bluuebunny/crossref_metadata_2025_split huggingface dataset:
Absence of Vascular Dementia in an Autopsy Series from a Dementia Clinic
Authors: Nolan Karen A. , Lino M. Maddelena , Seligmann Arthur W. , Blass John P. 
Published: April 2015

OBJECTIVE: The role of cerebrovascular disease in dementia in older people has been the subject of controversy. This study was undertaken to examine the prevalence of vascular disease in a prospective autopsy series of patients with clinically diagnosed dementia.DESIGN: Structured review of clinical and neuropathological examinations. Clinical diagnoses were assigned in accordance with the recommendations of the NINCDS/ADRDA consensus panel. Neuropathological examinations were performed at an academic neuropathology service using published consensus criteria for the diagnosis of Alzheimer's disease and other forms of dementia.SETTING: A subspecialty, outpatient dementia clinic in a university‐affiliated suburban American hospital.PARTICIPANTS: Eighty‐seven unselected patients coming to autopsy who had undergone clinical dementia evaluation.RESULTS: Dementia could not be attributed to the effects of cerebrovascular disease alone in any of the 87 patients coming to autopsy. Seventy‐six (87%) of the patients were found to have Alzheimer's disease (AD), 44 had AD alone, and 32 had AD in combination with cerebrovascular disease (CVD). All of the patients with signs of CVD at autopsy were also found to have some concomitant neurodegenerative disease. The absence of patients in whom vascular dementia could be diagnosed at neuropathology was not the result of recruitment bias.CONCLUSION: Clinicians should maintain a high index of suspicion of AD or other neurodegenerative process in older patients whose presenting complaint is dementia, even in the presence of well documented cerebrovascular disease. J Am Geriatr Soc 46:597–604, 1998.
The Effect of a Physician Assistant on the Hospitalization of Nursing Home Residents
Authors: Ackermann Richard J. , Kemle Kathy A. 
Published: April 2015

OBJECTIVES: To describe the impact of regular visits to a nursing home by a gerontologist physician assistant (PA) on the hospitalization and medical costs of patients.DESIGN: A 6‐year case series (1992–1997) incorporating events before and after introduction of a PA in May 1994. The PA visited the nursing home 3 to 4 times per week, provided nearly all of the acute medical care, and alternated routine visits with supervising physicians.SETTING: A 92‐bed teaching nursing home in central Georgia.MEASUREMENTS: Demographics of the nursing home population; hospitalizations of residents, including major diagnosis and length of stay; number and site of all resident deaths; costs of physician and PA services and hospital costs.RESULTS: After the introduction of the physician assistant, the number of annual hospital admissions fell by 38.0%, and the total number of hospital days per 1000 patient years fell by 68.6% (from 4170 in 1992 to 1310 in 1997). The number of nursing home visits increased by 62.1%. Annual Medicare‐allowed charges for MD and PA services increased by $22,304, but this was more than offset by a decline in hospital DRG reimbursements of $96,043.CONCLUSIONS: The introduction of regular visits to nursing home patients by a physician assistant can reduce hospitalization and medical costs of these frail older people. J Am Geriatr Soc 46:610–614, 1998.
Underutilization of Aspirin in Older Patients with Prior Myocardial Infarction at the Time of Admission to a Nursing Home
Authors: Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To investigate the prevalence of aspirin use in older patients with prior myocardial infarction at the time of admission to a nursing home.DESIGN: In a prospective study, the prevalence of aspirin use in 350 consecutive older patients with documented Q‐wave myocardial infarction and no contraindications to aspirin use was investigated in patients aged 60 years or older at the time of admission to a nursing home.SETTING: A large, long‐term, healthcare facility.PATIENTS: The patients included 231 women and 119 men, mean age 81 ± 8 years (range 60 to 100).MEASUREMENTS AND MAIN RESULTS: Of the 350 patients with documented Q‐wave myocardial infarction and no contraindications to aspirin therapy, 60 patients (17%) were receiving aspirin at the time of admission to the nursing home.CONCLUSION: There is a marked underutilization of aspirin in the treatment of older patients with documented prior myocardial infarction at the time of admission to a nursing home. J Am Geriatr Soc 46:615–616, 1998.
Depression and Disability Associated with Impaired Vision: The MoVIES Project
Authors: Rovner Barry W. , Ganguli Mary 
Published: April 2015

OBJECTIVE: To assess how depression and impaired vision relate to disability in older people.DESIGN: An epidemiological survey of an age‐stratified random community sample.SETTING: The rural mid‐Monongahela Valley in Southwestern Pennsylvania.PARTICIPANTS: A total of 872 noninstitutionalized persons aged 68 and older, fluent in English, and with at least a grade 6 education.MEASUREMENTS: Demographics, self‐reported vision impairment, OARS Instrumental Activities of Daily Living (IADL), and modified Center for Epidemiologic Studies‐Depression scale to assess depression.RESULTS: Compared with subjects with intact vision, those with impaired vision were more likely to have five or more depressive symptoms (29.7% vs 8.5%; OR = 4.6, 95% CI = 2.2, 9.6) and to be more functionally impaired (OR = 9.7, 95% CI = 4.9, 19.2). The number of depressive symptoms (1–4: OR = 2.4, CI = 1.8,3.4) and (5 +: OR = 5.9, CI = 3.6, 9.8) was associated independently with IADL impairment after controlling for vision, age, and gender.CONCLUSIONS: Impaired vision and depression are both associated strongly with functional impairment in this community population of older adults. Depression, however, increases the odds of functional impairment independent of vision impairment. Treating depression may reduce excess disability associated with impaired vision. J Am Geriatr Soc 46:617–619, 1998.
The APOE ∍4 allele Is Associated with Decline on Delayed Recall Performance in Community‐Dwelling Older Adults
Authors: O'Hara Ruth , Yesavage Jerome A. , Kraemer Helena C. , Mauricio Maritess , Friedman Leah F. , Murphy Greer M. 
Published: April 2015

OBJECTIVE: This study investigated whether the Apolipoprotein (APOE) ∍4 allele was associated with cognitive decline in community‐dwelling older adults.DESIGN: Longitudinal cognitive performance of older adults with the ∍3/∍4 genotype was compared with that of older adults with the ∍3/∍3 genotype.SETTING: Aging Clinical Research Center, Stanford University.PARTICIPANTS: One hundred community‐dwelling older adults were recruited from a pool of 531 individuals who had participated in a memory training study 4 to 5 years earlier. These individuals were concerned about their memory functioning and were recruited through newspaper advertisements and contacts with local senior centers. The 100 individuals who agreed to participate in the follow‐up investigation were between 59 and 95 years of age.MEASUREMENTS: At both baseline and follow‐up, subjects were administered a battery of seven cognitive tests that examined verbal and spatial memory, attention, speed‐of‐processing, and language abilities. APOE genotype was determined at follow‐up.RESULTS: Individuals with the ∍3/∍4 APOE genotype were significantly younger than individuals with the APOE ∍3/∍3 genotype. No significant differences were observed between the two groups on measures of attention, speed‐of‐processing, vocabulary, immediate verbal memory, and immediate spatial memory. However, those older adults with the ∍3/∍4 genotype exhibited significantly greater decline in performance on delayed recall of verbal material than did those with the ∍3/∍3 APOE genotype.CONCLUSION: These findings are consistent with previous studies, which suggest that the APOE ∍4 allele predicts decline on measures of delayed recall.
Psychiatric Diagnosis and Intervention in Older and Younger Patients in a Primary Care Clinic: Effect of a Screening and Diagnostic Instrument
Authors: Valenstein Marcia , Kales Helen , Mellow Alan , Dalack Gregory , Figueroa Sara , Barry Kristen Lawton , Blow Frederic C. 
Published: April 2015

OBJECTIVES: To determine whether patient age is associated with psychiatric diagnosis or provider intervention in a busy primary care clinic, and, if so, whether a screening and diagnostic tool, the PRIME‐MD, modifies age‐related differences.DESIGN, SETTING, AND PARTICIPANTS: PRIME‐MD use, psychiatric diagnosis, and provider interventions for psychiatric conditions were recorded for eligible patients attending a Veterans Affairs Medical Center primary care clinic. Data from 952 younger (< 65 years) and 1135 older patients (>65 years) were analyzed to determine whether there were age‐related differences in diagnosis/intervention and if use of the PRIME‐MD modified these differences.INTERVENTION: Implementation of the PRIME‐MD, a two‐step instrument consisting of a self‐administered patient questionnaire and a provider‐administered structured diagnostic interview.MEASUREMENTS: Outcome measures were rates of (1) PRIME‐MD use, (2) overall psychiatric diagnosis, (3) new psychiatric diagnosis, and (4) provider intervention for psychiatric conditions.RESULTS: There was no association between patient age and PRIME‐MD use. Older patients were less likely to receive a psychiatric diagnosis in analyses that adjusted for “highly positive” screening questionnaires (OR =. 45; P < .001). Older patients were also less likely to receive an intervention for a psychiatric condition in analyses that adjusted for whether a psychiatric diagnosis (OR = .62, P = .015) or a new psychiatric diagnosis (OR = .36, P < .001) was made during the study visit. The PRIME‐MD increased rates of diagnosis and intervention but did not alter age‐related disparities.CONCLUSIONS: Decreased rates of psychiatric diagnosis and intervention in older primary care patients are of concern. Implementing the PRIME‐MD will likely increase rates of diagnosis and intervention but will need to be accompanied by additional measures to eliminate age‐related disparities. J Am Geriatr Soc 46:1499–1505, 1998.
Validation and Application of the Pneumonia Prognosis Index to Nursing Home Residents with Pneumonia
Authors: Mylotte Joseph M. , Naughton Bruce , Saludades Charito , Maszarovics Zoltan 
Published: April 2015

OBJECTIVES: To evaluate the predictability of a pneumonia prognosis index in nursing home residents with pneumonia and to use the index to account for acute severity of pneumonia before comparing the short‐term outcome of residents with pneumonia treated with intravenous antibiotic therapy in two different settings: an inpatient geriatrics unit and a nursing homeDESIGN: A retrospective chart review of 158 episodes of nursing home‐acquired pneumonia treated initially with intravenous antibiotics; 100 episodes were treated in an inpatient acute geriatrics service (AGS), and 58 were treated completely in a nursing home (Nursing Home group)SETTING: The AGS is a 20‐bed unit within a 400‐bed, public, university‐affiliated hospital. The Nursing Home group consisted of residents of two nonproprietary nursing homes.PARTICIPANTS: Nursing home residents with radiographically proven pneumonia who had at least one of the following signs/symptoms: cough, fever, purulent sputum, respiratory rate ≥ 25 per minute, localized auscultatory findings, or pleuritic pain.MEASUREMENTS: The pneumonia prognosis index was calculated for each resident at the time of diagnosis of pneumonia; the index has been validated as a predictor of hospital outcome in patients with community‐acquired pneumonia and is also considered a measure of acute severity of pneumonia. Status (alive or dead) of each resident at 30 days after diagnosis was the major dependent variableRESULTS: Mean (± SD) duration of antibiotic therapy for the Nursing Home group (10.7 ± 4.5 days) was not significantly different from that of the AGS group (9.6 ± 3.4 days; P = .26). The pneumonia prognosis index stratified the 158 episodes of pneumonia into low‐ and high‐risk groups for 30‐day mortality; the mortality rates in each risk strata were not significantly different from those reported in the original derivation and validation studies of the index. In addition, the distribution of episodes among the risk strata of the index was not significantly different for the two study groups, which was an indication that the two groups were similar in terms of acute severity of pneumonia. Thirty‐day mortality was not significantly different between the two groups: AGS, 21% and Nursing Home, 24.1% (P = .66).CONCLUSION: The pneumonia prognosis index seems to have the same capability for predicting the outcome in nursing home residents with pneumonia as in residents with community‐acquired pneumonia. The index is also a measure of acute pneumonia severity. Nursing home residents with pneumonia, even those who are most acutely ill, can be treated successfully with intravenous therapy in the nursing home; their 30‐day mortality was no different than that of those with the same acute severity of illness who were admitted to a hospital for treatment.
Venous Thrombosis in Older People: Prevalence of the Factor V Gene Mutation Q506
Authors: André E. , Siguret V. , Alhenc‐Gelas M. , Saint‐Jean O. , Gaussem P. 
Published: April 2015

OBJECTIVES: Old age is usually considered to be a risk factor for venous thromboembolism, in conjunction with other factors such as heart failure, major surgery, cancer, long‐term immobilization, and antiphospholipid antibodies. Genetic risk factors, especially inherited deficiencies in coagulation inhibitors, also play a role in the pathogenesis of thrombosis, but these are usually diagnosed in thrombophilic patients before the age of 50. The factor V Q506 mutation, responsible for activated protein C resistance, was recently linked to thromboembolic disease. We therefore investigated the prevalence of biological risk factors in older hospital patients with venous thromboembolism.DESIGN: A 2‐year study period.SETTING: Ivry sur Seine (Paris), France.PARTICIPANTS: Seventy‐nine geriatric patients (60 women and 19 men, mean age 83 ± 6.8 years, range 70–102 years) who had had at least one proven episode of venous thromboembolism were enrolled over a 2‐year period.MEASUREMENTS: Lupus anticoagulant and antithrombin (AT), protein C (PC), and protein S (PS) levels were determined in plasma. The factor V Q506 mutation was detected on genomic DNA.RESULTS: Lupus anticoagulant was detected in two women, one of whom also had a high level of anticardiolipin IgG, leading to the diagnosis of an antiphospholipid syndrome. No hereditary deficiency in AT, PC, or PS was found, but one patient had an acquired AT deficiency. Interestingly, nine of the 79 patients (11.4%, six women and three men) were heterozygous for the factor V Q506 mutation, although none were homozygous. The only major risk factor for thrombosis identified in these patients was prolonged immobilization in four cases. Four of the nine patients who were heterozygous for the factor V Q506 mutation had recurrent thromboembolism, and two of these patients had been immobilized for long periods.CONCLUSIONS: This study confirms that hereditary deficiencies in coagulation inhibitors, and the lupus anticoagulant, are rarely involved in the pathogenesis of venous thromboembolism in older subjects. In contrast, the factor V Q506 mutation was frequently associated with thrombosis (11.4% of our patients) and should, therefore, be considered an important risk factor in the older people.
Gastroesophageal Reflux Disease
Authors: Katz Philip O. 
Published: April 2015

Gastroesophageal reflux disease (GERD) is a spectrum of disease that can best be defined as the symptoms and/or signs of esophageal or adjacent organ injury secondary to the reflux of gastric contents into the esophagus or, beyond, into the oral cavity or airways. Injury is defined based on symptoms or organ damage resulting in esophagitis, laryngeal inflammation, or acute and/or chronic pulmonary injury.Though specific studies are lacking, GERD seems to occur more frequently in older people. In general, because it has been present for a longer period of time, older patients will often present with more complicated GERD, including severe erosive esophagitis, peptic stricture, and Barrett's esophagus, a premalignant condition, making treatment of older patients with GERD potentially more difficult and complex. Though it is not usually life‐threatening, GERD can have a major effect on patients' well‐being and quality of life. This article reviews the presentation, pathophysiology, diagnosis, and treatment of GERD as it relates to the older patient. J Am Geriatr Soc 46:1558–1565, 1998.
Lower‐Extremity Functioning in Older Mexican Americans and Its Association with Medical Problems
Authors: Perkowski Linda C. , Stroup‐Benham Christine A. , Markides Kyriakos S. , Lichtenstein Michael J. , Angel Ronald J. , Guralnik Jack M. , Goodwin James S. 
Published: April 2015

OBJECTIVE: To describe lower‐extremity functioning in community‐dwelling older Mexican Americans and to examine its relationship with medical problems.DESIGN: Cross‐sectional analyses of survey and performance‐based data obtained in a population‐based study employing area probability sampling.SETTING: Households within selected census tracts of five Southwestern states: Arizona, California, Colorado, New Mexico, and Texas.PARTICIPANTS: A total of 2873 Mexican Americans aged 65 years and older.MEASUREMENTS: A multidimensional questionnaire assessing demographic, sociocultural, and health variables. Standardized tests of lower‐extremity physical functioning included measures of standing balance, repeated chair stands, walking, and an overall summary measure.RESULTS: Regression analyses revealed that being more than age 75 and female, having arthritis diabetes, visual impairments, or being obese or underweight were all significantly associated with performance on both individual and summary tests of lower‐extremity functioning. In separate regression analyses, the total number of medical conditions was also associated with performance.CONCLUSIONS: The likelihood of predicting performance or inability to complete tests of lower‐extremity functioning was greatest for those aged 80 and older, those with arthritis or diabetes, and those with three or more medical conditions. Because of the high prevalence of diabetes in Mexican Americans, documentation of the association of diabetes with performance‐based tests of lower‐extremity functioning may help guide early interventions targeted to prevent progression to more severe limitations or disability.
Urinary Incontinence in a Community‐Based Cohort: Prevalence and Healthcare‐Seeking
Authors: Roberts Rosebud O. , Jacobsen Steven J. , Rhodes Thomas , Reilly W. Terence , Girman Cynthia J. , Talley Nicholas J. , Lieber Michael M. 
Published: April 2015

OBJECTIVE: To estimate the prevalence of urinary incontinence and to assess care‐seeking behavior for urinary symptoms among community‐dwelling people.DESIGN: A community‐based cross‐sectional study.SETTING: Randomly selected men and women from Olmsted County, Minnesota.PARTICIPANTS: Two cohorts, one comprised of both men (n = 778) and women (n = 762) 50 years of age or older and a second comprised of men aged 40 years or older (n = 2150).MEASUREMENTS: Participants completed questionnaires assessing urinary incontinence in the previous 12 months, the number of days leaked, the amount leaked, and healthcare‐seeking measures for urinary symptoms.RESULTS: In the first cohort, the prevalence of incontinence was 24% in men and 49% in women; 29% of men and 13% of women with incontinence had sought care for urinary symptoms. Urinary incontinence was more strongly associated with care‐seeking measures for urinary symptoms in men (Odds Ratio (OR) = 4.3, 95% Confidence Interval (CI) = 2.4, 8.0) than in women (OR = 2.1, 95% CI = 1.2, 3.9). Moderate or severe urinary incontinence was associated significantly with care‐seeking for urinary symptoms (OR = 10.5, 95% CI = 5.6, 19.8). In the second cohort, the prevalence of urinary incontinence was 17.3%; 8.5% of men with incontinence had sought care for urinary symptoms. Men with incontinence were 1.2 times (95% CI = .8, 1.9) as likely to seek care for urinary symptoms as men without incontinence.CONCLUSION: Our findings indicate that although urinary incontinence is relatively common in the community, care‐seeking for urinary symptoms among persons with urinary incontinence is low, particularly among women, for whom the prevalence exceeds 40% between the ages of 50 and 70 years. These findings suggest that strategies to promote care‐seeking for incontinence need to be investigated and employed in the community.
Prevalence of Coronary Artery Disease, Atherothrombotic Brain Infarction, and Peripheral Arterial Disease: Associated Risk Factors in Older Hispanics in an Academic Hospital‐Based Geriatrics Practice
Authors: Mendelson Gad , Aronow Wilbert S. , Ahn Chul 
Published: April 2015

OBJECTIVE: To investigate the prevalence of coronary artery disease (CAD), atherothrombotic brain infarction (ABI), and peripheral arterial disease (PAD) in older Hispanics and the association with risk factors in this population.DESIGN: A retrospective analysis of charts from all Hispanics seen during January 1996 through July 1997 at an academic hospital‐based geriatrics practice.SETTING: An academic, hospital‐based, primary care geriatrics practice staffed by fellows in a geriatrics training program and by full‐time faculty geriatricians.PATIENTS: One hundred sixty women and 53 men, mean age 80 ± 8 years (range 64 to 100), were included in the study.MEASUREMENTS AND MAIN RESULTS: Of 213 Hispanics in the study, 59 (28%) had documented CAD, 43 (20%) had ABI, 34 (16%) had PAD, and 90 (42%) had either CAD, ABI, or PAD. Serum total cholesterol and triglycerides were measured in 202 of 213 subjects (95%). Serum high‐density lipoprotein cholesterol was measured in 137 of 213 patients (64%). Other risk factor data were documented in all patients. Multiple logistic regression analysis performed in 202 patients using the variables age, gender, cigarette smoking, hypertension, diabetes mellitus, obesity, serum total cholesterol, and serum triglycerides showed statistically significant associations between prevalent CAD, ABI, or PAD and age (P = .002, odds ratio (OR) = 1.083), cigarette smoking (P = .002, (OR) = 3.865), hypertension (P = .007, (OR) = 2.749), diabetes mellitus (P = .028, (OR) = 2.386), obesity (P = .014, (OR) = 2.608), serum total cholesterol (P < 0.001, (OR) = 1.025), and serum triglycerides (P = .017, (OR) = .993).CONCLUSIONS: Either CAD, ABI, or PAD was present in 42% of 213 older Hispanics. There were statistically significant associations between prevalent CAD, ABI, or PAD in older Hispanics and risk factors, including age, cigarette smoking, hypertension, diabetes mellitus, obesity, and serum total cholesterol.