bluuebunny/crossref_metadata_2025_split huggingface dataset:
Drug‐Drug Interactions Related to Hospital Admissions in Older Adults: A Prospective Study of 1000 Patients
Authors: Doucet J. , Chassagne P. , Trivalle C. , Landrin I. , Pauty M. D. , Kadri N. , Ménard J. F. , Bercoff E. 
Published: April 2015

OBJECTIVE: To investigate the frequency, nature, and side effects of drug‐drug interactions (DDI) in a group of geriatric inpatients.DESIGN: Study of drugs administered at home in the 2 weeks preceding hospitalization.SETTING: Evaluation of patients admitted to a geriatric unit from the emergency unit.PATIENTS: One thousand inpatients more than 70 years of age (83.0 $pL 7.1 years), admitted consecutively to a hospital for acute illness.MEASUREMENTS: All possible two by two combinations of drugs administered at home were considered to determine whether these associations could lead to a DDI and whether side effects resulted from these interactions.RESULTS: Five hundred thirty‐eight patients were exposed to 1087 DDI. The most frequently involved drugs were cardiovascular and psychotropic medications. There were 189 side effects observed in 130 patients. The most frequent side effects were neuropsychological impairment, arterial hypotension, and acute renal failure. The number of side effects did not differ between the 66 contraindicated drug associations and the 1021 associations that only required precautionary use.CONCLUSIONS: DDI frequently lead to side effects in older adults. Classifications of DDI must be adapted to increased DDI sensitivity in this population. Nevertheless the frequency of side effects might be reduced by limiting the prescription of the most frequent and dangerous DDI. J Am Geriatr Soc 44:944–948, 1996.
Nutritional Risk in Inner‐City‐Dwelling Older Black Americans
Authors: Miller Douglas K. , Carter Myrtle E. , Sigmund Robert H. , Smith John Q. , Miller J. Philip , Bentley Judy A. , McDonald Kim , Coe Rodney M. , Morley John E. 
Published: April 2015

OBJECTIVE: To define the degree of nutritional risk in older inner‐city black Americans and to identify important underlying factors associated with high nutritional risk.DESIGN: Cross‐sectional descriptive study.SETTING AND PARTICIPANTS: A population‐based sample of 400 noninstitutionalized persons older than 69 years of age in north St. Louis (NSL), Missouri, and a community‐based sample of 115 residents aged 50 years and older living in public housing in East St. Louis (ESL), Illinois. Both study areas have high levels of poverty.MEASUREMENTS: Nutritional risk was measured using the Nutrition Screening Initiative Checklist. Demographic information, economic status, self‐rated health, Geriatric Depression Scale score, and body mass index were assessed using established standardized instruments.MAIN RESULTS: Forty‐eight percent of NSL and 66% of ESL subjects scored high on the Checklist. Compared with a mostly white (96%) comparison group from New England, both samples demonstrated particularly high prevalence for limited intake of fruits, vegetables, and milk; tooth and mouth problems; lack of money for food; eating alone; polypharmacy; and inability to shop, cook or feed on their own. High levels of depressive symptoms, fair or poor self‐rated health, perceived inadequacy of income, and low income levels were associated with high risk, but even those subjects with no or few such predisposing factors were still high on the Checklist score compared with the New England sample.CONCLUSIONS: If confirmed, these results indicate that inner‐city‐dwelling older black Americans are at high nutritional risk. Attempts to reduce their nutritional risk should focus on improving nutritional content of their diet, oral health, polypharmacy, depressive symptoms, and poor general health; offering group meals; and providing assistance with shopping and cooking. J Am Geriatr Soc 44:959–962, 1996.
Characteristics of Urinary Incontinence in Homebound Older Adults
Authors: McDowell B. Joan , Engberg Sandra J. , Rodriguez Eric , Engberg Richard , Sereika Susan 
Published: April 2015

OBJECTIVE: To describe the characteristics of urinary incontinence and related factors in incontinent homebound older adults.DESIGN: A descriptive study of 90 cognitively intact incontinent homebound older persons referred to a clinical trial to examine the effectiveness of behavioral therapies in the treatment of urinary incontinence (UI) in homebound patients.SETTING AND PARTICIPANTS: Incontinent patients more than 60 years of age who met the Health Care Financing Administration's definition of homebound were referred to a clinical trial by home care nurses from a Medicare‐approved home care agency in a large metropolitan county in Pennsylvania.MEASURES: Structured continence and medical history, basic and instrumental activities of daily living, Folstein MMSE, Geriatric Depression Scale, mobility‐toileting skills, bladder diaries, and physical examination.RESULTS: Four hundred eighty‐four persons were referred to the clinical trial, and 90 cognitively intact persons were found eligible to participate in this study (80 women and 10 men). Subjects had a mean age of 75.8 years, reported a mean of 8.4 medical problems, and most, 80%, had functional limitations in ambulation. Subjects recorded a mean of 3.8 urinary accidents/day–1.4 large and 2.4 small accidents/ day – in baseline bladder diaries. The majority, 73.3%, had more than 10 accidents per week, and most patients reported mixed urge, stress (57.1%), or pure urge (37.7%) UI. Half (54.4%) reported that UI further restricted their activities, and 52.2% reported that this problem was extremely disturbing. However, 90.5% believed that UI could be treated.CONCLUSIONS: Urinary incontinence tends to be severe among cognitively intact homebound older adults in both frequency and volume of accidents. Although subjects were homebound with many health and functional disabilities, they perceived UI as a very disturbing problem that further restricted their activities. Participants in this study were optimistic about the potential benefits of treatment. J Am Geriatr Soc 44:963–968, 1996.
Predictors of Change in Walking Velocity in Older Adults
Authors: Gibbs James , Hughes Susan , Dunlop Dorothy , Singer Ruth , Chang Rowland W. 
Published: April 2015

OBJECTIVE: To determine factors that predict change in walking velocity in older people using a multivariate model.DESIGN: Longitudinal observational study.SUBJECTS: A total of 588 persons older than age 60, including subjects residing in a continuing care retirement community (CCRC) (n = 248), and homebound (n = 79) and ambulatory (n = 261) subjects. Mean age at baseline = 77.MEASUREMENT: Independent variables included demographics, physician measures of lower‐extremity joint impairment and other musculoskeletal and neurological variables, comorbidities derived from physical examination and chart abstract, self‐assessed arthritis pain, depression, and anxiety. The major dependent variables were 2‐ and 4‐year decline in walking velocity below a threshold associated with nursing home placement.MAIN RESULTS: From baseline to Year 4, median walking velocity declined from 61.8 to 53.0 m/min, and the proportion of subjects above a threshold value of 11.5 m/min declined from 95.3% to 80.4%. Age, joint impairment, and weakness of quadriceps, measured at baseline, predicted 2‐year and 4‐year decline in walking velocity.CONCLUSIONS: The findings indicate that joint impairment and quadriceps strength contribute significantly to crossing a clinically significant threshold in walking velocity among older people over time. Future research is needed to determine whether these risk factors can be modified through preventive interventions such as muscle‐strengthening exercises and pain medication. J Am Geriatr Soc 44:126–132, 1996.
The Benefits of Psychiatric Hospitalization for Older Nursing Home Residents
Authors: Kunik Mark E. , Ponce Hernando , Molinari Victor , Orengo Claudia , Emenaha Ify , Workman Richard 
Published: April 2015

OBJECTIVETo examine the demographic characteristics and treatment outcomes of nursing home residents admitted to a geropsychiatric inpatient unit.DESIGNA retrospective cohort design based on an ongoing data base effort.SETTINGThe geropsychiatric inpatient unit of the Houston Veterans Affairs Medical Center Hospital.PARTICIPANTSAll admissions to the unit from nursing homes during an 18‐month period.MEASUREMENTSMini‐Mental State Examination, Brief Psychiatric Rating Scale, Hamilton Rating Scale for Depression, Cohen‐Mansfield Agitation Inventory, Rating Scale for Side Effects, and Global Assessment of Functioning were administered on admission and discharge.RESULTSPaired t tests comparing change scores revealed significant decreases in general psychiatric symptoms (P < .001), depression (P < .001), and agitation (P < .001); significant improvement in global functioning (P < .001); with no significant changes in cognitive status (P = .485) or side effects (P = .120). When the patients were subgrouped according to reasons for admission, paired t tests revealed decreases in violence (CMAI Factor 1; P = .000), psychosis (BPRS thought disorder scale; P = .000 and hostility subscale; P < .008), and depression (HAM‐D; P = .002). Four patients were discharged to less restrictive environments, all with chronic mental illnesses.CONCLUSIONInpatient psychiatric hospitalization significantly benefits nursing home residents with and without dementia who are admitted for severe behavior problems.
Attitudes Toward Use of Nursing Homes and Home Care in Older Japanese‐Americans
Authors: McCormick Wayne C. , Uomoto Jay , Young Heather , Graves Amy B. , Vitaliano Peter , Mortimer James A. , Edland Steven D. , Larson Eric B. 
Published: April 2015

OBJECTIVE: A cohort of 1142 older Japanese Americans was identified to study preferences and attitudes regarding use of long‐term care (nursing home or home care).DESIGN: Prospective cohort study.PARTICIPANTS AND SETTING: Older Japanese Americans in King County, Washington.RESULTS: Subjects were asked to consider hypothetical situations in which they were temporarily disabled by hip fracture or permanently disabled by dementing illness. If they fractured a hip, only 12% intended to use a nursing home; 29% intended to recover at home with the help of family or friends; another 54% intended to use paid home health care. If they became demented, the majority (53%) intended to use a nursing home; only 11% intended to rely on family or friends for care, and another 29% intended to use paid home health care. Similar responses were observed when subjects were asked what most members of their family or friends would wish them to do; however, they tended to value the perceived wishes of religious figures or the Japanese American community‐at‐large less than those of family or friends. Significant correlates with intention to enter nursing homes were lack of social support (unmarried, few or no close relatives or housemates), female gender, and high levels of acculturation into American society (never lived in Japan, English‐speaking only). Other factors that were not significantly correlated were health perceptions, satisfaction and life control scales, and health care utilization (hospitalizations and MD visits). In multivariate logistic regression, marital status and level of acculturation were the most powerful independent predictors of intention to enter nursing homes. Age and female gender were predictors of intention to use home care. In the base population of subjects, the prevalence of nursing homes use (5%) was similar to that of the general US older population.CONCLUSIONS: We conclude that older Japanese Americans in the Pacific Northwest often intend to enter nursing homes if they became disabled by dementing illness. Actual use is similar to other older populations. This may be attributable largely to the existence of an ethnically appropriate nursing home which is strongly supported by, and familiar to, this close‐knit community. Intention to use long‐term care services appears to be dependent primarily on the level of social supports and acculturation into American society.
Do Neural Factors Underlie Age Differences in Rapid Ankle Torque Development?
Authors: Thelen Darryl G. , Ashton‐Miller James A. , Schultz Albert B. , Alexander Neil B. 
Published: April 2015

OBJECTIVES: Rapid torque development is substantially slower in healthy old adults compared with young adults, but the underlying cause of this age‐related loss remains unclear. Measurements of myoelectric signals in ankle dorsi‐ and plantarflexor muscles during rapid exertions were used to explore the extent to which the loss might be attributed to neural factors.METHODS: Myoelectric signals were measured in a laboratory setting in 24 healthy young and 24 healthy old adult volunteers during rapid isometric and isokinetic torque development. Premotor times, muscle activation rates, and myoelectric activity levels of agonistic and antagonistic muscles were quantified.RESULTS: There were few marked age differences in the premotor times or in the onset rates or magnitudes of agonistic muscles activities during maximum isometric and during isokinetic exertions. Premotor times were statistically associated with age but, in the mean, were only approximately 10 to 25 ms longer in the old. Age effects on agonist muscle activity magnitudes were significant only in the lateral gastrocnemius. Small decreases in antagonistic muscle activity levels with age were found.CONCLUSIONS: Given the outcomes of this study, the differences observed previously in rapid torque development abilities in healthy older adults, compared with healthy younger adults, seem attributable largely to differences in muscle contraction mechanisms rather than to differences in speeds of stimulus sensing or central processing of motor commands, or to differences in muscle recruitment strategies.
Looking Inside the Black Box of Comprehensive Geriatric Assessment: A Classification System for Problems, Recommendations, and Implementation Strategies
Authors: Reuben David B. , Fishman Linda K. , McNabney Matthew , Wolde‐Tsadik Girma 
Published: April 2015

OBJECTIVE: To develop and test the inter‐rater reliability of a coding system for geriatric problems identified through Comprehensive Geriatric Assessment (CGA) of hospitalized older persons, recommendations generated by the assessment, and implementation strategies for these recommendations.DESIGN: Validation study.SETTING: A health maintenance organization and a geriatrics academic program.PARTICIPANTS: A total of 49 hospitalized older persons, who met at least 1 of 13 inclusionary “targeting” criteria, two geriatricians, and one social worker who coded forms.MEASUREMENTS: Standardized coding of CGA consultation sheets into (1) geriatric problems identified, (2) recommendations, and (3) implementation strategies; inter‐rater reliability testing of coding system using two physicians and a social worker.RESULTS: On average, each assessed patient had 4.8 recommendations. The largest percentages of recommendations were for non‐physician referrals (18.2%), advance directives (13.4%), medication adjustments (11.5%), diagnostic evaluation/monitoring (11.5%), and community services (10.9%). The proportions of agreement between raters in coding problems ranged from 0.77 to 0.90, in coding recommendations from 0.69 to 0.86, and in coding implementation strategies from 0.68 to 0.83.CONCLUSION: A classification system for measuring some components of the process of care of CGA has satisfactory inter‐rater reliability, can be adapted for other settings, and may provide valuable insight into determining which components of CGA confer health benefits.
Self‐Report of Difficulty in Performing Functional Activities Identifies a Broad Range of Disability in Old Age
Authors: Langlois Jean A. , Maggi Stefania , Harris Tamara , Simonsick Eleanor M. , Ferrucci Luigi , Pavan Mara , Sartori Leonardo , Enzi Giuliano 
Published: April 2015

OBJECTIVE: To describe a broad range of physical disability by examining the association between a four‐level measure of disability, based on self‐report of difficulty in performing functional activities, and previously identified risk factors for disability.DESIGN: Cross‐sectional.SETTING: Community‐based.PARTICIPANTS: A total of 2373 noninstitutionalized men and women aged 65 and older from the Veneto Region of Italy.MEASUREMENTS: Odds ratios for the association of the four levels of disability (none, mild, moderate, and ADL disability) differentiated by this new measure with known risk factors for physical disability.MAIN RESULTS: This summary measure of physical disability distinguished older persons with disability from the population typically classified as nondisabled. Twenty‐one percent of study participants were identified as having Activities of Daily Living (ADL) disability (defined as self‐report of difficulty in one or more ADLs), and an additional 40% had mild or moderate disability based on degree of difficulty in Instrumental Activities of Daily Living (IADLs) and physical functional activities. Hip fracture and lower extremity performance were strongly independently associated with each level of disability. The association of a range of established risk factors for disability and health care utilization measures with the levels of disability identified in our study, and the trend toward increasing odds with increasing disability, provide evidence of the construct validity of this measure.CONCLUSIONS: Self‐report of difficulty in performing functional activities identifies older persons with physical disability not ascertained by self‐report of the need for help,
The Relative Importance of Strength and Balance in Chair Rise by Functionally Impaired Older Individuals
Authors: Schenkman Margaret , Hughes Michael A. , Samsa Greg , Studenski Stephanie 
Published: April 2015

OBJECTIVE: The ability to stand independently and safely from the seated position is essential for independent function. This investigation determined the relative contributions of measures of lower extremity strength and measures of balance control in explaining the performance characteristics of sitting‐to‐standing. Variables analyzed included those related to success of the activity (e.g., time to rise, lowest chair height) and to biomechanical characteristics of performance (e.g., how fast specific body segments moved).SETTING: Durham Veteran's Affairs Medical Center motion analysis laboratory.DESIGN: Cross‐sectional correlational study.PARTICIPANTS: Fifty‐eight men and women aged 66 to 96 (mean = 77) with functional limitations.MEASUREMENTS: Predictor variables were lower extremity strength (isometric) and balance (functional reach and sway). The outcome variable, chair rise performance, was quantified by: lowest successful chair height (chairs at 33 to 58 cm); time to rise; maximum hip flexion angular velocity; and the maximum horizontal and vertical velocities of the motion of the body center of mass (COM). Covariates were lower extremity range of motion and sensory status.RESULTS: With bivariate analysis, lower extremity strength demonstrated relationships with the lowest chair height (r = −0.639) and maximum vertical velocity of the COM (r = .389); functional reach was associated with three variables (lowest chair height r = .374; time to rise r = .297; and maximum horizontal velocity of the COM r = .251). Using a multivariate regression analysis (including lower extremity strength, functional reach, sensory loss, and lower extremity range of motion), the model accounted for 47% of the variance in lowest chair height; lower extremity strength was the only significant predictor (P < .001). The model also accounted for 20% of the variance in maximum horizontal velocity of the COM; lower extremity strength was a significant predictor (P = .006).CONCLUSIONS: Lower extremity strength and balance control both play a role in performance of chair rise; lower extremity strength is the stronger predictor of success for functionally impaired older adults.
Markers of Failure to Thrive Among Older Hip Fracture Patients
Authors: Fox Kathleen M. , Hawkes William G. , Magaziner Jay , Zimmerman Sheryl I. , Hebel J. Richard 
Published: April 2015

OBJECTIVES: To determine whether there is a group of recent hip fracture patients who exhibit the signs of failure to thrive and to identify potential precursors to their decline in physical functioning.DESIGN: Prospective (nonintervention) study of hip fracture recovery; patients were assessed in the hospital and at 2, 6, 12, 18, and 24 months post‐fracture.SETTING: Hip fracture patients admitted to one of eight Baltimore area hospitals from the community with a new fracture of the proximal femur between January 1, 1990, and June 15, 1991.PARTICIPANTS: Patients were 65 years of age and older and lived in the community before the fracture. A total of 804 patients were eligible for the study; the present study analyses were restricted to the 252 patients who survived 1 year and had a self‐report assessment at 6 and 12 months post‐fracture.MEASUREMENTS: A questionnaire administered during hospitalization assessed pre‐fracture functional and health status and current affective and cognitive status. In‐home interviews post‐fracture ascertained dependence and difficulty with physical and instrumental activities of daily living. Abstraction of the medical records provided information about comorbidities, surgical procedure, and hospital length of stay.RESULTS: Patients who declined in ability to walk from 6 to 12 months post‐fracture had greater use of health resources (more hospitalizations) and poorer physical functioning up to 2 years post‐fracture. Impaired function in physical activities of daily living at 6 months, high glucose, calcium, and CO2 at admission, and low BUN and creatinine at admission were more prevalent among decliners than among non‐decliners.CONCLUSIONS: Findings indicate that certain older hip fracture patients begin to exhibit signs and symptoms of failure to thrive. About 10% of patients who survived at least 1 year after fracture could not retain their recovery level of functioning after 6 months and began to decline further. High glucose and CO2 and low BUN and creatinine on hospital admission were associated with later functional decline among hip fracture patients, but their clinical significance is uncertain. J Am Geriatr Soc 44:371–376, 1996.