bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Dynamics of Disability and Functional Change in an Elderly Cohort: Results from the Alameda County Study
Authors: Strawbridge William J. , Kaplan George A. , Camacho Terry , Cohen Richard D. 
Published: April 2015

ObjectiveTo examine changes in functional status over time by age, gender, and ethnicity in a representative sample of older persons.DesignSix‐year prospective cohort study.SettingAlameda County, California.Participants508 persons 65 years old and older at baseline in 1984.Main Outcome MeasuresActivities of daily living (ADL) dependence, mobility impairment, and functioning on an 18‐item scale.ResultsThe prevalence of ADL dependence and mobility impairment at baseline increased with age, while function decreased. Particularly striking differences occurred for those 80 and older. Changes in function over the 6‐year follow‐up showed a similar pattern. While death rates for males were higher, females had poorer initial functioning, and surviving females declined more than surviving males. The incidence of ADL dependence and mobility impairment during follow‐up was similar for males and females, although females survived longer with incident disability than did males. Blacks had poorer baseline functioning, more ADL dependence and mobility impairment, and declined more than non‐Blacks during follow‐up. Some of the baseline difference in function between Blacks and non‐Blacks was due to higher rates of chronic illness and co‐morbidity. In spite of the general downward trend in functioning over the 6 years, 13% of the males and 20% of the females improved.ConclusionAge‐related changes in function for older persons are complex and result in much heterogeneity. Clarifying the reasons for such heterogeneity is an important and challenging area of research.
Hearing Loss Prevalence and Management in Nursing Home Residents
Authors: Garahan Margaret Bunce , Waller Julian A. , Houghton Martha , Tisdale William A. , Runge Carl F. 
Published: April 2015

ObjectivesTo determine the prevalence and management of hearing loss and hearing handicap among non‐demented nursing home residents.DesignDescriptive study of total population of two nursing homes.ParticipantsAll 121 eligible residents.SettingsTwo nursing homes.Mini Outcome MeasuresAudiometry, questionnaires of nurses and subjects regarding perceived hearing handicap, and documentation in medical records of hearing loss.Results77% had at least a mild (≥26 dB Hearing Level) hearing loss in the better ear, and 51% had a moderate to severe loss (≥41 dB HL). Self‐assessments of hearing handicap by residents, together with audiometric findings and expressed interest in a hearing aid, were more useful guides for aural rehabilitation needs than were nurses' assessments of residents' handicaps. Medical records failed to identify 48% of residents with moderate to severe hearing losses. Fifty‐eight percent of residents with severe hearing loss currently had hearing aids, and 38% more would like to have an aid.ConclusionResidents should have hearing evaluations with documentation of results on admission and periodically under the direction of a nurse trained as a hearing specialist. Environmental modifications of the NH plus use of hearing aids can improve hearing.
The Impact of Pacemaker Implantation on Cognitive Functioning in Elderly Patients
Authors: Rockwood Kenneth , Dobbs Allen R. , Rule Brendan G. , Howlett Susan E. , Black William R. 
Published: April 2015

ObjectiveTo describe and quantify the impact of pacemaker implantation on cognitive functioning in the elderly.DesignProspective case‐control, non‐randomized trial. Data were collected from clinical and family interviews and from a psychological test battery.SettingPacemaker clinic in a tertiary care hospital.ParticipantsNineteen elderly (65+ years) patients undergoing new or replacement pacemaker implantation for dysrhythmias and volunteer controls matched for age, sex, and short Mental Status Questionnaire test results, without dysrhythmia or intervention.Main Outcome MeasuresSubjective and clinical impressions based on family interviews; results of psychological test battery before and 6–12 months after pacemaker implantation.ResultsPrior to pacemaker implantation, three patients met DSM‐III criteria for dementia and two for delirium. Paced patients demonstrated deficiency in immediate memory, language, memory for less structured information, and learning of abstract materials. These deficits were due primarily to the poor performance of patients with complete heart block. Despite clinical and subjective impressions of improvement, there was no change in psychologic test performance subsequent to pacemaker implantation.ConclusionsImpaired cognitive functioning is not always clinically apparent but appears common in patients with cardiac dysrhythmias; it is not altered 6–12 months after pacemaker implantation.
Reduced Infectivity of Cold‐Adapted Influenza A H1N1 Viruses in the Elderly: Correlation with Serum and Local Antibodies
Authors: Powers Douglas C. , Murphy Brian R. , Fries Louis F. , Adler William H. , Clements Mary Lou 
Published: April 2015

ObjectiveTo compare young and elderly adults in terms of their immune responses and rates of infection following intranasal vaccination with a live attenuated influenza virus.DesignTime series, comparing outcomes in young and elderly convenience sample.MethodRetrospective laboratory analysis of serum and nasal wash specimens collected during prior studies in which young or elderly volunteers had been inoculated with cold‐adapted influenza A/Kawasaki/86 (H1N1) reassortant virus.SettingJohns Hopkins Center for Immunization Research.ParticipantsHealthy young and elderly adults with prevaccination serum hemagglutination inhibition (HAI) antibody titers ≤1:8.Outcome MeasurementsAntibody responses in serum and nasal washes.Main ResultsThe proportion of vaccinees who developed any serum or local antibody response was higher in young compared with elderly subjects (20/20 vs 5/14, P < 0.0005). Resistance to infection with cold‐adapted virus correlated with pre‐vaccination levels of serum immunoglobulin G (IgG), serum IgA, and nasal wash IgA antibody to whole virus antigen. Age was highly correlated with a lack of response to vaccine by simple regression, but not when data were adjusted for pre‐existing antibody levels.ConclusionsCold‐adapted reassortant influenza A H1N1 viruses achieve lower rates of infection in elderly than young adults, primarily due to age‐related differences in preexisting levels of immunity which may not be reflected by HAI titer.
Time Dependency of Cognitive Recovery with Cobalamin Replacement: Report or a Pilot Study
Authors: Martin David C. , Francis Joseph , Protetch Jack , Huff F. Jacob 
Published: April 2015

ObjectiveTo examine the effects of cobalamin repletion on cognition in elderly subjects with low serum cobalamin and evidence of cognitive dysfunction.DesignTime series data collected in an open trial of parenteral cobalamin therapy.SettingsOutpatient geriatric assessment centers, inpatient geropsychiatry unit, and tertiary care university hospital.ParticipantsTwenty‐two subjects with low serum cobalamin (<150 pmol/L) and evidence of cognitive dysfunction were entered consecutively over an 8‐month period of time. Eighteen subjects completed the study.InterventionsSubjects received 1000 micrograms of cyanocobalamin intramuscularly daily for 1 week, then weekly for 1 month, then monthly thereafter for a minimum of six months.Outpatient measureThe Maths Dementia Rating Scale (DRS) was administered both before and at least 6 months after full cobalamin replacement therapy. The hypothesis that cognitive improvement was dependent on the duration of cognitive symptoms was formulated a posteriori.ResultsAfter a minimum of 6 months of cobalamin therapy, 11 of 18 patients showed cognitive improvement. There was a striking correlation between duration of cognitive symptoms and response to therapy. Patients symptomatic for <12 months gained an average of twenty points on the DRS (paired f test P = 0.0076), whereas patients symptomatic >12 months lost an average of three points (paired t test P = .34). Two patients symptomatic for only 3 months normalized their DRS scores, gaining 31 and 28 points, respectively.ConclusionThere may be a time‐limited window of opportunity for effective intervention in patients with cognitive dysfunction and low serum cobalamin.
Light to Moderate Alcohol Consumption and Mortality in the Elderly
Authors: Scherr Paul A. , LaCroix Andrea Z. , Wallace Robert B. , Berkman Lisa , Curb J. David , Cornoni‐Huntley Joan , Evans Denis A. , Hennekens Charles H. 
Published: April 2015

ObjectiveTo determine whether there is a relationship of low to moderate alcohol consumption with cardiovascular mortality in the elderly.DesignProspective cohort studies with 5‐year mortality follow‐up.SettingThree populations of community‐dwelling elders.ParticipantsPopulation‐based cohorts of men and women, aged 65 or older, in three populations. Subjects with prior myocardial infarction, stroke, or cancer, as well as those lacking alcohol consumption data, were excluded from statistical analyses leaving 2,694 subjects in East Boston, Massachusetts, 2,293 subjects in Iowa, and 1,904 subjects in New Haven, Connecticut.Main Outcome MeasurementsAlcohol consumption, total mortality, cardiovascular mortality, and cancer mortality.ResultsLow to moderate alcohol consumption was associated with statistically significant lowered total as well as cardiovascular mortality in East Boston and New Haven. The relative risks of total mortality for low to moderate consumers of alcohol compared to those consuming no alcohol in the previous year were 0.7 (95% CI 0.6–0.8) in East Boston and 0.6 (95% CI 0.5–0.8) in New Haven. For cardiovascular mortality, the RRs were 0.6 in East Boston and 0.5 in New Haven (95% CI's exclude null). These results persisted after control for potential confounding variables. In Iowa, there were no significant differences in total or cardiovascular mortality according to alcohol consumption patterns. For cancer mortality, there were no significant associations with alcohol consumption in any of the three populations.ConclusionsThese data suggest that the relationship of low to moderate alcohol consumption with reduced total and cardiovascular mortality, which are well documented in middle age, also occur in older populations.
Fluoxetine in Elderly Patients: Is There Cause for Concern?
Authors: Brymer Chris , Winograd Carol Hutner 
Published: April 2015

ObjectiveTo assess whether fluoxetine use is associated with significant weight loss or other side effects in depressed elderly patients with concomitant medical illness.DesignA retrospective chart review.SettingA tertiary care VA hospital.PatientsFive groups of outpatients were studied: (1) patients greater than 75 years old receiving fluoxetine (n = 15); (2) patients 60 to 71 years old receiving fluoxetine (n = 20); (3) patients greater than 75 years old receiving nortryptiline or desipramine (n = 20); (4) patients greater than 75 years old with a history of depression but on no antidepressant medication (n = 20); and (5) patients greater than 75 years old with no history of depression (n = 28).MeasurementsMortality, change in weight, reports of anorexia or nausea, and serum sodium and glucose measurements.Main ResultsPatients greater than 75 years of age taking fluoxetine experienced significantly greater weight loss (average 4.6 kilograms, P = 0.0062) than the other groups. Both groups of patients taking fluoxetine were significantly more likely to report nausea (P = 0.0095) and anorexia (P = 0.0009). No significant differences were noted in mortality or the frequency of hypoglycemia or hyponatremia between groups.ConclusionThe frequency and degree of weight loss noted here in medically ill elderly receiving fluoxetine warrants further investigation.
Factors Attenuating the Validity of the Geriatric Depression Scale in a Dementia Population
Authors: Feher Edward P. , Larrabee Glenn J. , Crook Thomas H. 
Published: April 2015

ObjectiveThe validity of the Geriatric Depression Scale (GDS) in cognitively impaired patients has been questioned. We investigated possible factors (memory loss, dementia severity, unawareness of illness) attenuating the validity of the GDS in patients with dementia.PatientsEighty‐three patients who met research diagnostic criteria for “probable Alzheimer's disease.” Subjects with major depressive disorder were excluded. Dementia severity ranged from mild to moderate.SettingOutpatient clinics, including institutional settings and private research settings.MeasurementsDepression—GDS; Hamilton Depression Scale. Memory—Wechsler Memory Scale; Benton Visual Retention Test. Dementia severity—Mini‐Mental State Examination. Self‐awareness of cognitive deficits—Difference score between a self‐report memory questionnaire and an informant‐rated memory questionnaire.ResultsMultiple regression analysis revealed that Hamilton scores were the major predictor of GDS scores. Memory scores and self‐awareness scores were also significant predictors. Dementia severity scores were not a significant predictor.ConclusionsThe GDS is a valid measure of mild‐to‐moderate depressive symptoms in Alzheimer patients with mild‐to‐moderate dementia. However, Alzheimer patients who disavow cognitive deficits also tend to disavow depressive symptoms, and the GDS should be used with caution in such patients. Finally, the argument that memory impairment precludes accurate self‐report of recent mood is negated by our finding that many patients accurately reported depressive symptoms and that worse memory was associated with more self‐reported depressive symptoms.
Geriatric Education Part I: Efficacy of a Mandatory Clinical Rotation for Fourth Year Medical Students
Authors: Fields Suzanne D. , Jutagir Rajendra , Adelman Ronald D. , Tideiksarr Rein , Olson Ellen 
Published: April 2015

ObjectivesTo describe the curriculum of a mandatory, fourth‐year geriatrics clerkship and assess its impact on medical students' knowledge of geriatric medicine and attitudes toward the elderly.DesignOne group, before/after trial.SettingMount Sinai School of Medicine of the City University of New York.ParticipantsEntire fourth year class of medical students (n = 127).InterventionFour‐week‐long clinical geriatrics clerkship.MeasurementsPre‐ and post‐rotation: test of knowledge; Aging Semantic Differential (ASD) attitude scale; Modified Maxwell‐Sullivan attitude scale; questionnaire.Main ResultsSeventy percent of students found the rotation to be educationally valuable; however, only one‐third of students would have taken the clerkship had it not been required. Mean geriatric knowledge score increased by 18.7% (P < 0.001). Mean ASD attitude score did not change significantly (130.5 ± 19.2 pre‐rotation versus 126.6 ± 18.8 post‐rotation, P = 0.15), but students started the rotation with a neutral attitude. Over 90% of students agreed they would welcome elderly into their future practice.ConclusionIf a national curricular goal is to improve medical students' knowledge of geriatric medicine, required rather than elective rotations may be in order.
The Test for Severe Impairment: An Instrument for the Assessment of Patients with Severe Cognitive Dysfunction
Authors: Albert Marilyn , Cohen Carolyn 
Published: April 2015

ObjectiveTo develop a reliable and valid test of cognitive function suitable for patients with severe cognitive impairment.DesignAdministration of a test; test‐retest reliability; comparison to traditional test.SettingChronic long‐term‐care facility.Patients or Other ParticipantsThe participants were 40 elderly residents with severe cognitive impairment.Main Outcome MeasuresResults of the Test for Severe Impairment (TSI) and its subsections (language, memory, executive function, and motor performance); correlation of test and retest scores; correlation of TSI with Mini‐Mental State Exam.ResultsThe TSI was significantly correlated with the Mini‐Mental State Exam (r = 0.83, P ≤ 0.0001). Test‐retest reliability was high (r = 0.96, P < 0.0001). The internal reliability of the test was also good (alpha = 0.90). Preliminary result of a factor analysis suggests that factor scores may be derived that relate to memory, language production, and knowledge of body parts.ConclusionsThe TSI is a valid and reliable test of cognitive function in patients with severe cognitive impairment. It is appropriate to use it as a unified scale.
Measurement of Activities of Daily Living in Hospitalized Elderly: A Comparison of Self‐Report and Performance‐Based Methods
Authors: Sager Mark A. , Dunham Nancy Cross , Schwantes Amy , Mecum Laurie , Halverson Kaia , Harlowe Diane 
Published: April 2015

ObjectiveTo determine the accuracy of self‐reports of physical functioning by hospitalized elderly.DesignComparison of two measures.Patients and SettingTwo‐hundred forty‐seven medical inpatients (mean age 78.7 years) hospitalized at St. Marys Hospital Medical Center, Madison, WI.Main Outcome MeasuresMeasures of five activities of daily living by self‐report and by performance.ResultsThe rate of agreement between self‐report and performance ADL measures was the lowest in the areas of bathing and dressing where the agreement was 63% and 64%, respectively. When patients reported needing no help in these two tasks, they were measured lower 32% of the time for dressing and 42% for bathing. When patients reported needing help in an activity the agreement rate between patient and occupational therapist varied widely, from only 42% for toileting to 78% for bathing. The two factors which were statistically associated with poor agreement between the two ADL measurements were cognitive impairment (P < 0.001) and a decline from the pre‐hospital level of ADL functioning which had occurred during hospitalization (P < 0.001).ConclusionsThese data suggest that there may be significant differences between patient assessments and performance‐based measurements of ADL functioning in hospitalized elderly at time of discharge. These differences may have implications for the collection of functional measurements for discharge planning or for geriatric research in the hospital environment.
The Caretaker Obstreperous‐Behavior Rating Assessment (COBRA) Scale
Authors: Drachman David A. , Swearer Joan M. , O'Donnell Brian F. , Mitchell Ann L. , Maloon Alan 
Published: April 2015

ObjectiveTo evaluate the usefulness and reliability of the Caretaker Obstreperous‐Behavior Rating Assessment (COBRA), a new test instrument for caretaker assessment of types and severity of “obstreperous behaviors” (OBs) in demented patients.DesignCOBRA was completed by caretakers of 31 outpatients and 36 nursing home inpatients with dementia. Test‐retest reliability was determined when 25 of the outpatient caretakers re‐evaluated their demented relative 1 week later; inter‐rater reliability was determined on nursing home inpatients by comparing the reports of two nurse's aids with equivalent knowledge of seven of the patients.Setting(1) University medical center Alzheimer's Disease and Related Disorders Clinic; (2) community nursing home.PatientsThirty‐one sequentially‐seen outpatients with dementia; 36 nursing home patients with dementia.InterventionFollowing instruction in the use of the COBRA Scale, caretakers provided scores for their demented patient. The instrument has three unique features: (1) it divides OBs into four categories for ease of comprehension: Aggressive/Assaultive; Mechanical/Motor; Ideational/Personality; and Vegetative; (2) a companion videotape shown to caretakers in advance illustrates each behavior to improve reliability of reporting; (3) the significance of each OB is estimated with severity and frequency measures.Main Outcome MeasurementsFrequency and severity of OBs are epitomized in 12 summary scores. Test‐retest correlations (for outpatients) and inter‐rater correlations (for inpatients) were analyzed with Pearson Product Moment and Spearman Rank Order correlations.ResultsPrevalence of OBs and severity was reported for the experimental groups. Summary scores revealed test‐retest correlations of .95 to .73 for 11 of 12 scores (outpatients), and inter‐rater correlations of .99 to .73 for 8 of 12 scores (inpatients). Age, gender, and disease etiology were not significantly related to OBs; clinical severity correlated with type and severity of OBs.ConclusionsThe COBRA scale provides a convenient, comprehensive, and reliable means for caretakers to identify the types and measure the severity of OBs in demented outpatients and nursing home inpatients. If additional studies confirm these observations, COBRA will be a useful instrument for assessing the effects of interventions on OBs in patients with dementia.
Milacemide: A Placebo‐Controlled Study in Senile Dementia of the Alzheimer Type
Authors: Dysken Maurice W. , Mendels Joseph , LeWitt Peter , Reisberg Barry , Pomara Nunzio , Wood James , Skare Stacy , Fakouhi J. Daniel , Herting Robert L. 
Published: April 2015

ObjectiveMilacemide, a MAO‐B inhibitor that is also a prodrug for glycine, was tested as a treatment for senile dementia of the Alzheimer type (SDAT) because of its potential for enhancing cognition in animal models of impaired learning and memory.DesignDouble‐blind, placebo‐controlled, randomized clinical trial.SettingSixteen study sites, both university‐affiliated and private.PatientsA total of 228 outpatients (116 men and 112 women) with SDAT, ranging in age from 49–93 years. Intervention: 1200 mg/day milacemide treatment for 1 month (113 patients received milacemide, and 115 patients received placebo).Main Outcome MeasuresAlzheimer's Disease Assessment Scale and the Mini‐Mental State Examination.ResultsMilacemide‐treated SDAT patients did not show significant improvement in any of the outcome measures used. Significant elevations in liver enzymes in four subjects were of sufficient magnitude to necessitate withdrawal from the study.ConclusionsMilacemide does not appear to be an effective treatment in enhanci g cognition in SDAT patients.
A Comparison of a Two‐Wheeled Walker and a Three‐Wheeled Walker in a Geriatric Population
Authors: Mahoney Jane , Euhardy Reenie , Carnes Molly 
Published: April 2015

ObjectiveThere are few data on the effect of walkers on gait and mobility or on comparisons of different walker types. We compared a commonly used 4‐legged, 2‐wheeled walker and a newer 3‐legged, 3‐wheeled walker in measures of gait, mobility, and patient satisfaction.DesignCross‐over controlled trial.SettingIn the Physical Therapy Department of a Veterans Affairs hospital.ParticipantsSubjects were 15 male and female frail elderly veterans (mean age, 82 years), both inpatients and outpatients, consecutively enrolled from a sample of 35 patients referred to the Physical Therapy Department for mobility problems. Subjects met the following criteria: age 65 or over, ambulatory, no prior use of a wheeled walker, stable medical condition, and informed consent.InterventionSubjects were evaluated without either walker and with each of the two walkers on a 15‐foot walkway and a 60‐foot obstacle course. Subjects were asked which walker they preferred.Outcome MeasureOutcome measures were stride length on the walkway, time on an obstacle course, and walker preference.ResultsStride length was 1.4 inches (3.6 cm) greater with the 3‐wheeled walker than with the 2‐wheeled walker (P = 0.016 by Wilcoxon signed‐rank test). Time on the obstacle course was 16.0 seconds less with the 3‐wheeled walker than the 2‐wheeled walker (P = 0.002). The 3‐wheeled walker was subjectively preferred.ConclusionsThe 3‐wheeled walker appears to have a greater positive impact on gait and mobility than the 2‐wheeled walker.