bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Silent Myocardial Ischemia with New Atherothrombotic Brain Infarction in Older Patients With Extracranial Internal or Common Carotid Arterial Disease with and without Previous Atherothrombotic Brain Infarction
Authors: Aronow Wilbert S. , Ahn Chul , Mercando Anthony D. , Epstein Stanley , Gutstein Hal , Schoenfeld Myron R. 
Published: April 2015

OBJECTIVE: To correlate silent myocardial ischemia with the incidence of new atherothrombotic brain infarction (ABI) in older patients with 40 to 100% extracranial carotid arterial disease (ECAD) with and without prior ABI.DESIGN: In a prospective study of 208 older patients with 40 to 100% ECAD diagnosed by carotid duplex ultrasonogra‐phy, 24‐hour ambulatory electrocardiograms were obtained to detect silent myocardial ischemia. At 42‐month mean follow‐up, silent myocardial ischemia was correlated with the incidence of new ABI in patients with and without prior ABI.SETTING: A large long‐term health care facility where 208 older patients with 40 to 100% ECAD and technically adequate 24‐hour ambulatory electrocardiograms for detecting silent myocardial ischemia were studied.PATIENTS: The 208 patients included 68 men and 140 women, mean age 81 ± 8 years (range 60 to 100). One‐hundred three (50%) of the patients had prior ABI.MEASUREMENTS AND MAIN RESULTS: Sixy‐nine (33%) of the 208 patients had silent myocardial ischemia. Mean follow‐up was 42 ± 25 months (range 3 to 101 months). At follow‐up, the incidence of new ABI was 64% in patients with prior ABI and 32% in patients with no prior ABI (P < .0001). At follow‐up, the incidence of new ABI was 65% in patients with silent ischemia and 40% in patients with no silent ischemia (P = .0005). The multivariate Cox regression model showed that patients with prior ABI have a 2.5 times higher chance of developing new ABI than those without prior ABI after controlling other prognostic variables. Patients with silent ischemia have a 2.1 times higher probability of developing new ABI than those without silent ischemia after controlling other prognostic variables.CONCLUSIONS: Prior ABI and silent ischemia are independent risk factors for the development of new ABI in patients with 40 to 100% ECAD. This probably reflects that silent ischemia is a marker for more advanced or more significant atherosclerotic disease rather than a causal factor for ABI.
Weight Loss Precedes Dementia in Community‐Dwelling Older Adults
Authors: Barrett‐Connor Elizabeth , Edelstein Sharon L. , Corey‐Bloom Jody , Wiederholt Wigbert C. 
Published: April 2015

OBJECTIVE: To determine whether the weight loss associated with Alzheimer's disease precedes or follows the dementia.DESIGN: Older community‐dwelling men (n = 134) and women (n = 165) were followed for 20 years before they were diagnosed as cognitively intact or demented. A repeated measures analysis was used to compare weight change in those who developed Alzheimer's Disease (AD) with those who remained cognitively intact.MEASUREMENTS: Weight was measured at three clinic visits between 1972‐74, 1984‐87, and 1990‐93. Participants were classified as having probable or possible AD or being cognitively intact at the 1990‐93 evaluation. Diagnoses were made by two neurologists and a neuropsychometrist, based on neuropsychological tests and physical examination, using NINCDS‐ADRDA criteria.RESULTS: There were 36 men and 24 women diagnosed with probable or possible AD; they were considered to have mild to moderate dementia based on their test scores and community‐dwelling status. Those who developed dementia were older than those diagnosed as cognitively intact. In age‐adjusted analyses, both men and women who were later diagnosed with AD had a significant decrease in weight after the baseline visit (P < .001 and P < .003, respectively), but there was no significant weight loss in the men and women who remained cognitively intact. These differences were not explained by lifestyle, depression, or other illness.CONCLUSION: Weight loss precedes mild to moderate dementia; early weight loss is, therefore, unlikely to be a consequence of AD patients being unable or unwilling to eat.
Inner‐City Older Blacks Have High Levels of Functional Disability
Authors: Miller Douglas K. , Carter Myrtle E. , Miller J. Philip , Fornoff Jane E. , Bentley Judy A. , Boyd Sheila D. , Rogers Jason H. , Cox Matthew N. , Morley John E. , Lui Li‐Yung Lily , Coe Rodney M. 
Published: April 2015

OBJECTIVES: To describe the frequency and severity of functional problems in two groups of noninstitutionalized inner‐city blacks aged 70 years and older contrasted with results from appropriate groups of white and black older adults and with the goals of the Healthy People 2000 program.DESIGN: Cross‐sectional descriptive study.SETTING: Community‐based samples.PARTICIPANTS: A population‐based sample of 416 older adults living in a 3.5‐square mile catchment area in north St. Louis (NSL), Missouri, and a sample of 197 older residents living in public housing in East St. Louis (ESL), Illinois.MEASUREMENTS: Health status, preventive health activities, health services utilization, and risks for progressive frailty were assessed by self report and observation using well validated, standardized instruments. Whenever possible, comparison data were derived from national datasets, original samples used to validate the measures, and other useful comparison groups.RESULTS: The NSL sample had somewhat better health status and risk for progressive disability than the ESL sample. However, compared with national or regional reference groups using age‐gender adjustments, both study groups demonstrated increased levels of dependence in intermediate activities of daily living, restricted activity days, inability to walk one‐half mile without assistance, reported poor vision, living alone, and limited income compared with both older whites and blacks, and increased levels of worsening health, inability to perform heavy work around the house, never walking a mile or more, and currently unmarried versus whites with variable decrements versus blacks. Contrasted with other comparison groups, the two samples had increased body fat; consistent decrements in gait speed, timed chair stands, timed one‐leg balance, and frequency of preventive exercise; and lower levels of dental care; results relative to physician visits and hospital days were mixed. They also had high levels of measured visual and hearing impairments, unmet needs for home delivered meals, and problems with false teeth. Deficiencies compared with the goals of Healthy People 2000 were large.CONCLUSIONS: The special attributes of inner‐city blacks, including poverty and access to and acceptance of remedial programs, will have to be considered if the goals of Healthy People 2000 are to be met in this important and growing segment of older Americans.
Impact of Physical Illness on Quality of Life and Antidepressant Response in Geriatric Major Depression
Authors: Small Gary W. , Birkett Martin , Meyers Barnett S. , Koran Lorrin M. , Bystritsky Alexander , Nemeroff Charles B. ,   Fluoxetine Collaborative Study Group
Published: April 2015

OBJECTIVE: Because physical illness may influence quality of life, we assessed its impact on functional status and treatment outcome in older depressed patients who participated in a clinical trial, which showed a significantly higher remission rate for fluoxetine over placebo (31.6% vs 18.6%, P < .001).DESIGN: Six‐week, randomized, double‐blind, placebo‐controlled trial of fluoxetine, 20 mg daily.SETTING: Multiple clinical sites, both university and private.PARTICIPANTS: Outpatients (N = 671) were ≥ 60 years (mean ± SD = 67.7 ± 5.7), met DSM‐III‐R criteria for unipolar major depression and had baseline scores ≥ 16 on the Hamilton Depression Rating Scale.MEASUREMENTS: The 36‐item short‐form health survey (SF‐36) was used to measure baseline and posttreatment functional health and well‐being. Physical illness was rated by number of current chronic or historical illnesses. Change from baseline to endpoint in the Hamilton Depression Rating Scale total score was used to measure depression outcome.MAIN RESULTS: Most patients reported physical illness: 83% had one or more chronic illness, and 89% had one or more historical illness. Greater numbers of baseline chronic illness indicated worse physical functioning, general health perceptions, and vitality and greater bodily pain and role limitation from physical problems. Historical physical illness was associated with worse physical functioning, vitality, general health perceptions, social functioning, and mental health. Although the number of chronic illnesses did not influence treatment response, historical physical illness was associated with greater fluoxetine response and lower placebo response.CONCLUSIONS: These findings suggest that both current and previous physical illness are associated with lower quality of life in geriatric depression and that depressed older patients with chronic physical illness respond to antidepressants as well as those without such illness. Recovery from previous physical illness should be explored as a potential predictor of antidepressant treatment outcome.
Recent Advances in the Genetics of Alzheimer's Disease and Vascular Dementia with an Emphasis on Gene‐Environment Interactions
Authors: Plassman Brenda L. , Breitner John C.S. 
Published: April 2015

OBJECTIVE: To review recent findings in the genetics of Alzheimer's disease (AD) and vascular dementia (VaD) with particular emphasis on gene‐environment interactions.DESIGN: A survey and critique of recent literature on the genetic etiology of AD and VaD.CONCLUSIONS: Recent research has identified several genes associated with AD, including loci on chromosome 1, 14, 19, and 21. Two of these loci, encoding the β‐amyloid precursor protein and apolipoprotein E, have gene products that are well characterized and of evident significance in the pathogenesis of AD. The four genes together probably account for little more than 50% of all cases of AD, but other undiscovered loci are likely. Interaction of genetic effects with environmental influences may affect both onset and expression of AD. By contrast, only a small minority of VaD cases can be attributed to a pure genetic etiology. The majority of VaD is caused by both genetic and environmental factors. Many of the environmental antecedents also have genetic determinants (e.g., smoking). Knowledge of the gene‐environment interactions for both AD and VaD will facilitate identification of early preclinical symptoms of disease, a stage of the disease process during which treatment may be most beneficial.
Physical Restraints in Geriatric Care in Sweden: Prevalence and Patient Characteristics
Authors: Karlsson Stig , Bucht Gösta , Eriksson Sture , Sandman P.O. 
Published: April 2015

OBJECTIVE: Physical restraints are used frequently in geriatric care to promote the safety of frail older patients. This study investigated the prevalence of the use of physical restraints in geriatric care and the way in which patient characteristics are related to the use of physical restraints.DESIGN: A point prevalence study of patients cared for in various types of geriatric settings.SETTING: Eight nursing homes, 15 old people's homes, a somatic geriatric clinic, and a psychogeriatric clinic in a health care district in northern Sweden.PARTICIPANTS: A total of 1325 patients, mean age 82 years, 64% of whom were women.MEASUREMENTS: The Multi‐Dimensional Dementia Assessment Scale (MDDAS) was used to measure motor function, vision, hearing, speech, ADLs, behavioral symptoms, psychiatric symptoms, use of psychoactive drugs, and the physical and psychological workload of the staff. In addition, questions concerning the use of physical restraints were added to the instrument.RESULTS: Twenty‐four percent of the patients were physically restrained. The highest prevalence was found in nursing homes and psychogeriatric care. Physical restraints were found to relate most strongly to cognitive impairment, impaired ADLs, and speech and walking ability. Ninety‐four percent of the restrained patients were cognitively impaired. Other variables relating to the use of physical restraints were psychiatric symptoms and behavioral disturbances.CONCLUSIONS: This study has shown that physical restraints are used frequently in geriatric care in Sweden and that cognitive and physical impairments relate very closely to the use of physical restraints. J Am Geriatr Soc 44:1348–1354, 1996.
Association Between Alzheimer's Disease and Bound Autochthonous IgM on T Cells
Authors: Kell Sherron H. , Allman Richard M. , Harrell Lindy E. , Liu Tiepu , Solvason Nanette 
Published: April 2015

OBJECTIVE: To determine whether there is an association between the number of peripheral T cells binding IgM per total T cell population (%IgM + T cells) and dementia.DESIGN: Cross‐sectional study.SETTING: Two inpatient and two outpatient sites at a university medical center.PARTICIPANTS: Fifty‐three adults.MEASUREMENTS: Peripheral blood was collected from each individual, and the %IgM + T cells was determined by flow cytometry. The data obtained by medical record chart review were analyzed to determine whether the %IgM + T cells correlated with cognitive diagnoses, demographic variables, medical diagnoses, or prescribed medications.RESULTS: The %IgM + T cells was negatively correlated with MMSE scores (r = ‐.33, P = .016). There was a significant difference in the mean %IgM + T cells between Alzheimer's disease (AD) and non‐AD patients (35.6% ± 30.2% vs 14.6% ± 23.9%, P < .001) but no statistically significant association between the mean %IgM + T cells and age, sex, race, prescribed medications (except gastrointestinal (GI) medications), or medical diagnoses (except stroke). After statistically controlling for GI medications and stroke, AD remained independently associated with the %IgM + T cells (P = .008).CONCLUSIONS: Patients with AD had significantly more of their T cells coated with IgM than did non‐AD patients. J Am Geriatr Soc 44:1362–1365, 1996.
Sedative‐Hypnotic Use and Increased Hospital Stay and Costs in Older People
Authors: Zisselman Marc H. , Rovner Barry W. , Yuen Elaine J. , Louis Daniel Z. 
Published: April 2015

OBJECTIVE: To assess the relationship between sedative‐hypnotic (S/H) utilization, severity of illness, length of stay, and hospital costs among older patients admitted to a tertiary care university hospital.DESIGN: Retrospective review of computerized hospital and pharmacy data bases.SUBJECTS: A total of 856 older consecutive medical and surgical admissions from November 1993 to March 1994.MEASUREMENTS: Sedative/hypnotic utilization in accord with the Health Care Financing Administration (HCFA) guidelines for S/H use in nursing homes. Jefferson Disease Staging to estimate severity of illness. Hospital records to obtain demographic characteristics, length of stay, and hospital costs.RESULTS: Patients whose S/H use exceeded HCFA guidelines, compared with those within the guidelines and those receiving no drugs, had longer lengths of stay (21.5 days vs 12.3 days vs 6.7 days, P < .001), increased hospital costs ($29,245 vs $15,219 vs $7,516, P < .001), and greater severity of illness (245.8 vs 189.5 vs 148.5, P < .001). S/H use exceeding and within HCFA guidelines were associated with increased length of stay (both P < .0001) and hospital costs (both P < . 0001).CONCLUSIONS: Older hospitalized patients receiving S/H have greater severity of illness, longer lengths of stay, and higher hospital costs compared with other patients. S/H use, and, in particular, S/H use exceeding the HCFA guidelines, are associated with increased hospital stay and cost. J Am Geriatr Soc 44:1371–1374, 1996.
Laparoscopic Cholecystectomy in the Geriatric Population
Authors: Golden William E. , Cleves Mario A. , Johnston Judith C. 
Published: April 2015

OBJECTIVE: To assess effectiveness and conversion rates of inpatient laparoscopic cholecystectomy in older people living in the community.SETTING AND SUBJECTS: All acute care hospitals providing cholecystectomy in a single state. Medicare patients who underwent inpatient cholecystectomy in fiscal year 1994 in Arkansas.METHODS: A random sample comprising 449 of 2182 geriatric patients who underwent inpatient cholecystectomy in fiscal year 1994, stratified by hospital bed size, had charts reviewed for type of cholecystectomy performed, occurrence of conversion from a laparoscopic to an open cholecystectomy, surgical complications, and need for transfusion.RESULTS: Eighty‐two percent of nonincidental cholecystectomies were initially laparoscopic. Total conversion rate for all inpatient laparoscopic cases was 20%. Forty‐two percent of this group suffered acute cholecystitis, with male patients exhibiting a higher rate of acute cholecystitis than female patients. Conversion rates for elective cholecystectomy for both sexes was between 13 and 14%. Conversion rate to an open procedures was 28% for patients with acute disease, with male patients again having a higher rate than female patients (40% vs 19%, P < .001). Surgical complications and intraoperative transfusions were rare. Conversion rates did not vary between large and small hospitals or among different age groups within the older population.CONCLUSIONS: Inpatient laparoscopic cholecystectomy is common in older people both for acute and chronic gallbladder conditions. Conversion rates ranged from 13% for elective cholecystectomy to 28% for acute disease. These rates are higher than published literature, which focuses on younger populations undergoing elective procedures. Audit committees need to be aware of this higher conversion rate in older people when assessing surgical proficiency. J Am Geriatr Soc 44:1380–1383, 1996.
Percutaneous Transhepatic Cholangioscopy for Diagnosis and Therapy of Biliary Diseases in Older Patients
Authors: Van Steenbergen W. , Van Aken L. , Van Beckevoort D. , Stockx L. , Fevery J. 
Published: April 2015

OBJECTIVE: To describe the use of percutaneous cholangioscopy in older patients with complex diagnostic and therapeutic bile duct disorders.DESIGN: Case series.SETTING: Tertiary care center.PATIENTS: Fourteen patients with a mean age of 74 (SD ± 9) years (range, 60–91 years) underwent percutaneous cholangioscopy. Eleven of these patients presented with endoscopically irretrievable bile duct stones. These 11 patients represent 4.1% of a group of 342 patients (age ≥ 60 years) with a mean age of 76 (SD ± 9) years who were treated endoscopically because of common bile duct stones between January 1993 and January 1996. Three patients presented with obstructive jaundice resulting from a bile duct stricture. In these three patients, brushing cytology of the strictures had proved to be negative.INTERVENTION: After creation and dilatation of a percutaneous transhepatic tract, cholangioscopy was carried out with a flexible cholangioscope. All procedures were performed under mild sedation and analgesia. Stone disintegration was obtained by electrohydraulic lithotripsy, applied through the working channel of the cholangioscope.RESULTS: Complete stone disintegration and removal was obtained after one to three cholangioscopic sessions in all 11 patients with stones. A histological diagnosis of malignancy was obtained in the three patients with biliary strictures.CONCLUSIONS: Percutaneous cholangioscopy is a well tolerated and promising technique in our diagnostic and therapeutic strategy in older patients with complex biliary disorders not responsive to peroral endoscopic diagnosis or treatment. J Am Geriatr Soc 44:1384–1387, 1996.
Prevalence of Atrial Fibrillation and Association of Atrial Fibrillation with Prior and New Thromboembolic Stroke in Older Patients
Authors: Aronow Wilbert S. , Ahn Chul , Gutstein Hal 
Published: April 2015

OBJECTIVE: To correlate atrial fibrillation with the incidence of new thromboembolic (TE) stroke in older patients with and without prior TE stroke.DESIGN: In a prospective study of 2101 older patients, electrocardiograms showed that atrial fibrillation was present in 283 patients (13%). At 42‐month mean follow‐up, atrial fibrillation was associated with the incidence of new TE stroke in patients with and without prior TE stroke.SETTING: A large long‐term health care facility where 2101 older patients were studied.PATIENTS: The 2101 patients included 1451 women and 650 men, mean age 81 ± 8 years (range 60 to 103).MEASUREMENTS AND MAIN RESULTS: Atrial fibrillation was present in 283 of 2101 patients (13%). The mean age was 84 ± 7 years in patients with atrial fibrillation and 81 ± 8 years in patients with sinus rhythm (P = .0001). The prevalence of atrial fibrillation was 5% in patients aged 60 to 70 years, 14% in patients aged 71 to 80 years, 13% in patients aged 81 to 90 years, and 22% in patients aged 91 to 103 years (P < .0001). Mean follow‐up was 31 ± 18 months in patients with atrial fibrillation and 44 ± 27 months in patients with sinus rhythm (P = .0001). Previous TE stroke occurred in 123 of 283 patients (43%) with atrial fibrillation and in 431 of 1818 patients (24%) with sinus rhythm (P < .0001). New TE stroke occurred in 131 of 283 patients (46%) with atrial fibrillation and in 303 of 1818 patients (17%) with sinus rhythm (P < .0001). The log‐rank test showed that patients with atrial fibrillation had a significantly higher probability of developing new TE stroke than those with sinus rhythm (P < .0001). The multivariate Cox regression model showed that independent risk factors for new TE stroke were male sex (relative risk = 1.3), prior TE stroke (relative risk = 3.1), and atrial fibrillation (relative risk = 3.3).CONCLUSIONS: Atrial fibrillation, prior TE stroke, and male sex are independent risk factors for the development of new TE stroke in older patients.
Community‐Acquired Pneumonia in Older Patients
Authors: Janssens Jean‐Paul , Gauthey Laurent , Herrmann François , Tkatch Lubos , Michel Jean Pierre 
Published: April 2015

OBJECTIVE: To document the prevalence of Legionella sp., Mycoplasma Pneumoniae and Influenza A and B in older patients hospitalized for community‐acquired pneumonia (CAP) or nursing‐home acquired pneumonia (NHAP) and to determine risk factors associated with fatal outcome or prolonged hospital stay.DESIGN: Prospective clinical and serological study.PATIENTS: All patients with CAP or NHAP — confirmed by chest roentgenogram — admitted to a 320‐bed acute care geriatric university hospital from May 1, 1988, to August 31, 1989, were included. Serological testing was performed upon admission and after 2 and 4 weeks. Relevant data concerning medical history, clinical examination, and laboratory data were recorded upon admission. Ninety‐nine patients (age: 85 ± 6.3 years, 36 male, 63 female) met inclusion criteria; 20 came from nursing homes, 79 from their homes in the community.MAIN RESULTS: Fourteen patients died during the month after admission. An etiological diagnosis could be established in 22 patients. No cases of Legionella pneumonia and one case of M. pneumoniae were detected. Seven patients had evidence of Influenza pneumonia. Nonsurvivors were more likely to have been admitted from a nursing home and to have a temperature less than 37.5°C and elevated urea nitrogen (BUN). Cyanosis, involvement of upper lobes, elevated white blood cell counts, and higher percentage of band forms were associated statistically with longer treatment.CONCLUSIONS: This study confirms the low prevalence of Legionella sp. and M. Pneumoniae infection in CAP and NHAP in this age group. Risk factors as to outcome and length of treatment may be used as pointers to identify high risk patients, with special attention to patients coming from nursing homes, and patients with high BUN.