bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discussions about Limiting Treatment in a Geriatric Clinic
Authors: Goold Susan Dorr , Arnold Robert M. , Siminoff Laura A. 
Published: April 2015

Objective: Obtain detailed information about the frequency and content of discussions about withholding treatment between doctors and elderly outpatients.Design: Survey.Setting: Primary care geriatric clinic at an urban university.Participants: Twelve physicians and one nurse practitioner completed questionnaires for 185/198 (93.4%) patient visits.Measurements: Questionnaires were completed by physicians after each patient visit during August 1989. Interviews were conducted with physicians who had discussed limiting life‐sustaining treatment with patients.Results: Ten percent (n = 19) of patients seen had had discussions with their physicians about life‐sustaining treatment. These patients were older and had worse prognoses as estimated by their physicians. Physicians usually raised the issue with the families of demented patients and mentioned dementia, quality of life, prognosis, and the need to make other clinical decisions as motivation for initiating discussions. The majority of patients with poor prognoses, however, had not had discussions about life support.Conclusions: Despite increasing attention given to end‐of‐life decisions in the medical and lay press, discussions with elderly outpatients about limiting treatment occur rarely. They are more likely when patients are older or have worse prognoses, but age, prognosis, and poor quality of life do not consistently lead physicians to raise the issue.
Acute Autonomic Responses to Postural Change, Valsalva Maneuver, and Paced Breathing in Older Type II Diabetic Men
Authors: Naliboff Bruce D. , Gilmore Stephanie L. , Rosenthal Mark J. 
Published: April 2015

Purpose: To examine the effects of advanced age and diabetes on the response to standard tests of cardiovascular reflexes.Desigin: Group comparison.Setting: Psychophysiology laboratory, Department of Veterans Affairs Medical Center.Patients: Sixteen elderly male (67–81 years old) non‐insulin dependent diabetic subjects without hypertension and nine elderly male (63–77 years old) controls.Main Outcome Measures: Continuous (beat‐by‐beat) measures of heart rate, systolic blood pressure, diastolic blood pressure, and skin conductance were studied during tests of Valsalva maneuver, deep breathing, and postural change from sitting to standing.Results: In comparison with elderly controls, the diabetic patients showed altered cardiovascular responses in measures of heart rate variability during Valsalva and standing. None of the subjects evidenced frank postural hypotension, but there was a greater fall in diastolic blood pressure immediately after standing for the diabetic patients compared with the controls. There was also a significant relationship between this response and decreased heart rate variability during Valsalva.Conclusions: Older type II diabetic patients compared with healthy controls had mild cardiovascular abnormalities. These results parallel those of studies comparing younger diabetics and controls.
Reliability of Sampling Urine from Disposable Diapers in Elderly Incontinent Women
Authors: Belmin Joël , Hervias Yvonne , Avellano Eveline , Oudart Odette , Durand Isabelle 
Published: April 2015

Objective: To assess the reliability for biochemical and microbiological analysis of urine collection from disposable diapers in elderly women with severe urinary incontinence.Design: Cross‐sectional comparison of two methods of collection.Patients and Measurements: Urine was sampled from 52 women inpatients (aged 68–98 years) in a geriatric hospital ward by pressing a diaper which the patient had worn for 3 hours. Just after this collection, another sample was obtained by retrograde catheterization. Both samples were analyzed for sodium, potassium, chloride, proteins, urea, creatinine, calcium, and phosphate and for cell counts, the presence of bacteria, and bacteria culture.Results: For all the biochemical parameters, the urinary concentrations obtained by the two methods were strongly and significantly correlated. The following differences (mean and range, in mmol/L) were found between the values obtained by the two methods: sodium: 6.05 (−26 to 27), potassium: (−16 to 14), chloride: −1.13 (−24 to 23), urea: 6.85 (−33 to 37), creatinine: 0.24 (−0.95 to 1.45), calcium: −0.22 (−1.27 to 1.70), and phosphate: 2.17 (−2.5 to 13.4). For diagnosis of urinary tract infection, agreement between the two methods was good (kappa = 0.84), and bacteriological agreement was obtained in 25 out of 28 cases (89%). However, for diagnosis of microscopic hematuria, agreement was poor (kappa = 0.50), probably due to the overestimation of the true urinary red cell count in the samples collected by catheterization.Conclusion: For routine microbiological and biochemical analysis, urine extraction from disposable diapers is a simple and reasonably reliable method of sampling urine from elderly women with severe incontinence.
The Relationship between Age, Gender and Cognitive Performance in the Very Old: The Effect of Selective Survival
Authors: Perls Thomas T. , Morris John N. , Ooi Wee Lock , Lipsitz Lewis A. 
Published: April 2015

Objective: To determine the prevalence of cognitive disability as a function of advanced age and gender in elderly nursing home and community‐dwelling populations. Since cognitive dysfunction is associated with increased mortality, we hypothesized that selective survival results in a decreased prevalence of cognitive disability in the oldest old.Design: Cohort study. An analysis of 6‐month longitudinal data obtained from a national probability sample of older persons in 260 nursing homes (n= 1951) and 2‐year longitudinal data obtained from a sample of community‐dwelling older persons (n= 2947).Measures: In the nursing home sample, the primary outcome measure was cognitive performance score. In the community sample, cognitive performance was determined using the results of three orientation questions and assessment of decision‐making ability. Cognitive performance and subsequent survival, controlling for various disease states and demographic factors, were examined in three age cohorts of men and women (ages 65–79, 80–89, 90–99).Results: In the nursing home sample, the cognitive performance of very old men (≥90 years) was better than that of younger men (aged 80–89 years,P< 0.05) and very old women (age ≥90 years,P= 0.001). Among 80–89‐year‐olds with poor cognitive performance, the 6‐month mortality rate was higher in men than in women (38% vs 19%,P= 0.001). However, the mortality rates of men and women with good cognitive performance were not statistically different in any age group. Proportional‐hazards regression analysis demonstrated that poor cognitive performance remained a powerful predictor of death among men aged 80–89 years with a relative risk of 2.7 (95% C1, 1.19–3.17;P= 0.0006) after controlling for covariates. Results from the community sample lent support to our findings: within each age group, mortality rates for men and women with intact cognitive performance were not statistically different. However, in the two older age groups, the mortality rates of subjects with impaired cognitive performance were significantly greater for men than for women (P< 0.01 for both age groups).Conclusions: Decreased cognitive performance is significantly associated with mortality among elderly men. Survival by men who have relatively intact cognitive function results in a population of oldest men, those aged 90–99 years, with cognitive performance scores better than younger men or similarly‐aged women. The same selective survival phenomenon was not observed among women. Thus, there may be less cognitive disability among very old men than previously expected.
Cardiopulmonary Resuscitation in Elderly Patients Hospitalized In The 1990s: A Favorable Outcome
Authors: Tresch D. , Heudebert G. , Kutty K. , Ohlert J. , VanBeek K. , Masi A. 
Published: April 2015

Objective: To compare the clinical characteristics and survival of elderly and younger hospitalized patients who sustain cardiac arrest and receive cardiopulmonary resuscitation (CPR) in the 1990's and to assess predictors of survival.Design: Retrospective survey of cardiac arrest database and hospital charts, plus telephone follow‐up.Setting: 450‐bed acute care teaching hospital.Study Population: Seventy‐eight hospitalized patients 70 years or older and 73 hospitalized patients under 70 years of age.Measurements: Survey of cardiac arrest data base, hospital charts, and telephonic follow‐up to allow (1) comparison of clinical characteristics, survival, and long‐term follow‐up between two age groups and (2) univariate and multivariate analysis of predictors of mortality.Main Results: Pre‐arrest clinical characteristics were not significantly different between the age groups. Prior to arrest the majority of patients were functionally active, and over one‐third were hospitalized for acute coronary artery syndromes. In approximately 85% of the patients, the arrest was witnessed, and 70% of the patients had their cardiac rhythm monitored at onset of the arrest. Survival was not significantly different between the age groups; 26% of the total 151 patients were discharged. No significant difference was noted in pre‐post arrest functional status of survivors. Survival at 1, 2, and 3 years in elderly and younger survivors was 86% versus 80%, 76% versus 67%, and 71% versus 61%, respectively. Multivariate analysis identified the presence of coronary artery disease, admission systolic blood pressure, and functional level to be independent pre‐arrest predictors of mortality. At the time of the arrest, the initial cardiac rhythm and duration of CPR were found to be independent predictors of mortality.Conclusions: Elderly patients hospitalized in the 1990's who receive CPR have outcomes similar to younger patients who receive CPR. The favorable outcome in the elderly patients may reflect patient selection: the majority of our patients were functionally active prior to hospitalization, without multiple serious illnesses; many were hospitalized for acute coronary artery syndromes; and, in most cases, the arrest was witnessed with the patient's cardiac rhythm monitored at onset of the arrest.
Stature Estimated from Knee Height in Elderly Japanese Americans
Authors: Myers Sally A. , Takiguchi Sharon , Yu Mihae 
Published: April 2015

Objective: To validate the use of knee‐height‐to‐stature formulas established on Caucasian subjects to estimate height of Japanese‐Americans, ages 60 to 90 years.Design: Survey by measurement of a convenience sample.Subjects: Japanese‐American men and women patients, aged 60 years or older, at The Queen's Medical Center during March and April 1992.Measurements: Each subject's height (without shoes) was measured in inches by standard height scale and then converted to centimeters. Each subject's knee height was measured using the tool and procedure described by Chumlea et al (Journal of the American Geriatrics Society 1985; 33:116–120).Results: Statures of Japanese‐American men and women predicted by the regression models developed on the Hawaii sample were significantly different (P < 0.0001) from the heights predicted by the Caucasian regression model developed by Chumlea and associates (1985).Conclusions: The statistical models specific to elderly Japanese Americans predicted more precise height approximation than models developed on Caucasians.
Alzheimer's Disease and Cumulative Exposure to Anesthesia: A Case‐Control Study
Authors: Bohnen Nicolaas I.L.J. , Warner Mark A. , Kokmen Emre , Beard C. Mary , Kurland Leonard T. 
Published: April 2015

Objective: To evaluate prior exposure to general anesthesia as a potential risk factor for Alzheimer's disease (AD).Design: A retrospective, population‐based, case‐control study.Setting: The Rochester Epidemiology Resource.Patients: Cases were all incident cases of AD from 1975 to 1984 who resided for 40 years or more in Olmsted County prior to the onset of their dementia (n = 252). One age‐ and gender‐matched control for each case was selected from all registrations for care at Mayo Clinic during the year of onset in the incident case. The case and control groups each had 252 individuals. Of these, 208 cases and 199 controls had at least one exposure to general anesthesia prior to the year of onset of dementia in the matched AD patient.Measurements: The cumulative duration of anesthesia and the total number of general anesthetic exposures prior to the age of onset of dementia and the corresponding year in each matched control were ascertained.Results: There was no significant difference in mean cumulative exposure (in minutes) to general anesthesia (patients vs controls: 188.4 vs 170.5 rninutes, ns). Neither exposure to six or more episodes of general anesthesia (OR = 1.44; 95% CI: 0.77–2.71) nor cumulative exposure to 600 minutes or more of general anesthesia (OR = 1.63; 95% CI: 0.53–5.04) were associated with a significantly increased risk of AD.Conclusion: It is unlikely that multiple exposures to general anesthesia increase the risk of AD.
A Controlled Trial of Outpatient Geriatric Evaluation and Management
Authors: Boult Chad , Boult Lisa , Murphy Christine , Ebbitt Brenda , Luptak Marilyn , Kane Robert L. 
Published: April 2015

Objective: To evaluate the effects of targeted outpatient geriatric evaluation and management (GEM).Design: Controlled clinical trial. Elderly persons were identified as being at high risk for hospital admission on the basis of their responses to a short, mailed, self‐administered questionnaire. The high‐risk elders who chose to participate in the GEM program were compared to those who continued to receive usual care.Setting: Outpatient GEM clinic at an urban university hospital.Subjects: Elderly Medicaid recipients whose probability of repeated hospital admission (Pra) within 4 years was calculated as 40% or greater (Pra ≥ 0.40).Main Outcome Measures: Mortality, use of institutional services, satisfaction.Results: Of the 1210 persons who were sent questionnaires, 624 responded (response rate = 51.6%), of whom 154 (24.7%) were deemed to be a high risk for hospitalization. Of these, 43 received GEM (experimental subjects); 111 received usual care (controls). At baseline, the experimental and control groups' demographic and health‐related characteristics did not differ significantly. The average experimental subject was 76.5 years old, had 9.6 significant medical problems, and took 6.7 significant long‐term prescription medications. During the program's first 17 months of follow‐up, the experimental subjects had lower annual rates of mortality (2.9% vs 19.2%, P = 0.03) and emergency room use (0.6 vs 1.0 visits, P = 0.01) than did the controls. The experimental subjects also tended to use nursing homes, but not hospitals, at a lower rate than the controls. All of the experimental subjects rated the program as either excellent (81.0%) or good (19.0%); 100% said they would recommend it to others. Their established primary physicians rated the GEM services as appropriate and helpful.Conclusion: Targeted outpatient GEM was associated with reduced mortality, reduced use of emergency rooms, and a trend toward reduced use of nursing homes.
Impact of Nutritional Status on Morbidity in a Population of Geriatric Rehabilitation Patients
Authors: Sullivan Dennis H. , Walls Robert C. 
Published: April 2015

Objective: The primary objective was to confirm the results of a prior study that demonstrated a strong independent correlation between the severity of protein‐energy undernutrition and the risk of subsequent morbidity in a population of elderly rehabilitation patients. A second objective was to determine whether inadequate in‐hospital nutrient intake is a co‐contributor to the risk of subsequent morbidity.Design: Cohort study.Setting: Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital.Patients: Three hundred fifty randomly selected admissions to the GRU, of whom 99% were male, and 75% were white. The average age of the study patients was 76 years.Measurements: At admission, each patient completed a comprehensive medical, functional, neuro‐psychological, socioeconomic, and nutritional assessment. While remaining in the hospital, each subject was monitored on a daily basis for the development of complications. Complete calorie counts were obtained at least every other day, and the average pre‐complication daily nutrient intake was expressed as a percent of predicted requirements as determined using the Harris‐Benedict equation.Results: Of the 96 variables evaluated, the strongest predictor of subsequent complications was the Katz Index of ADL score, followed by serum albumin, usual weight percent, number of prescription medications, presence of renal disease, individual income, the presence of decubiti, dysphagia, and mid‐arm muscle circumference. When all nine of these variables were included in the logistic regression analysis, the final model had a sensitivity of 70%, a specificity of 71%, and an overall predictive accuracy of 71%. When tested using the data from the previous study, the model differentiated the patients who developed a complication from those who had not at a sensitivity of 76.7, a specificity of 76.1, and an overall predictive accuracy of 76.3. There was no difference in the pre‐complication average daily nutrient intake between the complication and the no‐complication groups (79% vs 75% of predicted requirements, P > 0.2).Conclusions: Protein‐energy undernutrition appears to be a strong independent risk factor for in‐hospital morbidity. However, in‐hospital nutrient intake may not be a significant determinant of risk.
Comparison of Clinical and Biomechanical Measures of Balance and Mobility in Elderly Nursing Home Residents
Authors: Thapa Purushottam B. , Gideon Patricia , Fought Randy L. , Kormicki Maciej , Ray Wayne A. 
Published: April 2015

Objective: To compare biomechanics force platform measurements of postural sway with clinical measures of balance and mobility, in frail elderly residents of community nursing homes, in terms of feasibility, correlation with other known risk factors for falls, and intercorrelation with each other.Design: Cross‐sectional study.Setting: Twelve Tennessee community nursing homes.Subjects: Of 1315 residents 360 (≥65) could stand independently (≥10 seconds). Of these eligible subjects, 303 (84%) provided informed consent and were assessed.Measurements: The biomechanics force platform measurements were postural sway during quiet standing characterized as elliptical area and mean velocity. The clinical measures were functional reach, mobility maneuvers (adapted from Tinetti's Mobility Index), timed chair stands, and 10‐foot walk. Resident characteristics and function were also obtained.Results: Balance measurements were obtained on most (100% for postural sway to 67% for chair stand) consenting residents and were reliable on test‐retest (intraclass correlation from .56 to .98). Performance in both groups of balance measures deteriorated with increasing musculoskeletal disability. Functional reach and mobility maneuvers correlated with height, and mobility maneuvers with depressive symptoms. Elliptical area correlated with mean velocity of postural sway (Pearson's r = 0.72; P < 0.001), and the clinical measures of balance (functional reach, mobility maneuvers, timed chair stands and walk) were modestly intercorrelated (r from 0.35 to 0.65; all P values ≤0.05). However, the biomechanical measures were not correlated with the clinical measures.Conclusions: Standard measures of balance were obtained reliably from nursing home residents who could stand independently for ≥10 seconds. However, in this group, further research is needed to determine which measures best predict falls. Further research is also needed to identify predictors of falls in the majority of residents who were too frail to undergo these standard assessments.
Identification and Intervention for Urinary Incontinence by Community Physicians and Geriatric Assessment Teams
Authors: McDowell B. Joan , Silverman Myrna , Martin David , Musa Donald , Keane Christopher 
Published: April 2015

Objective: To determine the difference in the recognition and intervention/referral rates for urinary incontinence (UI) by out‐patient Geriatric Assessment Units (GAUs) and private physicians in community‐based practices (CMDs).Design: A multi‐site, randomized, controlled study where block randomization was utilized to assign subjects 65 years of age and older to either a GAU or a CMD for assessment.Setting: One academic and three hospital‐based GAUs and CMDs in private practice in a large metropolitan area.Participants: Three hundred sixty‐four community‐dwelling frail men (14%) and women (86%) with a mean age of 75 years.Measurements: The independent variable was the type of out patient care, either CMD or GAU, to which the subjects were randomized. The dependent variables were recognition of UI by the health care providers and intervention or referral for the problem of UI once it was identified. Instruments included a structured in‐home interview performed before randomization designed to uncover health problems such as urinary incontinence, as well as a medical record review form used post‐assessment to ascertain recognition rates and intervention for UI by CMDS and GAUs. Both of the instruments were developed and piloted by the investigators in a preliminary study.Main Results: Of the 364 subjects, 151 (41.5%) reported UI during the in‐home interviews. Recognition rates for UI were significantly better for GAUs (48 of 81, 59.3%) than CMDs (11 of 70, 15.7%) (P < 0.001). This was true for mild (<3 times/week) 44.2% vs 2.1% (P < 0.000005) as well as severe UI (>3 times/week) 86.2% vs 43.5% (P = 0.00111) for GAUs and CMDs, respectively. There were no significant differences in the rate of referral/intervention for recognized cases of UI by GAUs or CMDs. GAUs referred/treated five (21.7%) cases of mild UI and 10 (40%) cases of severe UI while CMDs referred/treated three (30%) cases of severe UI but did not offer intervention for the one recognized case of mild UI. GAUs were more likely to refer to Continence Programs (12, 25%) compared with CMDs who were more likely to refer (3, 100%) to a urologist. A majority of the subjects with UI did not receive treatment or referral for their problem (8, 72.7% CMDs and 33, 68.6% of GAUs).Conclusions: GAUs out performed CMDs in the identification of subjects with both mild and severe UI. However, the intervention/referral rates were low for both GAUs and CMDs. The outcome of this study points to the need for increased emphasis on UI in curriculum preparing physicians and other health providers as well as the need for continuing education for those already in practice.