bluuebunny/crossref_metadata_2025_split huggingface dataset:
An In‐Home Preventive Assessment Program for Independent Older Adults: A Randomized Controlled Trial
Authors: Fabacher Diana , Josephson Karen , Pietruszka Fern , Linderborn Karen , Morley John E. , Rubenstein Laurence Z. 
Published: April 2015

Objective: To evaluate the effectiveness of in‐home geriatric assessments as a means of providing preventive health care and improving health and functional status of community‐living elderly veterans.Design: Randomized controlled trial with 1‐year follow‐up.Setting: Home visits performed in a suburb of Los Angeles.Participants: Community‐living veterans 70 years and older not currently receiving health care at the Sepulveda VA Medical Center (n= 131 intervention; 123 controls).Intervention: A home visit by a physician's assistant or nurse, to screen for medical, functional and psychosocial problems, followed by a letter describing findings and recommendations, and follow‐up visits by trained volunteers at 4‐month intervals for 1 year. Controls received only telephone interviews at 4‐month intervals to collect outcome data.Measurements: Compliance with recommendations was studied for the intervention group. Outcome comparisons between the two groups included: mortality, medication usage, functional status, immunization rates, and nursing home and hospital utilization.Main Results: A mean of four new or suboptimally treated problems was identified for intervention subjects. Subjects complied with 76% of recommendations to see a physician or initiate a specific health practice. At 12‐month follow‐up, intervention subjects had significantly increased their immunization rates (P< 0.001) and had a significantly increased likelihood of having a primary care physician (P< 0.05). Twelve‐month functional status (IADL) scores were significantly higher for intervention subjects than for controls; intervention subjects maintained their functional status, while controls experienced significant decline during the follow‐up year (P< 0.05). Non‐prescription drug use increased significantly among controls, but not among intervention subjects (P< 0.05).Conclusions: A brief geriatric screening assessment performed in the home can detect unrecognized and treatable problems, even among relatively healthy older adults. The use of trained volunteers is a feasible strategy for providing health education and follow‐up contacts. These results support the concept that preventive gerontological approaches can help maintain important aspects of health and function.
Effect of the Omnibus Reconciliation Act 1987 on Antipsychotic Prescribing in Nursing Home Residents
Authors: Semla Todd P. , Palla Kavita , Poddig Barbara , Brauner Daniel J. 
Published: April 2015

Objective: To determine the impact of OBRA 87 on antipsychotic prescribing in a 485‐bed nursing home.Design: Twelve‐month retrospective cohort review of medical charts, medication administration records, and computerized pharmacy records.Measurements: The percent of residents by diagnostic group and antipsychotic use.Main Results: An attempt was made to stop or lower the dose of antipsychotic in 75% of the 107 residents studied. Antipsychotics were stopped in 45% of residents with a dementia‐only diagnosis and 25% of residents with a psychiatric diagnosis (P < 0.05). Residents with documented symptoms appropriate for the use of an antipsychotic, per OBRA 87, were significantly less likely to have their antipsychotic stopped. Twenty percent of residents whose antipsychotic was either stopped or its dose lowered had the agent restarted or its dose increased.Conclusion: OBRA 87 had a significant impact on antipsychotic use in this facility.
Restraint Reduction in a Nursing Home and Its Impact on Employee Attitudes
Authors: Sundel Martin , Garrett Rosa M. , Horn Robyn D. 
Published: April 2015

Objective: To reduce physical restraint use in a nursing home and increase employee support for the restraint‐reduction program.Design: A one‐group pretest‐posttest design with repeated measures was used to determine changes in restraint use with participants over a 14‐month interval. All individuals employed at the nursing home were surveyed at two time periods to determine their opinions on restraint use.Setting: A 265‐bed private, non‐profit nursing home in Dallas, Texas.Participants: A restrained cohort of 170 residents with a mean age of 84 years; 84% were female. A total of 182 employees participated in the first survey and 209 in the second.Intervention: Formation of a project team that planned and supervised restraint removal. Inservice training on restraint use was conducted for all employees.Measurements: Type and frequency of restraint use among the restrained cohort at four evaluation points within a 14‐month interval. The frequency of restraint use in the nursing home population was also recorded. Survey measures included employee responses to a 16‐item closed‐end questionnaire before and after training.Results: The mean number of restraints used with each resident in the restrained cohort decreased from 1.56 to 0.67. The number of residents on restraints in the nursing home was reduced during the course of the study (67.5% vs. 36.7%, P < 0.0001). Changes in employee opinions about restraint use were found after training. On the second survey, more than twice as many employees indicated that restraints should be removed from almost all residents who have them (15.2% vs 36.3%, P < 0.0001).Conclusion: A restraint‐reduction program in a nursing home can produce positive results in terms of decreased restraint use and supportive employee attitudes. More practical alternatives to restraints need to be developed for application in the training of nursing home employees. Future studies on resident, employee, and family attitudes about restraint use are suggested.
Do Geriatric Programs Decrease Long‐Term Use of Acute Care Beds?
Authors: Brymer Christopher D. , Kohm Catherine A. , Naglie Gary , Shekter‐Wolfson Lorie , Zorzitto Marissa L. , O'Rourke Keith , Kirkland James L. 
Published: April 2015

OBJECTIVE: To determine whether the introduction of coordinated geriatric and discharge planning services at teaching and community hospitals in Toronto has changed the number of beds occupied by patients awaiting transfer to long‐term care institutions.DESIGN: Retrospective review of social work records for the period 1985–1992.SETTING: Two tertiary and four primary acute care hospitals in Metropolitan Toronto.PARTICIPANTS: Hospitals were matched for location, acuity, and teaching affiliation.MAIN OUTCOME MEASURES: The numbers of beds occupied by patients awaiting transfer to nursing homes or chronic care hospitals were noted.RESULTS: In those teaching and community hospitals that had introduced coordinated geriatric and discharge planning services, there was a reduction in the percentage of beds occupied by patients awaiting long‐term care placement (average −51%), whereas in hospitals without geriatric services, the percentage of beds occupied by patients awaiting long‐term care placement increased (average +25%) (P = .05 by Fisher's exact method, 95% confidence limit odds ratio 0, .9999).CONCLUSION: The introduction of coordinated geriatric and discharge planning services was associated with a decrease in the percentage of beds occupied by patients awaiting long‐term care in both teaching and community hospitals. J Am Geriatr Soc 43:885–889, 1995.
Hearing Impairment in Older Adults: New Concepts
Authors: Jerger James , Chmiel Rose , Wilson Nancy , Luchi Robert 
Published: April 2015

OBJECTIVE: To review present information about the epidemiology, etiologies, pathogenesis, evaluation, and quality of life aspects of hearing loss and to present an approach to rehabilitation for hearing loss in older adults.DESIGN: A survey of recent findings on the problem of hearing loss in older adults, efficacy of intervention with amplification, and new developments in intervention strategies.CONCLUSIONS: The complex nature of hearing problems in older adults involves changes in the auditory periphery as well as in the central mechanisms for processing sound input. These changes affect the social and emotional impact of the hearing disorder. The importance of understanding the many implications of hearing loss on quality of life is emphasized.Both older adults and immediate family members need information and advice about the consequences of age‐related hearing loss. The physician has a key role in helping them to overcome negative attitudes toward a hearing handicap.For most older persons, hearing aids alleviate many of the handicaps of hearing impairment. For some older persons who do not benefit adequately from conventional hearing aids, assistive listening devices may be helpful. Many old persons and their relatives are reluctant to confront the reality of hearing handicap and try to hide the fact that they need sound amplification. One important future direction is to foster acceptance of hearing loss and to support the more open use of amplification systems. J Am Geriatr Soc 43:928–935, 1995.
Older Patients' Willingness to Trade Off Urologic Adverse Outcomes for a Better Chance at Five‐Year Survival in the Clinical Setting of Prostate Cancer
Authors: Mazur Dennis J. , Merz Jon F. 
Published: April 2015

OBJECTIVE: To assess whether patients report a willingness to trade‐off urologic adverse outcomes–urinary incontinence and total impotence–for a better chance of 5‐year survival in the clinical setting of prostate cancer; and, if so, whether patients' current levels of symptoms of urinary incontinence, impotence, and frequency of sexual activity influence their decisions.DESIGN: Structured interviews with a convenience sample of male patients.SETTING: A university‐based Department of Veterans Affairs Medical Center.PATIENTS: One hundred sixty‐three patients seen consecutively in General Medicine Clinic at the Department of Veterans Affairs Medical Center in Portland, Oregon, were enrolled in the study. Mean age of the patients was 65.2 years (SD = 10.6, range = 35–84); mean level of formal education completed was 13 years (SD = 2.7, range = 5–19).MEASUREMENTS: In a hypothetical clinical setting of prostate cancer, patients were offered a choice of two procedures–Treatment A (surgery: worse short‐term, better long‐term survival) and Treatment B (radiation therapy: better short‐term, worse long‐term survival)–with varying benefit/risk trade‐offs in time. Patients were presented with pairs of treatment curves that were developed from research data on survival for surgery versus radiation therapy for stage II prostate cancer confined to the prostate gland. Treatments were not identified to control for labeling effects. Patients were asked their willingness to accept a chance of immediate mortality for better 5‐year survival in one of four treatment curve comparisons. Of those who accepted the net beneficial procedure, we then inquired as to whether urologic complications–urinary incontinence and wearing an appliance to collect urine or total impotence–altered the acceptability of that treatment.RESULTS: Ninety‐four percent (153/163) of patients were willing to choose Treatment A (worse short‐term, better long‐term survival) on one of the four scenarios; the remainder (10/163) were unwilling to take Treatment A (worse short‐term, better long‐term survival) on any of the four scenarios. Sixty‐two percent (95/153) of patients were willing to accept a 100% chance of urinary incontinence; 83% (127/153) were willing to accept a 100% chance of impotence (chi‐square = 16.8 with 1 df, P = .0001).CONCLUSIONS: Our results in an older male veteran population suggest than many patients are more concerned with long‐term survival in the clinical setting of prostate cancer than with short‐term treatment risks. In addition, patients are more willing to accept an impotence outcome than a urinary incontinence outcome, but this result was not related to patients' reported frequency of sexual activity. J Am Geriatr Soc 43:979–984, 1995.
Healthy Young and Old Women Differ in Their Trunk Elevation and Hip Pivot Motions When Rising from Supine to Sitting
Authors: Alexander Neil B. , Fry‐Welch Donna K. , Marshall Lisa M. , Chung Carolyn Chia‐Fung , Kowalski Ann Marie 
Published: April 2015

OBJECTIVE: To describe the differences between healthy young and older women in regards to trunk elevation and hip pivot motions when rising from a supine to a seated position.DESIGN: Cross‐sectional comparison.SETTING: University laboratory.PARTICIPANTS: Two groups of healthy female volunteers: young adult female controls (n = 22, mean age 23.5 years) and community‐dwelling older female adults (n = 17, mean age 73.8 years).MEASUREMENTS: Subjects were videotaped as they performed three controlled bed mobility tasks, starting from a supine position: (1) rising to a seated position at the edge of a firm plinth surface (SS); and rising to a seated position without moving to the edge of the bed while either (2) using hands (SUH) or (3) not using hands (SUNH). A series of movements involving the trunk were identified as subjects performed the SS task.RESULTS: The older women were more likely to rotate and laterally flex their trunks, particularly in the later phases of the SS task. In addition, during the SS task, the older group was more likely to bear weight on their hip/gluteal area, particularly in the later phases, and more likely to use a broad pivot base, consisting of the hip and the elbow. While all young and old performed the SUH task, less than half of the older group could complete the SUNH task. Moreover, the subgroup of older adults who could not complete the SUNH task may have accounted for much of the differences between the young and the old on the SS task.CONCLUSION: Healthy young and older women differ in their ability to rise from a supine to sitting position, primarily in the strategies used to elevate the trunk and facilitate a pivot. Trunk flexion ability likely contributes to the age group differences noted in rising. These data provide the basis for a biomechanical analysis of the critical body segment motions and the strengths required to perform bed mobility tasks.
Wheelchairs as Mobility Restraints: Predictors of Wheelchair Activity in Nonambulatory Nursing Home Residents
Authors: Simmons Sandra F. , Schnelle John F. , MacRae Priscilla G. , Ouslander Joseph G. 
Published: April 2015

OBJECTIVE: The purpose of this paper is to describe factors affecting wheelchair mobility in nonambulatory nursing home (NH) residents.DESIGN: Prospective descriptive study of a convenience sample of nonambulatory NH residents.SETTING: Seven nursing homes.PARTICIPANTS: Sixty‐five nonambulatory residents.MEASUREMENTS: One‐minute, time‐sampled observations of behavior for each resident were made every 15 minutes for 8 to 11 hours across 2 days, noting wheelchair propulsion activity for the dependent variable; independent variables included measures of wheelchair level of assistance, speed, endurance, handgrip strength, and balance.MAIN RESULTS: A stepwise Multiple Regression analysis found wheelchair speed to be the single best predictor of the percentage of time residents were behaviorally observed wheelchair propelling (Multiple r = .45, P < .02). Handgrip strength and wheelchair endurance measures were highly intercorrelated with wheelchair speed. Wheelchairs that were either dysfunctional or inappropriately fitted to the residents' size were a major barrier to wheelchair use, affecting 46% of residents using wheelchairs.CONCLUSION: Improving wheelchair skills with targeted intervention programs, along with making chairs more “user friendly” (e.g., grip extensions on brakes, foot pedals that one can move without bending over), could result in more wheelchair propulsion with resultant improvements in the NH resident's independence, freedom of movement, and quality of life.
Attitudes Toward Self‐Determined Death: A Survey of Primary Care Physicians
Authors: Duberstein Paul R. , Conwell Yeates , Cox Christopher , Podgorski Carol Ann , Glazer Rachel S. , Caine Eric D. 
Published: April 2015

OBJECTIVE: To survey physicians to determine whether sociodemographic and practice‐related variables are predictive of their attitudes toward suicide.DESIGN: Mailed questionnaire survey.SETTING: Monroe County, New York.PARTICIPANTS: A 50 percent random sample of practicing primary care physicians. Of 186 potential respondents, 114 (61.3%) physicians returned questionnaires.MEASUREMENT: In addition to age and gender, independent variables included medical specialty, practice composition defined in terms of patient age, and textbook knowledge of depression and suicide. The dependent variable, attitude toward suicide, was measured using four standard opinion survey questions and six items based on a case vignette. Dependent variables were rated on a Likert‐type scale and subsequently dichotomized for use in logistic regression analysis.RESULTS: Approximately 61 percent of the respondents believe that suicide can be rational under certain circumstances, 51 percent believe that physicians should not assist suicides under any circumstances, and 31 percent support legalization of assisted suicide under certain circumstances. Regression analyses revealed that gender was a significant predictor for three of the ten attitude items. Medical specialty, clinical and epidemiological knowledge of depression and suicide, and physician age significantly predicted one attitude item.CONCLUSIONS: These results suggest that physicians' attitudes toward suicide are multidetermined. Although gender, age, medical specialty, and knowledge of depression and suicide predict certain attitudes, the logistic regression analyses were not highly successful in predicting respondents' attitudes. Given the power of physicians to command public attention and to influence public and legal opinion, it is vital that future research continue to explore the determinants of physicians' attitudes toward self‐determined death.
Feasibility and Accuracy of a Postcard Diary System for Tracking Healthcare Utilization of Community‐Dwelling Older Persons
Authors: Reuben David B. , Wong Richard C. , Walsh Kathleen E. , Hays Ron D. 
Published: April 2015

OBJECTIVE: To test the feasibility of and to validate a self‐report weekly postcard diary of health care utilization.DESIGN: Case‐series and validation study.SETTING: Community‐based sample of fee‐for‐service and health maintenance organization (HMO) patients.PARTICIPANTS: A convenience sample of 24 community‐dwelling older persons who had failed a self‐administered screen and were eligible for a study of outpatient comprehensive geriatric assessment consultation.MEASUREMENTS: Subjects completed and mailed in a weekly postcard diary documenting medical, counseling, or rehabilitation therapy visits. If a subject did not respond within 10 days after the end of the week, a telephone call was placed to gather the information. For a subset of 10 subjects who were HMO enrollees, all records were reviewed to determine accuracy of the postcard diaries.RESULTS: Of the 24 subjects enrolled, one HMO enrollee dropped out following hip surgery after 4 weeks of completing diaries. The remaining 23 subjects (96% of total entered) provided complete information for 12 weeks. Telephone follow‐up to either obtain or clarify utilization information was required for 22% of subjects. For the subset of 10 HMO subjects, seven underreporting, two overreporting, and one incorrect day errors were detected–a total of 10 errors representing 9% of diaries and 1.3% of patient‐days. Kappa as a measure of agreement between the two methods (self‐report and chart review) was 0.82 (P < .0001). Compared with chart review, the diary report was 75.0% sensitive and 99.8% specific. Positive and negative predictive values were 91.3% and 99.2%, respectively.CONCLUSION: These findings suggest that a postcard diary system with telephone follow‐up is both a feasible and reasonably accurate method of tracking health care utilization by community‐dwelling older persons, although a small percentage will be unable to adhere to this method.
Beyond Labels: Nursing Home Care for Alzheimer's Disease In and Out of Special Care Units
Authors: Grant Leslie A. , Kane Rosalie A. , Stark Alice J. 
Published: April 2015

OBJECTIVE: To compare dementia special care units (SCUs) with their non‐SCU counterparts in terms of unit and facility characteristics.DESIGN: Cross‐sectional telephone survey and secondary database.SETTING: 1247 units in 436 Minnesota nursing homes.MEASUREMENTS: Specialized dementia care practices (e.g., staffing, environmental design and programming features) and organizational characteristics (e.g., size, geographic location, type of ownership, proportion dementia, case‐mix and percentage Medicaid).RESULTS: Comparing unit level data for all units in 436 facilities, we found that 75 SCUs offered more dementia‐specific features than did the 1122 units not designated as SCUs, but most units offered some dementia‐specific features similar to those of SCUs. The designation of SCU did not automatically translate into richer or more tailored services for dementia compared with units without the designation. Facilities with designated SCUs are more likely to be rural, larger and divided into more units, have a higher proportion of residents with dementia, and have fewer residents at higher levels of acuity.CONCLUSION: Presence of a SCU in a facility may be related to care of dementia in the rest of the nursing home in complex ways; some dementia‐specific features were less likely to be found in regular units of nursing homes with designated SCUs.
When Home Caregiving Ends: A Longitudinal Study of Outcomes for Caregivers of Relatives with Dementia
Authors: Gold Dolores Pushkar , Reis Myrna Feldman , Markiewicz Dorothy , Andres David 
Published: April 2015

OBJECTIVES: To study caregivers' decisions to end home care for relatives with dementia; to study the changes in caregiver functioning over time.DESIGN: A prospective longitudinal follow‐up study.SETTING: Individual homes and chronic care facilities in Montreal.PARTICIPANTS: 157 caregiver‐dependent dyads, followed up 2 years later; dependents had been diagnosed as having progressive dementia.MEASUREMENTS: A standard interview and a series of standardized psychological questionnaires were given to caregivers, assessing their functioning and their appraisals of the dependent person in their care. Dependents received the Mini‐Mental State Examination.MAIN RESULTS: Caregivers cited patient deterioration as the most common reason for ending home care. Most caregivers did not prepare their relative before institutionalization. Most caregivers were satisfied with having ended home care and believed the decision was positive for themselves and their dependent, but a sizable minority of caregivers and dependents had difficulty adjusting to the end of home care. Repeated measures multivariate analyses indicated that caregivers who had discontinued home care because of placement or death of the dependent had improved functioning and quality of life and better health than caregivers still providing home care.CONCLUSIONS: Caregivers most frequently cite deteriorating patient conditions as the main causes of ending home care. Caregiver exhaustion is the single most frequently given reason. Caregivers who were still providing home care at the end of the study were functioning less well than caregivers who had ended home care, despite having initially functioned at better levels.