bluuebunny/crossref_metadata_2025_split huggingface dataset:
Older Age and the Underreporting of Depressive Symptoms
Authors: Lyness Jeffrey M. , Cox Christopher , Curry Jennifer , Conwell Yeates , King Deborah A. , Caine Eric D. 
Published: April 2015

OBJECTIVE: To determine whether older age is associated with a decrease in self‐reported depressive symptoms, independent of examiner‐rated symptoms, in inpatients with major depression.DESIGN: Survey study.SETTING: Inpatient psychiatric units at a university medical center.PATIENTS: Eligible subjects were those over 20 years of age with a primary diagnosis of DSM‐III‐R major depression. Participation was sought from all subjects over 60 years of age and from every second or every third younger subject, depending on rater availability. Of 137 eligible subjects, 97 completed all study measures.MEASUREMENTS: The Beck Depression Inventory (BDI), as a measure of self‐reported depressive symptoms, was the dependent variable. The Hamilton Rating Scale for Depression (Ham‐D) was used to assess examiner‐rated symptoms.MAIN RESULTS: Older age (P = .03) was associated negatively and examiner‐rated depressive symptoms (P = .0001) were associated positively with BDI score. Other variables, including gender, education, age of depression onset, and medical illness burden, were not independently associated with BDI. Examination of depressive symptom subtotals (psychologic/affective vs. somatic/neurovegetative) revealed that only the self‐reported psychologic/affective subtotal was significantly associated with age (P = .0018).CONCLUSIONS: Some older patients with clinically significant depression underreport their symptoms. When asking older patients about depressive symptoms, clinicians should view negative responses only within larger clinical contexts and should obtain information from other sources as needed. Similar concerns must temper interpretation of research that relies on subject self‐report to study depression in late life. J Am Geriatr Soc 43: 216–221, 1995.
Effectiveness of Oral Antibiotic Treatment in Nursing Home‐Acquired Pneumonia
Authors: Degelau John , Guay David , Straub Kimberly , Luxenberg Michael G. 
Published: April 2015

Effectiveness of Oral Antibiotic Treatment in Nursing Home‐Acquired PneumoniaOBJECTIVE: To determine factors associated with success or failure of oral antibiotic treatment for nursing home‐acquired pneumonia (NHAP).DESIGN: Retrospective study of outcomes for all identifiable NHAP cases in 1991.SETTING: The Nursing Home Services Program of St. Paul Ramsey Medical Center and 31 metropolitan St. Paul, Minnesota, community nursing homes.PARTICIPANTS: Nursing home (NH) cohort: 124 patients (mean age 85.2 years) with a new respiratory symptom and new infiltrate on portable chest X‐ray for whom oral antibiotics were prescribed. Hospital cohort: 74 NH patients (mean age 84.3 years) admitted to hospital with new X‐ray infiltrate and pneumonia diagnosis. Supportive care status patients were excluded. Forty‐three physician/nurse practitioner (MD/NP) teams were represented.MEASUREMENTS: Nursing home cohort: Outcomes of hospitalization within 14 days or 30‐day mortality. A discriminant model was applied to predict outcome and discriminant rule performance was analyzed. Hospital cohort: 30‐day mortality.RESULTS: Of 198 episodes of NH pneumonia, 63% were treated in the facility; 30.6% (38) failed NH treatment. Thirty‐day mortality was 13%. There was no examination by the MD or NP for 59% of NH‐treated episodes. The hospital cohort had a higher mean pulse (P < .05) but a similar frequency of feeding dependence. Hospital cohort mortality was 17.6%. The NH treatment failure group had significantly higher proportions of pulse > 90/min, temperature > 100.5°F, respirations > 30/min, feeding dependence, and mechanically altered diets. A discriminant model using these factors was significant (P = .002). The NH treatment failure rate was 11% for no factors present, 23% for two or fewer factors, and 59.5% for three or more (likelihood ratio 3.1). Thirty‐two percent of the hospital cohort had zero or one factor present and were alive at 30 days.CONCLUSION: The majority of NHAP episodes were treated successfully with oral antibiotics, but 31% failed treatment in the NH. Patients with a mechanically altered diet or requiring feeding assistance by staff had significantly higher failure rates. Feeding dependence and need for a mechanically altered diet as well as abnormal vital signs are associated with oral antibiotic treatment failure. These factors should be considered in treatment decisions for NHAP. J Am Geriatr Soc 43: 245–251, 1995.
Life Satisfaction and Associated Factors in Older Hong Kong Chinese
Authors: Ho S. C. , Woo J. , Lau J. , Chan S. G. , Yuen Y. K. , Chan Y. K. , Chi I. 
Published: April 2015

Life Satisfaction and Associated Factors in Older Hong Kong ChineseOBJECTIVE: To determine life satisfaction and its association with physical, functional, socioeconomic, psychological, and social support characteristics in Hong Kong Chinese aged 70 years and older.DESIGN: Cross‐sectional study.SETTING: Territory‐wide random sample of persons aged 70 years and older.SUBJECTS: A total of 843 men and 714 women were selected by random sampling, stratified by age and sex, from the Old age and Disability Allowance Register, after exclusion of subjects with cognitive impairment.MEASUREMENTS: Life satisfaction was assessed by the subjects' response to the question “Are you satisfied with life”, using a 0 to 10‐point linear scale. They were also asked to name the most important factor contributing to life satisfaction. Information was also obtained regarding physical health, functional ability, depressive symptoms, and socioeconomic factors.RESULTS: There was a weak association between score and age. Health, adequate income to meet living expenses, and caring relatives were rated the most important factors (>65%). Some of these factors were also those associated with a high life satisfaction score. Factors associated with a life satisfaction score greater than 6 points were higher social class and educational attainment, adequate income to meet living expenses, satisfactory living arrangement, Christianity, good social support, participation in social activities, functional independence, good self‐perceived health, good hearing and vision, daily exercise, absence of recurrent falls, and low depressive symptom score. Multiple logistic regression identified having two or more relatives and tertiary education as positive associated factors, whereas inadequate income to meet expenses, dissatisfaction with living arrangement, non‐participation in religious group activities, and a high depressive symptom score were negative associated factors.CONCLUSION: In older Chinese, social factors such as the support provided by family members, as well as adequate income to meet living expenses, play a role equal to that of physical factors in contributing to life satisfaction. J Am Geriatr Soc 43: 252–255, 1995.
Usefulness of M‐Mode, 2‐Dimensional, and Doppler Echocardiography in the Diagnosis, Prognosis, and Management of Valvular Aortic Stenosis, Aortic Regurgitation, and Mitral Annular Calcium in Older Patients*
Authors: Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To review the diagnosis, prognosis, and management of valvular aortic stenosis, aortic regurgitation, and mitral annular calcium (MAC) with emphasis on older persons.DATA SOURCES: A computer‐assisted search of the English‐language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.STUDY SELECTION: Studies on the diagnosis, prognosis, and management of valvular aortic stenosis, aortic regurgitation, and MAC were screened for review. Studies in older persons and recent studies were emphasized.DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving older persons. Relevant articles were reviewed in depth.DATA SYNTHESIS: Available data about the diagnosis, prognosis, and management of valvular aortic stenosis, aortic regurgitation, and MAC with emphasis on studies involving older persons were summarized.CONCLUSIONS: Valvular aortic stenosis, aortic regurgitation, and MAC are degenerative cardiac disorders which are common in older people. The presence and severity of these cardiac disorders are diagnosed by M‐mode, 2‐dimensional, and Doppler echocardiography. M‐mode, 2‐dimensional, and Doppler echocardiographic techniques are also very useful in the prognosis and management of these cardiac disorders in older persons. J Am Geriatr Soc 43: 295–300, 1995.
The Effect of a 12‐Month Exercise Trial on Balance, Strength, and Falls in Older Women: A Randomized Controlled Trial
Authors: Lord Stephen R. , Ward John A. , Williams Philippa , Strudwick Maureen 
Published: April 2015

OBJECTIVE: To determine whether a 12‐month program of regular exercise can improve balance, reaction time, neuromuscular control, and muscle strength and reduce the rate of falling in older women.DESIGN: A randomized, controlled trial of 12 months duration.SETTING: Conducted as part of the Randwick Falls and Fractures Study in Sydney, Australia.PARTICIPANTS: One hundred ninety‐seven women aged 60 to 85 years (mean age 71.6, SD = 5.4) who were randomly recruited from the community.OUTCOME MEASURES: Accidental falls, postural sway, reaction time, neuromuscular control, and lower limb muscle strength.MAIN RESULTS: Exercise and control subjects were tested before, midway through, and at the end of the trial. At initial testing, exercisers and controls performed similarly in all tests and were well matched in relevant health and lifestyle factors. The mean number of classes attended for the 75 exercise subjects who completed the program was 60.0 (range 26–82). At the end of the trial, the exercise subjects showed improved performance in all five strength measures, in reaction time, neuromuscular control, body sway on a firm surface with the eyes open, and body sway on a compliant surface with the eyes open and closed. In contrast, there were no significant improvements in any of the test measures in the controls. In one test measure, hip flexion strength, the exercisers showed continued improvement throughout the study year. There was no significant difference in the proportion of fallers between the exercise and control subjects. Interesting trends were evident, however, between falls frequency and adherence to the exercise program.CONCLUSIONS: These findings show that exercise can produce long‐term benefits with regard to improving sensorimotor function in older persons. The findings also suggest that high compliance to an exercise program may reduce falls frequency, although further studies are required to conclusively demonstrate that exercise offers an effective means of preventing falls.
Risk Factors for Serious Injury During Falls by Older Persons in the Community
Authors: Tinetti Mary E. , Doucette John , Claus Elizabeth , Marottoli Richard 
Published: April 2015

BACKGROUND: Serious fall injury represents a little studied, yet common and potentially preventable, cause of morbidity and mortality among older persons. We determined the frequency of, and risk factors for, experiencing serious fall injury events among older persons in the community.SUBJECTS: A representative sample of 1103 community‐living persons aged 72 years and older underwent comprehensive baseline and 1‐year evaluations.MAIN OUTCOME MEASURES: During a median 31 months of follow‐up, fall data were obtained using fall calendars. Injury data were obtained from telephone interviews and from surveillance of emergency room and hospital records.RESULTS: At least one fall was experienced by 546 (49%) participants. A total of 123 participants, representing 23% of fallers and 12% of the cohort, experienced 183 serious fall injury events. The factors independently associated with experiencing a serious injury during a fall included cognitive impairment (adjusted odds ratios 2.2; 95% confidence interval 1.5,3.2); presence of at least two chronic conditions (2.0; 1.4,2.9); balance and gait impairment (1.8; 1.3,2.7); and low body mass index (1.8; 1.2,2.5). In a separate analysis, including only subjects who fell, female gender (1.8; 1.1, 2.9) as well as most of the above factors were associated with experiencing a fall injury.CONCLUSIONS: Several readily identifiable factors appeared to distinguish the subgroup of older fallers at risk for suffering a serious fall injury. These factors should help guide who and what to target in prevention efforts.
Can Physically Restrained Nursing‐Home Residents Be Untied Safely? Intervention and Evaluation Design
Authors: Neufeld Richard R. , Libow Leslie S. , Foley William , White Harry 
Published: April 2015

OBJECTIVE: To develop an intervention that will enable nursing home personnel to remove physical restraints from nursing‐home residents safely and cost effectively.DESIGN: A multicenter prospective pre‐post study.SETTING: Sixteen high‐restraint‐use nursing homes, four each from California, Michigan, New York, and North Carolina. The 16 facilities has 2075 beds.INTERVENTION: A 2‐year educational demonstration study, including a 2‐day workshop, specially prepared written and video materials, and telephone and on‐site clinical consultations. Each nursing home designated a nurse to be the clinical coordinator and to lead a multidisciplinary team in conducting a restraint assessment and devising interventions for removal.OUTCOME MEASURES: We compared pre‐ and post‐study aggregate and individual facility rates of restraint use, incidents and accidents, family attitudes, financial impact, serious injuries, and staff attitudes and work patterns.CONCLUSION: Preliminary data suggest that this intervention was well received and appears to be effective in achieving restraint‐free care.
Functional Improvement with Vitamin D Replenishment in a Cohort of Frail, Vitamin D‐Deficient Older People
Authors: Gloth F. Michael , Smith Charles E. , Hollis Bruce W. , Tobin Jordan D. 
Published: April 2015

OBJECTIVE: To evaluate functional improvement in a population of frail, homebound older persons with low vitamin D status as vitamin D stores improve.DESIGN: Randomized, controlled intervention study.SETTING: Subjects' homes and a nursing facility in Baltimore, Maryland.PARTICIPANTS: The first 32 subjects (community‐dwelling, homebound older subjects from the Johns Hopkins Elder Housecall Program and nursing home residents from the Johns Hopkins Geriatrics Center) entered in a longitudinal study of vitamin D replacement.MEASUREMENTS: Baseline 25‐hydroxyvitamin D levels were measured and repeated at least 1 month after therapy with either placebo or vitamin D (ergocalciferol). Subjects were also administered the Frail Elderly Functional Assessment (FEFA) questionnaire, an instrument demonstrated to be reliable, valid, and sensitive to small increments of functional change in this population.MAIN RESULTS: All subjects started with 25‐hydroxyvitamin D levels less than 15 ng/mL. Those subjects whose levels improved by at least 3 ng/mL (> assay coefficient of variation) also demonstrated improvement in FEFA score. Regression analysis between change in FEFA score compared with change in 25‐hydroxyvitamin D was significant (r = .4; P = .02).CONCLUSIONS: In this cohort of homebound older people, improvement in vitamin D status was associated with functional improvement as measured by the FEFA questionnaire.
Exitatory Amino Acids in Health and Disease
Authors: Thomas Robert Joseph 
Published: April 2015

PURPOSE: To review the role of excitatory neurotransmitters in normal mammalian brain function, the concept of excitotoxic neuronal death as an important final common path in a variety of diseases, and modification of excitatory synaptic transmission as an important new pharmacological principle. These principles are discussed, with special emphasis on diseases of importance to older adults.DATA SOURCES: A MEDLINE search from 1966 to May 1995 was undertaken, as well as a manual search of current issues of clinical and basic neuroscience journals, for articles that addressed glutamate N‐methyl‐D aspartate and/or excitotoxicity.STUDY SELECTION: A total of 5398 original and 68 review articles were identified that addressed animal and human experimentation relevant to excitotoxic neuronal death. There were 364 articles with potential significance for clinical application identified; 132 of the most recent references are provided.DATA EXTRACTION: All articles were classified into three categories: general receptor, biology pathogenesis of disease, and pharmacotherapy.RESULTS: Glutamic and aspartic acids are the physiological mediators of most excitatory synaptic transmission. This is critical to several normal nervous system functions, including memory and long‐term modification of synaptic transmission and nociception. Activation of the inotropic NMDA and non‐NMDA receptors increases transmembrane calcium and sodium fluxes, and the metabotropic glutamate receptor activation results in generation of inositol triphosphate and inhibition of adenylate cyclase. Numerous modulatory sites exist, especially on the NMDA receptor. Nitric oxide, arachidonic acid, superoxide, and intracellular calcium overload are the ultimate mediators of neuronal death. Glutamate re‐uptake transporters belong to a unique family of amino acid transport systems, the malfunction of which is intricately involved in disease pathogenesis. Ischemic stroke, hypoglycemia, Parkinson's disease, alcohol intoxication and withdrawal, Alzheimer's disease, epilepsy, and chronic pain syndromes are only some of the important clinical neurological disorders with a major pathogenic role for the excitatory amino acids.CONCLUSIONS: Pharmacological manipulation of the excitatory amino acid receptors is likely to be of benefit in important and common diseases of the nervous system. Only a few of the currently available drugs that modify excitatory neurotransmission, such as remacemide, lamotrigine, and tizanidine, have an acceptable therapeutic index. The identification of numerous receptor subtypes, topographic variabilities of distribution, and multiple modulatory sites will provide a true challenge to the neuropharmacologist.
Use of Post‐Hospital Care by Medicare Patients
Authors: Kane Robert L. , Finch Michael , Blewett Lynn , Chen Qing , Burns Risa , Moskowitz Mark 
Published: April 2015

BACKGROUND: Medicare's introduction of the Prospective Payment System for hospitals has shortened hospital stays and, as a consequence, has increased the use of post‐hospital care. Medicare coverage provides for various types of post‐hospital care. This paper examines the characteristics of patients, cities, and hospitals associated with discharge to these different types of post‐hospital care.METHODS: A total of 2248 consecutive Medicare patients having one of five diagnosis related groups (DRGs), who were about to be discharged from 52 hospitals in three cities in 1988–1989, were enrolled in the study. These DRGs comprised approximately one‐eighth of all Medicare hospital discharges and 40% of all Medicare‐paid post‐hospital care. Patients were interviewed in person before discharge and again 6 weeks after discharge. Clinical severity measures were developed from information abstracted from each patient's medical record. For each DRG, multinomial logit regression equations were developed to identify factors associated with the choice of one of four possible discharge locations: home with no formal care, home health care, nursing home care, or rehabilitation.RESULTS: Discharge location could be predicted correctly in 52 to 71% of cases, depending on the DRG. This level of predictive accuracy was significantly greater than relying on the modal discharge location, which accounted for 33 to 62% of cases. Most of the predictive power came from information gathered at the discharge interview. The variables associated significantly with the discharge location varied with the DRG and location examined. Living alone and functional dependency at discharge were the significant predictors found most often.CONCLUSIONS: Rather than assuming that everyone is discharged to the modal location, patient discharge location can be predicted. Much of the the explanation can be traced to a few variables such as functional status and living situation. The lack of greater accuracy suggests that factors other than those identified as important by clinical panels are involved in discharge planning for Medicare patients. J Am Geriatr Soc 44:242–250, 1996.
Function and Medical Comorbidity in South Texas Nursing Home Residents: Variations by Ethnic Group
Authors: Mulrow Cynthia D , Chiodo Laura K. , Gerety Meghan B , Lee Shuko , Basu Srabashi , Nelson Deanna 
Published: April 2015

OBJECTIVE: To evaluate differences in functional status and burdens of medical conditions in Mexican American and non‐Hispanic white nursing home residents.DESIGN AND SETTING: Cross‐sectional survey of 17 nursing homes in south Texas.PARTICIPANTS: A total of 617 older nursing home residents, of whom 366 were Mexican American and 251 were non‐Hispanic white.MEASURES: Activities of Daily Living (ADL) status abstracted from standard nurses notes and Burden of Disease abstracted from medical records.RESULTS: Mexican American residents had greater numbers of ADL dependencies and poorer overall ADL scores than non‐Hispanic white residents. This poor functioning was not explained by age, gender, or marital or educational status. The average number of medical conditions was greater, and specific conditions, such as cerebrovascular disease, recent acute infections, diabetes, hypertension, and anemia, were more common in Mexican American residents compared with non‐Hispanic white residents. In models relating function with medical conditions and ethnic group, ADL scores and dependencies were significantly related to bowel and bladder incontinence, cerebrovascular disease, dementia, recent infections, and skin decubiti, but not to ethnic group.CONCLUSION: Mexican American nursing home residents are more functionally dependent than non‐Hispanic white residents. The difference in function is explained by a greater burden of medical conditions in the Mexican American residents. J Am Geriatr Soc 44:279–284, 1996.
Does Treatment of Asymptomatic Bacteriuria in Older Ambulatory Women Reduce Subsequent Symptoms of Urinary Tract Infection?
Authors: Abrutyn Elias , Berlin Jesse , Mossey Jana , Pitsakis Peter , Levison Matthew , Kaye Donald 
Published: April 2015

OBJECTIVE: To determine whether treatment of asymptomatic bacteriuria in older ambulatory women affects the subsequent development of symptoms of urinary tract infection.DESIGN: A controlled clinical trial.PARTICIPANTS: Older women not having urinary catheters.MEASUREMENTS: Urine cultures every 6 months (the same organism at 105 colony‐forming units or more per mL on two midstream urine specimens defined asymptomatic bacteriuria) and questionnaire surveys for the new development of symptoms of urinary tract infection (dysuria, frequency, urgency, low back pain with fever) 1, 3, and 6 months after the initial survey.RESULTS: Of the 23 initally culture‐positive participants receiving antibiotic treatment for asymptomatic bacteriuria, nine were culture positive at 6 months, which contrasts with 18 of 27 who received no treatment or placebo, P = .05. However, symptoms of urinary tract infection were more common in the antibiotic‐treated group.CONCLUSION: Antibiotic therapy effectively reduced the subsequent occurrence of positive urine cultures, but symptoms were not reduced. Based on this study of morbidity, previous studies failing to show any relation to mortality, and the cost and complications of antibiotic therapy in the older population, treatment of asymptomatic bacteriuria in older women is contraindicated. J Am Geriatr Soc 44:293–295, 1996.