bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Changing Epidemiology of Human Immunodeficiency Virus Infection in Older Persons
Authors: Gordon Steven M. , Thompson Sumner 
Published: April 2015

OBJECTIVE: To describe the epidemiology of human immunodeficiency virus (HIV) infection diagnosed in persons aged 60 years and older at a large urban county hospital.DESIGN: Retrospective chart review of patients, aged 60 years and older, diagnosed with HIV infection, among 6,493 patients identified with positive EIA‐HIV tests performed at Grady Memorial Hospital between January 1, 1985 and July 1, 1992.RESULTS: A total of 32 HIV‐infected elderly patients, including 27 men and five women, with a mean age of 64.8 years (range, 60–83 years) were identified. Among the 27 men, HIV risk factors included: homosexual/bisexual (10 patients); injection drug users (IDU) (5); transfusion‐associated (2); heterosexual (2); eight patients had no HIV risk factor identified. Among the five women, only one had an identified risk factor (blood transfusion). HIV testing of 47% (15/32) elderly patients was performed after a diagnosis of an AIDS‐defining opportunistic infection. Among 24 elderly patients who presented to a physician with signs or symptoms of HIV infection, testing for HIV was often delayed (median 3.1 months, range: 1–10 months). Eleven patients underwent work‐ups to rule out a malignancy, and three patients were initially diagnosed with organic brain syndrome. Ten of the 32 patients (31%) had a history of syphilis, and 90% (19/21) of patients tested were found to be immune to hepatitis B.CONCLUSION: The majority of HIV‐infected patients 60 years or older acquired their infection through sexual intercourse or IDU. The diagnosis of HIV infection in the elderly was usually not considered by clinicians until late in the course of infection, despite a high prevalence of prior sexually transmitted diseases (STDs). Our data indicate that clinicians who take care of elderly patients should do a complete sexual history and offer sexual education. HIV testing and counseling should be considered for all individuals with a history of recent STDs or reporting behaviors putting them at risk for HIV infection.
Measuring Physical Function in Community‐Dwelling Older Persons: A Comparison of Self‐Administered, Interviewer‐Administered, and Performance‐Based Measures
Authors: Reuben David B. , Valle Laura A. , Hays Ron D. , Siu Albert L. 
Published: April 2015

PURPOSE: To compare two self‐administered, one interviewer‐administered, and one performance‐based measure of physical function in community‐based older persons.METHODS: Eighty‐three subjects were recruited from meal sites, senior recreation centers, and senior housing units for a comprehensive geriatric assessment program. At the time of screening, study participants self‐administered the Functional Status Questionnaire (FSQ) and were administered the Katz Activities of Daily Living (ADL) and the Older Americans Resources and Services Instrumental Activities of Daily Living (OARS‐IADL) instruments by interview. Participants also completed the Physical Performance Test (PPT) and were given the Medical Outcomes Study SF‐36 to self‐administer on site or at home and return by mail.RESULTS: All 83 subjects completed FSQ, Katz ADL, OARS‐IADL, and PPT; 72 returned SF‐36 forms. Correlations between the two self‐administered physical function measures (FSQ and SF‐36) were higher than between self‐administered and interviewer‐assessed (ADL and OARS‐IADL) or performance‐based (PPT) measures. When assessed for construct validity, the self‐administered, OARS, and PPT measures had comparable correlations with role limitations as a result of physical health problems, but relationships between physical functional status measures and other SF‐36 measures of health were inconsistent.CONCLUSION: The relationships between commonly used self‐administered, interviewer‐administered, and performance‐based measures of physical function were inconsistent and weak, suggesting that these instruments are not measuring the same construct.
Acute Respiratory Illness in Older Community Residents
Authors: Hodder Sally L. , Ford Amasa B. , FitzGibbon Paula A. , Jones Paul K. , Kumar Mary Lou , Mortimer Edward A. 
Published: April 2015

OBJECTIVE: To describe the 3‐year incidence of acute respiratory illness in a population of noninstitutionalized elderly persons.DESIGN: Cohort analytic study with an observation period of 3 years.SETTING: Large midwestern urban community.SUBJECTS: 574 noninstitutionalized persons aged 65 years and older, of whom 349 were living independently, 110 were in congregate settings, and 115 were living independently and regularly caring for small children.METHODS: Subjects were interviewed and examined by nurse practitioners at intake and every 4 months. Acute illness and convalescent visits were made when illnesses were reported by participants.MAIN OUTCOME MEASURES: The incidence of acute respiratory illness was used to test the hypothesis that elderly persons taking care of children have the highest incidence, congregate‐dwellers intermediate incidence, and those living independently the lowest incidence.RESULTS: The average incidence of acute respiratory illness was 2.5 per 100 person months, comparable to rates reported in the National Health Survey. The incidence of respiratory illness was significantly greater in subjects living in congregate settings or regularly caring for young children. Similarly, greater proportions of persons in the congregate and child‐care groups reported at least one episode of illness (P < .05). A more detailed analysis of exposure shows that acute respiratory illness was significantly more common in subjects who had contact with children (P < .05). This risk was definitely present during the months November through February, and probably also during July through October, but was not observed for March through June.CONCLUSIONS: Elderly persons living in the community experience low rates of acute upper respiratory illness. Contact with children increases their risk of developing such illnesses during certain seasons of the year.
Acute Respiratory Tract Infection in Daycare Centers for Older Persons
Authors: Falsey Ann R. , McCann Robert M. , Hall William J. , Tanner Martin A. , Criddle Mary M. , Formica Maria A. , Irvine Carrie S. , Kolassa John E. , Barker William H. , Treanor John J. 
Published: April 2015

OBJECTIVE: To evaluate the rate of specific pathogens and clinical syndromes associated with acute respiratory tract infections (ARTI) in frail older persons attending daycare.DESIGN: Prospective descriptive study, without intervention.SETTING: Two sites of a senior daycare program providing all‐inclusive care for the older persons in Rochester, New York.PARTICIPANTS: Staff members and participants of the daycare.MEASUREMENTS: Demographic, medical, and physical findings were collected from older subjects at baseline and while ill with respiratory illnesses. Nasopharyngeal specimens for viral and Chlamydia culture and sputum for bacterial culture were obtained from subjects when ill. Acute and convalescent sera were also collected with each illness and examined for viral, chlamydial, and mycoplasma infection.MAIN RESULTS: One hundred sixty‐five illnesses were documented in 165 older daycare participants as well as 113 illnesses among 67 staff members during the 15‐month study. The rate of ARTI in the elderly group was 10.8 per 100 person months. The most common etiologies in both the staff and elderly participants were respiratory syncytial virus (RSV), Influenza A, and coronavirus. The etiologies of illnesses in the staff compared with those in elderly group were similar except that bacterial infections were significantly more common among the elderly (7% vs. 0, P = 0.05). Multiple pathogens were found to cocirculate within centers, and no clear outbreak of a predominant organism was noted. Cough and nasal congestion characterized most illnesses. The elderly experienced significantly more cough, dyspnea, and sputum production than did the staff. There were 10 hospitalizations related to respiratory infections and four deaths during the acute illness among the elderly group and none in staff.CONCLUSIONS: Acute respiratory infections are a common occurrence in both the staff and participants of a senior daycare center and are the cause of substantial morbidity in frail older persons.
The Sessing Scale for Assessment of Pressure Ulcer Healing
Authors: Ferrell Bruce A. , Artinian Barbara M. , Sessing Daphne 
Published: April 2015

OBJECTIVE: To describe a new observational scale, the Sessing scale, for measuring the progression of pressure ulcers.CRITERION STANDARDS: Changes in Shea stage and the diameter of healing pressure ulcers.SUBJECTS: A cohort of 84 nursing home residents with pressure ulcers.RESULTS: There were strong relationships between changes in healing as measured by the Sessing Scale and those measured by the Shea Scale (Spearman's r = 0.90; P < .0001), and between changes in the Sessing scale compared with changes in ulcer diameter (Spearman's r = 0.64; P < .001). Test‐retest reliability was good (Kappa = 0.84) in a sample of 50 subjects.CONCLUSION: The Sessing scale is a simple, easy to use, observational instrument with validity and reliability for the assessment of progression of pressure ulcers in a clinical or research setting. Findings indicate that the Sessing scale, with its description of granulation tissue, infection, drainage, necrosis, and eschar, measures an important domain of wound healing that is independent and perhaps as important to clinicians and researchers as either Shea stage or ulcer size.
Validation of the Cumulative Illness Rating Scale in a Geriatric Residential Population
Authors: Parmelee Patricia A. , Thuras Paul D. , Katz Ira R. , Lawton M. Powell 
Published: April 2015

OBJECTIVE: To evaluate the validity of the Cumulative Illness Rating Scale (CIRS) in a geriatric institutional population by examining its associations with mortality, hospitalization, medication usage, laboratory findings and disability.DESIGN: A validation of the CIRS using self‐ and physician‐report surveys, with archival data drawn from medical charts and facility records.SETTING: Long‐term care facility with skilled nursing and congregate apartments.PARTICIPANTS: Four hundred thirty‐nine facility residents selected on the basis of completeness of self‐report data and physician ratings.PRIMARY MEASURES: Composite measures of illness severity and comorbidity, based on physicians' CIRS ratings; time to death or acute hospitalization after assessment; medication use, drawn from pharmacy records; medical chart data on laboratory tests; self‐reported functional disability.RESULTS: CIRS illness severity and comorbidity indices, as well as individual CIRS items, were significantly associated with mortality, acute hospitalization, medication usage, laboratory test results, and functional disability. The CIRS showed good divergent validity vis a vis functional disability in predicting mortality and hospitalization.CONCLUSIONS: The CIRS appears to be a valid indicator of health status among frail older institution residents. The illness severity and comorbidity composites performed equally well in predicting longitudinal outcomes. Item‐level analyses suggest that the CIRS may be useful in developing differential illness profiles associated with mortality, hospitalization, and disability.
Prevalence and Subtypes of Dementia in Taiwan: A community Survey of 5297 Individuals
Authors: Liu Hsiu‐Chih , Lin Ker‐Neng , Teng Evelyn Lee , Wang Shuu‐Jiun , Fuh Jong‐Ling , Guo Nai‐Wen , Chou Pesus , Hu Han‐Hwa , Chiang Benjamin N. 
Published: April 2015

OBJECTIVE: To study the prevalence rate of dementia in Taiwan, the relative frequencies of its subtypes, and its associations with age, education, gender, and residence location.PARTICIPANTS: A total of 2753 men and 2544 women from four urban and four rural communities participated. Their age ranged from 41 to 88 years; 28% of them were at least 65 years old. Their education ranged from 0 to 20 years; 27% of them had less than 1 year of formal schooling.DESIGN: Phase I was a screening survey by trained nurses who administered a Chinese version of the Mini‐Mental State Examination, the MMSE‐T1, to all participants. Phase II involved the assessment for dementia by neurologists on the 1521 individuals who had scored less than 24 on the 30‐point MMSE‐T1.MAIN RESULTS: Thirty‐one cases of dementia were identified by the DSM‐III‐R criteria, including 18 cases of Alzheimer's disease, 10 cases of vascular dementia, and three cases of other dementias. The prevalence rate in individuals aged 65 and over was 2.0%. Aging and illiteracy were associated with higher rates of dementia; gender and residence location made no difference.CONCLUSIONS: The prevalence rate of dementia was low in this Chinese population. consistent with common findings from other parts of the world, a high rate of dementia was associated with older age and illiteracy, and Alzheimer's disease was the most frequent cause.
High Density Lipoprotein Cholesterol is Associated with Serum Cortisol in Older People
Authors: Varma Vivek K. , Rushing Julia Thomas , Ettinger Walter H. 
Published: April 2015

OBJECTIVE: To determine the associations between serum cortisol and HDL cholesterol, other lipoprotein lipids and cardiovascular risk factors, carotid atherosclerosis, and clinical heart disease in older people.DESIGN: A cross‐sectional, observational, ancillary study of the Cardiovascular Health Study (CHS).POPULATION: A total of 245 community‐dwelling people, 65 to 89 years old, were recruited consecutively for a 2‐month period from the CHS cohort in Forsyth County, North Carolina.METHODS: Cortisol was measured by radioimmunoassay in serum collected between 7:00 and 10:00 AM after an overnight fast. Cortisol levels were correlated with lipoprotein lipids, insulin, glucose, body mass index, waist‐hip ratio, prevalent coronary heart disease, hypertension, diabetes, and carotid atherosclerosis by B‐mode ultrasound.RESULTS: Serum cortisol was correlated negatively (r = ‐.24) with body mass index and waist‐hip ratio (r = ‐.16) but was not related significantly to fasting insulin or glucose. Cortisol was not associated significantly with triglyceride and low density lipoprotein cholesterol but showed a positive correlation (r = .21) with high density lipoprotein cholesterol. The relationship between cortisol and high density lipoprotein cholesterol persisted after adjustment for gender, body mass index, waist‐hip ratio, cigarette and alcohol use, triglyceride level, and diabetes. There was a trend toward a negative correlation between cortisol and measures of carotid atherosclerosis, but no significant relationship was indicated between cortisol and prevalent coronary heart disease, hypertension, or diabetes.CONCLUSION: Endogenous glucocorticoid levels correlated with HDL cholesterol levels and may play a role in the physiologic regulation of high density lipoprotein levels in older people.
Insulin‐like Growth Factor 1 and Functional Status in Healthy Older Men
Authors: Papadakis Maxine A. , Grady Deborah , Tierney Mary Jo , Black Dennis , Wells Lauren , Grunfeld Carl 
Published: April 2015

OBJECTIVE: To determine if insulin‐like growth factor 1 (IGF‐1) is associated with strength and functional ability in healthy older men.DESIGN: Cross‐sectional study.SETTING: San Francisco Department of Veterans Affairs Medical Center.PARTICIPANTS: One hundred four ambulatory community‐dwelling men.MEASUREMENTS: Serum IGF‐1 levels were obtained. Measured variables included strength of the knee flexors and extensors, handgrip, score on the Physical Performance Test, body composition, and three tests of cognitive function.RESULTS: The subjects' mean age was 75.5±4.9 (SD) years (range 70–94 years), and their mean IGF‐1 level was 134.7±43.6 ng/mL. The univariate association of age with the variables was much stronger than the univariate association of IGF‐1 with the same variables. In multivariable models, age, but not IGF‐1, was associated with the variables.CONCLUSION: In this study of healthy older men, age is the most important variable in predicting functional decline. There was no association of IGF‐1 levels to functional status independent of age. J Am Geriatr Soc 43:1350–1355,1995.
Hyponatremia in a Nursing Home Population
Authors: Miller Myron , Morley John E. , Rubenstein Laurence Z. 
Published: April 2015

OBJECTIVE:To determine the prevalence of hyponatremia in a nursing home population and to identify clinical factors that increase the risk for development of hyponatremia.DESIGN:Retrospective and prospective record review.SETTING:A Veterans Affairs nursing home care unit.PATIENTS:One hundred nineteen residents, who ranged in age from 60 to 103 years. Sixty ambulatory patients, 62 to 91 years of age, who attended a geriatric medicine outpatient clinic served as a reference population.MEASUREMENTS:Most recent serum sodium, creatinine, BUN, and all serum sodium determinations during the preceding 12 months; clinical diagnoses, diet, medications, and significant events at the time of recorded hyponatremic episodes; response to acute water loading in a subset of patients; number of deaths in the 12 months following entry into the study.RESULTS:In the 119 nursing home patients, ages 60 years or older, the most recent serum sodium identified 18% who were hyponatremic, compared with a prevalence of 8% in similarly aged ambulatory patients. When all serum sodium determinations for the previous 12 months were examined, 53% of the nursing home patients had at least one episode of hyponatremia during this time period. There was a high incidence of central nervous system (CNS) and spinal cord disease in the total nursing home population. Episodes of hyponatremia were frequently associated with an increased intake of fluids, given either orally or intravenously, and with tube feeding. Water load testing revealed abnormal water handling consistent with the syndrome of inappropriate antidiuretic hormone (ADH) secretion in 18 of 23 patients who had a history of hyponatremia. Seventeen percent of the patients with hyponatremia died over the following 12 months, compared to a death rate of 21% in the normonatremic patients.CONCLUSIONS:Hyponatremia is a common occurrence in nursing home residents and may be a consequence of abnormal ADH secretion resulting from CNS disease. Exposure to increased fluid intake, or to a low sodium tube‐feeding diet, can lead to the onset of hyponatremia or to a worsening of an already present low‐serum sodium concentration.
Attitudes of Beginning Medical Students Toward Older Persons: A Five‐Campus Study
Authors: Reuben David B. , Fullerton Judith T. , Tschann Jeanne M. , Croughan‐Minihane Mary 
Published: April 2015

OBJECTIVE: To examine the attitudes of beginning medical students toward older persons and their medical care.DESIGN: Cross‐sectional survey.SETTING: Five University of California medical schools.PARTICIPANTS: Beginning medical school students from the Class of 1994.MEASUREMENTS: Demographic characteristics, personal contacts with older persons, and previous coursework or research experience with older persons were assessed. Knowledge with regard to aging was measured with a group of 10 questions, which were modified from the Facts on Aging Quiz. The attitudes of students toward older persons were assessed using the Aging Semantic Differential (ASD), the Maxwell‐Sullivan Attitude Scale (MSAS), and two case scenarios.RESULTS: Ninety‐two percent of the participants (554 of 603) responded; 93% of these responses were usable. Students were much less likely to admit an acutely ill 85‐year‐old woman to an intensive care unit, intubate her, and treat her aggressively than they were to treat an acutely ill 10‐year‐old girl with underlying chronic leukemia. In multivariate models, male gender and younger student age were both independently predictive of less favorable attitudes regarding a 70‐year‐old person on the ASD Instrumental‐Ineffective subscale. Asian‐Americans and males had less favorable attitudes on the Autonomous‐Dependent and the Personal Acceptability‐Unacceptability subscales. More knowledge with regard to aging was predictive of more favorable attitudes on the Autonomous‐Dependent and Personal Acceptability‐Unacceptability subscales. Male gender and Asian‐American ethnicity were significantly associated with less favorable attitudes on the two scales derived from the MSASs. Students who had previously visited a long‐term care facility were more likely to disagree that it takes too much time to care for older persons.CONCLUSION: Beginning medical students have already formed some unfavorable attitudes about older persons. Few independent predictors (either sociodemographic or students' previous experiences) of student attitudes could be identified that would help in the selection of students who had more favorable attitudes toward older persons. Hence, attempts to generate physicians with good attitudes must rely on curricular efforts during medical school and residency training.
Depression in a Long‐Term Care Facility: Clinical Features and Discordance Between Nursing Assessment and Patient Interviews
Authors: Burrows Adam B. , Satlin Andrew , Salzman Carl , Nobel Kenneth , Lipsitz Lewis A. 
Published: April 2015

OBJECTIVE: Nurses commonly observe more depression than is diagnosed and treated in nursing homes. Accordingly, we aimed to describe the clinical features of untreated nursing home residents whom nurses identify as depressed and to compare nurse ratings of depressed nursing home residents with ratings from direct interviews and patient self‐reports.DESIGN: Cross‐sectional survey followed by semi‐structured diagnostic interviews of depressed patients and their nurses.SETTING: A large academic, multi‐level, long‐term care facility.PARTICIPANTS: Thirty‐seven patients aged 74–99 (mean age 88.4) whom nurses identified as having daily symptoms of depression. Subjects had Mini‐Mental State Exam (MMSE) scores >10 (mean score 21.2), were not acutely or terminally ill, and were able to participate in an interview.MEASUREMENTS: DSM‐III‐R mood diagnoses and separate ratings of interviews with nurses and patients using the Cornell Scale for Depression.RESULTS: Nurses observed daily symptoms of depression in 110 of 495 (22%) long‐term care residents on units not reserved for advanced dementia. Of these 110 patients, 58 (53%) were not receiving antidepressants. Of 37 patients eligible for interviews, nine met criteria for major depression, 20 met criteria for another non‐major depression diagnosis, and eight did not have a diagnosable mood disorder. Cornell scale ratings derived exclusively from interviews of nurses were similar across the three diagnostic groups (12.5, 9.9, and 9.5, respectively; P = .31; mean 10.5), whereas Cornell scale ratings from patient interviews differed among groups (15.9, 6.9, and 4.1, respectively; P < .001; mean 8.4). Correlation between nurse Cornell ratings and patient Cornell ratings was poor (r = .27), especially for patients with non‐major forms of depression (r = ‐.20). MMSE and Cumulative Illness Rating Scale (CIRS‐G) scores were similar in the three groups.CONCLUSIONS: Nurses frequently observed symptoms of depression in a long‐term care setting, and many symptomatic patients were not being treated with antidepressants. In these patients, nurse‐derived symptom ratings did not vary across DSM‐III‐R diagnostic categories and correlated poorly with ratings from direct patient interviews. These findings suggest that nurse caregivers may contribute important diagnostic information about non‐major depression and raise questions about the application of standard diagnostic categories to late‐life depression in the nursing home.