bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of Mammography by Women Aged 75 and Older: Factors Related to Health, Functioning, and Age
Authors: Blustein Jan , Weiss Linda J. 
Published: April 2015

BACKGROUND AND OBJECTIVES: Mammographic screening for breast cancer is of uncertain clinical benefit for women 75 years of age and older. Some have argued against instituting routine screening in this age group, noting that disability and shorter life expectancy may diminish the desirability and cost‐effectiveness of screening. We sought to determine the extent to which health, functioning, and age influence mammography use in this cohort.DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of a representative sample of women in the US aged 75 and older (n = 2352) who participated in the Medicare Current Beneficiary Survey.MEASURES: Information about general health, level of functioning, medical history, age, and various sociodemographic characteristics elicited in the survey was linked with subjects' Medicare bills for 1991 and 1992 to ascertain patterns of mammography use.RESULTS: Overall, 26.7% of the women had mammograms during the 2‐year period. Advanced age was associated with a decreased likelihood of receiving a mammogram. This did not reflect simply the decline in health and functioning that may accompany aging; those aged 85 and older were less likely to receive mammograms than those in the 75 to 79 age group, controlling for general health, medical history, functional status, and sociodemographic factors (adjusted OR =.41; 95% CI = 0.27 to 0.64). ADL limitations were also associated independently with decreased mammography use. For example, controlling for age, women with any limitations in Activities of Daily Living were 0.71 times as likely to have mammograms as women without ADL limitations (95% CI = 0.59 to 0.85). However, several comorbid conditions, including hypertension, diabetes mellitus, and a history of myocardial infarction were not significantly related to mammography use.CONCLUSIONS: Within the cohort of women aged 75 and older, more advanced age and impaired functional status both substantially reduce the likelihood of mammography use. The extent to which this reflects patients' informed decisions, physicians' judgments, or other factors remains to be explored. J Am Geriatr Soc 46:941–946, 1998.
Hypoglycemia in Hospitalized Nondiabetic Older Patients
Authors: Shilo Shmuel , Berezovsky Svetlana , Friedlander Yechiel , Sonnenblick Moshe 
Published: April 2015

OBJECTIVES: To analyze the clinical characteristics, associated risk factors, and outcome of hypoglycemia in nondiabetic hospitalized older patients.DESIGN: A retrospective case control study.PARTICIPANTS: Sixty patients, aged 65 years and older, in the acute medical and geriatric wards who developed hypoglycemia. A control group was composed of 83 older patients, sex and age matched, in orthopedic and surgery wards who were undergoing corrective surgery for hip fracture or hernioplasty.MEASUREMENTS: For all patients, data for the following variables were abstracted from the charts: age, sex, degree of hypoglycemia, clinical presentation of hypoglycemia, number and duration of hypoglycemia episodes, nutritional state, and blood chemistry analysis. Risk factors were defined as nutritional state, heart failure, renal or liver disease, malignancy, and infection or sepsis.RESULTS: Mean blood glucose in hypoglycemic cases was 38.9 ± 7 mg/dL. Symptoms and signs of hypoglycemia were noted in only 38.4% (23/60) of patients. All identified risk factors except cachexia were found significantly more frequently in the hypoglycemic patients than in the control group. Mean total number of risk factors was greater in the hypoglycemic group than in the control group, 2.97 ± 1.1 versus 1.64 ±.8, respectively (P <.001). In a multivariant logistic model, low plasma albumin level, liver disease, malignancy, and congestive heart failure were significant predictors of hypoglycemia. In‐hospital mortality rate was higher among the hypoglycemic patients, 48% versus 18.1% (P <.001), and was independent of the degree of hypoglycemia or the number of hypoglycemic episodes. Mortality was correlated significantly with the number of risk factors (3.4 ± 1.1 vs 2.5 ± 1.1; P =.006). Hypoglycemia remained a significant predictor of mortality (OR = 3.67; 95% CI, 1.2–11.2) even after the adjustment for other risk factors.CONCLUSIONS: Hypoglycemic episodes occur even among nondiabetic hospitalized older patients. Symptoms and signs of hypoglycemia were noted in only two‐fifths of the patients. Albumin less than 3.0 g%, liver disease, renal insufficiency, malignancy, congestive heart failure, and sepsis were statistically significant predictors of developing hypoglycemia. The overall mortality rate was significantly higher among the hypoglycemic patients and was independent of hypoglycemia levels. Mean total number of risk factors was significantly higher among those who died compared with hypoglycemic patients who survived. Based on the present study, the estimated odds of mortality in an older patient with hypoglycemia were 3.67 times higher than in those without hypoglycemia. J Am Geriatr Soc 46:978–982, 1998.
Outcomes of Anesthesia and Surgery in People 100 Years of Age and Older
Authors: Warner Mark A. , Saletel Rachel A. , Schroeder Darrell R. , Warner David O. , Offord Kenneth P. , Gray Darryl T. 
Published: April 2015

OBJECTIVE: To assess the outcomes of anesthesia and surgery for men and women 100 years of age and older.DESIGN: Retrospective cohort study in the 20‐year time period from 1975 to 1994, with follow‐up through 1995.SETTING: Mayo‐affiliated hospitals and Olmsted Community Hospital, Rochester, Minnesota.PARTICIPANTS: All men and women 100 years of age and older who underwent surgery at a participating hospital.MEASUREMENTS: Forty‐eight‐hour and 30‐day perioperative morbidity and mortality; long‐term survival.RESULTS: Thirty‐one men and women aged 100 to 107 years underwent 42 procedures. One major complication (3%) within 48 hours was observed. The 48‐hour, 30‐day, and 1‐year mortality rates were 0%, 16.1%, and 35.5%, respectively. When compared with survival rates for age‐, gender‐, and calendar year of birth‐matched peers from the general population, the survival rate for centenarians who underwent surgery and anesthesia was comparable to the rate expected.CONCLUSION: These data suggest that people 100 years of age and older who have operable diseases or injuries should not be denied surgical interventions because of perceived risks associated with their advanced age. J Am Geriatr Soc 46:988–993, 1998.
Anterior Cervical Osteophytes as a Cause of Pharyngeal Stage Dysphagia
Authors: Granville Lisa J. , Musson Nan , Altman Roy , Silverman Michael 
Published: April 2015

OBJECTIVE: To describe the association of anterior cervical osteophytes impairing epiglottic movement as an etiology of pharyngeal stage dysphagia.DESIGN: A retrospective chart review.SETTING: An academic affiliated Veterans Affairs Medical Center.PATIENTS: Veterans 60 years of age or older referred to speech pathology for dysphagia evaluation.RESULTS: Of 376 veterans evaluated consecutively since 1990, 40 patients had dysphagia determined to be secondary to cervical bony protuberances. The evaluation and management of three cases with functional consequences at level C3–5 with no dysphagia etiology present are described.CONCLUSION: Cervical osteophytes need to be considered in the differential diagnosis of dysphagia in older people. J Am Geriatr Soc 46:1003–1007, 1998.
The Association of Urinary Incontinence with Poor Self‐Rated Health
Authors: Johnson Theodore M. , Kincade Jean E. , Bernard Shulamit L. , Busby‐Whitehead Jan , Hertz‐Picciotto Irva , DeFriese Gordon H. 
Published: April 2015

OBJECTIVES: To assess whether urinary incontinence (UI) and its severity are associated with poor self‐rated health in a national sample of community‐living older adults and whether this relationship persists after controlling for confounding attributable to functional status, comorbidity, and demographic factors.DESIGN: A cross‐sectional analysis using multivariate logistic regression.SETTING: Subjects were from the 1990–1991 National Survey of Self‐Care and Aging (N = 3485), a random sampling in geographic clusters of community‐dwelling Medicare beneficiaries 65 years of age or older in the contiguous United States.MEASURES: The responses to an interviewer‐administered questionnaire regarding urinary incontinence, Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), Mobility Activities of Daily Living (MADL), age, gender, place of residence, race, education, need for proxy response to the survey, and number of medical conditions.RESULTS: Unadjusted analysis showed the presence of urinary incontinence to be associated with poor self‐rated health (OR 2.7, 2.1–3.3). With gender, number of comorbid conditions, race, IADL impairment, and interaction terms of incontinence/race and incontinence/IADL in the final model, UI was associated with poor self‐rated health in certain subgroups. White subjects with no IADL impairment and mild‐moderate incontinence had an OR of 2.0 (95% CI 1.5–2.9) and those with severe incontinence had an OR of 4.5 (95% CI 2.4–8.4) of rating their health as poor, whereas those with no IADL impairment and no incontinence were the referent group. For those with a lot of difficulty performing one or more IADL activity, the association of UI and poor self‐rated health was weak. For non‐white subjects, there was no association, or a very weak association, of UI and poor self‐rated health.CONCLUSION: In this national sample, urinary incontinence was independently and positively associated with poor self‐rated health after adjustment for age, comorbidity, and frailty for most community‐dwelling older adults. This association between UI and poor self‐rated health was weaker and statistically insignificant when IADL impairment was present or in non‐white subjects. Further research is indicated to better understand the impact of urinary incontinence in specific cultural settings.
Causes and Prognosis of Acute Renal Failure in the Very Old
Authors: Pascual Julio , Liaño Fernando ,   Madrid Acute Renal Failure Study Group
Published: April 2015

OBJECTIVES: There is a tendency to treat older people with Acute Renal Failure (ARF) less aggressively because of the presumed less acceptable end results. This has not been proved, and their prognosis may be similar to that found in the younger population. There are no studies on the incidence, causes, and evolution of ARF in patients 80 years of age and older.DESIGN: A multicenter, prospective, longitudinal study.SETTING: The 13 hospitals with nephrology units that serve the 4.2 million people in Madrid, Spain.MEASUREMENTS: A number of demographic, clinical, and therapeutic variables were studied in each case.RESULTS: One hundred three episodes of ARF occurred in patients 80 years of age and older (Group 1), 256 in patients aged 65 to 79 years (Group 2), and 389 in people younger than age 65 (Group 3). Acute tubular necrosis was diagnosed in 39% of cases in Group 1, in 48% in Group 2, and in 55% in Group 3 (P = .004, 1 vs 3); prerenal ARF was diagnosed in 30%, 28%, and 21% (P = .054, 1 vs 3) and obstructive ARF in 20%, 11%, and 7% (P < .001, 1 vs 3) of cases, respectively. Serum creatinine at admission, peak values, values at discharge or death, duration of both admission and ARF episode, and mortality were similar in all groups. In stratified analysis, relative risk for mortality in patients aged more than 80 years was 1.09 [95% CI 0.86, 1.36 (P = .562)], and in those aged 65 to 79 it was 0.99 [95% CI 0.83, 1.18 (P = .954)] compared with patients aged less than 65 years. Risk of death was also similar when only acute tubular necrosis cases were considered. Sustained hypotension was associated with higher mortality (44% of nonsurviving older persons vs 9% of survivors, P < .001).CONCLUSION: Age is not a particularly poor prognostic sign, and outcome seems to be within acceptable limits for very old patients with ARF. Acute dialysis should not be withheld from patients solely because they are more than 80 years of age.
Alzheimer's Disease Under Managed Care: Implications from Medicare Utilization and Expenditure Patterns
Authors: Weiner Michael , Powe Neil R. , Weller Wendy E. , Shaffer Thomas J. , Anderson Gerard F. 
Published: April 2015

BACKGROUND: Little information is available about the costs, utilization patterns, and the delivery system used by Medicare beneficiaries with chronic illnesses. This information will become increasingly important as more Medicare beneficiaries with chronic illness enroll in managed care plans and delivery systems must be developed to meet their needs.OBJECTIVES: To analyze health care expenditures and utilization patterns for Medicare beneficiaries with dementia of the Alzheimer type (DAT) and compare them with those of all Medicare beneficiaries.DESIGN: A cross‐sectional study.SETTING: Practices providing services to Medicare beneficiaries in the U.S.SUBJECTS: Aged Medicare beneficiaries with DAT in fiscal year (FY) 1992.MEASUREMENTS: Medical expenditures and utilization patterns.RESULTS: In FY 1992, per capita Medicare expenditures for 9323 patients with DAT were $6208, or 1.9 times the per capita expenditure for all 1,221,615 beneficiaries in our sample. Inpatient care accounted for 62.7% of expenditures. Internal medicine was the specialty identified with the largest proportion of expenditures, but no single specialty accounted for the majority of care. Payments increased with comorbid conditions such as heart failure, chronic pulmonary diseases, and cerebrovascular disease.CONCLUSION: Current Medicare capitation payments to managed care plans may not meet the higher expected annual costs of care for beneficiaries with DAT. In turn, physicians (or physician groups) who accept capitation for Medicare beneficiaries with DAT should also consider how capitation rates are established by managed care plans and should learn ways to reduce financial risk.
Preventing Disability and Managing Chronic Illness in Frail Older Adults: A Randomized Trial of a Community‐Based Partnership with Primary Care
Authors: Leveille Suzanne G. , Wagner Edward H. , Davis Connie , Grothaus Lou , Wallace Jeffrey , LoGerfo Marianne , Kent Daniel 
Published: April 2015

BACKGROUND: Effective new strategies that complement primary care are needed to reduce disability risks and improve self‐management of chronic illness in frail older people living in the community.OBJECTIVE: To evaluate the impact of a 1‐year, senior center‐based chronic illness self‐management and disability prevention program on health, functioning, and healthcare utilization in frail older adults.DESIGN: A randomized controlled trial.SETTING: A large senior center located in a northeast Seattle suburb. The trial was conducted in collaboration with primary care providers of two large managed care organizations.PARTICIPANTS: A total of 201 chronically ill older adults seniors aged 70 and older recruited through medical practices.INTERVENTION: A targeted, multi‐component disability prevention and disease self‐management program led by a geriatric nurse practitioner (GNP).MEASUREMENTS: Self‐reported Physical function, physical performance tests, health care utilization, and health behaviors.RESULTS: Each of 101 intervention participants met with the GNP from 1 to 8 times (median = 3) during the study year. The intervention group showed less decline in function, as measured by disability days and lower scores on the Health Assessment Questionnaire. Other measures of function, including the SF‐36 and a battery of physical performance tests, did not change with the intervention. The number of hospitalized participants increased by 69% among the controls and decreased by 38% in the intervention group (P = .083). The total number of inpatient hospital days during the study year was significantly less in the intervention group compared with controls (total days = 33 vs 116, P = .049). The intervention led to significantly higher levels of physical activity and senior center participation and significant reductions in the use of psychoactive medications.CONCLUSIONS: This project provides evidence that a community‐based collaboration with primary care providers can improve function and reduce inpatient utilization in chronically ill older adults. Linking organized medical care with complementary community‐based interventions may be a promising direction for research and practice.
The Effect of Vitamin B12 Deficiency on Older Veterans and Its Relationship to Health
Authors: Bernard Marie A. , Nakonezny Paul A. , Kashner T. Michael 
Published: April 2015

OBJECTIVE: To examine the effect of vitamin B12 deficiency on older veterans and its relationship to general health and cognitive impairment.DESIGN: Cross‐sectional study.SETTING: Oklahoma City Veterans Affairs Medical Center.PARTICIPANTS: Data for this research were obtained from 303 ambulatory, older veterans who used the outpatient laboratories of the Oklahoma City Department of Veterans Affairs Medical Center. Subjects were included in the study if they were 65 years of age and older and if they had no known diagnosis associated with B12 deficiency. The sample in this study consisted of 301 men and 2 women aged 65 to 89 years.MEASUREMENTS: This study used two separate measurements of vitamin B12 deficiency: (1) a strict definition of B12 deficiency (serum B12 level < laboratory norm) and (2) a broader definition of B12 deficiency (serum B12 level < laboratory norm or laboratory norm < B12 < 300 pg/mL and methyl malonic acid (MMA) or homocysteine (HC) elevated by more than two standard deviations). The laboratory norm is 200 pg/mL. The dependent variables were measures of cognitive impairment and general health. Cognitive impairment was measured using the Folstein Mini‐Mental State Examination (MMSE) and general health was measured using the RAND 36–Item Health Survey Version 1.0. The control variables for this study were the subjects' daily alcohol intake, daily intake of a vitamin/mineral supplement, annual income, and level of education.RESULTS/CONCLUSIONS: Nineteen subjects (6%) were vitamin B12‐deficient as measured by the strict definition of B12 deficiency (serum B12 level < laboratory norm), and 49 subjects (16%) were vitamin B12‐deficient as measured by the broader definition of B12 deficiency (serum B12 level < laboratory norm or laboratory norm < B12 < 300 pg/mL and MMA or HC elevated by more than two standard deviations). Vitamin B12 level decreases as age increases. Of the nine general health outcomes measured by using the RAND 36‐Item Health Survey, only bodily pain is associated with vitamin B12 deficiency, and only then when B12 deficiency is measured as serum B12 level < laboratory norm, the strict definition of B12 deficiency. Vitamin B12‐deficient subjects experience more bodily pain than those with normal vitamin B12 levels. There is a significant difference between B12‐deficient subjects and B12 normal subjects on cognitive impairment, with B12 normal subjects indicating less cognitive impairment, only when B12 deficiency is measured as B12 level < laboratory norm, the strict definition of B12 deficiency. The broader measurement of vitamin B12 deficiency (i.e., serum B12 level < laboratory norm or laboratory norm < B12 < 300 pg/mL and MMA or HC elevated by more than two standard deviations) is not a significant correlate of cognitive impairment and general health.
Exercise to Improve Spinal Flexibility and Function for People with Parkinson's Disease: A Randomized, Controlled Trial
Authors: Schenkman Margaret , Cutson Toni M. , Kuchibhatla Maggie , Chandler Julie , Pieper Carl F. , Ray Laurie , Laub Kathryn C. 
Published: April 2015

OBJECTIVES: The effectiveness of an exercise intervention for people in early and midstage Parkinson's disease (stages 2 and 3 of Hoehn and Yahr) in improving spinal flexibility and physical performance in a sample of community‐dwelling older people is described.DESIGN AND SETTING: Fifty‐one men and women, aged 55–84 years, identified through advertisement, local support groups, and local neurologists were enrolled into a randomized, controlled trial. Subjects were assigned randomly to an intervention or a usual care arm (i.e., no specific exercise). Of the original 51 participants, 46 completed the randomized, controlled trial. Participants in the exercise arm (n = 23) received individual instruction three times per week for 10 weeks. Participants in the usual care arm (n = 23) were “wait listed” for intervention.MEASUREMENTS: Changes over 10 weeks in spinal flexibility (i.e., functional axial rotation) and physical performance (i.e., functional reach, timed supine to stand) were the primary outcome measures.RESULTS: MANOVA conducted for the three primary outcome variables demonstrated significant differences (P≤: s .05) between the two groups. Further analysis using ANOVA demonstrated significant differences between groups in functional axial rotation and functional reach for the intervention compared with the control group. There was no significant difference in supine to sit time.CONCLUSION: Study results demonstrate that improvements in axial mobility and physical performance can be achieved with a 10‐week exercise program for people in the early and midstages of PD.
The Association of Non‐Insulin‐Dependent Diabetes Mellitus and Cognitive Function in an Older Cohort
Authors: Scott Ronald D. , Kritz‐Silverstein Donna , Barrett‐Connor Elizabeth , Wiederholt Wigbert C. 
Published: April 2015

OBJECTIVE: In this study, we examined the association of non‐insulin‐dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) with cognitive function in a population‐based sample of older individuals.RESEARCH DESIGN AND METHODS: Subjects were 1509 healthy, community‐dwelling men and women aged 55 years and older who were participants in the Rancho Bernardo Study and attended clinic visits in 1984–87 and in 1988–91. An oral glucose tolerance test was administered during the 1984–87 visits. Based on World Health Organization criteria, participants were classified into those with NIDDM, IGT, or normal glucose tolerance. During the 1988–91 clinic visits, 12 tests of cognitive function were administered.RESULTS: Of the participants, 14.3% of the men and 9.9% of the women had NIDDM, and 21.0% of the men and 28.0% of the women had IGT. Multiple regression analysis was used to compare the cognitive function of individuals with NIDDM and IGT with individuals with normal glucose tolerance after adjustment for age, education, obesity, depression, blood pressure, and current estrogen use. In men, there were no statistically significant differences in any of the 12 cognitive function tests by glucose tolerance category. Compared with those with normal glucose tolerance, women with IGT had lower scores on almost every cognitive function test, whereas women with NIDDM had higher scores, but none of these differences were statistically significant after adjustment for multiple comparisons. Futhermore, observed differences by NIDDM or IGT status were small and accounted for <0.6% of the explained variance in cognitive function.CONCLUSIONS: This study shows no strong or consistent association between IGT or mild diabetes with cognitive function in community‐dwelling older adults.