bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dipyridamole Echocardiography as a Useful and Safe Test in the Assessment of Coronary Artery Disease in the Elderly
Authors: Ferrara Nicola , Leosco Dario , Abete Pasquale , Landino Pietro , Caccese Pompilio , Sederino Salvatore , MD Domenico Acanfora , Rengo Franco 
Published: April 2015

We prospectively studied the sensitivity, specificity, feasibility, and safety of high‐dose dipyridamole echocardiography, compared to exercise electrocardiography in 130 subjects (67 younger and 63 elderly patients) referred for angiographic evaluation of suspected or proven coronary artery disease. Sensitivity, specificity, and feasibility of dipyridamole echocardiography were respectively 75.5%, 100%, and 88.0% in younger patients and 82.9%, 100%, and 79.4% in elderly patients (P = NS). The sensitivity of exercise electrocardiography was 72.7% in young and 66.6% in elderly patients (P = NS); specificity 66.0% vs 60.0% (P = NS); feasibility 83.6 vs 63.5 (P = 0.05). Forty‐nine younger and 38 elderly patients performed both tests. Sensitivity of dipyridamole echocardiography compared to exercise electrocardiography was 76.2% vs 73.8% in young patients and 83.3% vs 70% in the older group (P = NS). The feasibility of the two tests was significantly different in the elderly group only (dipyridamole echocardiography 79.4% vs exercise electrocardiography 63.5%; P < 0.01).The incidence of side effects during dipyridamole echocardiography was similar in the two groups, except for dyspnea which was observed in 20% of older and 5% of younger patients (P < 0.05). Our data demonstrate that the dipyridamole test combined with echocardiographic monitoring of regional myocardial contractility may be considered a valid non‐invasive method for evaluating coronary artery disease in the elderly and that this test is a satisfactory alternative to the exercise stress test.
Pharmacological Treatment of Agitation in a Nursing Home
Authors: Billig Nathan , Cohen‐Mansfield Jiska , Lipson Steven 
Published: April 2015

Agitation is a significant problem in the management of residents in long‐term care settings. This study assessed the pharmacological treatment of agitation in a 550‐bed nursing home and correlated nurses' ratings of agitation with pharmacological treatment. It further examined the differential use of various psychotropic agents in the management of several sub‐types of agitated behavior.Significant results included: (1) subjects designated as demented and agitated were most likely to receive neuroleptics, while non‐demented agitated residents were most likely to be treated with a benzodiazepine; (2) agitated individuals received significantly less antidepressant treatment than non‐agitated patients.The sub‐typing of agitation may allow for the possibility of more selective treatment of various agitation syndromes.
Major Depressive Disorder in Hospitalized Medically Ill Patients: An Examination of Young and Elderly Male Veterans
Authors: Koenig Harold G. , Meador Keith G. , Shelp Frank , Goli Veeraindar , Cohen Harvey J. , Blazer Dan G. 
Published: April 2015

Objective: To study the epidemiology of depressive disorder in younger and older medical inpatients.Design, Patients, & Setting: Depressive disorders were examined using the Diagnostic Interview Schedule in 116 young and 332 elderly medically ill men hospitalized in a VA medical center.Results: Major depressive disorder was diagnosed in 22.4% of men under 40 and 13.3% of those age 70 or over; minor depression was found in 18.1% of young and 29.2% of older men. Besides age, other risk factors for major depression were impaired social support, severe medical illness or functional disability in older men, and history of psychiatric problems primarily in younger men; specific medical diagnosis was not a risk factor. Major depression was associated with more severe symptomatology in younger patients; in both age groups, however, symptoms were of prolonged duration and frequently included suicidal thoughts.Conclusions: Depressive disorder in hospitalized male veterans is common, varies with age, severity of medical illness, degree of social support, and history of psychiatric problems and is associated with considerable psychological morbidity.
Monitoring Progression in Alzheimer's Disease
Authors: Galasko Douglas , Corey‐Bloom Jody , Thal Leon J. 
Published: April 2015

Objective: To compare several clinical methods of following change in Alzheimer's disease (AD) over time.Data sources: MEDLINE search (restricted to English language); bibliographies of pertinent articles or books.Study selection: Studies included only if aim was to follow a cohort of AD patients; diagnosis of AD used DSM‐III‐R or NINCDS‐ADRDA guidelines; techniques or scales used for serial assessment were well‐established in terms of validity and reliability.Data extraction: All 3 authors reviewed all studies cited and reached consensus about interpretation.Results: Global instruments detect long term deterioration in AD and describe distinct though possibly artificial stages. Cognitive screening tests decline at a consistent rate for groups of AD patients but show considerable variability. Scales measuring activities of daily living (ADLs) need further study to determine annual rate of change. Instrumental ADLs decline early in AD and reach a floor before cognitive screening tests. Electrophysiologic or radiographic techniques do not necessarily change over time and are not superior to clinical methods for following AD. Variability in rate of cognitive change and prognosis in AD has not been adequately explained.Conclusions: Cognitive screening tests provide useful measures of rate of change in AD for clinical and therapeutic studies. Further studies should take advantage of longer follow‐up and more sophisticated statistical techniques to optimize use of these measures.
Delayed Plasma Clearance of Phenylalanine and Tyrosine in Elderly Men
Authors: Rudman Daniel , Abbasi Adil A. , Chaudry Farooq , Mattson Dale E. 
Published: April 2015

The plasma levels of 17 amino acids were measured in three groups of men: healthy young men, healthy elderly men, and demented tube‐fed elderly men living in a nursing home, prior to, and again 2, 4, and 6 hours after the consumption of a standard protein‐containing meal. The standard meal provided per kilogram of body weight 8.3 calories, 0.33 grams of protein, 0.90 grams of carbohydrate, and 0.37 grams of fat.The concentrations of all amino acids, except tryptophan, rose significantly at 2 hours and returned to baseline by 6 hours. Plasma phenylalanine and tyrosine were significantly (P < 0.05) higher at 2 hours in the two groups of elderly men than in the young healthy men. In other respects the pre‐ and post‐prandial amino acid profiles were not influenced by age. The ratio, tyrosine/other large neutral amino acids (tyr/LNAA), was significantly higher in both elderly groups than in the young men at nearly all time points before and after the test meal. It was generally higher in the demented older men than in the healthy older men.The data demonstrated a delayed plasma clearance of phenylalanine and tyrosine in old age. The elevated plasma tyr/LNAA ratio in the elderly men may have tended to augment an entry of tyrosine, the precursor of norepinephrine and dopamine, into their brains.
Inadequate Treatment of Depressed Nursing Home Elderly
Authors: Heston Leonard L. , Garrard Judith , Makris Lukas , Kane Robert L. , Cooper Susan , Dunham Trudy , Zelterman Daniel 
Published: April 2015

ObjectiveTo determine the prevalence of antidepressant drug treatment among nursing home elderly with major depression.DesignSurvey early and late in nursing home stay.SettingSixty Medicaid/Medicare‐certified skilled nursing homes.ParticipantsAdmission cohort of 5,752 residents age 65 or older in 1976 through 1983.MeasuresChart review by nurse‐abstractors of physicians' diagnoses, drug used, and alertness rating. Diagnosis of depression equivalent to DSM‐III‐R major depression.ResultsOf 868 persons with a diagnosis of depression in the medical record, only 10% were treated with antidepressant drugs. More received neuroleptics and benzodiazepines than received antidepressants, but most (52%) received no psychoactive drug at all. A subset of 258 depressed persons had positive notations in their records supporting a mental status rating of “alert and oriented.” Of that subset, only 15% received antidepressants. When followed from admission to discharge or end of study the prevalence rate of antidepressant drug treatment increased by 4%.ConclusionsIn the late 1970's and early 1980's, even when the primary care physician made and recorded a diagnosis of depression, most such nursing home residents remained untreated, incorrectly treated, or inadequately treated.
Recurrent Unexplained Syncope in the Elderly: The Use of Head‐Upright Tilt Table Testing in Evaluation and Management
Authors: Grubb Blair P. , Wolfe Douglas , Samoil Daniela , Madu Ernest , Temesy‐Armos Peter , Hahn Harry , Elliott Laura 
Published: April 2015

ObjectiveTo investigate the usefulness of head‐upright tilt table testing for vasovagal episodes in the evaluation and management of elderly patients with recurrent idiopathic syncope.DesignProspective survey.SettingElectrophysiology laboratory of a university hospital.PatientsTwenty‐five patients (11 male, 14 female; mean age 73 ± 6 years) with recurrent unexplained syncope and seven control subjects with other causes of syncope (4 male, 3 female; mean age 70 ± 4 years).MethodsEach patient underwent head‐upright tilt table testing for 30 minutes with or without an infusion of isoproterenol (1–3 μg/min given intravenously) in an attempt to provoke bradycardia, hypotension, or both.Main ResultsSyncope occurred in nine patients (36%) during the baseline tilt and in seven patients (28%) during isoproterenol infusion (total positives 64%). None of the controls had syncope during the test. All of the patients who had positive test results eventually became tilt table negative with therapy, and over a mean follow‐up period of 24 months, no further syncopal episodes have occurred.ConclusionsHead‐upright tilt table testing combined with isoproterenol infusion may be a useful tool in the diagnosis of vasovagal syncope in the elderly and in the evaluation of preventive therapy.
The Mini‐Mental State Examination: Identifying the Most Efficient Variables for Detecting Cognitive Impairment in the Elderly
Authors: Braekhus Anne , Laake Knut , Engedal Knut 
Published: April 2015

ObjectivesTo study how well the scoring on each item of the MMSE relates to the sum‐score when the purpose is to identify persons with cognitive impairment, and to identify an equally effective subset of MMSE items for predicting cognitive impairment.DesignRetrospective survey of MMSE data for 850 elderly. Setting: A variety of clinical settings.ParticipantsMean age 82 years (range 54 to 99), 74% women. The subjects were of three different categories: geriatric in‐patients, patients living under supervision, and elderly people living independently at home.ResultsFive of the binomial (“State,” “Town,” “Name a pencil,” “Name a watch,” “Read and obey”) and one of the polychotomous MMSE variables (“Learn three words and repeat immediately”) had low sensitivity and gave high percentages of misclassifications versus the sumscore dichotomized at the cut‐point 23/24. Univariate logistic regression indicated that the three remaining polychotomous variables (“Spell backwards,” “Recall three words,” and “Three‐stage command”) can be scored binomially. Two factors were identified on factor analysis. Logistic regression analysis showed that 12 of the original 20 items predicted the sumscore dichotomized at 23/24 with only 3% misclassifications. Validation against the psychogeriatrician's diagnosis showed that this 12‐item MMSE derivative performs as well as the full MMSE.ConclusionsSix of the 20 MMSE variables perform poorly regarding sensitivity and misclassifications versus the sum‐score at cut‐point 23/24. Two additional items did not contribute to the prediction of a low/high sumscore. The remaining 12 MMSE items can all be scored binomially and produce a sumscore which is equally as effective as the sumscore of the full MMSE when the purpose is to identify elderly patients with cognitive impairment.
Measurement of Drug Compliance by Continuous Electronic Monitoring: A Pilot Study in Elderly Patients Discharged From Hospital
Authors: Kruse Wolfgang , Koch‐Gwinner Peter , Nikolaus Thorsten , Oster Peter , Schlierf Günter , Weber Ellen 
Published: April 2015

ObjectiveA pilot study to assess patient compliance with medication by using a new measurement technique, continuous electronic monitoring.DesignSurvey. Compliance monitors were provided to eligible patients at discharge from the hospital to measure drug intake behavior prospectively for a period of 3 weeks.SettingAmbulant patient care after discharge from a geriatric hospital, Krankenhaus Bethanien, which is affiliated with the University Clinic, Heidelberg.PatientsA consecutive convenience sample of 18 independently living elderly patients (median age 76 years) completed the study. The patients were on maintenance therapy with cardiac glycosides and/or potassium‐sparing diuretics prescribed to be taken once daily.InterventionThe monitoring method provides information about patients' real timing of drug use by continuously recording date and time of openings and closings of the medication containers (monitors). In addition to a standard measure, the percentage of prescribed doses taken, information about regularity of drug use is obtained.ResultsCompliance, percentage of prescribed doses taken, was remarkably variable; it ranged from 24% to 100%, 95% CI: 62%‐84%. Mean compliance declined from the first to the third week after discharge, 85% vs 69%, 95% CI: 74%‐95% and 56%‐81%, respectively (P < 0.05). Omissions of doses, the predominant pattern of non‐compliance, were observed in 17 of 18 patients. Regularity of dose timing, as defined by the number of interdose intervals within 24 h ± 15%, varied from 10% to 100%, 95% CI: 46%‐76%. Conclusions: Continuous electronic monitoring revealed highly variable compliance in patients prescribed maintenance therapy. Even with a once‐daily regimen, persistent and high compliance cannot be assumed. The monitoring technique may be of great value to research and, possibly, to practical therapeutic management.
Major Surgery in Nursing Home Patients: Procedures, Morbidity, and Mortality in the Frailest of the Frail Elderly
Authors: Keating Herbert J. 
Published: April 2015

ObjectiveTo determine the surgical procedures being done on long‐term care (level 2) nursing home residents and the resultant in‐hospital morbidity and mortality.DesignA retrospective chart review of inpatient medical records from two hospitals, identified by computerized search of medical records and/or referral by directors of nursing of area nursing homes.SettingPatients originated in skilled‐care nursing homes in New Castle County, Delaware, USA. Surgery was performed in the area's two major hospitals, one a 1000‐bed regional referral and teaching hospital, and the other a 300‐bed community hospital.PatientsResidents of skilled‐care nursing homes (level 2) who underwent major surgery between January 1979 and December 1989.Measurements and Main ResultsEighty procedures were performed in 74 patients. Many different types of procedures were done. After primary repair of hip fracture the most common procedures were non‐orthopedic extremity and abdominal surgeries. Three deaths occurred (mortality 3.8%), and all were in patients undergoing emergency surgery who were classified above American Society of Anesthesiology Class 3. Serious complications occurred in 43% of the procedures and were most commonly cardiopulmonary and psychiatric, including profound depression in four. Antibiotic‐associated colitis occurred in three patients and required a second surgical procedure in one. Fewer adverse outcomes were seen in patients undergoing elective surgical procedures with spinal or local anesthesia than in patients receiving general anesthesia.ConclusionsAlthough retrospective and limited to inpatient data, in‐hospital surgical mortality in this very frail population was low, comparable to series in unselected geriatric populations. However, major complications were very common. Primary hip surgery repair may have been too frequently done. A multi‐institution, prospective trial would be useful to assess functional outcome of surgery in this population.
Longitudinal Prescribing Patterns in a Nursing Home Population
Authors: Wayne Sharon J , Rhyne Robert L , Stratton Mark 
Published: April 2015

ObjectiveThis study documents the patient characteristics associated with prescribed medications on entry to a nursing home and the change in prescribing patterns after 3 months.DesignOne‐year admission cohort.SettingThree university‐affiliated community nursing homes in Albuquerque, NM.PatientsAll new admissions (n = 81) to a University geriatrics team, covering intermediate and skilled levels of care during 1 year (July 1, 1988–July 1, 1989).MethodsOutcome measures were scheduled and as‐needed (PRN) medications prescribed at entry and 3 months. Data collected at entry included patient demographics, activities of daily living index, mental status score, and medical diagnoses.ResultsOlder persons were prescribed fewer scheduled medications than younger ones, and women fewer than men. There was a positive association between the number of diagnoses and the number of scheduled medications (r = 0.25, P = 0.02). No associations were found between medications prescribed and mental status or functional level. There were no associations between as‐needed (PRN) medications and any of the variables studied. Overall, there was a significant increase in the average total number of medications prescribed between admission (4.7) and 3 months (6.2). This was due to an increase in the number of PRN medications from 1.3 at admission to 3.0 at 3 months (P < 0.001).ConclusionsMeasuring medications at consistent points in a person's nursing home stay may be more informative than using cross‐sectional sampling. Future studies on medications in nursing home populations should distinguish between PRN and scheduled medications because medication prescribing patterns may be different in these categories.
A Prospective Study of Pressure Sore Risk among Institutionalized Elderly
Authors: Bergstrom Nancy , Braden Barbara 
Published: April 2015

ObjectiveTo determine if dietary intake, nutritional status, and other physical markers are risk factors for the development of pressure sores in the elderly.DesignCohort study.Setting250‐bed skilled nursing facility with 90 extended care beds in which the average length of stay is 28 days.PatientsTwo hundred newly admitted residents (70% female, 95% Caucasian) who were over age 65, estimated to stay > 10 days, at risk for pressure sore development (Braden Scale score ≤17) but free of existing pressure sores were studied for 12 weeks or until discharge.MeasuresSkin assessment, Braden Scale score, blood pressure, body temperature, anthropometrics, and dietary intake were studied weekly. CBC, serum albumin, serum total protein, serum iron, iron binding capacity, serum zinc and copper, and serum vitamin C were studied weekly for 4 weeks and biweekly for 8 weeks.Main Outcome MeasuresPresence/absence and stage of pressure sores.Main ResultsStage I pressure sores developed in 70 (35%) and Stage 2 or worse in 77 (38.5%) residents. Subjects who developed pressure sores were older (P < 0.001) and had lower systolic and diastolic blood pressure (P < 0.001) and higher body temperature (P < 0.001) than those without pressure sores. Dietary intake of all nutrients was lower among subjects who developed pressure sores. Using logistic regression, the best predictors or pressure sore development were the Braden Scale score, diastolic blood pressure, temperature, dietary protein intake, and age.ConclusionsRisk assessment is recommended upon admission to a nursing home and weekly for the first month. Risk status can be effectively predicted by using the Braden Scale in combination with knowledge of age, blood pressure, temperature, and dietary protein intake.
Post‐Operative Delirium: Predictors and Prognosis in Elderly Orthopedic Patients
Authors: Williams‐Russo Pamela , Urquhart Barbara L. , Sharrock Nigel E. , Charlson Mary E. 
Published: April 2015

ObjectiveTo compare the effect of post‐operative analgesia using epidural versus intravenous infusions on the incidence of delirium after bilateral knee replacement surgery in elderly patients. Additional risk factors and impact on post‐operative recovery were also assessed.DesignProspective randomized controlled trial.SettingUrban referral hospital specializing in elective orthopedic surgery.Patients60 consecutive patients undergoing bilateral knee replacement surgery with epidural anesthesia were approached; 51 patients were eligible and consented. The mean age was 68, 55% were women, and there was a high prevalence of comorbid medical disease. No patient was demented pre‐operatively.InterventionRandom allocation to either continuous epidural infusion of bupivicaine and fentanyl or continuous intravenous infusion of fentanyl. Infusions were initiated at the first complaint of pain and continued through the 36‐ to 48‐hour stay in the recovery room.Main Outcome MeasureAcute post‐operative delirium defined using an algorithm based on DSM III criteria.ResultsThe overall incidence of acute delirium was 41%, with no difference between types of post‐operative analgesia. Predictors of delirium were age, gender, and pre‐operative alcohol use. All cases resolved within 1 week, and length of stay and achievement of physical therapy goals were the same for delirious and non‐delirious patients.ConclusionsThere is a high incidence of post‐operative delirium in elderly non‐demented patients following bilateral knee replacement, regardless of whether post‐operative analgesia is administered by the epidural or intravenous route.
Napping and 24‐Hour Sleep/Wake Patterns in Healthy Elderly and Young Adults
Authors: Buysse Daniel J. , Browman Kaitlin E. , Monk Timothy H. , Reynolds Charles F. , Fasiczka Amy L. , Kupfer David J. 
Published: April 2015

ObjectiveTo examine differences between healthy elderly and young adults in daytime napping, nocturnal sleep, and 24‐hour sleep/wake patterns. A second objective was to determine whether elderly subjects with more and less frequent naps differed in their clinical features or nocturnal sleep.DesignSurvey by sleep/wake logs and polysomnography. Comparison by age.SettingSleep/wake logs were completed in the subjects' homes. Polysomnographic studies were conducted on an outpatient basis in a sleep and chronobiology research laboratory.SubjectsConvenience samples of forty‐five healthy subjects over 78 years of age (21M, 24F) and 33 healthy adults between 20 and 30 years of age (20M, 13F).Main Outcome MeasuresUsing self‐reports, we estimated the frequency and timing of daytime naps; timing, duration, and quality of nocturnal sleep; and 24‐hour patterns of sleep and wakefulness. Also Polysomnographic sleep measures.ResultsCompared to young adults, elderly subjects reported a greater mean number of daytime naps (P = .004), shorter nocturnal sleep with more wakefulness and earlier sleep hours (P < .003 for each), and a trend for a shorter 24‐hour sleep fraction. Among the elderly, more‐frequent and less‐frequent nappers did not differ in clinical ratings, self‐report sleep measures, or polysomnographic measures. There was a trend for more sleep‐disordered breathing and periodic limb movements in more frequent nappers.ConclusionsThese findings are consistent with an age‐related decrease in amplitude of the circadian sleep propensity rhythm, or with the expression of a semi‐circadian (12‐hour) sleepiness rhythm. However, we cannot exclude the additional possibility that napping results from lifestyle factors and nocturnal sleep pathologies in a subset of the elderly.