bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inappropriate Medication Prescribing in Homebound Older Adults
Authors: Golden Adam G. , Preston Richard A. , Barnett Scott D. , Llorente Maria , Hamdan Kamal , Silverman Michael A. 
Published: April 2015

OBJECTIVESLittle is known about the prescribing of medications in the growing population of homebound older adults. We report on the prevalence and pattern of inappropriate medications in a nursing home‐eligible, homebound population.DESIGNA cross‐sectional design.SETTINGA managed care plan for individuals meeting nursing home eligibility.PARTICIPANTS2193 homebound people older than age 60.MEASUREMENTSWe reviewed the pharmacy profiles of all older homebound enrollees. We identified the average number of medications per patient and the most commonly prescribed classes of drugs. The medication profiles were also analyzed in the context of the 26 drugs/groups listed as inappropriate by the explicit criteria of Beers [Arch Intern Med 1997; 157:1531–1536].RESULTSA total of 2193 people aged 60 to 106 (mean 82.8 ± 8.8) were taking an average of 5.3 ± 2.9 drugs (range 0–22). Cardiac drugs and benzodiazepines were the medications most commonly prescribed. We found 1152 of the total 11,689 prescriptions (9.9%) to be inappropriate. Eight hundred seventy‐one (39.7%) of these 2193 residents had at least one inappropriate prescription, and 230 (10.4%) had two or more. Of particular concern were 285 people prescribed excessive doses of temazepam and zoldipem, 211 people taking first‐generation antihistamines, 115 taking doxepin or amitriptyline, 106 taking an ergoloid, 98 taking dipyridamole, and 85 prescribed a long‐acting benzodiazepine.CONCLUSIONSOur study revealed a high prevalence of psychotropic medications and inappropriate drug use among older homebound residents, a group that is at the highest risk for adverse drug reactions. Because this group is not subject to oversight by regulatory agencies, further interventional studies and provider education will be important.
Age‐ and Gender‐Related Use of Low‐Dose Drug Therapy: The Need to Manufacture Low‐Dose Therapy and Evaluate the Minimum Effective Dose
Authors: Rochon Paula A. , Anderson Geoffrey M. , Tu Jack V. , Gurwitz Jerry H. , Clark Jocalyn P. , Shear Neil H. , Lau Paula 
Published: April 2015

OBJECTIVESLow‐dose drug therapy is promoted as a way to maximize benefit and minimize adverse drug effects when prescribing for older adults. This population‐based study evaluates the age and sex‐related use of two common therapies: thiazide diuretics, where evidence supports the use of low‐dose therapy, and beta‐blockers, where trials have not evaluated the minimum effective dose.DESIGNUsing linked administrative databases we identified all of the 120,613 persons dispensed a thiazide diuretic therapy and 12,908 myocardial infarction survivors dispensed beta‐blocker therapy in Canada's largest province. We used logistic regression models to study the association of age and sex with dispensing of low‐dose thiazide diuretic and beta‐blocker therapy at doses lower than evaluated in trials.RESULTSOf 120,613 older people dispensed a thiazide diuretic, 32,372 (26.8%) were dispensed a low dose. Patients 85 years of age or older, relative to the youngest group, were 30% more likely to be dispensed low‐dose therapy (OR=1.31; 95% CI, 1.27 to 1.36; P < .001). Women were 8% more likely than men to be dispensed a low‐dose thiazide diuretic (OR=1.08; 95% CI, 1.05 to 1.11; P < .001).Of 10,991 myocardial infarction survivors dispensed atenolol, metoprolol, propranolol, or timolol, 9458 (86.1%) were dispensed a lower‐than‐evaluated dose. Patients 85 years of age or older, relative to those in the youngest group, were more than twice as likely to be dispensed a lower‐than‐evaluated beta‐blocker therapy dose (OR=2.28; 95% CI, 1.74 to 3.04; P < .001). No difference was noted in the use of beta‐blocker therapy dose by sex (OR=1.0; 95% CI, .89 to 1.15; P = .95).CONCLUSIONSLow‐dose thiazide diuretic therapy prescribed widely to older people, particularly those of advanced age and women. The vast majority of myocardial infarction survivors were dispensed beta‐blocker therapy at lower‐than‐evaluated doses. These findings highlight the need to manufacture low‐dose thiazide diuretic therapy and to evaluate the minimum effective dose of beta‐blocker therapy.
Postoperative Complications in Parkinson's Disease
Authors: Pepper Patricia Vold , Goldstein Mary Kane 
Published: April 2015

BACKGROUNDAlthough Parkinson's disease is relatively common in America, with an average annual incidence of 20 cases per 100,000 population,1 little information exists about postoperative morbidity and mortality in those Parkinson's patients who undergo elective surgery.METHODSWe performed a retrospective cohort study using the Veterans Affairs (VA) Austin database system (a cumulative index of admissions and discharges from all US VA Medical Centers) to identify 41,213 patients who underwent elective bowel resection, cholecystectomy, or radical prostatectomy between January 1, 1990, and December 31, 1995. We examined the study population using univariate analysis, acute length of stay with multivariate analysis, and postoperative complications with logistic regression.RESULTSThe selected surgeries were performed on 234 patients with a diagnosis of Parkinson's disease and 40,979 with no such diagnosis. In univariate analysis, patients with Parkinson's disease had significantly longer acute hospital stays than non‐Parkinson's patients (11.4 ± 15.9 days vs 8.8 ± 9.0 days, P < .001). In addition, Parkinson's patients had a higher in‐hospital mortality than non‐Parkinson's patients (7.3% vs 3.8%, P = .006). After we adjusted for coexisting morbidity, age, admitting location, and gender, patients with Parkinson's disease had an average acute hospital stay 2.34 days longer than that of non‐Parkinson's patients (P < .001). However, the mortality difference did not reach statistical significance in multivariate analysis (P = .098). Finally, Parkinson's patients had significantly increased incidences of urinary‐tract infection (odds ratio 2.045, P < .001), aspiration pneumonia (odds ratio 3.825, P < .001), and bacterial infections (odds ratio 1.682, P < .001).CONCLUSIONSPatients with Parkinson's disease are at greater risk for specific complications and longer hospital stay after elective bowel resection, cholecystectomy, or radical prostatectomy. Awareness of these complications may help caregivers to reduce postoperative mortality and morbidity and to decrease the length of hospitalization.
Urge Incontinence: New Health‐Related Quality of Life Measures
Authors: Brown Jeanette S. , Posner Samuel F. , Stewart Anita L. 
Published: April 2015

OBJECTIVESTo develop and evaluate the psychometric properties of two new urge incontinence‐specific instruments that measure quality of life and symptom annoyance.DESIGNNew instruments were developed and validated in racially, ethnically, and age‐diverse community‐dwelling women with urge or mixed incontinence with a primary urge component.MEASUREMENTSA total of 83 women with a minimum of six urge losses per week were sequentially recruited. We began with the previously developed Incontinence Impact Questionnaire and Urogenital Distress Inventory and added information from focus groups, expert clinical opinion, and literature review. Final selection of questions was based on a combination of factor analysis, item‐scale analysis, and reliability of scales to identify the best performing questions from the preliminary instruments. Both convergent and divergent validity were evaluated using established health‐related quality of life measures, frequency of incontinence episodes, global ratings of interference with daily activities and effect on feelings, and overall severity.RESULTSMean age of subjects was 63.8 years, 37% were non‐white, 23% had a high school education or less, and 24% had a household income of less than $10,000/year. Ten percent reported urge incontinence alone, with the remainder having mixed incontinence. Six domains were identified for the Urge‐IIQ and one domain for the Urge‐UDI. All domains had adequate reliability (Cronbach's alpha 0.74 ‐ 0.95) and test‐retest reliability (intraclass correlations ≥ 0.59).CONCLUSIONSThe newly developed Urge‐Incontinence Impact Questionnaire and Urge‐Urinary Distress Inventory are reliable, and evidence of validity was found in a diverse population. These instruments are available for use in trials of new therapeutic interventions for urge incontinence.
Validity and Responsiveness of the Minimum Data Set
Authors: Snowden Mark , McCormick Wayne , Russo Joan , Srebnik Debra , Comtois Kate , Bowen Jim , Teri Linda , Larson Eric B. 
Published: April 2015

OBJECTIVETo determine the criterion validity and responsiveness to change over time of the Minimum Data Set (MDS).DESIGNCross sectional analysis comparing prospectively collected research data with MDS data reported from nursing homes on identical subjects. Longitudinal follow‐up of subjects allowed for calculation of responsiveness to change over time.PARTICIPANTSSubjects (n = 140) participating in epidemiological research on the natural history of Alzheimer's disease in the University of Washington Group Health Cooperative Alzheimer's Disease Patient Registry (ADPR) who entered nursing homes in Washington State from January 1990 through March 1996.MAIN OUTCOME MEASUREMENTSSpearman's correlation coefficients to compare MDS cognitive performance scale scores with Mini‐Mental State Examinations (MMSE), MDS behavior domain scores with ADPR Physician Behavior checklist scores, and MDS activities of daily living (ADL) functioning scores with Dementia Rating Scale scores for ADLs. Partial correlations were used to control for the number of days between MDS and ADPR assessments, age, and function in the other two MDS ratings of ADL, cognition, or behavior. We determined responsiveness by using the mean change in an effect size (ES) calculation for each domain of interest.RESULTSMDS measures in all three domains were correlated modestly to the analogous ADPR research instruments, with correlation coefficients 0.45 for cognition, 0.50 for behavior, and 0.59 for ADL functioning. Controlling for age, time between ADPR and MDS assessments, and the MDS ratings of the other two MDS domains did not improve the correlations significantly. In a subgroup of 60 subjects followed for an average of 636 days, the Cognitive performance scale of the MDS had a slightly larger effect size (ES = 0.60) than the Folstein Mini‐Mental Status Exam (ES = 0.39) used by the ADPR. However, the Dementia Rating Scale (ES = 0.77) used by the ADPR researchers reflected more change over time than the ADL domain of the MDS (ES = 0.02). The MDS behavior domain (ES = 0.058) was comparable to the research behavior checklist (ES = 0.065).CONCLUSIONSThese data demonstrate reasonable criterion validity of the MDS and the MMSE, ADL, and behavior rating scales and suggest that the MDS data is of adequate validity for research purposes in these areas. The MDS was less able to capture dementia‐related change in ADLs in this population of patients with dementia even though the same nursing home staff completing the MDS often supplied the information for completing the research scales. As a result, the MDS may be limited as an outcome assessment instrument.
The Relationship Between Body Composition and Physical Performance in Older Women
Authors: Zamboni Mauro , Turcato Emanuela , Santana Helena , Maggi Stefania , Harris Tamara B. , Pietrobelli Angelo , Heymsfield Steven B. , Micciolo Rocco , Bosello Ottavio 
Published: April 2015

BACKGROUND: The relationship between age‐associated change in body composition and physical disability is still unknown. Skeletal muscle mass declines with age in both sexes; however, since women have less muscle mass per unit of weight than men, these changes may be more debilitating in women.OBJECTIVE: To evaluate the relationship between body composition and physical performance.DESIGN: A cross‐sectional study.PARTICIPANTS: 144 women aged 68 to 75 were selected randomly from the general population of Verona.MEASUREMENTS: Body composition was evaluated using dual energy X‐ray absorptiometry and bioimpedance. Physical performance was evaluated using a modified version of the Activities of Daily Living scale. Distance walked in 6 minutes was calculated, and isometric knee strength was tested.RESULTS: Normal women had a significantly lower body mass index (BMI) and percent body fat. These women also had a higher ratio of body cell mass (BCM) and total fat free mass (FFM) than women with physical impairments. After adjusting for BMI, women in the lowest tertile of muscle strength had significantly lower BCM than those in the highest tertile.CONCLUSIONS: These cross‐sectional data show that although muscle strength is related to fat‐free mass, disability in older women is associated with heavier BMI and with a higher percentage of body fat. J Am Geriatr Soc 47:1403–1408, 1999.
Urinary Catheters: What Type Do Men and Their Nurses Prefer?
Authors: Saint Sanjay , Lipsky Benjamin A. , Baker Paul D. , McDonald Linda L. , Ossenkop Kathleen 
Published: April 2015

OBJECTIVES: Urinary catheters are used frequently, but the relative risks and benefits of different types of devices are not clear. We sought to determine the beliefs of both older male patients and nursing staff about the relative merits and problems of condom and indwelling catheters.DESIGN: Patient and nurse survey using convenience sampling.SETTING: A University‐affiliated Veterans Affairs medical center.PARTICIPANTS: Men hospitalized on medical, rehabilitation and nursing home units using either an indwelling or a condom catheter were invited to participate as were all members of the nursing staff on these units. Of 116 eligible patients, 104 were interviewed (response rate = 90%). Of 107 eligible nursing staff members, 99 completed the questionnaires (response rate = 92%).INTERVENTION AND MEASUREMENTS: Consenting patients were interviewed personally about their urinary catheter. The nursing staff were asked to complete a self‐administered questionnaire.RESULTS: Patients were mostly older and predominantly hospitalized on the medical service. Compared with those using an indwelling catheter, patients using a condom catheter were more likely to believe that their catheter was comfortable (86 vs 58%, P = .04) and less likely to believe it was painful (14 vs 48%, P = .008) or to restrict their activity (24 vs 61%, P = .002). The nursing staff had a mean of 13 years nursing experience, and the majority worked in the nursing home unit. Most of the nursing staff respondents believed that condom catheters were less painful and restrictive for patients and were easier to apply, but they also believed that they fell off and leaked more often and required more nursing time.CONCLUSIONS: Both patients and nursing staff prefer condom to indwelling catheters for patient comfort, but they recognize that dislodgment and leaking are major drawbacks of condom catheters. A more secure condom catheter would greatly improve the management of male incontinence. J Am Geriatr Soc 47:1453–1457, 1999.
Serum IL‐6 Level and the Development of Disability in Older Persons
Authors: Ferrucci Luigi , Harris Tamara B. , Guralnik Jack M. , Tracy Russell P. , Corti Maria‐Chiara , Cohen Harvey J. , Penninx Brenda , Pahor Marco , Wallace Robert , Havlik Richard J. 
Published: April 2015

BACKGROUND: The serum concentration of interleukin 6 (IL‐6), a cytokine that plays a central role in inflammation, increases with age. Because inflammation is a component of many age‐associated chronic diseases, which often cause disability, high circulating levels of IL‐6 may contribute to functional decline in old age. We tested the hypothesis that high levels of IL‐6 predict future disability in older persons who are not disabled.METHODS: Participants at the sixth annual follow‐up of the Iowa site of the Established Populations for Epidemiologic Studies of the Elderly aged 71 years or older were considered eligible for this study if they had no disability in regard to mobility or in selected activities of daily living (ADL), and they were re‐interviewed 4 years later. Incident cases of mobility‐disability and of ADL‐disability were identified based on responses at the follow‐up interview. Measures of IL‐6 were obtained from specimens collected at baseline from the 283 participants who developed any disability and from 350 participants selected randomly (46.9%) from those who continued to be non‐disabled.FINDINGS: Participants in the highest IL‐6 tertile were 1.76 (95% CI, 1.17‐2.64) times more likely to develop at least mobility‐disability and 1.62 (95% CI, 1.02‐2.60) times more likely to develop mobility plus ADL‐disability compared with to the lowest IL‐6 tertile. The strength of this association was almost unchanged after adjusting for multiple confounders. The increased risk of mobility‐disability over the full spectrum of IL‐6 concentration was nonlinear, with the risk rising rapidly beyond plasma levels of 2.5 pg/mL.INTERPRETATION: Higher circulating levels of IL‐6 predict disability onset in older persons. This may be attributable to a direct effect of IL‐6 on muscle atrophy and/or to the pathophysiologic role played by IL‐6 in specific diseases. J Am Geriatr Soc 47:639–646, 1999.
The Importance of Subsyndromal Depression in Older Primary Care Patients: Prevalence and Associated Functional Disability
Authors: Lyness Jeffrey M. , King Deborah A. , Cox Christopher , Yoediono Z. , Caine Eric D. 
Published: April 2015

OBJECTIVE: Existing diagnostic categories for depression may not encompass the majority of older people suffering clinically significant depressive symptoms. We have described the prevalence of subsyndromal depressive symptoms and tested the hypothesis that patients with subsyndromal depression have greater functional disability and general medical burden than nondepressed subjects but less than patients with diagnosable depressions.METHODS: Subjects were 224 patients, aged 60 years and older, recruited from private internal medicine offices or a family medicine clinic. Validated measures of psychopathology, medical burden, and functional status were used. The subsyndromal depression group was defined by a score of more than 10 on the Hamilton Rating Scale for Depression and by the absence of major or minor depressive disorder. Analyses included multiple regression techniques to determine the presence of group differences adjusted for demographic covariates.RESULTS: Subsyndromal depression was common (estimated point prevalence of 9.9% compared with 6.5% for major depression, 5.2% for minor depression, and .9% for dysthymic disorder), associated with functional disability and medical comorbidity to a degree similar to major or minor depression, and often treated with antidepressant medications.CONCLUSIONS: Although depressive conditions are common and are associated with considerable functional and medical morbidity in older primary care patients, many patients with clinically significant depressive symptoms are not captured by criteria‐based syndromic diagnostic categories. Future work should include intervention studies of subsyndromally depressed older persons as well as attention to the course and biopsychosocial concomitants of diagnosable and subsyndromal depressions in this population. J Am Geriatr Soc 47:647–652, 1999.
Effects of Shoe Collar Height and Sole Hardness on Balance in Older Women
Authors: Lord Stephen R. , Bashford Guy M. , Howland Amelia , Munroe Bridget J. 
Published: April 2015

OBJECTIVE: To determine whether shoe collar height and sole hardness affect balance in older women.DESIGN: A randomized order, cross‐over, controlled comparison.SETTING: Intermediate care institution and regional hospital.PARTICIPANTS: Forty‐two women aged 60 to 92 years (mean 76, SD = 9.03). The sample comprised 15 hostel (intermediate care) residents, 11 women who lived in a retirement village, and 16 women who lived independently in the community.OUTCOME MEASURES: Postural sway, maximal balance range and coordinated stability.MAIN RESULTS: The subjects underwent assessments of static balance (body sway) and dynamic balance (maximal balance range and coordinated stability) under five conditions: (1) in soft‐soled bowls shoes, (2) in hard‐soled bowls shoes, (3) in college‐style shoes, (4) in college‐style shoes with a high (boot) collar, and (5) barefoot. MANOVA analysis indicated that subjects were more stable when wearing the high collar shoes than when wearing the college shoes (P < .001) or when barefoot (P < .05). In contrast, subjects performed similarly in the balance tests in the soft and hard‐soled shoes (P = .30) and no better than when barefoot (P = .12 and P = .93, respectively).CONCLUSIONS: The findings indicate that subjects had better balance when wearing shoes with high collars than when wearing shoes with low collars and that sole hardness was not related to balance. J Am Geriatr Soc 47:681–684, 1999.
Endogenous Levels of Dehydroepiandrosterone Sulfate, but Not Other Sex Hormones, Are Associated with Depressed Mood in Older Women: The Rancho Bernardo Study
Authors: Barrett‐Connor Elizabeth , von Mühlen Denise , Laughlin Gail A. , Kripke Adrianna 
Published: April 2015

OBJECTIVE: The purpose of this study was to determine whether endogenous steroid hormone levels are associated with depressed mood in community‐dwelling older women.DESIGN: A cross‐sectional population‐based study.SETTING: Rancho Bernardo, CaliforniaPARTICIPANTS: A total of 699 non‐estrogen using, community‐dwelling, postmenopausal women (aged 50 to 90 years) from the Rancho Bernardo cohort who were screened for depressed mood and had plasma obtained for steroid hormone assays in 1984–1987.MEASUREMENTS: Plasma levels of total and bioavailable (non‐SHBG‐bound) estradiol and testosterone, estrone, androstenedione, cortisol, dehydroepiandrosterone, and (DHEA) and its sulfate (DHEAS) were measured by radioimmunoassay. Mood and depression were assessed using the Beck Depression Inventory.RESULTS: Only DHEAS levels were significantly and inversely associated with depressed mood, and the association was independent of age, physical activity, and weight change (P = .0002). Age, sedentary lifestyle, and weight loss were positively associated with depressed mood. Alcohol intake, cigarette smoking, marital status, type of menopause, and season of testing were unassociated with depressed mood. A subset of 31 women with categorically defined depression had lower DHEAS levels compared with 93 age‐matched nondepressed women (1.17 ± 1.08 vs 1.57 ± .98 μmol/L; P = .01).CONCLUSIONS: These results add to the evidence that DHEA/S is a neuroactive steroid and point to the need for careful long‐term clinical trials of DHEA therapy in older women with depressed mood. J Am Geriatr Soc 47:685–691, 1999.