bluuebunny/crossref_metadata_2025_split huggingface dataset:
Depression in the Elderly: Effect on Patient Attitudes toward Life‐Sustaining Therapy
Authors: Lee Melinda A. , Ganzini Linda 
Published: April 2015

Objective: To determine the effect of depression on preferences for life‐sustaining therapy in older persons.Design: A survey comparing depressed, older veterans and a similar, but non‐depressed, control group.Setting: A 490‐bed Veterans Affairs teaching hospital.Patients: Medical inpatients over 65 years of age were potential subjects. Patients who were in intensive care, cognitively impaired, unable to communicate, abusing alcohol or drugs, or unable to return for outpatient care were excluded. Ninety‐five eligible subjects (29%) refused to participate. Depressed subjects scored >14 on the Geriatric Depression Scale (GDS) and were diagnosed as depressed by a psychiatrist who was blind to the GDS results. Complete data were collected on 50 depressed and 50 control subjects.Main Outcome Measures: A self‐administered questionnaire quantified patients' preferences regarding life‐saving interventions in their current state of health and in four hypothetical scenarios of serious illness.Results: Depressed subjects desired fewer interventions than control subjects in their current health and in hypothetical scenarios with a good prognosis (P < 0.05). There were no differences between groups in poor prognosis scenarios. However, depression did not explain more than 5% of the variance in decision‐making in any situation. In good prognosis scenarios, subjects' assessment of quality of life was the most powerful predictor of desire for life‐saving interventions, accounting for 9%–17% of the variance (P < 0.01).Conclusions: These results suggest that depression is associated with treatment refusal in situations with a good medical prognosis. Depression, however, is only a weak predictor of treatment refusal. Further research is needed to define which patients would accept medical treatment if effectively treated for depression. J Am Geriatr Soc 40:983–988, 1992
Exporting a Successful Influenza Vaccination Program from a Teaching Hospital to a Community Outpatient Setting
Authors: Margolis Karen L. , Nichol Kristin L. , Wuorenma Jan , Von Sternberg Thomas L. 
Published: April 2015

Purpose: To assess whether we could export a successful multifaceted influenza vaccination program from an academic medical center to a community setting.Design: Pre/post study using concurrent control groups.Setting: Clinics in a staff model Health Maintenance Organization (HMO). One urban and one suburban clinic were chosen as intervention clinics, while two similar clinics were selected as control clinics.Patients: All patients aged 65 and over enrolled in the four clinics.Interventions: An informational mailing to patients, a standing‐order policy allowing nurses to administer vaccine, a vaccination reminder on daily appointment lists, and availability of walk‐in visits for vaccination. Patients in the control clinics received usual care.Measurements: Vaccination rates were determined using a validated postcard survey of 150 randomly selected patients at each clinic both at baseline (1988–89) and after the intervention (1989–90).Results: The baseline vaccination rates ranged from 51.4% to 74.6%, with nearly all vaccinations taking place at the HMO. In one intervention clinic, the vaccination rate improved from 56.4% to 72.3%, P = 0.01. In the other, the baseline rate was 74.6% and did not change significantly after the intervention. There was no change in the vaccination rate in the control clinics after the intervention period.Conclusions: An influenza vaccination program that combines several organizational interventions may be successfully exported from an academic to a community setting and may serve as a useful model for others. J Am Geriatr Soc 40:1021–1023, 1992
Are Activity‐Based Assessments of Balance and Gait in the Elderly Predictive of Risk of Falling and/or Type of Fall?
Authors: Topper A. K. , Maki B. E. , Holliday P. J. 
Published: April 2015

ObjectiveTo determine whether an activity‐based test of balance and gait is predictive of the risk of: (1) falling in situations that are related to specific tasks evaluated as part of the test, (2) experiencing falls precipitated by different classes of biomechanical events, or (3) falling in general; and to compare the predictive ability of the activity‐based test for the falls described in (2) and (3) to that of a posturography test that has been found previously to be predictive of falling risk.DesignCohort study.SettingBaseline tests performed in balance laboratory; subsequent history of falling monitored prospectively for 1 year in two residential‐care facilities.ParticipantsSeventeen male and 83 female consecutive volunteers (mean age = 83, SD = 6) who were independent in activities of daily living and able to stand unaided.MeasurementsIndependent variables were derived from an activity‐based balance‐and‐gait test and a posturography test. Dependent variables were the numbers of subjects with one or more: (1) falls in specific situations related to activity‐based test items, (2) falls related to general classes of biomechanical precipitant, and (3) falls in general.Main ResultsSubjects who were rated as “abnormal” in activity‐based test items related to transfers, turning or reaching were more likely to experience one or more falls in related situations in everyday life. Activity‐based scores were predictive of risk of experiencing falls with no obvious biomechanical precipitant and falls precipitated by center‐of‐mass perturbation, but not falls precipitated by base‐of‐support perturbation. In comparison, a posturographic measure of spontaneous medial‐lateral postural sway (blindfolded conditions) failed to predict falls having no biomechanical precipitant, but provided the best predictions of both center‐of‐mass and base‐of‐support falls, as well as risk of falling in general.ConclusionsActivity‐based testing of certain tasks (transfer, turning, reaching) may be useful in indicating a specific need for intervention to reduce the risk of falling during related everyday activities. In terms of predicting falling risk, a static posturography test may provide better prediction overall of the different classes of falls and may be useful as a quick and simple screening tool to help identify high‐risk individuals.
Hypouricemia, Abnormal Renal Tubular Urate Transport, and Plasma Natriuretic Factor(s) in Patients with Alzheimer's Disease
Authors: Maesaka John K. , Wolf‐Klein Gisele , Piccione Joanne M. , Ma Chan M. 
Published: April 2015

ObjectiveTo study tubular urate transport in Alzheimer's disease (AD) and measure sodium and lithium transport rates in rats exposed to AD plasma.DesignCross‐sectional study in three comparison groups.SettingReferral private institution involving outpatient and hospitalized patients.PatientsAD, multi‐infarct dementia (MID) and non‐demented controls (C) were selected and evaluated by a geriatrician and a psychiatrist according to availability and willingness to participate in the study. Demented patients had brain imaging, categorized according to NINCDS‐DSM III criteria, and had Mini‐mental status examination (MMSE) scores determined.InterventionsInjection of 0.5 mL of plasma I.P. followed 120 minutes later by an IV plasma injection of 0.2 mL priming dose and infusion of 1.8 mL of plasma at 0.01 mL/min in Sprague Dawley rats.MeasurementsRenal clearance studies were performed in subjects and in rats exposed to the plasma of study subjects. We measured serum urate concentration and fractional excretion (FE) of urate in subjects and FE sodium and FE lithium in rats.ResultsSerum urate was lower and FE urate higher in 18 AD patients compared with six patients with MID, P < 0.05 and P < 0.005, and 11 C, P < 0.02 and P < 0.005, respectively. Higher FE sodium and FE lithium were noted in rats given plasma from 19 AD patients compared with 12 with MID, P < 0.005 and P < 0.0025, and 14 C, P < 0.0025 and P < 0.0005, respectively. FE sodium and FE lithium decreased progressively after serial dilutions of three AD plasmas and FE lithium was negatively correlated with MMSE scores only in AD, r = ‐0.71 and P < 0.0005.ConclusionsIn AD there is defective tubular urate transport and a plasma natriuretic factor(s). FE sodium and/or FE lithium in rats exposed to plasma of demented patients may differentiate AD from MID and estimate the severity of AD.
Dementia, Agitation, and Care in the Nursing Home
Authors: Aronson Miriam K. , Post Donna Cox , Guastadisegni Paul 
Published: April 2015

ObjectiveTo examine the behavioral and functional problems of the cognitively impaired.DesignA survey of a cohort of residents from six nursing homes.ParticipantsSubjects were randomly selected based on a minimum age of 70 years and a Resource Utilization Group (RUG) classification of the Physical or Behavioral type. Of those eligible, 44% (n = 366) agreed to participate. The participants and non‐participants had similar demographics except for a higher incidence of mental illness in the non‐participant group, which did not have a significant impact on agitation.SettingSix nursing homes in New York City, three voluntary non‐profit and three proprietary.MeasurementThe study used chart review, assessment of residents' cognitive and functional abilities, nursing assistants' ratings of residents' functional abilities, behavioral problems, and the amount of effort required in care, and time‐motion observations of staff‐resident interactions.ResultsResidents' level of cognitive impairment had a significant impact on problem behaviors during ADL tasks, along with supervision required in patient care (P < 0.05). These results were validated by time‐motion analysis. Regression analysis revealed that for non‐demented subjects, the best indicator of care needs was health status, while for demented residents the best indicator was cognitive status (P < 0.0003).ConclusionsThe care needs of residents with dementia are better estimated by a mental status test for cognitive impairment then by ADL assessment alone. Greater agitation is associated with increasing cognitive impairment. Further, agitation and behavioral problems associated with care result in a need for increased staff supervision.
Predicting Short‐Term Survival for Patients with Advanced Alzheimer's Disease
Authors: Volicer Beverly J. , Hurley Ann , Fabiszewski Kathy J. , Montgomery Paul , Volicer Ladislav 
Published: April 2015

ObjectiveThe purpose of this study was to develop a statistical model for predicting short term survival in patients with dementia of the Alzheimer type (DAT).DesignA prospective cohort study.SettingThree 25‐bed intermediate medical care units using a structured approach to patient care management including palliative care options and patients from a second, traditional long‐term care setting.ParticipantsOf 104 patients with advanced DAT monitored for 34 months, 68 patients (97% white male) who had at least one fever episode were included in the model development phase. Data from 71 additional DAT patients with at least one fever episode were used to test the statistical model.Main Outcome MeasuresSix‐month survival following a fever episode.ResultsOlder age and higher severity of DAT at the time of the fever episode, palliative care, and hospital admission for long‐term care within 6 months prior to the fever were found to be positively associated with likelihood of mortality within 6 months of the fever onset. Adjusted odds ratios for each of these variables were statistically significant. The model performed well in subsequent testing on an independent sample of patients.ConclusionResults provide a formula which can be used to predict likelihood of dying within 6 months following onset of a fever in DAT patients. This statistical prediction is recommended for use in combination with clinical judgment to certify DAT patients for Medicare hospice coverage.
Adverse Clinical Events in Dependent Long‐Term Nursing Home Residents
Authors: Bernardini Bruno , Meinecke Claudia , Zaccarini Cinzia , Bongiorni Nadia , Fabbrini Stefano , Gilardi Camilla , Bonaccorso Orazio , Guaita Antonio 
Published: April 2015

ObjectiveTo assess the occurrence, type, and burden of adverse clinical events (ACE) among residents of chronic facilities. An ACE is any acute or subacute change in health status suggesting acute or subacute illness.DesignSurvey with face‐to‐face functional assessment and 3‐month retrospective chart review.Study PopulationOne hundred six continuing‐care residents with a minimum length of stay of 4 months at an Italian chronic care facility.MeasurementsFunctional assessment and chart review‐based classification of ACE burden on care management according to a clinical‐functional Severity Rating Scale.Main ResultsFunctional dependence, dementia and concurrent clinical problems were common. Two hundred seventy‐three ACEs were detected. Eighty‐nine percent of residents experienced at least one ACE. Only 21% of ACEs could be managed by simple medical intervention and monitoring within 1 day; in 23% there was need for more complex care management; 7% of the latter ACEs resulted in residual (new) functional impairment. Cardiovascular and gastrointestinal systems were most commonly involved in ACEs. Neurological ACEs were the most frequent category leading to new functional impairment (22%). ACE occurrence/burden was higher in male residents (P < 0.01) and strongly associated with the number of concurrent medical problems (P < 0.001). Neither cognitive nor functional dependence levels were related to ACE occurrence.ConclusionsThis description of the burden on care management resulting from acute and subacute changes in clinical and functional status of chronic patients emphasizes the continuing and unpredictable nature of medical attention required in a nursing home or chronic care facility. ACEs occur far more frequently among the elderly than is generally recognized. Thus a high level of medical and nursing skill is necessary in chronic care facilities.
Clinical Presentation of Meningioma in the Elderly
Authors: Wofford James L. , Moran William P. , Wilson Thomas A. S. , Velez Ramon 
Published: April 2015

ObjectiveTo compare presenting manifestations of meningioma in elderly patients with those in younger patients.DesignRetrospective survey.SettingTertiary care center.PatientsAll hospitalized adult patients with the primary diagnosis of meningioma over a 5‐year period (n = 116). Nine patients with recurrence of a previously resected meningioma were excluded. Fifty‐two percent (56/107) of patients were ≥65 years of age.MeasurementsPresenting symptoms were classified as asymptomatic, focal, non‐specific, or both focal and non‐specific. Presenting neurologic signs on physical examination were classified as focal, non‐focal, or normal. Duration of symptoms was classified as ≤1 week, 1 week to 1 month, 1 to 6 months, and >6 months.ResultsOlder patients presented more commonly with confusion (32% vs 4%) and dystaxia (28% vs 10%) than younger patients and presented less commonly with headache (23% vs 49%) and visual changes (21% vs 43%). While 2% of patients were asymptomatic at presentation, the remainder had symptoms categorized as focal (38%), non‐specific (26%), or both (34%). There was no significant difference between older and younger age groups in the proportions of patients having focal symptoms. Duration of symptoms for all patients was categorized as ≤1 week (15%), 1 week to 1 month (16%), 1 to 6 months (23%), and >6 months (44%). In general, older patients were diagnosed earlier than younger patients. The presence of focal neurologic signs was not significantly different between older and younger patients.ConclusionsPresenting manifestations of meningioma differ between older and younger adult patients, but focality of symptoms and signs is similar. In this case series, the duration of symptoms prior to diagnosis was shorter in older than in younger patients.
Selenium and Oxygen‐Metabolizing Enzymes in Elderly Community Residents: A Pilot Epidemiological Study
Authors: Berr Claudine , Nicole Annie , Godin Jean , Ceballos‐Picot Irene , Thevenin Marc , Dartigues Jean‐François , Alperovitch Annick 
Published: April 2015

ObjectiveTo investigate the relationship of selenium and oxygen‐deactivating enzymes with age in the elderly.SampleThe study sample consisted of volunteers recruited from the PAQUID study. This study is conducted in a representative sample of non‐institutionalized individuals aged ≥65 years living in Southwestern France; its main objective is to study longitudinally the incidence and risk factors of dementia.MethodsPlasma and erythrocyte selenium and activities of oxygen metabolizing enzymes in erythrocytes (GSH‐Px, CuZn‐SOD, and GSSG‐RD) were measured in 239 volunteers (108 males and 131 females; mean age 73.7 years).ResultsPlasma selenium (PSe) decreased significantly with age; a similar but non‐significant trend was found for erythrocyte selenium (ESe). None of the enzyme activities showed a clear relationship with age. Women had significantly higher GSH‐Px activities than men. For PSe levels lower than 77 ng/mL, there was a strong correlation between PSe and GSH‐Px; above this value, the correlation decreased, suggesting that the selenium requirement for GSH‐Px production had been satisfied. In this sample, CuZn‐SOD was correlated negatively with GSH‐Px (r = −0.18; P ≤ 0.01) and positively with GSSG‐RD (r = +0.20; P ≤ 0.01).ConclusionsIn individuals aged ≥65 years, we found that blood selenium levels were negatively correlated with age. Our analysis of the relationship between selenium and GSH‐Px activity suggests that low selenium values are associated with decreased GSH‐Px activity.
A Comparative Study of Monoclonal Gammopathies and Immunoglobulin Levels in Japanese and United States Elderly
Authors: Bowden Mark , Crawford Jeffrey , Cohen Harvey Jay , Noyama Osamu 
Published: April 2015

Objective: To define the prevalence of monoclonal immunoglobulin (Ig) proteins and quantitative serum immunoglobulin levels in elderly Japanese in comparison with elderly Caucasians as possible factors related to the reported lower incidence of multiple myeloma in elderly Japanese than in elderly Caucasians.Design: Survey studySetting: Community Center in Yokohama, Japan and Retirement Community in the United States.Participants: Convenience sample of community‐dwelling elderly subjects (age 63–95) presenting for health screening examinations in each setting. Frozen serum samples were obtained from routine screening from 146 consecutive Japanese subjects and 111 US subjects.Intervention: NoneMeasurements: Presence of monoclonal immunoglobulin protein determined by serum protein electrophoresis and immunofixation and quantitative Ig by laser nephelometry.Results: Four (2.7%) of the Japanese cohort had monoclonal gammopathies compared with 11 (10%) of the American cohort. Two of the monoclonal gammopathies were IgG Kappa and two were IgG Lambda. No cases of multiple monoclonal gammopathy were identified in the Japanese group, compared with 25% of the monoclonal gammopathies in the American group. The mean quantitative serum IgG level for the Japanese group was 1,685 ± 520 mg/dL versus 1,118 ± 402 mg/dL for the American group; mean quantitative IgA levels were 283 ± 116 mg/dL versus 226 ± 116 mg/ dL (P < 0.001). Albumin levels were normal in both populations, suggesting that there was not an increase in occult inflammatory disorders in the Japanese population.Conclusion: The low prevalence of monoclonal gammopathy in elderly Japanese is consistent with the reported lower frequency of multiple myeloma. The reason for the higher quantitative immunoglobulin levels in this population is unclear. Further cross‐cultural investigation is warranted to explore the genetic influences on altered immune regulation with aging.
A Brief Agitation Rating Scale (BARS) for Nursing Home Elderly
Authors: Finkel Sanford I. , Lyons John S. , Anderson Rachel L. 
Published: April 2015

Objective: To determine the effectiveness of a brief agitation rating scale (BARS) derived from the Cohen‐Mansfield Agitation Inventory (CMAI).Design: Test of reliability and validity of a new test.Setting: The Lieberman Geriatric Health Centre, a skilled nursing facility.Participants: Forty members of the Lieberman Geriatric Health Centre nursing staff, 232 residents, and a sample of 40 randomly selected residents.Measurements: Observational agitation ratings by registered nurses and certified nurses' assistants; item to total correlations for the CMAI on each of the three shifts; Pearson correlations between the 10‐item BARS and the BEHAVE‐AD and the BSSAD scales.Results: Internal consistency reliability for the BARS was .74 (for the day shift), .82 (evening shift), and .80 (night shift), compared with .86, .91, and .87 for the full CMAI. Each of the 232 residents' scores on the BARS was correlated with a total score from the CMAI separately on each shift. Correlations were of .95, .94, and .95. Thus, across all shifts, the BARS accounted for approximately 90 percent of the variance of the total score of the CMAI. Concurrent validity of the BARS was supported by significant correlation with BEHAVE‐AD and BSSD.Conclusions: The BARS represents a brief and effective mechanism to assess the presence and severity of physically aggressive, physically non‐aggressive, and verbally agitated behaviors in elderly nursing home residents.
Decisions about Enteral Tube Feeding among the Elderly
Authors: Ouslander Joseph G. , Tymchuk Alexander J. , Krynski Michele D. 
Published: April 2015

Objective: To determine choices about enteral tube feeding and factors associated with deciding to accept or forego this intervention in a group of ambulatory non‐demented older individuals.Design: Descriptive survey.Setting and Participants: Thirty four volunteers from a senior adult day center and 34 volunteers from the residential care section of a multilevel long‐term care institution, mean age 77.8.Intervention: Structured interview using a hypothetical clinical vignette in simplified language, story‐book format depicting an irreversibly and severely impaired state of health.Measurement: Choice of whether to accept or forego enteral tube feeding based on the clinical vignette.Results: Thirty four (50%) decided to accept and 34 (50%) chose to forego enteral tube feeding in the situation presented in the vignette. No demographic, cognitive, or affective factors were associated with the decision. Presentation of the vignette and associated questions were not anxiety‐provoking or upsetting to the vast majority of participants.Conclusion: A hypothetical clinical vignette depicting a state of severely impaired health resulted in 34 (50%) of 68 ambulatory non‐demented older individuals deciding to accept enteral tube feeding. No factors we examined were strongly associated with the decision. The vignette and discussion were not anxiety‐provoking when presented in the format used in this study. Advance‐directive discussions about enteral tube feeding and other health care decisions, using understandable hypothetical clinical vignettes that describe risks and benefits that might influence decisions, should be encouraged in the practice of geriatric medicine.