bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cognitive Function in Old and Very Old Residents of a Residential Facility: Relationship to Age, Education, and Dementia
Authors: Osterweil Dan , Mulford Patty , Syndulko Karl , Martin Maria 
Published: April 2015

OBJECTIVE: To determine if age, education, and dementia status affect neuropsychological performance in old and very old frail residential care subjects.DESIGN: Descriptive study of performance at the time of preadmission assessment.SETTING: Jewish Home for the Aging, Reseda, California.PARTICIPANTS: 201 applicants to the Jewish Home for the Aging residential care setting. Mean age was 84.7 years; SD was 5.6. Ninety‐five subjects were 84 years of age or younger, while 106 were age 85 and older. There were 141 nondemented, 21 demented, and 39 were possibly demented applicants. Levels of education were as follows: 0–4 years: n = 25; 5–8: n = 69; 9–12: n = 77; and, 13–20: n = 23.MEASUREMENTS: Independent variables were age, education, and dementia status. Outcome measures were Folstein MMSE, Inglis P‐A Learning Test, Digit Span, Cube Copying, selected Boston Diagnostic Aphasia Exam subtests.RESULTS: Subjects with 0 to 4 years of education scored more poorly on cognitive tests than other subjects. The very old tended to score more poorly than the old. Neuropsychological tests discriminated between those with normal cognitive function, possible dementia, and established dementia. About one‐third of nondemented elderly scored below the traditional impairment cut‐off of 24 points on the Mini‐Mental State Exam.CONCLUSIONS: Questions are raised about how to interpret the poorer cognitive performance of very old and often frail subjects, especially in long‐term‐care settings where there are fewer demands upon residents whose impairments might otherwise cause them more functional difficulty.
Disability and Severe Gastrointestinal Hemorrhage. A Prospective Study of Community‐Dwelling Older Persons
Authors: Pahor Marco , Guralnik Jack M. , Salive Marcel E. , Chrischilles Elizabeth A. , Manto Andrea , Wallace Robert B. 
Published: April 2015

OBJECTIVE: To describe the occurrence of severe gastrointestinal bleeding in community‐dwelling older persons and to examine whether disability is a risk factor for this life‐threatening condition independent of other known predictors.DESIGN: Prospective cohort survey.SETTING: Three communities of the Established Populations for Epidemiologic Studies of the Elderly (EPESE).PARTICIPANTS: 8205 persons age ≥68 years.MEASUREMENTS: The hospital discharge diagnoses provided by the Medicare Provider Analysis and Review files and the death certificates were prospectively surveyed for 3 years. Those with at least 1 discharge diagnosis of gastrointestinal bleeding and who received a blood transfusion or died were identified as cases of severe gastrointestinal hemorrhage. Physical disability, cognitive function, smoking and alcohol intake habits, body mass index, blood pressure, chronic conditions, number of hospital admissions in past year and medications taken were assessed at baseline.RESULTS: The occurrence rate of severe gastrointestinal bleeding was 10.8 per 1000 person‐years (241 events/22,277 person‐years). In proportional hazards regression models, compared with no disability, ≥ 1 disabilities in the Rosow‐Breslau scale (RR = 2.1, 95% CI = 1.5–2.9), and ≥1 ADLs limitations (RR = 3.1, 95% CI = 2.1–4.6) independently predicted gastrointestinal hemorrhage after adjusting for age, gender, body mass index, comorbidity, number of hospital admissions, blood pressure, intake of coumarin, corticosteroids, aspirin and other nonsteroidal antiinflammatory drugs.CONCLUSIONS: In this prospective analysis, disability is an independent predictor of gastrointestinal hemorrhage. Further studies are needed to explain the mechanisms by which disability may cause gastrointestinal hemorrhage. Because physical disability is potentially modifiable, strategies to lower the risk of gastrointestinal bleeding should be evaluated.
Differences in the Treatment of Patients with Acute Myocardial Infarction According to Patient Age
Authors: Rosenthal Gary E. , Fortinsky Richard H. 
Published: April 2015

OBJECTIVE: To identify age‐related differences in the treatment of patients with acute myocardial infarction.DESIGN: Retrospective cohort study.SETTING: Two university‐affiliated medical centers with integrated clinical programs.PATIENTS: 329 patients admitted with acute myocardial infarction in 1988–1990 for whom complete medical records were available. Study exclusions included patients transferred from other hospitals specifically to undergo angiography or other cardiac procedures, nursing home residents, patients with metastatic cancer or dementia, and patients in whom “do not resuscitate” orders were written during the first 2 hospital days.MEASUREMENTS: Medical records were reviewed to determine socio‐demographic data, comorbidity, admission severity of illness, medications, the use of specific diagnostic and therapeutic modalities during and after hospitalization, treatment limitations, and patient outcomes.MAIN RESULTS: Chronological age of patients was related to the use of several diagnostic and therapeutic modalities. Using logistic regression to adjust for comorbidity, severity, infarct size and location, and other covariates, patients 75 years and older were 12 times less likely to receive thrombolytic therapy, 8 times less likely to undergo coronary angiography, and 7 times less likely to undergo coronary angioplasty than patients less than 65 years of age. However, age was not related to the use of other modalities, including echocardiography or gated blood pool scanning, pulmonary artery catheterization, and transvenous pacing. Finally, in a logistic regression model, the risk of in‐hospital death was 4 times greater for patients 75 years and older than patients less than 65 years.CONCLUSIONS: Physicians' management of patients with acute myocardial infarction differed greatly according to patient age for some diagnostic and therapeutic modalities, but not for others. These findings indicate that generalizations about age‐related practice variations should not be based on analysis of a single procedure. Moreover, judgments about the appropriateness of age‐related differences in management require knowledge of the relative effectiveness of management strategies in older and younger patients.
Improving Treatment of Late Life Depression in Primary Care: A Randomized Clinical Trial
Authors: Callahan Christopher M. , Hendrie Hugh C. , Dittus Robert S. , Brater D. Craig , Hui Siu L. , Tierney William M. 
Published: April 2015

OBJECTIVE: Facilitate primary care physicians' compliance with recommended standards of care for late life depression by reducing barriers to recognition and treatment.DESIGN: Randomized controlled clinical trial of physician‐targeted interventions.SETTING: Academic primary care group practice caring for an urban, medically indigent patient population.PATIENTS/PARTICIPANTS: Patients aged 60 and older who exceeded the threshold on the Centers for Epidemiologic Studies Depression Scale (CES‐D) and the Hamilton Depression Rating Scale (HAM‐D) and their primary care physicians.INTERVENTION: Physicians of intervention patients were provided with patient‐specific treatment recommendations during 3 special visits scheduled specifically to address the patient's symptoms of depression. In general, physicians were encouraged to establish a diagnosis of depression and educate their patient about the diagnosis, discontinue medications that can cause or exacerbate depressive symptoms, initiate antidepressants when appropriate, and consider referral to psychiatry. Guidelines for prescribing antidepressants were provided. Control physicians received no intervention, and control patients received usual care.MAIN OUTCOME MEASURES: Frequency of recording a depression diagnosis, stopping medications associated with depression, initiating antidepressant medication, and psychiatry referral; mean changes in HAM‐D and Sickness Impact Profile (SIP) scores.RESULTS: One hundred three physicians and 175 patients were involved in the clinical trial. Physicians of intervention patients were more likely to diagnose depression and prescribe antidepressants (P < 0.01). There were no differences between the groups in the frequency of stopping medications associated with depression or referrals to psychiatry. Medications with the strongest cause and effect relationship to depression were infrequently used in this cohort of patients. Although both groups showed improvement in HAM‐D and SIP scores, we were unable to demonstrate significant differences in HAM‐D or SIP scores between the 2 groups.CONCLUSIONS: Intensive screening and feedback of patient‐specific treatment recommendations increased the recognition and treatment of late life depression by primary care physicians. However, we were unable to demonstrate significant improvement in depression or disability severity among intervention patients despite the informational support provided to their physicians. Efforts to improve the functional status of these patients may require more integrated interventions and more aggressive attempts to target psychosocial stressors traditionally outside the purview of primary care.
Indicators of Quality Medical Care for the Terminally Ill in Nursing Homes
Authors: Keay Timothy J. , Fredman Lisa , Taler George A. , Datta Soma , Levenson Steven A. 
Published: April 2015

PURPOSE: To identify medical care indicators for nursing home terminal care.DATA SOURCES: Studies examining care of terminally ill patients were identified using computer, bibliography, and expert searches; input from nursing home medical directors in Maryland; and input from expert geriatricians.STUDY SELECTION: More than 900 articles, books, and abstracts from meetings covering medical care for terminally ill patients were reviewed. Information from more than 100 publications is included.DATA EXTRACTION: Indicators of medical care for terminally ill patients, which can be used to quantify performance with respect to standards, guidelines, and options, were identified initially through review of the literature.DATA SYNTHESIS: Indicators were refined by input from medical directors of Maryland long‐term care facilities and subsequent review by expert geriatricians.CONCLUSIONS: Minimum standards for which 100% performance is expected are communication of advance directives, attention to pain control, and attention to relief of dyspnea. Performance indicators for medical care guidelines and options in terminal care of nursing home patients are also described.
Estrogen Replacement Therapy and Memory in Older Women
Authors: Robinson David , Friedman Leah , Marcus Robert , Tinklenberg Jared , Yesavage Jerome 
Published: April 2015

OBJECTIVE: To study the relationship between estrogen hormone replacement therapy and recall of proper names and words in cognitively intact older women.DESIGN: A case‐control study using subjects matched on age and education.PARTICIPANTS: From a group of 278 older (age range 55 to 93 years) community‐dwelling women volunteers for memory research, 72 older women taking estrogen replacement therapy were matched on age and education with a group of 72 women not taking estrogen.MEASUREMENTS: Dependent measures were performances on: a proper name recall test and a word recall test.RESULTS: Proper name recall was significantly better in those receiving estrogen (mean = 4.3; SD = 3.3) than in those not receiving estrogen (mean = 3.1; SD = 2.5), P = 0.01. There was also significantly greater variance in the name recall scores of the group taking estrogen than in the group not taking estrogen. For word recall, there was no significant difference between those subjects taking estrogen (mean = 6.4; SD 3.8) and those not taking estrogen (mean = 5.8; SD 3.7), P > 0.10.CONCLUSIONS: Estrogen use was associated with enhanced recall of proper names. Previous failures to find differences associated with estrogen use may reflect the memory measures used or an increased inter‐individual variability of the estrogen‐taking group, as was observed in the present study. Interpretation of these results should be tempered by their retrospective nature.
Postprandial Hypotension in 499 Elderly Persons in a Long‐Term Health Care Facility
Authors: Aronow Wilbert S. , Ahn Chul 
Published: April 2015

OBJECTIVE: To present baseline data from a prospective study of postprandial hypotension in 499 elderly persons in a long‐term health care facility.DESIGN: Analyses of baseline data for a prospective study.SETTING: A large long‐term health care facility where 499 ambulatory or wheelchair‐bound residents were studied.PATIENTS: The 499 residents were ≥ 62 years of age, mean age 80 ± 9 years (range 62–100), 71% female, 29% male, 66% white, 27% black, 7% Hispanic, 68% ambulatory, and 32% wheelchair‐bound.MEASUREMENTS AND MAIN RESULTS: The mean maximal decrease in postprandial systolic and diastolic blood pressures was 15 ± 6 mm Hg/6 ± 2 mm Hg. The mean maximal decrease in postprandial systolic blood pressure occurred 15 minutes after eating in 13% of residents, 30 minutes after eating in 20% of residents, 45 minutes after eating in 26% of residents, 60 minutes after eating in 30% of residents, and 75 minutes after eating in 11% of residents. Of 499 residents, 118 (24%) had a maximal decrease in postprandial systolic blood pressure of ≥20 mm Hg. The mean maximal decrease in postprandial systolic blood pressure was 24 ± 5 mm Hg in residents with syncope in the prior 6 months and 14 ± 5 mm Hg in residents without syncope (P < 0.0001). The mean maximal decrease in postprandial systolic blood pressure was 21 ± 5 mm Hg in residents with falls in the preceding 6 months and 13 ± 4 mm Hg in residents without falls (P < 0.0001). The mean maximal decrease in postprandial systolic blood pressure was significantly greater in residents treated with angiotensin‐converting enzyme inhibitors, calcium channel blockers, diuretics, nitrates, digoxin, and psychotropic drugs than in residents not treated with these drugs. The mean maximal decrease in postprandial systolic and diastolic blood pressures was not significantly different in elderly blacks, Hispanics, and whites.CONCLUSIONS: A more severe reduction in postprandial systolic blood pressure correlates with a history of syncope or falls in the previous 6 months. Long‐term follow‐up is being planned to determine whether a marked reduction in postprandial systolic blood pressure in elderly persons correlates with a higher incidence of falls, syncope, new coronary events, new stroke, and total mortality.
Effects of Resistive and Balance Exercises on Isokinetic Strength in Older Persons
Authors: Judge James O. , Whipple Robert H. , Wolfson Leslie I. 
Published: April 2015

OBJECTIVE: To determine the safety and efficacy of 3 months of resistive training of multiple lower extremity muscle groups compared with balance training in persons over 75 years.DESIGN: Randomized 3‐month clinical trial. Subjects (n = 110, mean age 80) were randomized to 4 groups in a 2 × 2 design (control, resistive, balance, combined resistive/balance).INTERVENTIONS: Resistive training involved knee extension and flexion, hip abduction and extension, and plantar and dorsiflexion using simple resistive machines and sandbags. Balance training consisted of exercises to improve postural control. The control group attended 5 health‐related discussion sessions.MEASUREMENTS: Summed isokinetic moments (N m) of 8 leg movements: hip, knee and ankle flexion/extension, and hip abduction/adduction. Secondary outcomes were gait velocity and chair rise time.MAIN RESULTS: Summed peak moment increased in both resistive exercise‐trained groups (13% increase in the resistive group and 21% in the combined training group, P < 0.001). The effect of resistance training was significant (MANOVA F = 21.1, P < 0.001), but balance training did not improve strength, and there was no interaction (positive or negative) between balance and resistive training. Maximal gait velocity and chair rise time did not improve. Eleven subjects (20%) had musculoskeletal complaints related to resistive training, but all were able to complete the program with modifications.CONCLUSION: Resistive training using simple equipment is an effective and acceptable method to increase overall leg strength in older persons. Resistive or balance training did not improve maximal gait velocity or chair rise time in this sample of relatively healthy older persons.
Dehydration and Death During Febrile Episodes in the Nursing Home
Authors: Weinberg Andrew D. , Pals Jean K. , Levesque Paul G. , Beal Lorraine F. , Cunningham Thomas J. , Minaker Kenneth L. 
Published: April 2015

OBJECTIVE: To determine the incidence of early hypernatremic dehydration among residents of a nursing home care unit (NHCU) presenting with significant febrile episodes (FE).DESIGN: Prospective cohort analytic study. FE were defined as temperature (T) > 100°F oral (o) or 101°F rectal (r) for ≥ 24 hours.SETTING: NHCU in a Veterans Administration hospital.PATIENTS: A total of 130 residents of the NHCU were monitored for FE during a 4‐month study period.MAIN OUTCOME MEASURES: Blood urea nitrogen (BUN)/creatinine (Cr) (abnormal ≥ 25) and serum sodium (Na)(abnormal ≥ 146 mmol/L) were drawn within 24–48 hours of the onset of all FE; documentation of impaired oral intake (OI) by staff; necessity of transfer to acute medical wards and mortality were recorded.RESULTS: There were 48 FE among 42 residents (39 M, 3 F; mean age 75 ± 11.3). Maximum recorded T during the FE ranged from 100.1°F–102.2°F o and 101.2°F‐105.3°F r. Laboratory values were available for 40/48 FE. Twenty‐three percent (9/40) had elevated BUN/Cr ratios, 25% (10/40) had elevated serum Na, and 12.5% (5/40) had both. In patients noted to have impaired OI (n = 11) as documented by staff, increased serum Na or BUN/Cr ratio was observed in 82% (9/11). A random control group of 37 nonacutely ill, nonfebrile NHCU residents (33 M, 4 F; mean age 75 ± 10.1) having routine annual laboratory tests revealed only 1 resident (age 95) with an elevated Na of 146 and BUN/Cr ratio of 26 and 1 resident with an increased BUN/Cr ratio of 28. None of the controls had any staff documentation of impaired OI. Of the 5 deaths in the febrile group with laboratory data (total deaths = 6; 14%), 100% had either elevated serum Na and/or elevated BUN/Cr ratios, and 80% (4/5) had both. Comparing the febrile group with controls, BUN/Cr ratios were found to be significantly elevated in the febrile group (P < 0.05). Serum sodium values were also significantly elevated in the febrile group (P < 0.01).CONCLUSIONS: Staff documentation of impaired OI was highly associated with either elevated serum Na or increased BUN/Cr ratios. These data show that many older NHCU patients with significant fevers often have early impaired OI and laboratory evidence of dehydration. These data indicate that staff should institute appropriate monitoring for dehydration at the time of earliest detection of fever in this population.
Safety Assessment for the Frail Elderly: A Comparison of Restrained and Unrestrained Nursing Home Residents
Authors: Schnelle John F. , Rae Priscilla G. Mac , Simmons Sandra F. , Uman Gwen , Ouslander Joseph G. , Rosenquist Lori L. , Chang Betty 
Published: April 2015

Objective: To facilitate clinicians judgment concerning physical restraint decisions by identifying potentially reversible injury risk factors that differentiate representative samples of restrained and unrestrained nursing home residents.Design: Comparison of restrained and unrestrained nursing home residents on a safety assessment for the frail elderly (SAFE) protocol.Setting: Long‐term care facilities in the Greater Los Angeles Area.Participants: One hundred eight physically restrained and 111 unrestrained nursing home residents.Intervention: None.Main Outcome Measures: (1) Internal, Interrater, and test/retest reliability of the overall SAFE protocol and of the four major factors measured by SAFE; (2) The relationship of SAFE scores to expert judgment of resident injury risk; (3) Differences between large samples of restrained and unrestrained residents on specific SAFE score factors.Results: Two walking, one transition, and one judgment factor are reliably measured by the SAFE protocol. SAFE scores were significantly correlated with expert judgment of risk for injury and showed large differences between restrained and unrestrained residents, even after differences in ambulation ability between the two groups were accounted for.Conclusion: The SAFE is a reliable protocol that measures behavioral factors related to falls and risk for injury among nursing home residents with a broad range of cognitive impairment. Factors that significantly differentiate restrained and unrestrained groups should be targeted for rehabilitation and remediation in physical restraint reduction efforts. Removing or changing restraints for the large sample (50%) of restrained residents who were not ambulatory will not significantly increase their mobility, since the majority of this group could not independently propel their wheelchairs. Increased mobility for the large group of both restrained and unrestrained residents will likely be realized only if restraint reduction programs are combined with interventions to improve both mobility and the specific behavioral performance factors measured by SAFE.
Mortality Differences Between Elderly Mexican Americans and Non‐Hispanic Whites in San Antonio, Texas
Authors: Espino David V. , Parra Ernesto O. , Kriehbiel Rod 
Published: April 2015

Objective: To identify differences in causes of death between elderly Mexican Americans (MA) and non‐Hispanic whites (NHW).Design: Retrospective death certificate review.Subjects: Elderly Mexican Americans and non‐Hispanic Whites age 65 and over who died in Bexar County, Texas during 1989.Measures: Data obtained from chart review included age, sex, race/ethnicity, and cause of death. Age‐adjusted and cause‐specific mortality rates, odds ratios (OR), and 95% confidence intervals (CI) were calculated.Results: Mexican Americans were at greater risk of dying in nine of the thirty causes of death examined. The mortality rates of MA subjects were higher than those of NHW from death caused by diabetes (OR = 3.19, CI = 2.27–4.49), renal failure (OR = 2.06, CI = 1.44–2.94), congestive heart failure (OR = 1.50, CI = 1.44–2.94), and multiple systemic diseases (OR = 2.59, CI = 1.89–3.57). Among the male subjects, MA had a greater risk than NHW of dying from myocardial infarction (OR = 1.83, CI = 1.15–2.90), coronary disease (OR = 1.37, CI = 1.07–1.75) and septicemia/pyuria (OR = 2.12, CI = 1.09–4.10). Among female subjects, MA had a greater likelihood of dying from cirrhosis (OR = 3.03, CI = 1.00–9.29). For only one of the causes of death was the risk lower among MA than NHW: MA female subjects had a lesser chance of dying from the chronic obstructive pulmonary disease (COPD) than NHW females (OR = 0.36, CI = 0.18–0.72).Conclusion: Mexican American elders have a greater risk of dying from non‐insulin dependent diabetes mellitus and renal failure than their NHW counterparts. Elderly MA men have a greater risk of dying from cardiovascular disease than their NHW counterparts. Mexican American women may have a greater risk of dying from cirrhosis, but a lower risk of dying from complications of COPD. Finally, death from ill defined causes, such as multiple systemic diseases, may be a major under‐acknowledged cause of death among older MA.