bluuebunny/crossref_metadata_2025_split huggingface dataset:
Teaching Physical Diagnosis in the Nursing Home: A Prospective, Controlled Trial
Authors: Mayo‐Smith Michael F. , Gordon Victor , Gillie Edward , Brett Allan 
Published: April 2015

Study Objective: To investigate the suitability of the nursing home as a site for teaching physical diagnosis to second‐year medical students.Design: Prospective comparison of teaching sessions in the nursing home to concurrent control sessions in acute care wards.Setting: Nursing Home Care Unit (NHCU) and acute care hospital wards of a Veterans Affairs Medical Center.Patients: Sessions with 38 NHCU patients and 68 hospital patients.Measurements and Main Results: Patient interviews and student questionnaires were used to obtain responses on a 1–10 scale (1 = poor, 10 = excellent). Patient responses were very favorable in both settings for overall quality of experience (mean score NHCU vs control: 8.8 vs 8.6) and willingness to participate again (8.4 vs 8.2). Student ratings showed no significant differences for patient attitude (7.4 vs 8.4) or quality of exam (7.2 vs 7.7) while quality of history (6.0 vs 7.6) and overall quality of session (7.6 vs 8.6) were rated higher (P < 0.05) for the control sessions. Students rated both environments highly (8.6 vs 8.4) but reported that fewer NHCU sessions were interrupted (15% vs 25%) or disrupted by noise (6% vs 30%, P < 0.005).Conclusions: Advantages of the nursing home include readily available patients who view participation favorably, instructive physical findings, and a suitable environment. However, students rate the quality of the histories obtained there lower. This problem could be addressed by more careful patient selection and greater emphasis by course instructors on other goals of the history in addition to exploring the chief complaint.
The Prevalence of Undiagnosed Protein‐Calorie Undernutrition in a Population of Hospitalized Elderly Patients
Authors: Mowé Morten , Bøhmer Thomas 
Published: April 2015

Objective: To determine the extent to which patients with objective signs of malnutrition had been diagnosed as such by physicians and the diagnosis documented in the medical record.Design: Cross‐sectional.Subjects: All non‐critically ill patients (n = 121) aged 70 years or older admitted to an Oslo hospital during a 3‐week period.Methods: Compared problem list and other elements of the medical record with observations of height, weight, triceps skinfold, midarm circumference, and arm‐muscle circumference made on first weekday in hospital. Serum albumin available on 66 subjects.Main Results: Nine patients had weight/height ratios below 60% of normal, 16 patients between 60% and 75%, and 41 patients between 74% and 90% of normal. Of these 66 patients, only 24 were recognized as malnourished on admission, only five received nutritional support, and none was diagnosed as having malnutrition at the time of discharge.Conclusions: Malnutrition is underdiagnosed and under‐treated. The consequences of this are likely to be deleterious to health.
Physician Response to Notification of Acute Problems in Nursing Homes
Authors: Zimmer James G. , Watson Nancy M. 
Published: April 2015

A frequently cited example of physicians' alleged disinterest in nursing home patients is their failure to respond rapidly or appropriately to telephone calls about acute events or important changes in patient status.This study of 45 SNFs and their 15 attached ICFs evaluated the length of time required to reach physicians by phone about significant clinical changes in patients' conditions and the appropriateness and timeliness of action taken by the physicians once contact was made. Calls on administrative matters, updating of orders, and similar routine calls were excluded. Seven hundred and fifty calls were identified from 24‐hour nursing reports; the nature of the problem and the time and details of physicians' responses were recorded from patient charts. Judgment on the quality of physicians' responses was made by consensus of the regional UR committee except in the case of infections where decisions were based on detailed criteria developed in a previous study. The most frequent clinical problems were acute infections (32%), trauma (12%), GI tract disorders (11%), cardiorespiratory problems (10%), neurological disorders (7%), and diabetic control (7%). Results were very encouraging: 96% of physicians' call‐backs and actions were judged to be timely, and 87% of physicians' actions taken were judged to be appropriate. However, actions taken were judged inappropriate for certain specific clinical problems, ie, in 22% (54/243) of infections, 24% (4/17) of CVA's, and 12% (6/49) of diabetic control problems. Implications for nursing home care and recommendations for improving the response to acute problems are discussed.
The Utilization of the Durable Power of Attorney for Health Care among Hospitalized Elderly Patients
Authors: Cohen‐Mansfield Jiska , Droge Janet A. , Billig Nathan 
Published: April 2015

Objective: To explore the potential use of the durable power of attorney for health care (DPAHC), considerations in executing a DPAHC, and influences in making decisions related to it.Design: Interview with follow up.Setting: A teaching hospital.Subjects: 37 males, 60 females, aged 64–97.Methods: Interview of ninety‐seven hospitalized patients and followup telephone interview of those who had not originally executed a DPAHC after 3 months. Patients were asked whom they would appoint as an agent for health care decisions, how this person was related to them, and why they chose this person. Patients' cognitive functioning and level of depression were assessed.Results: Most patients (65%) chose their closest relative to make health care decisions for them if they were unable to. Reasons for choosing this person included: the agent knew the patient best, was the closest relative, and was most accessible geographically. Over half of the participants had not discussed their feelings about health care decisions with anyone. Sixteen percent had previously executed a durable power of attorney for health care, and 46% said they intended to execute one. Executing a durable power of attorney for health care was associated with higher levels of cognitive functioning but not with level of depression.Conclusions: Both an understanding of advanced directives and a general outlook on matters of life and death seem to affect people's utilization of the DPAHC. The ability to execute a DPAHC and the choice of an agent are affected by individuals' interpersonal relations.
Adverse Reactions to Amantadine Prophylaxis of Influenza in a Retirement Home
Authors: Stange Kurt C. , Little Dana W. , Blatnik Bernadette 
Published: April 2015

Objective: Controversy exists about the safety of following the recommendation of the Immunization Practice Committee of the Centers for Disease Control that nursing home residents be given amantadine prophylaxis during influenza outbreaks. This study was undertaken to define the incidence of adverse reactions to amantadine in the elderly and to identify risk factors for side effects.Design: A retrospective cohort study.Setting: A retirement home which offered amantadine prophylaxis to its residents during a presumed influenza outbreak.Participants: Of the 96 elderly residents, 79 accepted the offer of amantadine prophylaxis.Main Outcome Measures: Attributable adverse health outcomes as assessed by chart review.Results: 41% of the people receiving amantadine had attributable adverse reactions, of which 22% were classified as severe. Severe adverse reactions were associated with residence in the assisted living section of the facility (P = 0.002), a greater number of underlying diagnoses (P = 0.009), congestive heart failure (P = 0.02), and high serum creatinine (P = 0.02). A person with none of these risk factors had a 7% chance of having a severe adverse outcome compared to a 70% chance for someone with all four risk factors.Conclusion: The findings raise concern that the prophylactic administration of amantadine to all elderly residents of nursing and retirement homes may be associated with a high incidence of unacceptable reactions, particularly among less healthy residents.
Cerebrospinal Fluid Markers of Alzheimer's Disease
Authors: van Gool W. A. , Bolhuis P. A. 
Published: April 2015

Objective: To review studies on cerebrospinal fluid (CSF) in patients with Alzheimer's disease (AD) in order to answer the question whether CSF contains a specific marker which can be used to support a clinical diagnosis of AD.Data sources: Studies identified through an English‐language literature search using MEDLINE (1966 to 1990) and a review of bibliographies of relevant articles.Study Selection: All studies on CSF in AD patients were selected. Double publications on the same original data were not included. Otherwise, no particular selection was made.Data Extraction: The diagnostic utility of more than 60 substances, including CSF measures related to classical neurotransmitters, (neuro)peptides, proteins, amino acids, purines, trace elements, and constituents of senile plaques and neurofibrillary tangles, is evaluated. Clinical epidemiological criteria for deciding on the usefulness of new diagnostic methods are emphasized in this analysis.Data Synthesis: Concentrations of some CSF constituents are consistently found to be significantly changed in AD. However, overlap with data of control populations and methodological shortcomings in study design, limit the diagnostic value of all CSF measurements reviewed.Conclusion: None of the CSF constituents studied so far can be used in support of the diagnosis of AD. However, increased knowledge concerning macromolecular abnormalities in amyloid containing plaques and neurofibrillary tangles makes the outlook for a diagnostic test for AD on CSF promising.
Predictors of Mortality in Older Patients following Medical Intensive Care: The Importance of Functional Status
Authors: Mayer‐Oakes S. Allison , Oye Robert K. , Leake Barbara 
Published: April 2015

Objective: We examined predictors of hospital and 6‐month mortality in older Medical Intensive Care Unit (MICU) patients with particular attention to age and functional status. Age is generally thought to be strongly associated with intensive care outcomes, but this relationship may be confounded by age‐related changes. These age‐related changes may be approximated by changes in functional status (FS).Design: We conducted a retrospective chart review and collected severity of illness data using the Acute Physiology Score (APS), pre‐hospitalization FS dichotomized as limited or not limited, and hospital mortality. County death records were reviewed for 6‐month mortalitySetting: Three community hospital MICUs.Patients: Four‐hundred MICU patients aged 50 and older admitted during the study period.Results: Limited FS was found in 42% of the 227 patients who had FS data in the chart. Mortality was significantly associated with APS, age, FS, immunocompromise state, comorbidity, and nursing home residence. In logistic regression analyses, while controlling for important variables, APS (P < 0.001) and age ≥75 with limited FS (P < 0.05) were associated with hospital mortality. Six‐month mortality predictors were APS (P < 0.001), hospital (P < 0.05), immunocompromised state (P < 0.05) and age ≥75 with limited FS (P < 0.05).Conclusions: We found that among patients without functional limitations, the oldest group was no more likely to die than the youngest group. Age and functional status had a significant interaction: patients older than 75 years with functional limitations were almost six times more likely to die in hospital compared to the reference group of patients between 50–64 years old without functional limitations. We conclude that functional status is an important predictor of outcome in older MICU patients.
Nursing Home Resources and Tranquilizer Use among the Institutionalized Elderly
Authors: Svarstad Bonnie L. , Mount Jeanine K. 
Published: April 2015

Objective. To examine the relationship between selected resident and facility characteristics and the frequency and quality of tranquilizer prescribing and use in skilled nursing facilities.Design. Retrospective review of medication profiles and pharmacy billing records using standardized protocol.Settings. Seven skilled nursing facilities.Participants. All residents aged 65 years or older were eligible. Consent was given by 760 residents or guardians. Six refused permission.Outcome Measures. Drug use measures included the presence or absence of a tranquilizer order, any tranquilizer use during previous 30 days, and any deviation from selected drug use criteria.Results. Of 760 residents, 38% had an order for an antipsychotic or antianxiety agent, and 28% actually received a tranquilizer. Comparing tranquilizer practices with specific drug‐use criteria showed that nearly 19% of all elderly residents were exposed to some type of excess use such as long duration, polymedicine, or therapeutic duplication. Residents in facilities with less adequate staffing and other resources were significantly more likely to have a tranquilizer order, to have a tranquilizer administered, and to have any deviation from drug‐use criteria. The data also show higher rates of deviation from criteria among residents with a diagnosed mental disorder, younger residents, and Medicaid recipients.Conclusion. More attention must be paid to environmental factors that may undermine current efforts to improve psychotropic drug prescribing and use in skilled nursing facilities.
The Demented Elderly in the City of Helsinki: Functional Capacity and Placement
Authors: Juva Kati , Sulkava Raimo , Erkinjuntti Timo , Valvanne Jaakko , Tilvis Reijo 
Published: April 2015

ObjectiveTo study prevalence, functional capacity, and placement of demented patients in a randomly selected population.DesignSurvey.SettingRandom sample from population registry of the City of Helsinki.ParticipantsNine hundred subjects aged 75 years, 80 years and 85‐years, 300 in each group.MeasurementsFor each participant, we completed a questionnaire for the subject and an informant and a functional‐capacity scale and Mini‐Mental Status Examination by a community nurse, including the Clinical Dementia Rating (CDR) scale. Subjects with CDR of 0.5 or greater were examined by a neurologist who diagnosed the presence or absence of dementia according to DSM‐III‐R.ResultsNinety‐three subjects of the 656 whose CDR was known were found to have dementia. Three‐quarters of them lived in institutions, and they comprised 33%, 60%, and 68% of all institutionalized patients in the above‐mentioned age groups, respectively. Community residents suffering from dementia often lived with a caring relative and needed many services. A considerable part of the need was not met.ConclusionsIn the older age groups, the need for institutional placement due to dementia is great. According to our study, it seems unlikely that these patients could be cared for in any other way, at least not on a large scale. The need for services for home‐dwelling patients is also great, and the relatives carry a heavy load in taking care of demented patients.
PTCA in the Elderly: The “Young‐Old” versus the “Old‐Old”
Authors: Forman Daniel E. , Berman Aaron D. , McCabe Carolyn H. , Baim Donald S. , Wei Jeanne Y. 
Published: April 2015

ObjectiveTo evaluate the use of percutaneous transluminal coronary angioplasty (PTCA) in elderly coronary artery disease (CAD) patients.DesignA prospective study of patients 60 years and older undergoing de novo PTCA. We analyze patient risk factors, underlying disease, and clinical outcomes, with at least 3‐year follow‐up. Comparisons between different age strata among these patients are made to clarify differences between the young old (60 to 69 years), the middle old (70 to 79 years), and the very old (80 years and older).SettingBeth Israel Hospital, Boston, both a primary care and tertiary care teaching hospital.Patients907 consecutive elderly cardiac patients referred for PTCA are studied.InterventionsPTCA's were completed using the newest catheter technologies as they became available. All patients were premedicated with aspirin and dipyridamole, and all were anticoagulated with heparin.ResultsSubdivision by age demonstrates that the majority (67%) of patients aged 60 to 69 were males, but females were preponderant (61%) in those aged 80 and older. Octogenarians also had lower incidence of hypercholesterolemia, tobacco use, and family history of CAD, and a higher frequency of CHF, angina, and previous MI. Although total procedure‐complications increased with age, critical complications (MI, reocclusion, CABG, death) did not. Primary procedural success was similar in all age strata, but older patients had a higher prevalence of multi‐vessel disease and longer hospital stay. Follow‐up shows that most patients did well after PTCA; there was no increase in repeat PTCA, CABG, and MI with age.ConclusionsWhile advanced age is associated with changes in risk and clinical parameters for CAD patients, age alone is not a reasonable criterion to limit the use of PTCA.
Improvement of Pain and Disability in Elderly Patients with Degenerative Osteoarthritis of the Knee Treated with Narrow‐Band Light Therapy
Authors: Stelian Jean , Gil Israel , Habot Beni , Rosenthal Michal , Abramovici Iulian , Kutok Nathalia , Khahil Auni 
Published: April 2015

ObjectiveTo evaluate the effects of low‐power light therapy on pain and disability in elderly patients with degenerative osteoarthritis of the knee.DesignPartially double‐blinded, fully randomized trial comparing red, infrared, and placebo light emitters.PatientsFifty patients with degenerative osteoarthritis of both knees were randomly assigned to three treatment groups: red (15 patients), infrared (18 patients), and placebo (17 patients). Infrared and placebo emitters were double‐blinded.InterventionsSelf‐applied treatment to both sides of the knee for 15 minutes twice a day for 10 days.Main Outcome MeasuresShort‐Form McGill Pain Questionnaire, Present Pain Intensity, and Visual Analogue Scale for pain and Disability Index Questionnaire for disability were used. We evaluated pain and disability before and on the tenth day of therapy. The period from the end of the treatment until the patient's request to be retreated was summed up 1 year after the trial.ResultsPain and disability before treatment did not show statistically significant differences between the three groups. Pain reduction in the red and infrared groups after the treatment was more than 50% in all scoring methods (P < 0.05). There was no significant pain improvement in the placebo group. We observed significant functional improvement in red‐ and infrared‐treated groups (p < 0.05), but not in the placebo group. The period from the end of treatment until the patients required retreatment was longer for red and infrared groups than for the placebo group (4.2 ± 3.0, 6.1 ± 3.2, and 0.53 ± 0.62 months, for red, infrared, and placebo, respectively).ConclusionsLow‐power light therapy is effective in relieving pain and disability in degenerative osteoarthritis of the knee.
Routine Laboratory Assessment of Nursing Home Patients
Authors: Joseph Carol , Lyles Yvonne 
Published: April 2015

Little is known about protocols for routine laboratory testing in nursing homes. To determine what laboratory protocols are employed by community nursing homes, directors of nursing service in the 73 long‐term‐care facilities in Portland, Oregon were surveyed. One‐hundred percent responded, and 56% reported having laboratory testing protocols. Ninety percent of protocols employed screening tests, and 88% employed monitoring tests, but content varied widely.Although physicians are ultimately responsible for ordering laboratory tests, protocols were derived from various sources including nursing staff, pharmacy and laboratory consultants, and Department of Health and Human Service guidelines. It is recommended that physicians take a leadership role in helping nursing homes develop clinically useful, cost‐effective testing strategies.
The Relations among Caregiver Stress, “Sundowning” Symptoms, and Cognitive Decline in Alzheimer's Disease
Authors: Gallagher‐Thompson Dolores , Brooks John O. , Bliwise Donald , Leader Julie , Yesavage Jerome A. 
Published: April 2015

ObjectiveTo investigate the relations among the initial perceived stress of Alzheimer patients' caregivers, the rate of change of perceived stress, patients' sundowning behaviors, and patients' rate of cognitive decline.DesignA longitudinal cohort study in which Alzheimer patients and their caregivers were assessed at 6‐month intervals.SettingHospital out‐patient clinic. Patients and caregivers lived at home.SubjectsSubjects were 35 patients (50–79 years) with Alzheimer's disease and their primary caregivers (24 males and 11 females); all caregivers were spouses.MethodsAt time of entry into the study, caregivers indicated which of seven behaviors indicative of sundowning were exhibited by the patient. Patients were evaluated successively using the Mini‐Mental State Examination, whereas caregivers completed the Perceived Stress Scale, provided an index of social support utilization, and completed the Beck Depression Inventory.Main Outcome MeasuresCaregivers' initial perceived stress and the rate of change of perceived stress, patients' sundowning behavior, and rate of cognitive decline.ResultsThe pattern of correlations indicated that both rate of cognitive decline and initial sundowning behavior were significantly correlated with initial perceived caregiver stress. The average rate of increase of caregivers' perceived stress was positively correlated with the initial incidence of sundowning behaviors, even when controlling for the effects of caregiver depression and social support utilization.ConclusionSundowning behavior of Alzheimer patients is associated with an increased rate of change of caregivers' perceived stress. This association may be specific to sundowning behavior because there was no relation between the rate of change of perceived stress and morning agitation. The findings suggest that future caregiver intervention programs could profitably focus on sundowning behavior rather than general agitation.
Ambulatory Monitoring of Sleep‐Wakefulness Patterns in Healthy Elderly Males and Females (>88 Years): The “Senieur” Protocol
Authors: Wauquier A. , van Sweden B. , Lagaay A. M. , Kemp B. , Kamphuisen H. A. C. 
Published: April 2015

ObjectiveThe study was designed to investigate sleep‐wake patterns in healthy elderly men and women (>88 years) using ambulatory recording techniques.DesignCross‐sectional observations on 2 consecutive days.MethodsTwo consecutive 24‐hour recordings were made. Each 30‐second period of the recording was scored as characteristic of wakefulness, REM, and non‐REM sleep (stages 1–4).SettingInterviews and recordings were done in the home of the elderly, not interfering with the habitual routine.ParticipantsAmong eligible members of the “Senieur” protocol, screened for wellness, seven females (88–102 years) and seven males (88–98 years) volunteered to participate.Main Outcome MeasuresOrganization of sleep, sleep structure, and daytime napping.ResultsThere was no difference between the first and second night recording. Important gender differences were observed: males had significantly less total sleep, shorter REM latency, more transitions to wake from REM, less NREM 3 sleep, and virtually no NREM 4. Daytime napping, REM amount, and distribution did not show sex differences. Although the variability in the amount of napping was considerable, it occupied less than 10 percent of the total sleep time in both women and men. Daytime napping was unrelated to sleep characteristics.ConclusionsAmbulatory sleep‐wake recordings allow an objective and critical evaluation of sleep function in normal aging. Interesting findings include a shift of REM sleep to the first part of the sleep period an increased cycle variability, and non‐correlation of night‐time sleep with daytime napping. In contrast to earlier findings in elderly persons, a polygraphic and subjective first‐night effect was lacking.