 and September 1982.Participants: The sample consisted of 204 consecutive suicides. These included 49 cases aged 60–88, 94 cases aged 31–59, and 61 cases aged 16–30. The older group consisted of 20 females and 29 males.Measurements: Comparisons were made in demographic, diagnostic, and other clinical characteristics.Results: There were no significant differences between female and male suicides over age 60 on any of the variables examined. Only minor differences were found among the groups in patterns of mental disorders diagnosed. Older suicides were significantly more likely to be married or, if not married, widowed than either of the two younger groups. They were also significantly more likely to be stressed by medical illness. They were significantly less likely to have financial problems as stressors. They were significantly less likely to have talked about suicide or made prior suicide attempts than either of the two younger groups.Conclusions: Patterns of certain characteristics of suicides are very similar regardless of age. However, specific age‐related differences occur that need to be considered when assessing suicide risk. Older suicides may be harder for clinicians to predict and, therefore, prevent.