bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vaginal Estrogen Creams: Use Patterns Among a Cohort of Women
Authors: Keenan Nora L. , Franks Adele L. , Croft Janet B. , Scholes Delia , Murray E. Taylor 
Published: April 2015

OBJECTIVE: To assess the prevalence, amount, and duration of use of vaginal estrogen cream among several birth cohorts of women from 1983 through 1992.DESIGN: Analyses are based on automated membership, pharmacy, and hospital discharge databases from Group Health Cooperative (GHC) of Puget Sound, a large health maintenance organization in Seattle, Washington.PARTICIPANTS: A total of 33,822 women, aged 45 years and older as of December 31, 1983, who were enrolled in GHC from 1983 to 1992 or who were enrolled at baseline and died in the following decade.RESULTS: About 24% of the cohort had filled at least one prescription for vaginal estrogen cream during 1983 through 1992, and about 60% of the users had more than one prescription filled. The annual birth cohort‐specific prevalence of having filled one or more prescriptions for vaginal estrogen creams ranged between 1.6 and 8.2% across birth cohorts, whereas the average annual prevalence for the cohort was between 5.3 and 6.8%. The total amount, duration of use, and proportion of total estrogen exposure from creams increased with age of the birth cohort. Among the 733 women with intact uteri who were long‐term cream users, 60.4% had no progestin prescriptions while averaging 22.1 tubes of estrogen cream.CONCLUSION: The prescription‐filling patterns for estrogen in this cohort show an increase in the amount, years of use, and proportion of estrogen exposure from creams with the age of the birth cohort and extensive unopposed cream use among a small proportion of women with intact uteri. The systemic effects of vaginal estrogen cream among older postmenopausal women with urogenital atrophy deserve closer scrutiny.
Effects of Long‐Acting Versus Short‐Acting Calcium Channel Blockers Among Older Survivors of Acute Myocardial Infarction
Authors: Gillman Matthew W. , Ross‐Degnan Dennis , McLaughlin Thomas J. , Gao Xiaoming , Spiegelman Donna , Hertzmark Ellen , Goldman Lee , Soumerai Stephen B. 
Published: April 2015

OBJECTIVE: Recent studies have highlighted the potentially harmful effects of short‐acting calcium channel blockers, especially of the dihydropyridine type, in patients with coronary heart disease. Some have argued that long‐acting calcium channel blockers are safer, but few outcome data exist. The objective of the study was to compare the occurrence of adverse outcomes among recipients of long‐acting versus short‐acting calcium channel blockers, with dihydropyridines and non‐dihydropyridines compared separately.SETTING: The New Jersey Medicare population.DESIGN: A retrospective cohort study using linked Medicare and drug claims data.PARTICIPANTS: Older survivors of acute myocardial infarction (MI) occurring in 1989 and 1990. Eligible subjects had survived at least 30 days after the MI, participated in Medicare and a drug benefits program, and were prescribed a single type of either a long‐acting or a short‐acting calcium channel blocker within 90 days after the MI.MEASUREMENTS: The two outcome measures were rates of all‐cause mortality and cardiac rehospitalization. Using separate Cox regression models for dihydropyridines (nifedipine, nicardipine) and non‐dihydropyridines (diltiazem, verapamil), we examined these outcomes for recipients of long‐acting compared with short‐acting calcium channel blockers.RESULTS: Of the 833 patients eligible for the study, 160 were prescribed long‐acting and 673 short‐acting calcium channel blockers. Clinical characteristics of long‐acting and short‐acting users were comparable. During 2 years of follow‐up, 221 deaths and 300 rehospitalizations occurred. Controlling for age, sex, race, and indicators of disease severity and comorbidity, the relative risk of dying for recipients of long‐acting, compared with short‐acting, dihydropyridines was .42 (95% confidence interval (CI), 0.21‐0.86). For cardiac rehospitalization, the relative risk was 0.57 (95% CI, 0.34‐0.94). For the long‐acting versus short‐acting non‐dihydropyridines, the adjusted relative risk of dying was 1.43 (95% CI, 0.88‐2.32), and for cardiac rehospitalization, .65 (95% CI, 0.40‐1.05).CONCLUSION: Use of long‐acting dihydropyridine calcium channel blockers after acute MI was associated with substantially lower rates of cardiac rehospitalization and death compared with use of their short‐acting counterparts. More data are needed to address the possibility that long‐acting, compared with short‐acting, non‐dihydropyridines could decrease rehospitalization rates but increase mortality. J Am Geriatr Soc 47:512–517, 1999.
An Analysis of Falls in the Hospital: Can We Do Without Bedrails?
Authors: Hanger H.C. , Ball M.C. , Wood L.A. 
Published: April 2015

OBJECTIVES: To determine the effects of introduction of a bedrail policy, and an educational program, on patient falls and fall‐related injuries.DESIGN: A prospective “Before and After” design.PARTICIPANTS AND SETTING: All patients admitted during 1 calendar year in an assessment, treatment, and rehabilitation unit for older people.INTERVENTION: A policy change for the use of bedrails (restricting their use) and an educational program about their effects.MEASUREMENTS: Patient fall rates ‐ all falls and around the bed falls — and patient and staff injuries.RESULTS: There was a significant reduction in the number of beds with bedrails attached after the policy introduction (mean of 40/135 vs 18.5/135, respectively, P = .02), but the fall rate (either total or around the bed) did not change significantly. Serious injuries were significantly less common after the bedrail policy was introduced (P = .008), with fewer head injuries.CONCLUSIONS: Reducing the use of bedrails did not alter patient fall rates significantly, but it was associated with a reduction in serious injuries. Unless it can be shown that bedrails are beneficial, their continued use in older patients must be seriously questioned. J Am Geriatr Soc 47:529–531, 1999.
Drug Treatment of Hypertension in Older Persons in an Academic Hospital‐Based Geriatrics Practice
Authors: Mendelson Gad , Ness Jose , Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To investigate the prevalence of hypertension in older persons, the prevalence of the different antihypertensive drugs used to treat hypertension, the prevalence of the different antihypertensive drugs used to treat hypertension in persons with prior myocardial infarction (MI) or congestive heart failure (CHF), and the prevalence of lowering the blood pressure to < 140/90 mm Hg with therapy.DESIGN: A retrospective analysis of charts from all older patients seen from December 1, 1997, through August 31, 1998, at an academic, hospital‐based geriatrics practice was performed to investigate the prevalence of hypertension in older persons, the prevalence of different antihypertensive drugs used to treat hypertension, the prevalence of different antihypertensive drugs used to treat hypertension in persons with prior MI or CHF, and the prevalence of lowering the blood pressure to < 140/90 mm Hg with therapy.SETTING: An academic hospital‐based geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.PATIENTS: A total of 459 men and 1360 women, mean age 80 ± 8 years (range 59 to 101 years), were included in the study.MEASUREMENTS AND MAIN RESULTS: Hypertension was present in 1051 of the 1819 persons in the study (58%). Target organ damage, clinical cardiovascular disease, or diabetes mellitus was present in 738 (70%) of these 1051 persons. Of the 1051 persons with hypertension, 520 (49%) were treated with diuretics, 297 (28%) with beta‐blockers, 445 (42%) with angiotensin‐converting enzyme (ACE) inhibitors, 171 (16%) with calcium channel blockers, and 13 (1%) with other antihypertensive drugs; 41 (4%) received no antihypertensive therapy. The last blood pressure recorded on the chart was <140/90 mm Hg for 735 of the 1051 persons (70%) with hypertension. Of 306 persons with hypertension and prior MI, 182 (59%) were treated with beta‐blockers, 146 (48%) with ACE inhibitors, 96 (31%) with diuretics, and 29 (9%) with calcium channel blockers. Of 103 persons with hypertension and CHF, 103 (100%) were treated with diuretics, 94 (91%) with ACE inhibitors, 22 (21%) with beta‐blockers, and 3 (3%) with calcium channel blockers.CONCLUSIONS: The prevalence of hypertension in the 1819 older persons seen in an academic, hospital‐based geriatrics practice was 58%. Educational efforts led to increased use of diuretics and beta‐blockers and decreased use of calcium channel blockers in treating hypertension. The last blood pressure recorded on the chart was <140/90 mm Hg in 70% of older persons with hypertension in the study. J Am Geriatr Soc 47:597–599, 1999.
The Effect of Major Depression on Functional Status in Patients with Coronary Artery Disease
Authors: Steffens David C. , O'Connor Christopher M. , Jiang Wei Jan , Pieper Carl F. , Kuchibhatla Maragatha N. , Arias Rebekka M. , Look Adair , Davenport Chad , Gonzalez Michael B. , Krishnan K. Ranga Rama 
Published: April 2015

OBJECTIVE: To examine the effect of major depression on reported functional status in a group of patients with coronary artery disease (CAD).SETTING: An inpatient cardiology service.PARTICIPANTS: Three hundred thirty‐five inpatients with coronary artery disease who were free of dementia, Parkinson's disease, and other primary neurological illnesses.MEASUREMENTS: Duke Depression Evaluation Schedule, a structured psychiatric interview which included the Diagnostic Interview Schedule depression subscale, the Cumulative Illness Rating Scale, and two scales for measuring instrumental and self‐maintenance activities of daily living.RESULTS: Twenty‐seven subjects met DSM‐IV criteria for major depression. Compared with subjects without major depression, depressed subjects were more than twice as likely to report a self‐maintenance ADL deficit and were significantly more likely to report an IADL deficit than were non‐depressed subjects (93 vs 71%). In regression models, female gender, older age, greater medical illness severity, and presence of major depression were significant predictors of self‐maintenance ADL disability; and female gender, older age, greater medical severity, and presence of major depression significantly predicted greater IADL impairment.CONCLUSION: The presence of major depression was associated with functional disability in patients with CAD. Further research is needed to clarify whether antidepressant treatment significantly impacts both affective symptoms and functional status in patients with coronary heart disease.
Influence of Companion Animals on the Physical and Psychological Health of Older People: An Analysis of a One‐Year Longitudinal Study
Authors: Raina Parminder , Waltner‐Toews David , Bonnett Brenda , Woodward Christel , Abernathy Tom 
Published: April 2015

OBJECTIVE: To examine whether companion animals or attachment to a companion animal was associated with changes in physical and psychological health in older people and whether the relationships between physical and psychological health and human social networks were modified by the presence or absence of a companion animal.DESIGN: A 1‐year longitudinal study with standardized telephone interview data collected at baseline and repeated at 1‐yearSETTING: Wellington County, Ontario, CanadaPARTICIPANTS: An age‐ and sex stratified random sample (baseline n = 1054; follow‐up n = 995) of noninstitutionalized adults aged 65 and older (mean age = 73, SD ± 6.3)MEASUREMENTS: Social Network Activity was measured using a family and non‐family social support scale, participation in an organized social group, involvement in the affairs of the social group, the practice of confiding in others, feelings of loneliness, and the perceived presence of support in a crisis situation. Chronic conditions were measured as the current number of selected health problems. Pet ownership was assessed by the report of owning a dog or a cat and the Lexington Attachment to Pets Scale score. Physical health was assessed as the ability to perform Activities of Daily Living (ADLs). Psychological health was measured as a summed score comprising the level of satisfaction regarding one's health, family and friend relationships, job, finances, life in general, overall happiness, and perceived mental health. Sociodemographic variables assessed include subject age, sex, marital status, living arrangements, education, household income, and major life events.RESULTS: Pet owners were younger, currently married or living with someone, and more physically active than non‐pet owners. The ADL level of respondents who did not currently own pets deteriorated more on average (β = −.270, P = .040) than that of respondents who currently owned pets after adjusting for other variables during the 1‐year period. No statistically significant direct association was observed between pet ownership and change in psychological well‐being (P > .100). However, pet ownership significantly modified the relationship between social support and the change in psychological well‐being (P = .001) over a 1‐year period.CONCLUSIONS: The results demonstrate the benefits of pet ownership in maintaining or slightly enhancing ADL levels of older people. However, a more complex relationship was observed between pet ownership and an older person's well‐being.
Predictors of Continued Physical Restraint Use in Nursing Home Residents Following Restraint Reduction Efforts
Authors: Sullivan‐Marx Eileen M. , Strumpf Neville E. , Evans Lois K. , Baumgarten Mona , Maislin Greg 
Published: April 2015

OBJECTIVES: To examine predictors of continued restraint use in nursing home residents following efforts aimed at restraint reduction.DESIGN: Secondary analysis of data from a clinical trial using a one‐group, pre‐test post‐test design.SETTING: Three nonprofit, religion‐affiliated nursing homes in a metropolitan area.PARTICIPANTS: The sample consisted of 201 physically restrained nursing home residents. Following restraint reduction efforts, 135 of the sample were still restrained. Mean age of participants was 83.9 years.MEASUREMENTS: Physical restraint use was measured by observation and included any chest/vest, wrist, mitt, belt, crotch, suit, or harness restraint plus any sheet used as restraint or a geriatric chair with fixed tray table. Nursing home residents were subjected to any one of three conditions aimed at restraint reduction, including adherence to the mandate of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87), staff education, and education with consultation from a gerontological clinical nurse specialist. Resident characteristics including dependency, health status, mental status, depression, behavior, fall risk; presence of treatment devices and institutional factors were determined.RESULTS: Physical dependency, lower cognitive status, behavior, presence of treatment devices, presence of psychiatric disorders, fall risk, and fall risk as staff rationale for restraint were associated (P < .10) with continued restraint use. Nursing hours, staff mix, prevalence of restraint use by unit, and site were also associated (P < .10) with continued use of physical restraints. Following bivariate analysis, associated resident characteristics were subjected to logistic regression. Lower cognitive status (OR = 2.4 (for every 7‐point decrease in MMSE), 95% CI, 1.7, 3.3) and fall risk as staff rationale for restraint (OR = 3.5, 95% CI., 1.5, 8.0) were predictive of continued restraint use. Adding nursing hours, staff mix, and prevalence of restraint use by unit to the logistic regression model was not statistically significant (partial chi‐square = 2.79, df = 6, P = .834). Nursing home site was added to the model without changing the significance (P < .05) of cognitive status or fall risk as a staff rationale for restraint use.CONCLUSION: Continued restraint use in nursing home residents in this study most often occurred with severe cognitive impairment and/or when fall risk was considered by staff as a rationale for restraint. Efforts to reduce or eliminate physical restraint use with these groups will require greater efforts to educate staff in the assessment and analysis of fall risk, along with targeted interventions, particularly when cognition is also impaired.
The Relation Between Cortisol Excretion and Fractures in Healthy Older People: Results from the MacArthur Studies ‐ Mac
Authors: Greendale Gail A. , Unger Jennifer B. , Rowe John W. , Seeman Teresa E. 
Published: April 2015

BACKGROUND: In persons with depression, higher urinary Cortisol is associated with lower bone mineral density.OBJECTIVE: To examine the relation between urinary free Cortisol (UFC) and fractures.SETTING: Community‐based samples from Durham, NC, East Boston, MA, and New Haven, CT. PARTICIPANTS: 684 men and women, aged 70 to 79 at baseline, who were part of the MacArthur Study of Successful Aging.DESIGN: Cohort study. Participants with previous history of fractures at baseline were excluded.MEASURES: The primary exposure variable was overnight (8: 00 p.m. to 8: 00 a.m.) UFC (μg/g creatinine) at baseline (1988). Outcomes were self‐reported hip, arm, spine, wrist, or other fracture during the follow‐up period (1988–1995). Covariates were baseline age, gender, race, body mass index, current physical activity, lower extremity strength, depression subscale of the Hopkins Symptom Checklist, and current use of cigarettes and alcohol.ANALYSIS: Logistic regression was used to predict the occurrence of incident fractures (1988–1995) as a function of quartiles of baseline UFC. Models were adjusted for age, gender, and race and were also multiply adjusted for the remaining covariates listed above. Gender‐stratified models and models that excluded corticosteroid users were also run. RESULTS: In multiply adjusted models, higher baseline levels of UFC were significantly associated with incident fractures. Odds of fracture (95% Confidence Intervals) for increasing quartiles of baseline UFC, multiply adjusted, were: 2.28 (.91, 5.77); 3.40 (1.33, 8.69); 5.38 (1.68, 17.21). Results were not materially influenced by exclusion of persons using corticosteroids.CONCLUSIONS: Higher baseline UFC is an independent predictor of future fracture.
Psychotropic Medication Withdrawal and a Home‐Based Exercise Program to Prevent Falls: A Randomized, Controlled Trial
Authors: Campbell A. John , Robertson M. Clare , Gardner Melinda M. , Norton Robyn N. , Buchner David M. 
Published: April 2015

OBJECTIVE: To assess the effectiveness of psychotropic medication withdrawal and a home‐based exercise program in reducing falls in older people.DESIGN: A randomized controlled trial with a two by two factorial design.SETTING: Seventeen general practices in Dunedin, New Zealand.PARTICIPANTS: Women and men aged 65 years registered with a general practitioner and currently taking psychotropic medication (n = 93).INTERVENTIONS: Two interventions: (1) gradual withdrawal of psychotropic medication versus continuing to take psychotropic medication (double blind) and (2) a home‐ based exercise program versus no exercise program (single blind).MEASUREMENTS: Number of falls and falls risk during 44 weeks of follow‐up. Analysis was on an intent to treat basis. RESULTS: After 44 weeks, the relative hazard for falls in the medication withdrawal group compared with the group taking their original medication was. 34 (95% CI,. 16–74). The risk of falling for the exercise program group compared with those not receiving the exercise program was not significantly reduced.CONCLUSIONS: Withdrawal of psychotropic medication significantly reduced the risk of falling, but permanent withdrawal is very difficult to achieve.
Mortality One‐Year Postdischarge from a Veterans Affairs Geriatric Evaluation and Management Unit: Assessing Mortality Risks
Authors: Williams Arthur R. , Meuleman John M. , Shaw Mary M. Conlin 
Published: April 2015

OBJECTIVE: To assess at Geriatric Evaluation and Management Unit (GEM) admission factors that affect mortality 12‐months postdischarge and to develop a preliminary risk scoring protocol to guide targeting of GEM care.SETTING: A 24 bed‐GEM at a Veterans Affairs (VA) Medical Center.DESIGN: Relative risks (RR) were assessed using prospective data; a risk protocol from 1988–1989 data was tested on 1990–1991 patients.SUBJECTS: A total of 283 male patients, aged 60 to 102, discharged over 4 years.RESULTS: Age at GEM admission did not correlate with death (r =. 14; P =. 145), but did correlate with risk scores (r =. 33, P <. 001). The risk protocol had a sensitivity of. 67 and specificity of 1.00. High and low risk patients had mortalities of 51% versus 20%, a Wilcoxon (Gehan) statistic of 15.22, df = 1, and P <. 001. Differences in mortality ceased about 100 days postdischarge. Three univariate RR exceeded 1.00 at a 99% Confidence Interval (CI): IADL score (RR: 1.12; CI, 1.03–1.21); nursing acuity score (RR: 1.78; CI: 1.02–3.11); and a primary diagnosis of pneumonia/sepsis (RR: 3.95; CI, 1.60–9.78). Four RRs exceeded 1.00 at a 90% CI: dementia (RR: 1.78; CI, 1.02–3.09); transfer into the GEM from a medical service (RR: 1.47; CI, 1.02–2.12); deconditioning/functional decline (RR: 1.67; CI, 1.12–2.48); and use of a Foley catheter (RR: 2.22; CI, 1.11–4.45). Thirteen other potential risk factors were found in a multivariate analysis.CONCLUSIONS: The point estimates of risk factors may help clinicians target GEM care, but the development of a useable risk protocol requires additional work. Causal models may be needed to assess patient conditions related to successful treatment in GEMs.
Use of Physician and Acute Care Services by Persons With and Without Alzheimer's Disease: A Population‐Based Comparison
Authors: Leibson Cynthia , Owens Tomas , O'Brien Peter , Waring Steve , Tangalos Eric , Hanson Virginia , Plevak Matt , Kokmen Emre 
Published: April 2015

OBJECTIVE: To estimate differences in use of acute care services between persons with and without Alzheimer's disease (AD).SETTING/SUBJECTS: All Rochester, Minnesota, residents with AD onset between January 1, 1980, and December 31, 1984 (n = 301), plus one age‐ and sex‐matched nondemented control per case, were identified with a retrospective review of community‐based medical records.MEASUREMENTS: Cases and controls were followed in their medical records for number of acute care encounters in the year before January 1 of the index year (year of onset for AD case and their matched control) and in the 4 years following December 31 of the index year. Encounters included clinician visits (office or nursing home), emergency room (ER) visits, hospitalizations (inpatient and outpatient), and inpatient days. Multivariate regression analyses were adjusted for age, sex, pre‐index level of illness, and follow‐up time.RESULTS: In the pre‐index period, cases and controls were similar with respect to level of illness, number of office visits, ER visits, and hospitalizations. In the year before AD onset, 17 cases (7%) had a clinician visit in the nursing home compared with no controls. In the 4 years after the index year, mean length of follow‐up was 3.4 years for both cases and controls. The numbers of ER visits, hospitalizations, and inpatient days were similar for cases and controls. Sixty‐four percent of AD cases had a clinician visit in a nursing home versus 1 % of controls. Controls experienced more office visits than cases (median = 16 vs 10, P <. 001). CONCLUSIONS: The onset of AD is not associated with greater use of acute care services. However, neither is the high use of nursing home care offset by fewer ER or hospital encounters.