bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of the Diagnosis “Failure to Thrive” in Older Veterans
Authors: Hildebrand Jeanne K. , Joos Sandra K. , Lee Melinda A. 
Published: April 2015

OBJECTIVES: To describe how physicians apply the term “failure to thrive” (FTT) to older patients. Specifically, to describe the clinical presentation, underlying etiologies, diagnostic and therapeutic interventions, and discharge outcomes of veterans having the discharge diagnosis of FTT.DESIGN: Retrospective chart review.SETTING: The Department of Veterans Affairs Medical Center (VAMC), Portland, Oregon, a 400‐bed referral and teaching hospital.PARTICIPANTS: All veterans 65 years of age and older admitted to the Portland VAMC from October 1, 1990, through September 30, 1993, whose coded discharge diagnoses included FTT (n = 132).MEASUREMENTS: Medical records were reviewed by a trained abstractor to obtain key data about clinical presentation, etiologies, interventions, and discharge outcomes.RESULTS: Subjects were predominantly male (98%), with a mean age of 76 years ± 9 years. Weight loss was a key feature: 67% of subjects had evidence of weight loss by study criteria. Anemia was present in 55%, low cholesterol in 50%, and low albumin in 44%. Lymphopenia was common, present in 66% of subjects. Most patients were admitted from home (83%); only 7% came from nursing homes. On admission, the majority (82%) were dependent in at least One ADL, and 36% were cognitively impaired. Cancer was the most common underlying diagnosis (30%), followed by infection (18%), dehydration (13%), and depression (12%). Only 46% of subjects were discharged home, while 34% went to nursing homes. Fourteen percent of subjects died during the hospitalization, an additional 11% died within 30 days after discharge, and 32% died within 1 year after discharge. The subgroup of subjects with cancer and/or infection had increased mortality rates at 30 days and 1 year after hospitalization.CONCLUSION: We conclude that FTT may constitute a discrete syndrome with diagnostic, therapeutic and prognostic implications in older people, but in the absence of consensus about diagnostic criteria, there is a large degree of subjective variation in how physicians apply the term. J Am Geriatr Soc 45:1113–1117, 1997.
CONGESTIVE HEART FAILURE IN OLDER PATIENTS: The Clinical Diagnosis of Heart Failure in Older Patients*
Authors: Tresch Donald D. 
Published: April 2015

OBJECTIVE: To review the differences in presentation and clinical manifestation of heart failure in older and younger patients and to determine if these differences influence the ability to diagnose the disorder clinically. Based on this information, an approach to diagnosing heart failure in older patients is provided.DATA SOURCE: Scientific reports regarding heart failure in both the general population and the geriatric population were identified from repeated searches of MEDLINE data base and citations from appropriate articles.DATA EXTRACTION AND SYNTHESIS: Relevant data were obtained from articles, with special importance placed on studies designed to examine older patients exclusively or as a subgroup in a larger study. Review of data pertaining to clinical characteristics and presentation of heart failure was performed, with emphasis on comparing the characteristics between age groups. Specific cardiac diseases that cause ventricular impairment in older patients were assessed, and the importance of systolic versus diastolic dysfunction in this age group was analyzed.CONCLUSION: Clinical diagnosis of heart failure in older patients may be difficult because of the absence of typical symptoms and physical findings. When present, the symptoms and signs may be mistakenly diagnosed as caused by concomitant disorders or aging changes. In other older patients, the symptoms and signs will be obscured by the presence of aging changes or the presence of other diseases. As a result of these difficulties, the initial diagnosis of heart failure in older patients is made later in the course of the cardiac disease process; older patients will be more unstable, and secondary preventive therapies may be of less benefit than in younger patients with the disorder. Though clinically difficult, the differentiation between systolic and diastolic ventricular dysfunction is mandatory in all older patients with heart failure. J Am Geriatr Soc 45:1128–1133,1997.
Predictors of Mortality in Patients with Bacteremia: The Importance of Functional Status
Authors: Deulofeu Francesc , Cervelló Betlem , Capell Santiago , Martí Carmina , Mercadé Vicenç 
Published: April 2015

OBJECTIVE: To evaluate the influence of functional status on the outcome in older patients with bacteremia.DESIGN: Prospective study of all episodes of bacteremia that occurred in adults during a 27‐month period (January 1991 to March 1993).SETTING: A 280‐bed community hospital.PARTICIPANTS: During the study period, bacteremia was diagnosed in 242 consecutive patients (incidence of 11.2 bacteremic episodes per 1000 hospital admissions). One hundred twenty‐seven of these patients were 65 years of age or older, and 115 were less than age 65.MEASUREMENTS: On identification of a positive blood culture, data on demographics, clinical findings, and a series of factors frequently cited as predisposing to infection were collected. The patient's functional status was assessed using the Barthel index (a score of <60 identifies moderately and highly dependent patients).RESULTS: The overall mortality rate was 14.9% (36 of 242). In the univariate analysis, mortality was associated significantly with age greater than 65 years, nosocomial infection, absence of fever, shock, leukocytosis or leukopenia, inappropriate therapy, more than one underlying disease, immunocompromised state, and limited functional status. Multiple logistic regression analysis revealed that shock (OR = 27.6, 95% CI 5.7–133), a Barthel score less than 60 (OR = 11.7, 95% CI 3.2–43), nosocomial infection (OR = 6.7, 95% CI 1.8–25.5), absence of fever (OR = 5.2, 95% CI 1.05–26), and immunocompromised state (OR = 15.6, 95% CI 2.4–101.5) were significantly associated with death attributable to bacteremia.CONCLUSION: The main prognostic factors in a patient with bacteremia were the presence of shock, impaired functional status, immunodeficiency state, acquisition of infection in the hospital, and absence of fever on admission. Age alone did not influence outcome.
Decreasing Hospitalization Rates for Older Home Care Patients with Symptoms of Depression
Authors: Flaherty Joseph H. , McBride Mary , Marzouk Shaden , Miller Douglas K. , Chien Norman , Hanchett Marilyn , Leander Sheila , Kaiser Fran E. , Morley John E. 
Published: April 2015

OBJECTIVE: To target medically ill older home care patients with symptoms of depression in order to reduce their rate of hospitalization.DESIGN: A case‐control study.SETTING: A private, nonprofit home care organization, the Visiting Nurse Association of St. Louis.PARTICIPANTS: Home care patients 65 years of age and older with symptoms of depression who were participants of a Total Quality Management (TQM) intervention (n = 81) were compared with an historical control of home care patients 65 years of age and older with symptoms of depression (n = 69).INTERVENTION: Utilization of TQM principles to develop a plan including: (a) an educational seminar on depression for home care staff involved in the project; (b) letters to physicians introducing the TQM project; (c) use of the Geriatric Depression Scale (GDS) for screening; (d) recommendation to the primary physician of a home social service (SS) consultation for patients with a GDS of 10 to 14; (e) recommendation to the primary physician of three interventions for patients with a GDS ≥ 15: home SS consultation + mental health (MH), or gerontological nurse (GN) consultation + antidepressant medication (a pharmacotherapeutic algorithm sent by facsimile to the primary physician upon request).OUTCOME MEASURES: Hospitalization rates of the control group compared with the TQM intervention group, the degree to which part (e) of the plan was implemented, and the effect this had on hospitalization rates.RESULTS: The TQM intervention patients had a higher mean age than the historical control patients but were not different in percent female, percent white race, percent with a caregiver in the home, functional status, and in 15 of 16 diagnostic categories. Overall, the TQM intervention group had a hospitalization rate of 23.5% (19/81) compared with a rate of 40.6% (28/69) for the historical control group (P = .024). For part (e) of the plan (56/81 patients had a GDS ≥ 15), 29/56 (52%) received the recommended SS consultation, 50/56 (89%) received the recommended MH or GN consultation, and 32/56 (57%) received antidepressant medication. One type of intervention did not seem to lower hospitalization rates more than another although having received the MH or GN visits approached significance (12/50, 24%; P = .052) when compared with the control group.CONCLUSION: Utilization of TQM principles and the development of an intervention such as the one described here can decrease hospitalization rates for medically ill older home care patients with symptoms of depression.
Benzodiazepine Exposure and Functional Status in Older People
Authors: Ried L. Douglas , Johnson Richard E. , Gettman David A. 
Published: April 2015

OBJECTIVE: To determine the association between benzodiazepine exposure and functional status in older patients.DESIGN: A nonexperimental, observational study design.SETTING: Kaiser Permanente, Northwest Division, a health maintenance organization (HMO) providing prepaid, comprehensive inpatient and outpatient care for more than 410,000 persons.PATIENTS: Patients were the 4192 Social HMO Project members 65 years of age and older, enrolled for 1 full year, who returned their annual health status survey during 1990.MEASUREMENTS: Functional status was measured using self‐reported activities of daily living and instrumental activities of daily living. Predictor variables were self‐reported medical conditions and benzodiazepine exposure during the previous 12 months.RESULTS: Age, gender, and living status were associated with functional status. Severe memory loss, stroke, Parkinson's disease, circulation problems, lung problems, hip fracture, urinary problems, arthritis, heart trouble, diabetes, stomach/bowel problems, and cancer were associated independently with functional status. Persons exposed to a benzodiazepine scored lower on the functional status measure. Benzodiazepine exposure added significantly to the prediction of functional status after controlling for patients' sociodemographic characteristics and medical conditions.CONCLUSIONS: Age and medical conditions were the most significant predictors of functional status. Benzodiazepine exposure was associated with functional status to the same extent as several chronic medical conditions. When prescribing benzodiazepines for older people, caution should be taken to minimize the possibility of iatrogenic‐functional limitations.
Identifying Nursing Home Residents at Risk for Falling
Authors: Kiely Dan K. , Kiel Douglas P. , Burrows Adam B. , Lipsitz Lewis A. 
Published: April 2015

OBJECTIVES: To develop a fall risk model that can be used to identify prospectively nursing home residents at risk for falling. The secondary objective was to determine whether the nursing home environment independently influenced the development of falls.DESIGN: A prospective study involving 1 year of follow‐up.SETTING: Two hundred seventy‐two nursing homes in the state of Washington.PARTICIPANTS: A total of 18,855 residents who had a baseline assessment in 1991 and a follow‐up assessment within the subsequent year.MEASUREMENTS: Baseline Minimum Data Set items that could be potential risk factors for falling were considered as independent variables. The dependent variable was whether the resident fell as reported at the follow‐up assessment. We estimated the extrinsic risk attributable to particular nursing home environments by calculating the annual fall rate in each nursing home and grouping them into tertiles of fall risk according to these rates.RESULTS: Factors associated independently with falling were fall history, wandering behavior, use of a cane or walker, deterioration of activities of daily living performance, age greater than 87 years, unsteady gait, transfer independence, wheelchair independence, and male gender. Nursing home residents with a fall history were more than three times as likely to fall during the follow‐up period than residents without a fall history. Residents in homes with the highest tertile of fall rates were more than twice as likely to fall compared with residents of homes in the lowest tertile, independent of resident‐specific risk factors.CONCLUSIONS: Fall history was identified as the strongest risk factor associated with subsequent falls and accounted for the vast majority of the predictive strength of the model. We recommend that fall history be used as an initial screener for determining eligibility for fall intervention efforts. Studies are needed to determine the facility characteristics that contribute to fall risk, independent of resident‐specific risk factors. J Am Geriatr Soc 46:551–555, 1998.
The Sequelae of Hospitalization for Ischemic Stroke Among Older Adults
Authors: Wolinsky Fredric D. , Gurney James G. , Wan George J. , Bentley David W. 
Published: April 2015

OBJECTIVES: To estimate the independent effect of hospitalization for ischemic stroke on change in functional status, subsequent hospitalization, and mortality.DESIGN: Secondary analysis of the nationally representative Longitudinal Study on Aging. Baseline (1984) interview data were linked to Medicare hospitalization and death records for 1984–1991 and to functional status reports at three biennial follow‐ups.SETTING: In‐person and telephone interviews were conducted.PARTICIPANTS: A total of 6071 noninstitutionalized respondents 70 years old or older at baseline.MEASUREMENTS: Hospitalization for ischemic stroke was defined as having one or more episodes with primary discharge ICD9‐CM codes of 433.0–434.9, 436, and 437.0–437.1. Two reference groups were used: those who were hospitalized for something other than stroke, and those who were not hospitalized at all. The statistical methods employed were multivariable proportional hazards, logistic, and linear regression.RESULTS: The adjusted hazards ratio for having a primary hospital discharge diagnosis of ischemic stroke on mortality was 7.57 (CI95% = 6.47 to 8.85) versus 3.67 (CI95% = 3.28 to 4.10) for having been hospitalized for something other than stroke (both compared with the reference category of those not hospitalized at all). The adjusted odds ratio for having any subsequent hospitalization associated with having a primary hospital discharge diagnosis of ischemic stroke (compared with having been hospitalized for something other than stroke) was not significantly elevated (AOR = 1.16; CI95% = .94 to 1.42). However, the percent increases in the subsequent number of hospital episodes, total charges, and total length of stay for those who were hospitalized for ischemic stroke relative to those hospitalized for something other than stroke were significant (P < .001), and ranged from 16.3 to 39.0%. Hospitalization for ischemic stroke was also related significantly to greater increases in the regression‐adjusted mean number of instrumental activities of daily living and lower body function limitations at follow‐up.CONCLUSION: Hospitalization for ischemic stroke among older adults substantially increases the risk of subsequent mortality, the volume of hospital resource consumption, and greater functional decline, even when compared with hospitalization for something other than stroke. Therefore, greater attention to the prevention and management of ischemic stroke is needed. J Am Geriatr Soc 46:577–582, 1998.
Alprazolam as an Alternative to Low‐Dose Haloperidol in Older, Cognitively Impaired Nursing Facility Patients
Authors: Christensen Dale B. , Benfield William R. 
Published: April 2015

OBJECTIVES: To determine if alprazolam is equally as effective as low dose haloperidol in managing disruptive behavioral episodes associated with delirium, dementia, and amnesic and other cognitive disorders (formerly called organic mental syndromes).SETTING: Twenty‐five community nursing homes in western Washington.PARTICIPANTS: Older nursing home residents (N = 48) receiving a low‐dose neuroleptic for the treatment of agitation and behavioral disturbances.INTERVENTION: Randomized, double‐blind, crossover trial of alprazolam and low dose haloperidol. Data were gathered at baseline and at the end of 6 and 12 weeks from direct observation and from clinical forms completed routinely by trained nurses.MEASUREMENTS: Number of behavioral episodes, activities of daily living as measured by the Blessed Dementia Scale, extrapyramidal symptoms as measured by the Abnormal Involuntary Movement Scale (AIMS), and psychopathology as measured by the Clinical Global Impressions (CGI) and the Sandoz Clinical Assessment ‐ Geriatric (SCAG) scalesRESULTS AND CONCLUSIONS: No significant differences were observed between patients using haloperidol or alprazolam in terms of behavioral episodes per week. Further, with few exceptions, no significant differences were found in other outcome scales. Essentially the same findings were found when analyses were repeated for subgroups of patients with high levels of cognitive impairment and for patients with low and high levels of recorded problematic behavioral episodes. Alprazolam was as effective as low dose haloperidol in this population. J Am Geriatr Soc 46:620–625, 1998.
Executive Dyscontrol: An Important Factor Affecting the Level of Care Received by Older Retirees
Authors: Royall Donald R. , Cabello Maria , Polk Marsha J. 
Published: April 2015

OBJECTIVES: To examine the relative contributions of Executive Control Function (ECF), general cognition, mood, problem behavior, physical disability, demographic variables, and the number of prescribed medications to the level of care received by older retirees.DESIGN: Multivariate regression and discriminant modeling.SETTING: A single Continuing Care Retirement Community (CCRC) in San Antonio, Texas.PARTICIPANTS: A total of 107 older retirees (mean age = 83.7 ± 7.2 years), including 17 community‐dwelling, well, older controls and 90 CCRC residents. CCRC subjects represented a convenience sample of consecutive referrals for geropsychiatric assessment. Sixty‐one subjects resided at a noninstitutionalized level of care, and 46 were institutionalized.MEASUREMENTS: Tests of ECF (the Executive Interview (EXIT25)), general cognition (the Mini‐Mental State Examination (MMSE)), mood (the Geriatric Depression Scale short‐form (sGDS)), problem behavior (the Nursing Home Behavior Problem Scale (NHBPS)), physical disability (the Cumulative Illness Rating Scale (CIRS)), age, gender, years of education, and the number of prescribed medications were studied.RESULTS: All variables except gender and education varied significantly across level of care. Four variables made significant independent contributions; EXIT25 score (r2 = .48, P < .001), medication usage (partial r2 = .11, P < .001), sGDS score (partial r2 = .06, P = .001), and problem behavior (partial NHBPS r2 = .04, P < .04). These variables accounted for 69% of the total variance in level of care (R2 = .69; F (df 7,99) = 32.1, P < .001). A discriminant model based on the number of prescribed medications, EXIT25, sGDS, and NHBPS scores classified 83.2% of cases correctly (Wilke's lambda = .50, F (5, 101) = 20.1; P < .001). The MMSE enters but fails to contribute significantly, independent of the other variables. Age and CIRS scores fail to enter.CONCLUSIONS: Cognitive (particularly ECF) impairment contributes most to the observed variance in level of care received by older retirees in this CCRC. In contrast, markers of general cognition, depression, and physical illness contributed relatively little additional variance. ECF is not detected well by traditional cognitive measures and must be sought by specific tests. Further study is needed to replicate these findings in other populations.
Prevalence and Outcome of Methicillin‐Resistant Staphylococcus Aureus Colonization in Two Nursing Centers in Georgia
Authors: MD Ali R. Rahimi 
Published: April 2015

OBJECTIVES: To evaluate the cost‐effectiveness and validity of aggressive diagnosing and eradication of methicillin‐resistant Staphylococcus aureus (MRSA) colonization.DESIGN: An observational study of MRSA colonization.SETTING: Two skilled nursing facilities in Georgia.PARTICIPANTS: Eighty‐seven residents of the abovementioned skilled nursing facilitiesINTERVENTION: No changes were made in either nursing facility practices or patient treatments.MEASUREMENTS: The presence or absence of MRSA colonization was determined at the beginning of the study, after hospitalizations or absences from the facility, and 12 months after initial testing.RESULTS: Eighty‐seven participants began the study, and 56 completed it. At the beginning of the study, 17.9% of the 56 who later completed the study were positive for MRSA. By the end of the study, colonization had decreased to 14.3%. The difference in the number of positive cultures for residents returning from the hospital compared with those returning from non‐hospital settings was not statistically significant (P = .546). No deaths or hospitalizations were attributable to MRSA infection.CONCLUSION: Because no significant correlation was found between MRSA colonization and active MRSA‐related infections, patients colonized by MRSA should not be barred from admission to nursing homes.
A Prospective Study of Posturography in Normal Older People
Authors: Baloh Robert W. , Corona Sonia , Jacobson Kathleen M. , Enrietto Jane A. , Bell Theodore 
Published: April 2015

OBJECTIVE: To follow posturographic measurements over time in a group of normal older subjects to see if sway increases with aging and if sway is greater in those with deteriorating balance and falls.SUBJECTS: Seventy‐two community‐dwelling older people (age range 79–91 years), who initially had normal neurological evaluations, were followed with three yearly follow‐up examinations.MEASUREMENTS: Amplitude and velocity of sway on static and dynamic posturography, Tinetti gait and balance score, reports of falls.RESULTS: Velocity of sway on dynamic tests increased significantly during the 3 years of follow‐up. The percentage increase in sway was about the same in the anterior‐posterior and medial‐lateral directions and with eyes open and eyes closed. Subjects with low Tinetti scores had higher sway amplitude and velocity, particularly on dynamic tests, but no measure of sway was significantly different in those who reported falls compared with those who did not report falls.CONCLUSIONS: Sway increases in normal subjects over time, and sway is greater in older subjects with deteriorating balance compared with those with normal balance. Sway was not greater in those who fell compared with those who did not fall, probably because falls are highly dependent on individual behavior.