bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geriatric Syndromes as Outcome Measures of Hospital Care: Can Administrative Data Be Used?
Authors: Berlowitz Dan R. , Brand Harriet K. , Perkins Cynthia 
Published: April 2015

OBJECTIVE: To determine how often hospital administrative databases capture the occurrence of two common geriatric syndromes, pressure ulcers and incontinence.DESIGN: Retrospective comparison of a nursing home and hospital database.SETTING: Department of Veterans Affairs (VA) hospitals.PARTICIPANTS: All patients between 1992 and 1996 discharged from VA acute medical care and admitted to a VA nursing home.MEASUREMENTS: The presence of incontinence or a pressure ulcer (stage 2 or larger) on admission to the nursing home was determined. Hospital discharge diagnoses were then reviewed to determine whether these conditions were recorded. The effect of ulcer stage, total number of discharge diagnoses, and temporal trends on the recording of these conditions in discharge diagnoses was also noted.RESULTS: There were 17,004 admissions to nursing homes from acute care in 1996; 12.7% had a pressure ulcer and 43.4% were incontinent. Among these patients with a pressure ulcer, the hospital discharge diagnosis listed an ulcer in 30.8% of cases, and incontinence was included correctly as a discharge diagnosis in 3.4%. While deeper pressure ulcers were more likely to be recorded than superficial ulcers (P < .01), nearly 50% of stage 4 ulcers were not listed among hospital discharge diagnoses. Patients with more discharge diagnoses were more likely to record both conditions correctly. From 1992 to 1996, small but significant (P = .001) improvements were noted in the correct recording of these geriatric syndromes as discharge diagnoses.CONCLUSIONS: The occurrence of pressure ulcers and incontinence cannot be determined from hospital administrative databases and should not be used as outcomes when measuring quality of care among hospitalized patients. J Am Geriatr Soc 47:692–696, 1999.
Home Hospital Program: A Pilot Study
Authors: Leff Bruce , Burton Lynda , Guido Susan , Greenough William B. , Steinwachs Donald , Burton John R. 
Published: April 2015

OBJECTIVE: To evaluate the basic safety and feasibility of hospital care at home (Home Hospital (HH)) for treating acutely ill older persons requiring hospitalization.DESIGN: Prospective case seriesSETTINGS AND PARTICIPANTS: Community‐dwelling persons aged 65 and older requiring acute hospital admission for community‐acquired pneumonia, chronic heart failure, chronic obstructive airways disease, or cellulitis.RESULTS: Seventeen subjects were treated in HH. One hundred twenty‐two could not be enrolled because they presented for admission at times when HH was not operational. Six patients refused to enroll in HH. Subjects treated in HH had comparable clinical outcomes to those treated in the acute hospital and were highly satisfied with HH. Charges for HH care were 60% of those for the acute hospital care.CONCLUSIONS: In this pilot study, HH was safe, feasible, highly satisfactory, and cost‐effective for certain acutely ill older persons who required acute hospitalization. J Am Geriatr Soc 47:697–702, 1999.
Definition of Race and Ethnicity in Older People in Medicare and Medicaid
Authors: Pan Cynthia X. , Glynn Robert J. , Mogun Helen , Choodnovskiy Igor , Avorn Jerry 
Published: April 2015

BACKGROUND: Race and ethnicity are important predictors of health care access and outcomes, but quality of their documentation in the healthcare system is often problematic.OBJECTIVES: To study the agreement between Medicare and Medicaid descriptions of race and ethnicity in older beneficiaries.DESIGN: Quasiexperimental design in a natural practice setting.SETTING: New Jersey.PARTICIPANTS: 153,241 dually enrolled participants in Medicare and Medicaid.MEASUREMENTS: Agreement rates between administrative databases on recipients' race and ethnicity.RESULTS: Agreement between Medicare and Medicaid on the recipients' race and ethnicity was modest (kappa = .58; 95% CI, .57‐.58) for men and women alike and across different age groups. Depending on whether Medicare or Medicaid was used as the reference standard, the relative agreement rates for race and ethnic group assignments varied. For example, using Medicare as the reference, the relative agreement rate was 84% for whites, 74% for blacks, 61 % for others, 23% for Hispanics, and only 5% for Asians. Using Medicaid as the reference, a different pattern emerged. However, such gradients of agreement rates across racial groups were observed in both programs. Medicare and Medicaid reported different percentages of all race and ethnicity groups, with Medicaid reporting greater proportions of White and Black beneficiaries, and Medicare reporting greater proportions of Hispanic, Asian, and Other groups.CONCLUSIONS: Depiction of race and ethnicity data in large government health insurance programs is approximate at best and often contradictory from one program to another. This can impede efforts to study the relationship between these important characteristics and health care utilization and outcomes. J Am Geriatr Soc 47:730–733, 1999.
MANAGEMENT OF ATRIAL FIBRILLATION, VENTRICULAR ARRHYTHMIAS AND PACEMAKERS IN OLDER PERSONS: Series Editor: Wilbert S. Aronow, MD: Management of the Older Person With Atrial Fibrillation
Authors: Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To review the management of the older person with atrial fibrillation (AF).DATA SOURCES: A computer‐assisted search of the English language literature (MEDLINE) database followed by a manual search of the bibliographies of pertinent articles.STUDY SELECTION: Studies on the management of persons with AF were screened for review. Studies of persons older than age 60 and recent studies were emphasized.DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was placed on studies involving older persons. Relevant articles were reviewed in depth.DATA SYNTHESIS: Available data about the management of persons with paroxysmal or chronic AF were summarizedCONCLUSIONS: Management of AF includes treatment of the underlying disease and precipitating factors. Immediate direct‐current cardioversion should be performed in persons with AF associated with an acute myocardial infarction, chest pain caused by myocardial ischemia, hypotension, severe heart failure, or syncope. Intravenous verapamil, diltiazem, or beta‐blockers should be used to slow a very rapid ventricular rate associated with AF immediately. Oral verapamil, diltiazem, or a beta‐blocker should be given if a rapid ventricular rate occurs at rest or during exercise despite digoxin. Amiodarone may be used in selected persons with symptomatic life‐threatening AF refractory to other drug therapy. Nondrug therapies should be performed in persons with symptomatic AF in whom a rapid ventricular rate cannot be slowed by drug therapy. Paroxysmal AF associated with the tachycardia‐bradycardia syndrome should be treated with a permanent pacemaker in combination with drugs. A permanent pacemaker should be implanted in persons with AF who develop cerebral symptoms such as dizziness or syncope associated with ventricular pauses greater than 3 seconds that are not drug‐induced. Elective cardioversion of AF should not be performed in asymptomatic older persons with chronic AF. Unless transesophageal echocardiography has shown no thrombus in the left atrial appendage before cardioversion, oral warfarin should be given for 3 weeks before elective direct‐current or drug cardioversion of AF and continued for at least 4 weeks after maintenance of sinus rhythm. Many cardiologists prefer the treatment strategy, especially in older persons, of ventricular rate control plus warfarin rather than maintaining sinus rhythm with antiarrhythmic drugs. Digoxin should be avoided in persons with sinus rhythm who have a history of paroxysmal AF. Older persons with chronic or paroxysmal AF who are at high risk for stroke or who have a history of hypertension and no contraindications to warfarin should receive long‐term warfarin to achieve an International Normalized Ratio of 2.0 to 3.0. Older persons with AF who are at low risk for stroke or who have contraindications to warfarin should receive 325 mg of aspirin daily. J Am Geriatr Soc 47:740–748,1999.
Drugs and Falls in Older People: A Systematic Review and Meta‐analysis: I. Psychotropic Drugs
Authors: Leipzig Rosanne M. , Cumming Robert G. , Tinetti Mary E. 
Published: April 2015

OBJECTIVES: To evaluate critically the evidence linking psychotropic drugs with falls in older people.DESIGN: Fixed‐effects meta‐analysis.DATA SOURCES: English‐language articles in MEDLINE (1966 – March 1996) indexed under accidents or accidental falls and aged or age factors; bibliographies of retrieved papers.STUDY SELECTION: Systematic evaluation of sedative/hypnotic, antidepressant, or neuroleptic use with falling in people aged 60 and older.DATA EXTRACTION: Study design, inclusion and exclusion criteria, setting, sample size, response rate, mean age, method of medication verification and fall assessment, fall definition, and the number of fallers and non‐fallers taking specific classes of psychotropic drugs.RESULTS: Forty studies, none randomized controlled trials, met eligibility criteria. For one or more falls, the pooled odds ratio (95% confidence interval) was 1.73 (95%CI, 1.52‐1.97) for any psychotropic use; 1.50 (95%CI, 1.25‐1.79) for neuroleptic use; 1.54 (95%CI, 1.40‐1.70) for sedative/hypnotic use; 1.66 (95%CI, 1.4‐1.95) for any antidepressant use (mainly TCAs); 1.51 (95%CI, 1.14‐2.00) for only TCA use; and 1.48 (95%CI, 1.23‐1.77) for benzodiazepine use, with no difference between short and long acting benzodiazepines. For neuroleptics in psychiatric inpatients, the pooled OR was 0.41 (95%CI, 0.21‐.82); for all other patients, the pooled OR was 1.66 (95%CI, 1.38‐2.00). Comparing ≥1 with ≥ 2 falls, mean subject age >75 versus ≥ 75 years old, communities with >35% versus ≥35% fallers, or subject place of residence did not affect the pooled OR. Increased falls occurred in patients taking more than one psychotropic drug.CONCLUSION: There is a small, but consistent, association between the use of most classes of psychotropic drugs and falls. The evidence to date, however, is based solely on observational data, with minimal adjustment for confounders, dosage, or duration of therapy. The incidence of falls and their consequences in this population necessitate that future large randomized controlled trials of any medication in older persons should measure falls prospectively as an adverse outcome event.
Mismatches Between the Home Environment and Physical Capabilities Among Community‐Living Older Persons
Authors: Gill Thomas M , Robison Julie T. , Williams Christianna S. , Tinetti Mary E. 
Published: April 2015

OBJECTIVE: To determine whether environmental hazards related to transfers, balance, and gait are any less prevalent in the homes of older persons with specific deficits in physical capabilities than they are in the homes of older persons without the same deficits.DESIGN: Cross‐sectional study of a population‐based cohort.SETTING: The general community in New Haven, Connecticut.PARTICIPANTS: A total of 1088 persons, aged 72 years and older, who had an environmental assessment of their homes.MEASUREMENTS: Each participant underwent a physical performance assessment and comprehensive interview to document the presence of underlying deficits in physical capabilities. Items from the environmental assessment that were potentially hazardous for participants with specific deficits in transfers, balance, or gait were identified.RESULTS: With the exception of no grab bars in the tub/shower, environmental hazards were as prevalent in the homes of participants with specific deficits in physical capabilities as they were in the homes of participants without the same deficits, and, in many cases, they were actually more prevalent. Among participants with and without observed difficulty standing from a chair, for example, the prevalence of a low lying chair was 24% versus 14% (x2 = 13.4; P < .001), respectively. Among participants with and without an observed deficit in turning, the prevalence of an obstructed pathway was 47% versus 37% (x2 = 8.7; P = .003), respectively; and the prevalence of loose throw rugs was 72% in both groups.CONCLUSIONS: If the epidemiologic link between environmental hazards and adverse functional outcomes can be strengthened, then interventions designed to enhance the everyday function of frail, older persons should focus on the environment as well as the individual.
Estrogen Replacement Therapy and Cognitive Decline in Older Community Women
Authors: Matthews Karen , Cauley Jane , Yaffe Kristine , Zmuda Joseph M. 
Published: April 2015

BACKGROUND: The purpose of this study was to evaluate the cross‐sectional and longitudinal association of oral estrogen replacement therapy (ERT) and cognitive function in an older, nondemented sample of women.METHODS: In a prospective cohort of 9651 white women aged 65 years and older enrolled in the Study of Osteoporotic Fractures, a modified Mini‐Mental Status Exam (mMMSE), and digit symbol substitution and Trails B tests were administered twice, 4 to 6 years apart. History and current use of oral ERT was documented. Age, educational attainment, and activity limitations were the primary covariates in the analyses; in addition, stroke and depression scores were adjusted in subsets of women with available data.RESULTS: Current and past users of ERT had better initial scores on the mMMSE than did never users, P < .05 and .001, respectively, with better scores for current estrogen hormone users being most apparent among the older and less educated women. The percentages of women scoring ≤23 of a possible 26 on the mMMSE were 14.3 for current users, 14.5 for past users, and 20.5 for never users, P < .001. However, only past users exhibited smaller declines upon retesting in mMMSE and Trails B performance, P < .05, than did never users. Educational attainment predicted both initial test scores and change scores and was, next to age, the most powerful predictor of cognitive function.CONCLUSIONS: Current oral ERT does not protect against age‐related declines in cognitive function in older nondemented women, whereas formal education does protect, even though it had been completed many years earlier. The influence of education in late‐life on cognitive function should be tested. J Am Geriatr Soc 47:518–523, 1999.
Associations of Symptoms of Sleep Apnea with Cardiovascular Disease, Cognitive Impairment, and Mortality Among Older Japanese‐American Men
Authors: Foley Daniel J. , Monjan Andrew A. , Masaki Kamal H. , Enright Paul L. , Quan Stuart F. , White Lon R. 
Published: April 2015

OBJECTIVES: To examine the association between symptoms of sleep apnea and prevalent cardiovascular disease, cognitive impairment, and subsequent 3‐year mortality.DESIGN: A longitudinal study.SETTING: Participants lived in the community on Oahu, HawaiiPARTICIPANTS: A total of 2905 older Japanese‐American men participating in the fourth examination of the Honolulu Heart Program cohort study from 1991–1993, which is the baseline for the Honolulu‐Asia Aging Study of dementia.MEASUREMENTS: Self‐reported snoring, daytime sleepiness, and breathing pauses; diagnosed cardiovascular disease and dementia; cognitive functioning and vital status approximately 3 years later.RESULTS: More than 12% of the participants reported that they often or always snored loudly, and 8% reported being sleepy most of the day. Fewer than 2% reported that they stop breathing when sleeping, and this was found more frequently among habitual snorers (7%, P < .001) and those sleepy during the day (5%, P < .001). The prevalence of habitual snoring declined in the older age groups, was higher among those with greater Body Mass Index scores, and was not associated with the reporting of daytime sleepiness, diagnosis of heart disease, stroke, dementia, or cognitive impairment. Daytime sleepiness was more prevalent at older ages and was associated with a higher prevalence of heart disease and with cognitive impairment and dementia, chronic obstructive pulmonary disease, and diabetes. Self‐reported apnea was associated only with a history of pneumonia. Three‐year mortality was not associated with these symptoms after adjusting for prevalent heart disease and cognitive impairment.CONCLUSION: Symptoms of sleep apnea are reported less frequently in older Japanese‐American men. Excessive day‐time sleepiness is associated with poor cognition and dementia, but whether it also is an indicator for sleep apnea in this age group remains unclear. Epidemiologic studies of sleep apnea in older adults will require polysomnography to determine accurately the correlates and consequences of this condition. J Am Geriatr Soc 47:524–528, 1999.
Two Nursing Home Outbreaks of Respiratory Infection with Legionella sainthelensi
Authors: Loeb Mark , Simor Andrew E. , Mandell Lionel , Krueger Paul , McArthur Margaret , James Marilyn , Walter Stephen , Richardson Elizabeth , Lingley Michael , Stout Janet , Stronach David , McGeer Allison 
Published: April 2015

OBJECTIVE: To describe outbreaks of infection caused by Legionella sainthelensi occurring in older residents of two nursing homes and to determine risk factors for the development of infection.DESIGN: Descriptive epidemiology and a case‐control study.SETTING: Two nursing homes (140 beds and 254 beds in nursing homes A and B, respectively) located in southern Ontario, Canada, experiencing outbreaks of respiratory tract infection in July and August 1994.SUBJECTS: Case‐residents of the two nursing homes who met clinical and laboratory criteria for Legionella infection. Control‐residents were defined as those who were in the homes during the outbreaks and were asymptomatic.MEASUREMENTS: Active surveillance was conducted in both nursing homes to identify symptomatic residents. Residents with fever or respiratory tract symptoms had nasopharyngeal swabs taken for viral antigen detection and culture, urine for Legionella antigen detection, and acute and convalescent serology for viruses, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella. Chest X‐rays were performed, and an attempt was made to obtain blood and sputum cultures. Water samples from shower heads, faucets, and air conditioning units were collected for Legionella culture and polymerase chain reaction (PCR) assay. A case‐control study was done to assess possible risk factors for legionellosis.RESULTS: Twenty‐nine cases — 17 in nursing home A; 12 in nursing home B — were identified. Four (14%) case‐residents had documented pneumonia and four case‐residents died. Univariate analysis revealed that a history of stroke (odds ratio (OR) 2.3 (95% CI, 1.0–5.3)), eating pureed food (OR 4.6 (95% CI, 1.6–12.7)), and having fluids administered with medication (OR 2.5 (95% CI, 1.0–5.9)) were significant risk factors. Cases were less likely to wear dentures (OR .4 (95% CI, .2‐.9)) or to eat solid food (OR .3, (95% CI, .1‐.6)). Only eating pureed food remained significant in a multivariable analysis (OR 4.6 (95% CI, 1.6–13.0, P = .01)).CONCLUSION: This report describes outbreaks of legionellosis in two nursing homes, representing the first reported outbreaks of infection caused by Legionella sainthelensi. The association with illness of dietary characteristics indicative of swallowing disorders suggests that aspiration was the most likely mode of infection. The diagnosis of legionellosis should be considered during outbreaks of respiratory infection in nursing homes. J Am Geriatr Soc 47:547–552, 1999.
Patterns of Use of Common Major Procedures in Medical Care of Older Adults
Authors: Levinsky Norman G. , Ash Arlene S. , Yu Wei , Moskowitz Mark A. 
Published: April 2015

OBJECTIVES: We analyzed Medicare data to determine the influence of age, mortality during the study year, and high individual Medicare costs on the frequency of hospitalization for the most common major procedures and for general medical diagnoses.METHODS: We used 1992 Medicare data to classify the most frequent diagnosis related groups (DRGs), representing one‐half of all admissions, as procedural or general medical. We studied the frequency of hospitalization for the most common procedures (bowel surgery, cardiovascular procedures, hip and femur surgery) and for general medical care in the entire Medicare population, in persons aged 65 to 74, 75 to 84, and 85 or older, in those who died, and in the 5% of persons whose annual Medicare costs were the highest.RESULTS: In the entire population, common procedures accounted for 21 % of the most frequent DRGs. Among those who died, the procedures were performed in only 8% of admissions. In the 5 % of persons with the highest Medicare costs, 28% of admissions involved procedures. Admissions for cardiovascular procedures and for cancer chemotherapy decreased with age and were infrequent in persons 85 years and older. Hip and femur procedures increased with age and accounted for 70% of the common procedures in persons 85 years and older.CONCLUSIONS: The most common major procedures account for a minority of hospitalizations of persons more than age 65, of persons 85 and older, of those who died, and of persons with the highest Medicare expenditures. Most hospitalizations are for general medical care. Major procedures appear to be used with restraint in the very old and in persons in their last year of life. J Am Geriatr Soc 47:553–558, 1999.
Medication Management Capacity in Highly Functioning Community‐Living Older Adults: Detection of Early Deficits
Authors: Edelberg Helen K. , Shallenberger Elizabeth , Wei Jeanne Y. 
Published: April 2015

OBJECTIVE: The Drug Regimen Unassisted Grading Scale (DRUGS) was developed and employed in testing the hypothesis that the inability to take medication independently may correlate with the presence of cognitive impairment.DESIGN: Cross‐sectional study.SETTING: Two continuing care retirement facilities in the Greater Boston area.PARTICIPANTS: The study population included outpatients ≥ 70 years old.MEASUREMENTS: We developed a novel performance‐based measure, the DRUGS tool, involving a step‐wise progression of four tasks: (1) identification; (2) access; (3) dosage; and (4) timing.RESULTS: Fifty‐nine participants aged 84.2 ± 5.1 years (mean ± SD) completed the study. The DRUGS tool score was inversely related to age (r = ‐.41, P = .001). Compared with independent‐living, residence in assisted‐living was associated with lower DRUGS tool scores (82.0% vs 93.8%, P = .009). The DRUGS tool score was associated with self‐reported Medication Management capacity (94.8% able vs 86.2% unable to take medications independently by self‐report, P = .047). Both DRUGS tool score and self‐reported Medication Management capacity were associated with MMSE (P = .0008 and P = .044, respectively). The multivariate model, with DRUGS tool Summary Score as the dependent variable, adjusted for age and sex, included MMSE (P = .023) and self‐reported IADL (P = .038).CONCLUSION: There is an association between performance on the DRUGS tool and level of cognitive function. The DRUGS tool represents a unique individualized, yet standardized, assessment of the ability to function independently for ambulatory older persons. It may be useful for identifying those highly functioning older persons, at an early phase of cognitive decline, in whom targeted intervention would likely be most effective and efficient. J Am Geriatr Soc 47:592–596, 1999.