bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age‐Related Differences in Management of Heart Disease: A Study of Cardiac Medication Use in an Older Cohort
Authors: Ganz David A. , Lamas Gervasio A. , Orav E. John , Goldman Lee , Gutierrez Peter R. , Mangione Carol M. 
Published: April 2015

BACKGROUND: Previous studies have suggested suboptimal use of cardiac medications for secondary prevention after myocardial infarction (MI) and atrial fibrillation (AF), especially among older people.OBJECTIVE: To determine whether patients older than 75 years are less likely than those aged 65 to 74 to be prescribed medications with evidence‐based indications, including angiotensin‐converting enzyme (ACE) inhibitors for left ventricular dysfunction (LVD) and/or diabetes mellitus (DM), aspirin and/or β‐blockers for those with a history of MI, and warfarin for chronic AF.DESIGN: A retrospective cohort study.SETTING: Twenty‐nine hospitals, predominantly tertiary‐care institutions.PARTICIPANTS: A total of 407 patients randomized to ventricular or dual‐chamber pacing from February 26, 1993, to September 30, 1994, in the Pacemaker Selection in the Elderly (PASE) trial.MEASUREMENTS: A review of the patient's medical history and a physical exam at study enrollment, three follow‐up timepoints, and a study closeout.RESULTS: Patients older than 75 years with LVD and/or DM were less likely to be prescribed ACE inhibitors (OR = .56 (0.31‐1.00)); patients older than 75 with a history of MI were less likely to be taking aspirin (OR = .43 (0.19‐.95)), and patients older than 75 with AF were less likely to be prescribed warfarin (OR = .18 (0.05‐.61)). Patients older than 75 years of age with any or all of the conditions studied were less likely to be prescribed indicated medications than those ages 65 to 74 (OR = .35 (0.18‐.70)), after controlling for between‐group differences in comorbidity, gender, and number of noncardiac medications.CONCLUSION: Older age is a significant independent negative correlate of evidence‐based cardiac medication use in this cohort. Causes for this finding need to be explored. J Am Geriatr Soc 47:145–150, 1999.
An Evaluation of a Family Visit Education Program
Authors: McCallion Philip , Toseland Ronald W. , Freeman Kurt 
Published: April 2015

OBJECTIVES: This study was designed to examine the impact of the Family Visit Education Program (FVEP) on family members, nursing staff, and nursing home residents with dementia.DESIGN: The study employed a 2 × 3 single‐blind, randomized control group design with two study conditions, FVEP or usual care (UC), and three times of measurement, baseline, 3‐months, and 6‐months.SETTING: The study was conducted in five skilled‐care nursing homes that ranged in size from 120 to 300 beds.PARTICIPANTS: Sixty‐six residents with dementia and their primary visitor were randomly assigned to FVEP (n = 32) or UC (n = 34).MEASUREMENTS: Residents were assessed for (1) psychosocial functioning, (2) depression, (3) agitated behavior, and (4) degree of positive social interaction. Nursing staff were assessed for changes in the time and methods used to manage problem behaviors. Visitors were assessed for (1) dementia management skills, (2) extent of perceived caregiving hassles, and (3) visit satisfaction.RESULTS: FVEP was effective for reducing residents' problem behaviors and for decreasing their symptoms of depression and irritability. It was also effective for improving the way family members and other visitors communicated with residents, but, with the exception of reducing the use of mechanical restraints, it was not effective in changing nurses' management of residents' behavior problems.CONCLUSIONS: It is possible to educate family members to communicate and interact more effectively with nursing home residents with dementia. This has beneficial effects on residents but not on nursing staff's management of problem behaviors. J Am Geriatr Soc 47:203–214, 1999.
Enhanced Cognitive Performance with Estrogen Use in Nondemented Community‐Dwelling Older Women
Authors: Steffens David C. , Norton Maria C. , Plassman Brenda L. , Tschanz Jo Ann T. , Wyse Bonita W. , Welsh‐Bohmer Kathleen A. , Anthony James C. , Breitner John C. S. 
Published: April 2015

OBJECTIVE: To examine the association between history of postmenopausal estrogen use and cognitive function in a large sample of nondemented community‐dwelling older women.SETTING: A community of older residents in Cache County, Utah.PARTICIPANTS: A total of 2338 nondemented women aged 65 and older.MEASUREMENTS: All subjects were administered the Modified Mini‐Mental State Examination (3MSE). Self‐reported information on current and past use of estrogen after menopause was also obtained using a structured interview. Estrogen use was drichotomized as: no use, past use, and current use. Apolipoprotein E (APOE) genotype was determined and was dichotomized by the presence of an e4 allele. A series of variance/covariance models was conducted with the 3MSE score as the dependent variable, first considering estrogen use alone, then adding, sequentially as covariates, education, age, health status, APOE genotype, current depression status, and history of head injury.RESULTS: In the simplest bivariate model, the 3MSE means (and confidence intervals) were 92.1 (91.7–92.4), 93.5 (93.1–93.9), and 94.4 (94.0–94.7) for never‐, past‐, and current users, respectively. In the final model (R2 = 0.28), no use of estrogen replacement therapy (P = .006), lower education (P < .001), poorer perceived health status (P = .035), current depression (P = .014), and presence of at least one APOE e4 allele (P < .001) each independently predicted lower 3MSE score. Both current and past estrogen users had significantly higher 3MSE scores than never‐users (P = .0063 and P = .0096, respectively).CONCLUSIONS: In this large community study, women who had used estrogen after menopause scored higher on the 3MSE. This finding remained, even after controlling for the effects of age, education, APOE genotype, and other variables that may affect cognition. These data support studies reporting a beneficial role of estrogen on cognition in postmenopausal women, particularly among current estrogen users.
Association Between Bone Mineral Density and Cognitive Decline in Older Women
Authors: Yaffe Kristine , Browner Warren , Cauley Jane , Launer Lenore , Harris Tamara 
Published: April 2015

OBJECTIVE: To test the hypothesis that bone mineral density (BMD), a marker of cumulative estrogen exposure, is associated with cognitive function in nondemented older women.DESIGN: A prospective cohort study.SETTING: Clinical centers in Baltimore, Maryland, Minneapolis, Minnesota, the Monongahela Valley near Pittsburgh, Pennsylvania, and Portland, Oregon.PARTICIPANTS: We evaluated 8333 older community‐dwelling women enrolled in the Study of Osteoporotic Fractures who were not taking estrogen replacement.MEASUREMENTS: Calcaneal and hip BMD were measured at baseline and at follow‐up (4–6 years later);vertebral fractures were ascertained radiologically at year 6. Women were administered a modified Mini‐Mental State Exam, Trails B, and Digit Symbol at baseline and at follow‐up.RESULTS: Compared with women with higher bone mineral density, women with low baseline BMD had up to 8% worse baseline cognitive scores (P = .001) and up to 6% worse repeat cognitive scores (P = .001), even after multivariate adjustments. For 1 SD decrease in baseline hip BMD or calcaneal BMD, women had a 32% (95% CI, 19–47%) or a 33% (95% CI, 20–48%) greater odds of cognitive deterioration (worst 10th percentile of change). Women with vertebral fractures had lower cognitive test scores and a greater odds of cognitive deterioration than those without fractures (OR = 1.29; 95%CI, 1.03‐1.60).CONCLUSIONS: Women with osteoporosis, whether measured by baseline BMD, reductions in BMD, or vertebral fractures, have poorer cognitive function and greater risk of cognitive deterioration. Our findings suggest a link between two of the most common conditions affecting older women. Further understanding of this association may be important for new treatment and prevention directions. J Am Geriatr Soc 47:1176‐1182,1999.
Thyroid Function, Morphology and Prevalence of Thyroid Disease in a Population‐Based Study of Danish Centenarians
Authors: Andersen‐Ranberg Karen , Jeune Bernard , Høier‐Madsen Mimi , Hegedüs Laszlo 
Published: April 2015

OBJECTIVES: To investigate thyroid function, morphology, and autoimmunity in relation to physical function in an unselected population of centenarians.DESIGN: A population‐based survey.SETTING: Denmark.PARTICIPANTS: All persons living in Denmark who celebrated their 100th anniversary during the period April 1, 1995 to May 31, 1996, a total of 276 persons.MAIN OUTCOME MEASUREMENTS: Thyroid hormones (TSH, T4, FT4I, T3, FT3I, and T3RU), thyroid autoantibodies (TPOab and Tgab), thyroid volume, activities of daily living according to the Katz Index of ADL.RESULTS: In all, 207 (75%) of the 276 eligible subjects participated, and 148 agreed to blood tests. Among the participants, 2.9% had previously known hyperthyroidism, and the same proportion had previously known hypothyroid‐ism. The blood tests did not reveal any undiagnosed cases of overt thyroid dysfunction. However 7.2% had a subnormal serum TSH, and 2.9% had an elevated serum TSH; all had normal serum T3 and serum T4 levels. Thyroid autoantibodies were detected in 26 (17.6%) centenarians (11.5% had Tgab and 9.5% had TPOab). Among relatively independent centenarians, low serum T3 was significantly associated with high comorbidity (P = .029), whereas both low serum T3 and thyroid autoantibodies were significantly associated with ADL‐dependency (P < .001 and P = .030, respectively). Ultrasonography (n = 50) revealed a small gland with a median volume of 8.3 mL (range 3.2–27.9) compared with an expected volume of 20 mL (14–26) (P < .001. (There was no significant relationship to body weight. When examined by ultrasound, only 26% had significant morphological alterations.CONCLUSIONS: Thyroid dysfunction does not seem to be more prevalent among centenarians than among younger old people. Low serum T3 is related to poor physical function and co‐morbidity, whereas thyroid autoimmunity is related only to poor physical functioning. Despite atrophy of the thyroid gland, these findings suggest that thyroid function is well preserved in centenarians. J Am Geriatr Soc 47:1238–1243, 1999.
MediCaring: Development and Test Marketing of a Supportive Care Benefit for Older People
Authors: Lynn Joanne , Dulac Jennie D. , O'Connor Mary Ann S. , Roach Mary Joan , Ross Cathy S. , Wasson John H. 
Published: April 2015

OBJECTIVES: To develop an alternative healthcare benefit (called MediCaring) and to assess the preferences of older Medicare beneficiaries concerning this benefit, which emphasizes more home‐based and supportive health care and discourages use of hospitalization and aggressive treatment. To evaluate the beneficiaries' ability to understand and make a choice regarding health insurance benefits; to measure their likelihood to change from traditional Medicare to the new MediCaring benefit; and to determine the short‐term stability of that choice.DESIGN: Focus groups of persons aged 65+ and family members shaped the potential MediCaring benefit. A panel of 50 national experts critiqued three iterations of the benefit. The final version was test marketed by discussing it with 382 older people (men s 75 years and women a 80 years) in their homes. Telephone surveys a few days later, and again 1 month after the home interview, assessed the potential beneficiaries' understanding and preferences concerning MediCaring and the stability of their responses.SETTINGS: Focus groups were held in community settings in New Hampshire, Washington, DC, Cleveland, OH, and Columbia, SC. Test marketing occurred in New Hampshire, Cleveland, OH; Columbia, SC, and Los Angeles, CA.PARTICIPANTS: Focus group participants were persons more than 65 years old (11 focus groups), healthcare providers (9 focus groups), and family decision‐makers (3 focus groups). Participants in the in‐home informing (test marketing group) were persons older than 75 years who were identified through contact with a variety of services.MEASUREMENTS: Demographics, health characteristics, understanding, and preferences.RESULTS: Focus group beneficiaries between the ages of 65 and 74 generally wanted access to all possible medical treatment and saw MediCaring as a need of persons older than themselves. Those older than age 80 were mostly in favor of it. Test marketing participants understood the key points of the new benefit: 74% generally liked it, and 34% said they would take it now. Preferences were generally stable at 1 month. In multivariate regression, those preferring MediCaring were wealthier, more often white, more often living in senior housing, and using more homecare services. However, they were not more often in poor health or needing ADL assistance.CONCLUSIONS: Older persons aged more than 80 years can understand a health benefit choice; most liked the aims of a new supportive care benefit, and 34% would change immediately from Medicare to a supportive care benefit such as MediCaring,. These findings encourage further development of special programs of care, such as MediCaring, that prioritize comfort and support for the old old. J Am Geriatr Soc 47:1058–1064,1999.
Incidence of and Predictors for Chronic Disability in Activities of Daily Living Among Older People in Taiwan
Authors: Wu Shwu Chong , Leu Szu‐Yun , Li Chung‐Yi 
Published: April 2015

OBJECTIVES: To estimate the incidence of chronic activities of daily living (ADL) disability and to analyze the sociodemographic, health status, adverse lifestyle, and leisure‐time physical activity predictors for chronic ADL disability.DESIGN: We recruited a cohort of community‐dwelling older people in Taipei, Taiwan, who were not ADL disabled in August 1993, and we followed them until August 1996.SETTINGS AND PARTICIPANTS: The study subjects were 1321 community‐dwelling people aged 65 years or older who were ADL intact at the initial interview in August 1993. The study sample was a subset of a probability sample (n = 1583) randomly selected from household registrations in the four districts of the Taipei metropolitan area.MEASUREMENTS: Baseline information regarding various factors potentially associated with the development of chronic ADL disability was assessed and collected at the beginning of the study. Study participants were assessed annually for ADL function by a structured home interview using a six‐item scale. Participants who were unable to perform independently at least one of the six items—eating, bathing, dressing, toileting, transfers, and walking inside the house—for more than 3 months were considered chronically ADL disabled. Cox proportional hazard regression models were utilized to examine the independent effect of the potential predictors on risk of chronic ADL disability.RESULTS: During the 3‐year study period, 145 (11.0%) participants developed chronic ADL disability, 58 (4.4%) participants were lost to follow‐up, and 83 (6.3%) participants died. Multiple hazard regression analysis showed that individuals aged 70 to 79 years or older than age 80 had increased risk of ADL disability (relative risk: 2.05 (95% confidence interval (CI), 1.35‐3.11) and 3.89 (95%CI, 2.33‐6.50), respectively) compared with those participants younger than age 70. Risk of chronic ADL disability was inversely associated with routine exercise (RR = 0.52; 95% CI, 0.39‐0.68).CONCLUSIONS: Age is the most significant predictor of chronic ADL disability. Lack of routine exercise is also a significant predictor of ADL disability in older adults. J Am Geriatr Soc 47:1082–1086,1999.
Circadian Heart Rate Rhythms in Japanese Centenarians
Authors: Shimizu Kenichiro , Hirose Nobuyoshi , Yonemoto Takayuki , Wakida Yasushi 
Published: April 2015

OBJECTIVE: To investigate age‐associated changes in the circadian rhythm of the heart rate.DESIGN: The circadian rhythm was extracted from diurnal heart rate (HR) variations, and patterns of HR rhythm were compared in centenarians and controls.SETTING: Centenarians living in the metropolitan area of Tokyo and in Aichi prefecture in 1992.PARTICIPANTS: Fifty centenarians underwent 24‐hour ambulatory electrocardiogram (Holter) monitoring. The control group, comprised of 100 clinically healthy subjects who underwent similar Holter monitoring, was subdivided, by age, into two groups: the younger controls (age range 23 to 54 years, mean age 41) and the older controls (age range 55 to 82 years, mean age 69).MEASUREMENTS: Harmonic analysis was used to approximate the 24‐hour RR interval (the interval between two neighboring R waves on the electrocardiogram) data obtained by Holter monitoring to a summation of three cosine waves with 24‐hour, 12‐hour, and 8‐hour periods. The power of the period was adjusted for the goodness of curve‐fit. The power of each period and the circadian acrophase (the timing of the peak in a 24‐hour rhythm) were compared among the centenarians, older controls, and younger controls. HR rhythms were classified by k‐means cluster analysis based on the power of the period. The prevalence of each pattern was compared among the three age groups. In the centenarians, the relationship between clinical parameters (activities of daily living, cognitive function, nutritional status, and present illness) and patterns of HR rhythm was investigated.RESULTS: The power of the 24‐hour period in the centenarians was significantly smaller than that in the older (P < .05) and younger (P < .001) controls. The power of the 8‐hour period in the centenarians was significantly larger than that in the younger controls (P < .05). Advances or delays in the circadian acrophase were frequently observed in the centenarians compared with the younger controls. The power of each period did not differ between centenarians with (n = 11) and without (n = 39) overt diseases capable of altering HR rhythms. Five patterns of HR rhythm were identified: 24‐hour period dominant (n = 84), 24‐hour+12‐hour period (n = 18), 12‐hour period dominant (n = 11), 8‐hour period dominant (n = 7), and low goodness of curve‐fit (n = 30). The 8‐hour period dominant pattern and the low goodness of curve‐fit pattern were observed commonly in the centenarians, whereas the 24‐hour period dominant pattern and the 24‐hour + 12‐hour period pattern were observed frequently in the younger controls. Patterns of HR rhythm were not related to clinical parameters in the centenarians.CONCLUSIONS: The circadian rhythm of HR changed with aging: there was reduction in the power of the 24‐hour period, augmentation in the power of the 8‐hour period, and a shift in the circadian acrophase. J Am Geriatr Soc 47:1094–1099,1999.
Seroprevalence of Viral Hepatitis in an Older Nursing Home Population
Authors: Chien Norman T. , Dundoo Gayatbri , Horani Mohamad H. , Osmack Patricia , Morley John H. , Di Bisceglie Adrian M. 
Published: April 2015

OBJECTIVES: To assess the prevalence of current or previous infection with viral hepatitis agents in an older nursing home population.DESIGN: A prospective cohort study.SETTING: Three nursing homes in the greater St. Louis area affiliated with Saint Louis University.SUBJECTS: Older residents admitted to these facilities.MEASUREMENTS: Residents were interviewed and examined for evidence of hepatitis or liver disease. Serum samples were tested for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core and surface antigens (anti‐HBc and anti‐HBs), antibody to hepatitis A virus (anti‐HAV), antibody to hepatitis C virus (anti‐HCV), and hepatitis G virus RNA (HGV RNA).RESULTS: Of 329 residents queried, 199 gave consent and were able to participate. The seroprevalence of hepatitis was: HBsAg 0%, anti‐HBc 24.1%, anti‐HBs 19.5%, anti‐HAV 79.9%, anti‐HCV 4.5%, and HGV‐RNA 10.6%. Frequency of HAV infection increased significantly with age whereas HBV infection correlated with ethnic status and former occupation as a manual worker. A history of blood transfusion was associated with a higher rate of anti‐HCV. End stage renal disease, present in 17 patients, was associated with anti‐HBc, anti‐HCV, and HGV RNA positivity but not with anti‐HBs or anti‐HAV positivityCONCLUSIONS: The seroprevalence of anti‐HCV was surprisingly high in this population residing in skilled nursing facilities, and we recommend that all new patients admitted to this type of institution be screened for anti‐HCV. The prevalence of HGV RNA was higher than in the general US blood donor population, but the significance of this finding remains uncertain. J Am Geriatr Soc 47:1110–1113,1999.
“Warm‐Up” Phenomenon Detected by Electrocardiographic Ambulatory Monitoring in Adult and Older Patients
Authors: Napoli Claudio , Liguori Antonio , Cacciatore Francesco , Rengo Franco , Ambrosio Giuseppe , Abete Pasquale 
Published: April 2015

OBJECTIVE: Inducing tolerance to myocardial ischemia by repeated brief episodes of ischemia has been called “ischemic preconditioning.” “Warm‐up” phenomenon refers to patients with coronary heart disease improving performance after a first exertion and may represent a clinical counterpart to ischemic preconditioning. The goal of this study was to assess whether the severity of myocardial ischemia would be attenuated by two repeated walking‐induced ischemic episodes in adult and older patients.SUBJECTS: Thirty‐eight adults (51 ± 5 years) and 39 older patients (76 ± 4 years) with stable angina and angiographic evidence of coronary stenosis.MEASUREMENTS: Holter monitoring was performed in adult and older patients walking on two consecutive occasions, with a 5‐minute rest between walks, a distance known to have previously caused myocardial ischemia.RESULTS:Computer‐assisted analysis recorded by ambulatory Holter monitoring revealed that the mean maximal ST‐segment depression (P < .001) and ischemia duration decreased (P < .001), whereas the ischemic threshold increased (P < .001), from the first to the second walk in the adult but not in the older group.CONCLUSIONS: Myocardial ischemia is attenuated and ischemic threshold is increased between two brief ischemic episodes in adult but not in older patients. These results indicate that the “warm‐up” phenomenon, involved in increasing myocardial ischemic tolerance, is absent in the aging heart. J Am Geriatr Soc 47:1114–1117,1999.
The Predictive Value of Combined Hypoalbuminemia and Hypocholesterolemia in High Functioning Community‐Dwelling Older Persons: MacArthur Studies of Successful Aging
Authors: Reuben David B. , Ix Joachim H. , Greendale Gail A. , Seeman Teresa E. 
Published: April 2015

OBJECTIVES: To examine the effect of simultaneous hypoalbuminemia and hypocholesterolemia levels on 3‐ and 7‐year rates of mortality and decline in functional status.METHODS: In this cohort study, 937 community‐based persons aged 70 to 79 years in 1988, who had high baseline physical and cognitive functioning, were classified into four groups: Group 1 (low albumin, low cholesterol), Group 2 (low albumin, normal cholesterol), Group 3 (normal albumin, low cholesterol) and Group 4 (normal albumin, normal cholesterol) using baseline blood values. Crude and multiply adjusted rates of (1) mortality (2) decline in Rosow‐Breslau (RB) functional status, and (3) mortality or decline in RB functional status in 1991 and 1995 were calculated.RESULTS: Group 1 subjects had multiply adjusted relative risks (ARR) of 3.62 and 3.53 for 3‐and 7‐year mortality compared with Group 4. Group 1 subjects had ARRs of 3.82, 3.02, and 2.67 of 3‐year mortality or decline in RB activity scale when compared with Groups 4, 2, and 3, respectively.CONCLUSIONS: Concomitant low serum cholesterol and albumin levels may identify high functioning older persons who are at increased risk of subsequent mortality and functional decline.