bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Change in Serum Protein Concentration in Response to the Stress of Total Joint Surgery: A Comparison of Older Versus Younger Patients
Authors: Puskarich‐May Cheryl L. , Sullivan Dennis H. , Nelson Carl L. , Stroope Henry F. , Walls Robert C. 
Published: April 2015

OBJECTIVE: To investigate whether the physiological response to surgery‐induced stress, as measured by changes in serum secretory proteins, is more profound in older than in younger total joint arthroplasty patients.DESIGN: Retrospective study.SETTING: A 267‐bed teaching hospital.PARTICIPANTS: A total of 220 ambulatory patients with normal admission serum albumin levels, of whom 106 were 65 years of age or older (mean age 73.3 ± 6.2 years) and 114 less than age 65 (mean age 48.8 ± 12.2 years).METHODS: Serum albumin and transferrin levels obtained at admission and on the fifth and tenth postoperative days were compared in the two age groups.RESULTS: In both age groups, admission serum albumins were significantly higher than on the corresponding postoperative Day 5 levels (40.4 ± 3.7 g/L vs 25.0 ± 3.3 g/L, P < .001 and 39.5 ± 2.5 g/L vs 23.9 ± 3.1 g/L, P < .001 in older and younger patients, respectively). The drop in the serum concentration of albumin by postoperative Day 5 in the older patients was not significantly different from that of the younger patients (a drop of 15.6 ± 3.3 g/L in the older vs 15.4 ± 4.4 g/L for the younger, P = .740). Among the 64 patients who remained in the hospital 10 days subsequent to surgery, the average postoperative Day 10 serum albumin concentration was significantly lower in the older patients when compared with the younger (26.2 vs 29.1 g/L P = .016). Similar results were obtained for serum transferrin.CONCLUSIONS: Subsequent to elective arthroplasty, the magnitude of change in serum albumin and transferrin concentrations is similar in older compared with younger, patients, suggesting that this stress response to surgery is not age dependent. In contrast, the rate of recovery of the serum protein concentrations to preoperative levels may be slower in the older patients. However, this issue needs to be investigated further.
Patients' Willingness to Accept Life‐Sustaining Treatment When the Expected Outcome is a Diminished Mental Health State: An Exploratory Study
Authors: Mazur Dennis J. , Merz Jon F. 
Published: April 2015

OBJECTIVE: To assess patients' willingness to accept life‐sustaining treatment when the expected outcome is a diminished mental health state.DESIGN: Structured interviews with a consecutive series of patients.SETTING: A university‐based Department of Veterans Affairs Medical Center.PATIENTS: One hundred four male patients (mean age = 65.4 years; range 37–82) seen consecutively in a general medicine clinic.MEASUREMENTS: We assessed the acceptability of temporary ventilatory support for a hypothetical case of severe pneumonia. Patients were asked to consider mental health states involving minor cognitive deficits that varied only in their expected frequency and duration.RESULTS: All patients except one were willing to accept temporary life support in the management of severe pneumonia. Of these 103 patients, 76 patients specified the number of days they would allow themselves to be continued on intubation and ventilatory support. The length of time varied from 1 day to 2 years and was longer when patients reported having had a stroke or reported being in fair or poor health.Fifty patients were willing to accept all diminished mental health states, including the most severe state (F). Patients who reported having been in a medical intensive care unit were more likely to accept intubation in the most severe state (F).CONCLUSIONS: In the case of “severe pneumonia,” about half of our older male veterans reported a willingness to accept intubation and ventilatory support even if it resulted in persistent cognitive disability. These results suggest that experience in a medical intensive care unit with ventilators and experience with strokes may make patients more tolerant of treatments that may result in impaired cognitive function.
Effects of Exercise on Neurobehavioral Function in Community‐Dwelling Older People More Than 75 Years of Age
Authors: Okumiya Kiyohito , Matsubayashi Kozo , Wada Tomoko , Kimura Shigeaki , Doi Yoshinori , Ozawa Toshio 
Published: April 2015

OBJECTIVE: We evaluated the effects of exercise on neurobehavioral function in healthy older people more than 75 years of age.DESIGN: A randomized controlled trial with 6‐month follow‐up was conducted.SETTING: The study was performed in the rural town of Kahoku, Japan, the population of which is considered representative of the older popuration of Japan.PARTICIPANTS: We studied 42 healthy volunteers (18 men and 24 women; mean age, 79 years (range, 75 to 87 years)) who were randomly assigned to one of two groups, exercise or control.INTERVENTION: Subjects assigned to the exercise group were instructed to exercise for 60 minutes twice a week for 6 months. Subjects in the control group were not instructed to engage in any specific exercise regimen.MEASUREMENTS: The following measurements were recorded for both groups at baseline and at 6‐month follow‐up: (1)Neurobehavioral function as determined by the following tests: Mini‐Mental State Exam (MMSE), Hasegawa Dementia. Scale Revised (HDSR), Visuospatial Cognitive Performance Test (VCP‐test), Button score, Up & Go test, and Functional Reach; and (2)Body mass index and blood pressure.RESULTS: The effects of exercise were shown in the Up & Go test and Functional Reach (ANOVA with repeated measures).CONCLUSION: This study demonstrates the acceptability and effectiveness of exercise on neurobehavioral function, even in older people more than 75 years of age.
Low TSH Levels in Nursing Home Residents Not Taking Thyroid Hormone
Authors: Drinka Paul J. , Amberson John , Voeks Susan K. , Schomisch Jerry , Schirz Paul , Christensen Dean 
Published: April 2015

BACKGROUND: Many practitioners perform a thyroid stimulating hormone (TSH) assay as a screening test in older patients. The introduction of sensitive TSH assays with lower normal limits has created a laboratory abnormality that is often of uncertain significance. Mechanisms include autonomous overproduction of thyroid hormone, nonthyroidal illness including medication effects, and hypothalamic/pituitary dysfunction.OBJECTIVE: To characterize the clinical status and course of nursing home residents with low TSH and normal total T4 levels in the absence of treatment with thyroid hormone.DESIGN: Retrospective chart review was performed to determine participants status at the time of the low TSH level, with additional recording of follow‐up thyroid hormone levels, cardiac rhythm, and mortality. Mortality was compared with that of a control group matched for age and sex.SETTING: A nursing home for veterans and their spouses.MAIN RESULTS: Forty subjects with low TSH and initially normal total T4 were identified. Only three subjects were subsequently diagnosed as hyperthyroid. TSH levels of 18 subjects subsequently normalized, and four additional subjects had low total T3 levels suggesting a nonthyroidal mechanism. Seven subjects died during the first 4 months of follow‐up compared with three in a control group (P < .001). Nine of the 40 subjects had a history of or current atrial fibrillation. No new atrial fibrillation was documented during 388 months of EKG follow‐up.CONCLUSIONS: Low total T3 levels, TSH normalization, and excess mortality suggest that nonthyroidal illness plays a role in the pathogenesis of low TSH determinations in the nursing home. Autonomous production of thyroid hormone also plays a role. We believe that the term “subclinical hyperthyroidism” should be used only if the clinician believes that autonomous overproduction of thyroid hormone is the cause of a low TSH level. If subsequent research shows correctable adverse consequences associated with subclinical hyperthyroidism from autonomous overproduction of thyroid hormone, a more aggressive diagnostic approach will be needed to define the mechanism of a low TSH level at the time of its discovery.
Prevalence of Appropriate and Inappropriate Indications for Use of Digoxin in Older Patients at the Time of Admission to a Nursing Home
Authors: Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To investigate the prevalence of digoxin use and appropriate and inappropriate indications for digoxin use in older patients at the time of admission to a nursing home.DESIGN: In a prospective study of 500 consecutive patients aged 60 years of age or older admitted to a nursing home, 96 (19%) patients were receiving digoxin at the time of admission to the nursing home. Appropriate and inappropriate indications for digoxin use were investigated in these 96 patients.SETTING: A large, long‐term health care facility where 500 consecutive older patients were studied.PATIENTS: The 500 patients included 344 women and 156 men, mean age 81 ± 8 years (range 60–100).MEASUREMENTS AND MAIN RESULTS: Ninety‐six of the 500 patients (19%) were receiving digoxin at the time of admission to the nursing home. Fifty‐one (53%) of the 96 patients receiving digoxin had an appropriate indication for digoxin use, and 45 (47%) had an inappropriate indication for digoxin use. Appropriate indications for digoxin use included atrial fibrillation with or without congestive heart failure (CHF) in 35 patients (36%) and CHF with sinus rhythm and abnormal left ventricular (LV) ejection fraction in 16 patients (17%). Inappropriate indications for digoxin use included CHF with sinus rhythm and normal LV ejection fraction in 18 patients (19%), misdiagnosis of edema or dyspnea as CHF in patients with sinus rhythm and normal LV ejection fraction in 17 patients (18%), history of possible (undocumented) paroxysmal atrial fibrillation in nine patients (9%), and sinus tachycardia in one patient (1%). Two of the 45 patients (5%) inappropriately treated with digoxin had evidence of digitalis toxicity on their admission electrocardiogram.CONCLUSIONS: The prevalence of digoxin use was 19% in older patients at the time of admission to the nursing home. Almost half of patients (47%) receiving digoxin at the time of admission had an inappropriate indication for digoxin use at that time.
Physical Restraint Use and Falls in Nursing Home Residents
Authors: Capezuti Elizabeth , Evans Lois , Strumpf Neville , Maislin Greg 
Published: April 2015

OBJECTIVE: To examine the relationship between restraint use and falls while controlling for the effect of psychoactive drug use among nursing home residents, including subgroups of nursing home residents with high rates of restraint use and/or falls.DESIGN: Secondary analysis of data from a longitudinal clinical trial designed to reduce restraint use.SETTING: Three nursing homes.PARTICIPANTS: Subjects (n = 322) were either restrained (n = 119) or never restrained (n = 203) at each observation point during a 9.5‐month data collection period that preceded the intervention phase of the clinical trial.MEASUREMENTS: We evaluated restraint status (independent variable) three times during the data collection period by direct observation over a 72‐hour period. Incident reports documenting falls and fall‐related injuries (dependent variables) were reviewed. Cognitive status was measured using the Folstein Mini‐Mental State Exam and functional status (including ambulation status) by the Psychogeriatric Dependency Rating Scale. Psychoactive drug use profile was obtained through record review.MAIN RESULTS: Using multiple logistic regression, we compared the effect of restraint use on fall risk between a confused ambulatory subgroup and the remaining sample and found a significant difference in the odds ratio for falls and recurrent falls (P = .02; chi‐square = 5.24, df = 1; P = .003, chi‐square = 9.12, df = 1). In the confused ambulatory subgroup, restraint use was associated with increased falls (odds ratio: 1.65, 95% CI: 0.69, 3.98) as well as recurrent fall risk (odds ratio: 2.46, 95% CI: 1.03, 5.88). Increased falls and recurrent fall risk was not observed in the remaining sample (falls odds ratio: 0.49, 95% CI: 0.28,0.87; recurrent falls odds ratio: 0.42, 95% CI: 0.20,0.91). One subgroup, the nonconfused ambulatory residents, were never restrained; after removing this subgroup, the confused ambulatory continued to be associated, though not significantly, with a higher risk of falls and injuries. Only nonconfused nonambulatory restraints were associated with a lower risk of all three outcomes: falls (odds ratio: 0.28, 95% CI: 0.05, 1.58), recurrent falls (odds ratio: 0.48, 95% CI: 0.05, 4.72), and injurious falls (odds ratio: 0.42, 95% CI: 0.04, 4.01); these results, however, were not statistically significant. There was no evidence that the effect of restraint use on fall risk depended upon the use of psychoactive drugs (chi square = 4.43; df = 2, P = .11).CONCLUSION: Restraints were not associated with a significantly lower risk of falls or injuries in subgroups of residents likely to be restrained. These findings support individualized assessment of fall risk rather than routine use of physical restraints for fall prevention. Researchers and clinicians should continue to focus efforts on developing a variety of approaches that reduce risk of falls and injuries and promote mobility rather than immobility.
Using a Mailed Survey to Predict Hospital Admission Among Patients Older than 80
Authors: Freedman John D. , Beck Arne , Robertson Barbara , Calonge B. Ned , Gade Glenn 
Published: April 2015

OBJECTIVE: To determine if the results of a questionnaire mailed to older patients can help identify those patients at greatest risk of hospital admission.DESIGN: A longitudinal cohort study.SETTING: A prepaid managed care plan in the Denver metropolitan area.PARTICIPANTS: Of the 4414 eligible patients at least 81 years old, 3745 (84.8%) responded.MEASUREMENTS: We studied the predictive power of self‐reported demographic, health status, medical history, health habits, functional status (including Katz' activities of daily living and OARS instrumental activities of daily living), and socioeconomic status data to identify those older adults at greatest risk of hospitalization within 4.5 months of completing the survey. We derived our predictive model on one‐half the subjects and tested its validity it on the other half.RESULTS: Univariate analysis revealed 25 variables significantly associated with hospital admission. In a logistic regression model, four significant variables successfully stratified the patients by risk of admission. These four variables are: the presence of heart disease, the presence of diabetes, need for help preparing meals, and limited physical independence (requiring the help of a person or mechanical aid to get around). In addition, there was an antagonistic interaction between the presence of heart disease and limited physical independence. The model stratified patients from low risk (4.5% chance of admission) to high risk (39% chance of admission). As measured by the Hosmer‐Lemeshow statistic and the area under a receiver‐operator characteristic (ROC) curve, this model fit both the derivation and validation subjects well.CONCLUSIONS: A mailed questionnaire achieved a high response rate, and the information collected produced an effective model predictive of hospitalization in the short term. Four easily ascertained pieces of information identify those patients older than age 81 at increased risk.
Risk of Napping: Excessive Daytime Sleepiness and Mortality in an Older Community Population
Authors: Hays Judith C. , Blazer Dan G. , Foley Daniel J. 
Published: April 2015

OBJECTIVE: To describe the demographic and health‐related factors related to excessive daytime sleepiness. To estimate the risk of mortality associated with excessive daytime sleepiness independent of nighttime sleep problems and other factors that limit survival.DESIGN: Four‐year prospective cohort study with annual interviews.SETTING: One urban and four rural counties in north‐central North Carolina.PARTICIPANTS: Adults 65 years and older (n = 3962) living in the community.MAIN OUTCOME MEASURES: Excessive daytime sleepiness was measured as, “How often do you get so sleepy during the day or evening that you have to take a nap?” Mortality was based on continuous surveillance of the population by field investigators and abstraction of death certificates.RESULTS: Point prevalence of excessive daytime sleepiness in this population was 25.2%. Frequent daytime nappers were more likely than infrequent nappers to report nighttime sleep complaints and were more likely to be male and urban‐dwellers, to report more depressive symptoms, more limited physical activity, and more functional impairment, and were more likely to be overweight. Of the frequent nappers, 23.9% died, compared with 15.4% of infrequent nappers. In an adjusted Cox proportional hazard model, the 4‐year mortality rate was accelerated 1.73 times among older people who nap most of the time and make two or more errors on a cognitive status examination.CONCLUSION: Excessive napping is associated with impaired sleep hygiene as well as with a broad range of activity‐related health deficits among community‐dwelling older adults. Frequent napping was associated with impaired sleep hygiene, male gender, urban‐dwelling, depressive symptoms, physical activity deficits, functional impairment, and excess weight. Mortality risk was elevated selectively among the most cognitively impaired subjects.
Impact of Sample Selection on APOE ∈4 Allele Frequency: A Comparison of Two Alzheimer's Disease Samples
Authors: Tsuang Debby , Kukull Walter , Sheppard Lianne , Barnhart Ross L. , Peskind Elaine , Edland Steve D. , Schellenberg Gerard , Raskind Murray , Larson Eric B. 
Published: April 2015

OBJECTIVE: In a highly selected sample of unrelated Alzheimer's disease (AD) patients, we found that the APOE ∈4 allele frequency was higher than previously reported. Differing selection and ascertainment criteria may lead to these differences. To address this possibility, we compared the ∈4 allele frequency in two samples of AD patients selected from the same geographical area.SETTING AND PARTICIPANTS: Cases (n = 55) and controls (n = 99) from a research clinic‐based sample were compared with subjects (n = 537) from a community‐based AD patient sample. The samples consisted of unrelated cases who met NINCDS/ADRDA criteria for probable AD.DESIGN AND MEASUREMENTS: Clinical characteristics and APOE genotype data were obtained from AD cases and controls from both samples.RESULTS: Frequency of APOE ∈4 allele in the research cases compared with the community cases (0.45 vs 0.36) was nearly significant. We compared demographic and clinical characteristics that might account for this difference and found that the research cases were younger, had an earlier age of onset, and had more advanced disease than the community cases. After onset age was controlled, there was no overall difference between ∈4 allele frequency of the two samples.CONCLUSIONS: We found that the ∈4 allele frequency tended to be higher in the research AD sample compared the community‐based sample. The two samples differed in several demographic and clinical characteristics. We conclude that research‐based samples may lead to enrollment of younger patients with more severe disease who have higher APOE ∈4 allele load. This potential selection bias must be considered in the interpretation of studies of APOE allele frequency.
Smoking and Cognitive Impairment: A Population‐Based Study
Authors: Ford Amasa B. , Mefrouche Zak , Friedland Robert P. , Debanne Sara M. 
Published: April 2015

OBJECTIVE: To test the hypothesis that there is an inverse relationship between smoking and cognitive impairment by examining the prevalence and incidence of such impairment in a representative cohort of older urban residents.DESIGN: Survey follow‐up with three interviews over a 4‐year period.SETTING: City of Cleveland, Ohio.PARTICIPANTS: Six hundred forty‐seven survivors of a population‐based, multi‐stage probability sample of urban residents, aged 74 years and older in 1984.MEASUREMENTS: Past and present cigarette smoking was measured in 1984 by direct questioning. Cognitive impairment was measured in 1984, 1987, and 1988 by the 10‐item Short Portable Mental Status Questionnaire. Mortality was determined at each interview date, and death certificates were obtained. Data were analyzed by univariate analysis, stratified analysis, and multivariate logistic regression.RESULTS: There were 99 cases of cognitive impairment at baseline among 628 individuals for whom complete data were available. Crude data suggest that the prevalence of cognitive impairment was lower among smokers than among non‐smokers, but logistic regression, adjusted for age, income, and gender, showed this difference to be nonsignificant, OR 0.73; 95% CI (0.42,1.29).Fifty‐one new cases of cognitive impairment occurred during the 4‐year observation period. Neither the crude data nor logistic regression showed any significant relationship between smoking and the incidence of cognitive impairment, OR 1.03; 95% CI (0.54, 1.99).Four‐year mortality did not differ significantly between these older smokers and non‐smokers, but smokers died at a relatively younger age and were more likely to die of diseases associated with smoking.CONCLUSION: This study does not confirm the hypothesis that there is a negative relationship between smoking and cognitive impairment. The mortality data suggest that case‐control prevalence studies of the hypothesized relationship may be distorted by complex life‐long trends in behavior, morbidity, and mortality which could result in a misleading appearance of low prevalence of cognitive impairment among smokers. Additional large, prospective, population‐based studies of the incidence of cognitive impairment and related disorders and possible protective or risk factors other than smoking are needed. J Am Geriatr Soc 44:905–909, 1996.
Report of an Outbreak: Nursing Home Architecture and Influenza‐A Attack Rates
Authors: Drinka Paul J. , Krause Peggy , Schilling Margo , Miller Barbara A. , Shult Peter , Gravenstein Stefan 
Published: April 2015

OBJECTIVE: To determine factors that might account for a significantly lower attack rate in a newly constructed nursing building during an epidemic of type A influenza.SETTING: A four‐building, long‐term care facility for veterans and their spouses, with an average daily census of 690.DESIGN: Prospective surveillance with retrospective analysis.PARTICIPANTS: Symptomatic residents submitting to viral culture.MEASUREMENTS: Number of respiratory illnesses and influenza cultures in consenting symptomatic residents. Building characteristicsRESULTS: An influenza A (H3N2) outbreak was culture‐confirmed in 68 nursing home residents. Influenza A was isolated in 3/184 (2%) residents in Building A, 31/196 (16%) in Building B, 18/194 (9%) in Building C, and 16/116 (14%) in Building D. Denominators are average daily census during the outbreak. Building A had significantly fewer culture‐confirmed cases than the other buildings (P < .001). Fewer residents in Building A, 47% compared with 61% in Buildings B, C, and D, were participants in a formal study of influenza. Eight of 15 respiratory illnesses identified during the outbreak that were not cultured occurred in Building A. These factors could not account for the difference in attack rates. Building A has a unique ventilation system, more square feet of public space per resident, and does not contain office space that serves the entire four‐building facility.CONCLUSION: Our retrospective observation suggests that architectural design may influence the attack rate of influenza A in nursing homes. J Am Geriatr Soc 44:910–913,1996.