bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship Between Aerobic Exercise Capacity and Circulating IGF‐1 Levels In Healthy Men and Women
Authors: Haydar Ziad R. , Blackman Marc R. , Tobin Jordan D. , Wright Jeanette G. , Fleg Jerome L. 
Published: April 2015

OBJECTIVES: To determine whether aerobic capacity is associated independently with insulin‐like growth factor‐I (IGF‐1) levels in healthy community‐dwelling men and women.SETTING: The Baltimore Longitudinal Study on Aging (BLSA).DESIGN: A cross‐sectional analysis of data from the population‐based cohort of the Baltimore Longitudinal Study of Aging (BLSA).PARTICIPANTS: We studied 181 men and 92 women aged 20 to 93 years, volunteers in the Baltimore Longitudinal Study on Aging (BLSA). Subjects were free of endocrine, renal, hepatic, gastrointestinal, or cardiac diseases, and they were taking no medications known to interfere with the growth hormone‐IGF‐1 axis.MEASUREMENTS: All subjects underwent a single measurement of serum IGF‐1 in the fasting state, as well as peak V̇o2 determinations during maximal treadmill exercise testing performed within one visit of the IGF‐1 determination. Dual energy X‐ray absorptiometry (DEXA) scans were performed in a subset of 171 subjects (64 women and 107 men) for determination of fat free mass (FFM).RESULTS: In the pooled group of women and men, univariate regression analysis revealed that age was correlated strongly with decreasing IGF‐1 levels (r = −0.53, P < .001) and with peak V̇o2 r = −0.56, P < .001). IGF‐1 levels were also significantly correlated with peak V̇o2 (r = 0.29, P < .001). There were no significant gender‐related differences in these relationships. On multivariate analysis, age (β = −0.54, P < .001), but not peak V̇o2 (β = −0.01, P = .840), remained strongly associated with IGF‐1 levels. After adjustment of peak V̇o2 for FFM in subjects with DEXA scans, results were similar.CONCLUSIONS: These findings indicate that although both peak aerobic capacity and circulating IGF‐1 levels decline with age, aerobic capacity is not independently related to circulating IGF‐1 in healthy men and women across the adult life span. J Am Geriatr Soc 48: 139–145, 2000.
Aging Is Associated with Endothelial Dysfunction in the Human Forearm Vasculature
Authors: MD Nabil Andrawis , MD Drew S. Jones , MD Darrell R. Abernethy 
Published: April 2015

OBJECTIVE: Our objective was to examine the role of the endothelium in maintaining vascular tone in the basal as well as in the contracted state during aging.DESIGN/PARTICIPANTS: Responses to brachial artery infusion of acetylcholine in presence and absence of NG‐nitro‐L‐arginine methyl ester (L‐NAME) and to angiotensin II were studied in 11 young and 12 old white subjects.MEASUREMENTS: Strain gauge plethysmography was used to measure forearm vascular resistance (FVR). The dose of acetylcholine at 50% maximal observed decrease in forearm vascular resistance (EC50) was significantly higher (11.0 ± 1.59 vs 7.07 ± .65 μg/min, respectively; mean ± SEM; P < .05) and the FVR at maximal acetylcholine effect (Emax) remained greater (12.6 ± 1.75 vs 7.15 ± 1.25 mm Hg/100 mL tissue volume/min; P < .02) in old compared with young subjects. Acetylcholine effect was significantly reversed by concomitant administration of L‐NAME, as indicated by the increase in EC50 (old, 20.2 ± 3.69; young, 11.9 ± 1.68 μg/min).RESULTS: There was no age‐related difference in sodium nitroprusside‐induced decrease in FVR. The EC50 and Emax for angiotensin II‐mediated increase in FVR were 7.87 ± 1.15 and 8.36 ± 1.00 ng/min (EC50) and 5.30 ± .67 vs 6.56 ± 1.25 mm Hg/100 mL tissue volume/min (Emax), and these were not different in old and young subjects, respectively.CONCLUSIONS: These data indicate that aging is associated with impaired endothelial‐ dependent vascular relaxation and that this is selective, with no age‐related change in endothelial‐independent vascular relaxation or angiotensin II‐mediated vascular contraction. J Am Geriatr Soc 48: 193–198, 2000.
Change in Disability Follows Inpatient Treatment for Late Life Depression
Authors: Oslin David W. , Streim Joel , Katz Ira R. , Edell William S. , TenHave Thomas 
Published: April 2015

OBJECTIVES: The objective of this study was to examine the relationship between functional disability and improvement in late life depression after acute inpatient treatment.DESIGN: The study was a longitudinal assessment of depression and disability. Patients were assessed during an initial inpatient hospitalization and then 3 months postdischarge.SETTING: All patients were evaluated initially after admission to one of 71 inpatient psychiatric treatment facilities.PARTICIPANTS: The study comprised of 2572 patients older than age 60 who were relatively cognitively intact and experiencing significant depressive symptoms.MEASUREMENTS: Depressive symptoms were measured using the Geriatric Depression Scale. Disability was measured using the Instrumental Activities of Daily Living Scale and the Medical Outcomes SF‐36.RESULTS: Depressive symptoms improved in the majority of patients. Moreover, improvement in depressive symptomatology was significantly related to improvement in instrumental activities of daily living (IADLs) and to health‐related quality of life as measured by the SF‐36. This relationship was strongest among those who initially presented with some disability in IADLs.CONCLUSIONS: This work underscores further the disabling nature of depression. Moreover, findings from this study suggest that treatment focused on depression can lead to significant improvements in both depressive symptoms and functional abilities. However, the results also suggest that the relationship between depression and disability is complex and that the effect of treating depression is not the only factor in the reversal of disability. J Am Geriatr Soc 48: 357–362, 2000.
Selecting Target Conditions for Quality of Care Improvement in Vulnerable Older Adults
Authors: Sloss Elizabeth M. , Solomon David H. , Shekelle Paul G. , Young Roy T. , Saliba Debra , MacLean Catherine H. , Rubenstein Laurence Z. , Schnelle John F. , Kamberg Caren J. , Wenger Neil S. 
Published: April 2015

OBJECTIVE: To identify a set of geriatric conditions as optimal targets for quality improvement to be used in a quality measurement system for vulnerable older adults.DESIGN: Discussion and two rounds of ranking of conditions by a panel of geriatric clinical experts informed by literature reviews.METHODS: A list of 78 conditions common among vulnerable older people was reduced to 35 on the basis of their (1) prevalence, (2) impact on health and quality of life, (3) effectiveness of interventions in improving mortality and quality of life, (4) disparity in the quality of care across providers and geographic areas, and (5) feasibility of obtaining the data needed to test compliance with quality indicators. A panel of 12 experts in geriatric care discussed and then ranked the 35 conditions on the basis of the same five criteria. We then selected 21 conditions, based on panelists' iterative rankings. Using available national data, we compiled information about prevalence of the selected conditions for community‐dwelling older people and older nursing home residents and estimated the proportion of inpatient and outpatient care attributable to the selected conditions.RESULTS: The 21 conditions selected as targets for quality improvement among vulnerable older adults include (in rank order): pharmacologic management; depression; dementia; heart failure; stroke (and atrial fibrillation); hospitalization and surgery; falls and mobility disorders; diabetes mellitus; end‐of‐life care; ischemic heart disease; hypertension; pressure ulcers; osteoporosis; urinary incontinence; pain management; preventive services; hearing impairment; pneumonia and influenza; vision impairment; malnutrition; and osteoarthritis. The selected conditions had mean rank scores from 1.2 to 3.8, and those excluded from 4.6 to 6.9, on a scale from 1 (highest ranking) to 7 (lowest ranking). Prevalence of the selected conditions ranges from 10 to 50% among community‐dwelling older adults and from 25 to 80% in nursing home residents for the six most common selected conditions. The 21 target conditions account for at least 43% of all acute hospital discharges and 33% of physician office visits among persons 65 years of age and older. Actual figures must be higher because several of the selected conditions (e.g., end‐of‐life care) are not recorded as diagnoses.CONCLUSIONS: Twenty‐one conditions were selected as targets for quality improvement in vulnerable older people for use in a quality measurement system. The 21 geriatric conditions selected are highly prevalent in this group and likely account for more than half of the care provided to this group in hospital and ambulatory settings. J Am Geriatr Soc 48: 363–369, 2000.
The Association of Depressive Symptoms and Urinary Incontinence Among Older Adults
Authors: Dugan Elizabeth , Cohen Stuart J. , Bland Deirdre R. , Preisser John S. , Davis Cralen C. , Suggs Patricia K. , McGann Paul 
Published: April 2015

OBJECTIVES: To examine the relationship of urinary incontinence (UI) and depressive symptoms (DS) in older adults.DESIGN: A randomized, controlled trial to determine the effects of clinical practice guideline implementation on provider attitudes and behavior, and patients' UI, health status, quality of life, and satisfaction with care. Baseline and endpoint data were collected from patients via computer‐assisted telephone interviewing.SETTING: Forty‐one nonacademic primary care practices (PCP) in North Carolina.PARTICIPANTS: A total of 668 community‐dwelling adults (age > 60) who had visited the one of the selected PCPs.INTERVENTION: PCPs in the intervention group were given instruction in the detection and management of UI, educational materials for providers and patients, office system supports, and academic detailing.MEASUREMENTS: The dependent measure was assessed using an eight‐item screener for DS. UI (status, frequency, amount), health (physical, mental), and demographic (age, gender, marital status) and self‐report information about bladder control served as predictors.RESULTS: Wilcoxon rank sum tests showed that UI status was associated with moderate to severe DS (43% vs 30%, P = .05). Multivariate analyses showed that UI status, physical and mental health, and gender were significant predictors of DS. Among UI adults (n = 230), physical and mental health, life satisfaction, and the perception that UI interfered with daily life were significant predictors of DS.CONCLUSIONS: This study provides clear evidence that UI is related to DS in older adults. J Am Geriatr Soc 48: 413–416, 2000.
How Much Do Persons with Alzheimer's Disease Cost Medicare?
Authors: Taylor Donald H. , Sloan Frank A. 
Published: April 2015

BACKGROUND: Medicare claims are increasingly being used to identify persons with chronic diseases such as Alzheimer's disease (AD) for the purpose of determining the cost to Medicare of caring for such persons. Past work has been limited by the use of only 1 or 2 years of claims data to identify cases, leading to worries that this might lead to an undercount of prevalent cases and bias cost findings.OBJECTIVES: To analyze the average total cost to the Medicare program in 1994 of persons with a claims‐based diagnosis of AD, using a 12‐year period of claims history to identify prevalent cases, and to investigate the effect on cost of time since diagnosis.DESIGN: A cross‐sectional design with a 12‐year retrospective period to identify persons with AD.SETTING: Medical care practices, hospitals, and other providers of services to Medicare beneficiaries in the US in 1994.SUBJECTS: Respondents to the screener (n = 10,858) and community (5429) and institutional (n = 1341) questionnaire of the 1994 National Long Term Care Survey, with and without a claims‐based diagnosis of AD.MEASUREMENTS: Average total cost to Medicare in 1994, measured as the actual amount Medicare paid for inpatient, outpatient, home health, skilled nursing facility, hospice, and Part B services, including payments to physicians, and other items such as durable medical equipment. We also measured disability in a variety of ways, including cognition, activity limitations, and residence in a nursing home.RESULTS: The average total cost to Medicare of persons with a claims‐based diagnosis of AD was $6021 versus $2310 (P < .001) for persons without a diagnosis. When adjusting for patient characteristics, the ratio of cost between persons with AD and those without was reduced to about 1.6 to 1. Time since diagnosis was an important predictor of average total cost in 1994, with each additional year since diagnosis resulting in a $248 (P = .04) decrease in total cost (about 10% of the total sample mean cost of $2426). There was mixed evidence that persons with a diagnosis of AD incurred less cost than otherwise similarly disabled Medicare beneficiaries.CONCLUSIONS: Time since diagnosis with AD is an important predictor of cost and one that should be explicitly included in any rate‐setting formula. Expanding the period used to identify cases resulted in an increase in the unadjusted ratio of cost of a Medicare beneficiary with AD relative to one without primarily because our control group costs are lower compared with those of past work. J Am Geriatr Soc 48:639–646, 2000.
Revisiting the One‐Year Geriatric Fellowship Option: A Preliminary Assessment
Authors: Hazzard William R. , Currin Dorothy Law , Woolard Nancy 
Published: April 2015

OBJECTIVE: To ascertain early opinions of geriatric fellowship program directors regarding the 1‐year clinical training option.DESIGN: A brief mail survey of the 100 program directors listed in Graduate Medical Education, 1998–1999.MEASUREMENTS: Answers (favorable (+), no effect (0), or negative (‐)) to questions regarding the effect on the training program, position of the director, and geriatrics as a discipline.RESULTS: This preliminary assessment produced decidedly mixed results. Seventy‐six program directors responded (76% response rate). The clearest positive effect on the program itself was on the quantity of applicants (63% +, 4% ‐) but less so on their quality (33% +, 15% ‐). The clearest negative impact was on research aspects of the fellowship (0% +, 67%‐). Other effects on the program were either null (clinical aspects and faculty morale) or moderately negative (educational, administrative, and financial aspects and the position of the program director), with few effects on the geriatrics division as a whole. Overall, the 1‐year option was felt to have adversely affected geriatrics as a respected professional field (11% +, 41% ‐). Nevertheless, the majority (61%) answered that introduction of the 1‐year option was wise. Although not attributed to this training pathway, program directors overwhelmingly perceived (75% +) that geriatrics has enjoyed enhanced strength and attractiveness as a discipline since introduction of the 1‐year option in 1992.CONCLUSIONS: The 1‐year geriatric fellowship option has, at best, proved a mixed blessing to program directors. However, optimism regarding the future would seem to justify continuing to offer this option because of several observations and trends: (1) the increase in quantity and also perhaps quality of applicants; (2) growth in numbers of fellows and higher percentage program fill rates; (3) success of both 1‐and two‐year fellows in passing the Certificate of Added Qualifications examination and consequent increased generation of certified fellowship‐trained geriatricians; (4) strong sentiment that geriatrics is gaining strength and attractiveness; and (5) that introduction of the 1‐year option was wise. J Am Geriatr Soc 48:686–690, 2000.
Catechol‐O‐Methyltransferase (COMT) Inhibitors in Parkinson's Disease
Authors: Waters Cheryl 
Published: April 2015

Catechol‐O‐methyltransferase (COMT) inhibitors are a new therapeutic option in the treatment of patients with Parkinson's disease. COMT inhibitors act by extending the duration of action of levodopa, thus improving the amount of time a patient can experience benefit from levodopa. COMT inhibitors are only used in conjunction with levodopa. They do have a propensity to augment dopaminergic effects, such that levodopa doses might need to be adjusted downward. Other side effects of COMT inhibitors include diarrhea and liver function abnormalities. Due to the latter, recent guidelines have been developed to monitor patients on tolcapone for this rare side effect, and these guidelines will be discussed.This article also provides representative case histories for the appropriate use of COMT inhibitors that illustrate how these drugs can be used to manage patients with a fluctuating response to levodopa. J Am Geriatr Soc 48:692–698, 2000.
Effect of Enalapril and Nifedipine on Orthostatic Hypotension in Older Hypertensive Patients
Authors: Slavachevsky Inna , Rachmani Rita , Levi Zohar , Brosh David , Lidar Merav , Ravid Mordchai 
Published: April 2015

OBJECTIVE: To compare the effect of enalapril with long‐acting nifedipine on orthostatic hypotension in older patients.DESIGN: A prospective, double blinded, cross‐over study.SETTING: The outpatient clinic of a university hospital.PARTICIPANTS: Thirty‐nine patients aged 65 years or older with systolic blood pressure (SBP) of 140–190 mm Hg and diastolic blood pressure (DBP) of 90–110 mm Hg.INTERVENTION: Enalapril 5–20 mg od or nifedipine 30–90 mg od for 8 weeks, followed by 4 weeks washout and cross‐over for a second 8‐week period.MEASUREMENTS: Supine and standing 0‐, 1‐, and 5‐minutes blood pressure was recorded before and at the end of each treatment period.RESULTS: At baseline, SBP was 158.8 ± 8.7 mm Hg, and DBP was 97.1 ± 5.9 mm Hg. There was a decline in SBP of 6.1 ± 2.7 mm Hg and 8.4 ± 4.1 mm Hg after 1 and 5 minutes of standing, respectively.Both agents caused a significant decline in supine blood pressure. Enalapril: supine SBP 158.8 ± 8.7 to 143 ± 7.3 mm Hg; supine DBP 97.1 ± 5.9 to 85.1 ± 5.1 mm Hg (P = .0001). The drop in SBP after standing for 5 minutes was only 2.4 ± 1.6 mm Hg with no change in diastolic values. A ≥ 10 mm Hg drop in SBP was observed in only three patients, and no patient experienced a decline of 20 mm Hg or more. Nifedipine: supine SBP: 160.3 ± 9 to 145.3 ± 8.1 mm Hg; supine DBP: 96.3 ± 5.7 to 86.3 ± 5.8 (P = .0001). Nifedipine induced an orthostatic decline in SBP values; there was an 8.7 ± 4.8 mm Hg difference between supine and 5 minutes standing values (P = .0005) without change in diastolic values. An orthostatic decline in SBP of ≥ 10 mm Hg occurred in 13 patients, and there was a drop of ≥ 20 mm Hg in six patients. The cross‐over of enalapril and nifedipine reproduced the hypotensive effect and reversed the postural effect. (P = .0002 nifedipine vs enalapril)CONCLUSIONS: Enalapril and nifedipine were equipotent in reducing supine blood pressure levels. Enalapril also reduced the number of orthostatic episodes significantly, whereas nifedipine aggravated this phenomenon. J Am Geriatr Soc 48:807–810, 2000.
Long‐Term Continuous Use of Benzodiazepines by Older Adults in Quebec: Prevalence, Incidence and Risk Factors
Authors: Egan Mary , Moride Yola , Wolfson Christina , Monette Johanne 
Published: April 2015

OBJECTIVE: To determine the prevalence and incidence of long‐term use of benzodiazepines and to assess patient‐, prescriber‐, and drug‐related risk factors.DESIGN: Cohort study.PARTICIPANTS: 1423 community‐dwelling older adults in Quebec who participated in the Canadian Study of Health and Aging (CSHA1).MEASUREMENTS: Patient characteristics were obtained from the CSHA1 database. These were linked to provincial health insurance data to ascertain benzodiazepine use and prescriber characteristics.MAIN OUTCOME MEASURE: Use of benzodiazepines for at least 135 of the first 180 days following initiation of use.RESULTS: Twelve‐month prevalence of long‐term continuous use, standardized by age and gender to the Quebec population, was 19.8%. Twelve‐month cumulative incidence of long‐term continuous use was 1.9%. Older patients were more likely to proceed to long‐term continuous use.CONCLUSIONS: Risk of long‐term continuous use of benzodiazepines seems to increase with age. This association was found to be independent of gender, health status, anxiety, cognitive status, benzodiazepine type, and physician characteristics. J Am Geriatr Soc 48:811–816, 2000.
Mammography Use Among Women as a Function of Age and Patient Involvement in Decision‐Making
Authors: Burack Robert C. , George Julie , Gurney James G. 
Published: April 2015

OBJECTIVE: To assess the extent to which self‐reported patient involvement in decision‐making for initiation of mammography differs with age.DESIGN: Data from the 1992 National Health Interview Survey (NHIS) Cancer Control Supplement were evaluated. Prevalences were weighted and variances were adjusted using SUDAAN software to account for the complex, multistage sampling probability design of the NHIS. Logistic regression was used to evaluate the relative likelihood of self‐reported involvement in the decision to have a mammogram within the preceding year as a function of age and other covariates.PARTICIPANTS: Mammography use was assessed among 3863 NHIS female respondents 40 years of age or older. The analysis of decision‐making was restricted to the subgroup of 1064 women who reported a screening mammogram within the preceding year and who provided information on the other relevant variables.MEASUREMENTS AND MAIN RESULTS: The probability of reported mammography use within the preceding year declines among older groups of interviewees. Among women with a mammogram in the preceding year, the weighted percentage of women reporting active involvement in the decision (patient decision or decided jointly with a physician) declines from 51% among women 40 to 45 years of age to 19% among those aged 75 years or older. The adjusted odds ratio comparing the likelihood of participating in the decision to have a mammogram for the oldest women, compared with the youngest, was 0.31 (95% confidence interval 0.15 to 0.61).CONCLUSIONS: Older women are substantially less likely than younger women to report active involvement in the mammography decision‐making process. Increased use of screening mammography among older women will require greater promotion by physicians. Other interventions, such as directed educational efforts, may also be needed to increase mammography demand among older women. J Am Geriatr Soc 48:817–821, 2000.