bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rehospitalization Rates in Older Depressed Adults After Antidepressant and Electroconvulsive Therapy Treatment
Authors: Stoudemire Alan , Hill Connie D. , Dalton Sandra T. , Marquardt Martha G. 
Published: April 2015

OBJECTIVE: To determine (1) if a “high risk” period for rehospitalization can be identified in a population of depressed older adults and (2) if age of onset and previous history of depression is associated with an increased risk of rehospitalization.DESIGN: Naturalistic, longitudinal treatment outcome study.SETTING: Medical‐psychiatry unit and outpatient clinic at a university hospital.PATIENTS: Ninety‐four older adults diagnosed with major depression based on SCID and DSM‐III‐R criteria who were hospitalized for treatment.INTERVENTIONS: All patients were initially hospitalized on a medical‐psychiatry unit and treated with either antide‐pressants or electroconvulsive therapy.MEASUREMENTS: Patients were initially evaluated with the Structured Clinical Interview for DSM‐III‐R (SCID), the Hamilton Depression Rating Scale, and a battery of neuro‐psychological and behavioral tests. Patients were followed over time with an average follow‐up interval of 3.09 + 1.45 years, and the date of the first psychiatric rehospitalization (if any) was recorded.RESULTS: Approximately 43.6 percent of the total sample required at least one psychiatric rehospitalization. The greatest risk of rehospitalization occurred in the first 18 months. No significant differences were noted between patient groups treated with ECT and those treated with antidepressants or between patients with a younger and those with an older age of onset of depressive disorder. A statistical trend was observed in which patients without previous episodes of depression had a lower overall rate of rehospitalization compared with patients with one or more previous episodes of depression.CONCLUSIONS: There appears to be a relatively high risk of psychiatric rehospitalization in depressed older adults, particularly in the first 18 months. This rate of rehospitalization underscores the importance of providing maintenance therapy and intensive psychiatric supervision for a minimum of 18 months to 2 years during the course of a depressive episode requiring inpatient hospitalization.
Medical Conditions and Motor Vehicle Collision Injuries in Older Adults
Authors: Koepsell Thomas D. , Wolf Marsha E. , McCloskey Lon , Buchner David M. , Louie Douglas , Wagner Edward H. , Thompson Robert S. 
Published: April 2015

OBJECTIVETo determine whether medical conditions that can impair sensory, cognitive, or motor function increase the risk of injury due to motor vehicle collision in older drivers.DESIGNCase‐control study.SETTINGGroup Health Cooperative of Puget Sound, a large prepaid health plan.PARTICIPANTSGroup Health members age 65 or older who were licensed drivers in 5 counties. Cases were injured while driving during 1987 or 1988. Controls were matched to cases on age, gender, and county of residence but experienced no such injury during the study years.MEASUREMENTSThe outcome was injury requiring medical care due to a police‐investigated motor vehicle collision. Risk factors evaluated included selected medical conditions active within the previous 3 years, as determined from the medical record.MAIN RESULTSInjury risk was 2.6‐fold higher in older diabetic drivers (95% CI: 1.4–4.7), especially those treated with insulin (odds ratio [OR] = 5.8, 95% CI: 1.2–28.7) or oral hypoglycemic agents (OR = 3.1, 95% CI: 0.9–11.0), those with diabetes for over 5 years (OR = 3.9, 95% CI: 1.7–8.7), and those with both diabetes and coronary heart disease (OR = 8.0, 95% CI: 1.7–37.7). Increases were also found for older drivers with coronary artery disease (OR = 1.4), depression (OR = 1.7), alcohol abuse (OR = 2.1), or falls (OR = 1.4), but these associations could easily have arisen by chance.CONCLUSIONSCounseling about driving risks may be warranted for certain elderly diabetic drivers. Further research is needed to determine whether transient hypoglycemia or long‐term complications explain these effects.
Test‐Retest Reliability of a Questionnaire That Identifies Elders at Risk for Hospital Admission
Authors: Boult Lisa , Boult Chad , Pirie Phyllis , Pacala James T. 
Published: April 2015

OBJECTIVE: To determine the test‐retest reliability of a questionnaire designed to measure elderly persons' probability of repeated admission (Pra) to a hospital within 4 years.DESIGN: Participants received the test questionnaire by mail; respondents to the test questionnaire received the retest questionnaire 3 weeks later.PARTICIPANTS: Elderly (65+) community‐dwelling enrollees in the Medical Assistance (Medicaid) program of Ramsey County, MN (n = 192).MAIN OUTCOME MEASURE: The correlation (r) between the Pra values computed from the test‐retest correlations (k) of the questionnaire's individual items were also measured.RESULTS: The response rate was 63% (121/192) for the test questionnaire and 69% (84/121) for the retest questionnaire. The test and retest values of Pra computed from responses to the questionnaires were highly correlated (r = 0.78, P < 0.0001). For the individual questionnaire items, the range of k values was 0.50–1.00 (P < 0.0001 for all items). Slightly higher values of r and k were obtained when the respondents were women and when the same person (either proxy or self) completed both questionnaires. Age was not consistently related to reliability.CONCLUSION: the test‐retest reliability of individual items and of the computed Pra was high, suggesting that responses by elderly persons to mailed questionnaires pertaining to health status are stable over brief periods of time. The resulting Pra values may be useful in identifying elders at high risk for hospital admission.
Age and Functional Correlations of Markers of Coagulation and Inflammation in the Elderly: Functional Implications of Elevated Crosslinked Fibrin Degradation Products (D‐dimers)
Authors: Currie Mark S. , Rao K. Murali Krishna , Blazer Dan G. , Cohen Harvey J. 
Published: April 2015

OBJECTIVE: To measure markers of inflammation in a cohort of young and old subjects and relate these findings to the functional level of the individuals.DESIGN: For the pilot study, blood samples were obtained from 18 young (age 20–35 years) and 18 old (age 68–83 years) subjects. The main study population included community‐dwelling subjects between the ages of 70 and 79. The group consisted of 282 subjects with minimal physical limitations, 17 subjects from the middle third, and 16 from the lower third of physical function rankings.METHODS: Plasma markers were measured by ELISA techniques, and certain biochemical values were obtained through routine clinical tests performed by a commercial laboratory.RESULTS: D‐Dimers were higher for physically impaired subjects in all groups, but most prominently among black females, who also had significantly higher D‐Dimer levels in every functional group. To inquire whether higher D‐Dimers were associated with markers of inflammation, we also examined the macrophage metabolite, neopterin, the neutrophil product, elastase complexed to antitrypsin (E/a), and the albumin globulin ratio (A/G ratio). No differences were found in neopterin or E/a levels on the basis of gender, race, or functional status. The A/G ratio was significantly lower in functionally impaired subjects.CONCLUSION: These preliminary findings demonstrate racial/ethnic and gender differences in D‐Dimers in a population of community‐dwelling elderly, and suggest that factors influencing hemostasis may be particularly relevant to physical functional status in black women. A sample containing more subjects with lower physical function will be needed to establish the relationship between inflammation, altered hemostasis, and physical function decline.
Physician Staffing Patterns Correlates of Nursing Home Care: An Initial Inquiry and Consideration of Policy Implications
Authors: Karuza Jurgis , Katz Paul R. 
Published: April 2015

BACKGROUND: To determine, post‐OBRA 1987, medical organization in nursing facilities (ie, medical director and staff profile, closing of medical staff, use of physician contract); structural correlates of medical organization; and links between medical organization, especially closed staffing, and medical care.METHOD: Mail survey of New York state nursing facility administrators (63% response). Survey consisted of open and closed end items that focused on facility and staff demographics, medical organization, and markers of medical care delivery, ie, physicians' daily presence, average response time to emergency calls, cross coverage for acute conditions and emergencies, attendance at care conferences, and offering of in‐services.RESULTS: On average, facilities had 8.6 attending physicians, 32 residents per physician, 70% of residents cared for by non‐staff physicians, no daily physician presence (60%), and no cross coverage. Most medical directors were from family (42%) or internal (55%) medicine, had a tenure of 7.5 years, did not have a certificate of added qualification in geriatrics (73%), and attended residents (66%). Forty‐three percent of facilities had closed medical staffs, and 12% had physician contracts. Closed staffs were more likely in facilities that were larger, had more Medicaid residents, used physician extenders, and had more residents per nurse. Facilities with closed medical staffs had fewer physicians, more residents per physician, reported medical care practice patterns that would be associated with quality of care. These effects were independent of nursing and facility characteristics. Physician contract was unrelated to care.CONCLUSIONS: Medical organization and practice patterns emerge as important factors in considerations of nursing home quality. Results argue that, as in acute settings, limiting practice privileges in nursing homes may be a useful organizational strategy to improve quality of care.
The Evolution of Nursing Homes Into Comprehensive Geriatrics Centers: A Perspective
Authors: Burton John R. 
Published: April 2015

Nursing homes typically have been a relatively isolated component of health care in the United States. Now, however, nursing homes are experiencing a change in the patients they serve. In recent years, nursing home patients have been admitted sicker and after a shorter hospital stay than in the past. Such changes are likely to continue to occur as the size of the population of frail elderly continues to increase and as insurers look for alternatives to high cost hospital care. An additional stimulus to change is that the public is asking for innovation in noninstitutionalized long‐term care.This essay advocates that nursing homes are the ideal component of the health care system to lead innovative program development focused on the creation of a highly organized continuum of care for the frail elderly. Physicians must be a fundamental part of this process, providing the guidance and leadership necessary for nursing homes to evolve into comprehensive geriatrics centers. Strategies are provided for developing physician office practices in nursing homes, a fundamental first step in the process of change. Additionally, ideas are provided for developing day care centers and physician house call programs based in nursing homes. Also, tight and highly functional relationships among nursing homes and acute hospitals must be developed. The example of the Johns Hopkins Geriatrics Center is described briefly as one such program now in place.As nursing homes evolve into comprehensive geriatrics centers and provide a full continuum of health care programs, they will serve the needs of the elderly much more effectively than is now possible.
Age and the Renal Blood Supply: Renal Vascular Responses to Angiotensin Converting Enzyme Inhibition in Healthy Humans
Authors: Hollenberg Norman K. , Moore Thomas J. 
Published: April 2015

OBJECTIVE: To assess the relation between age, sodium intake, renal blood flow (RBF) and the renal vascular response to an angiotensin converting enzyme (ACE) inhibitor, captopril.DESIGN: Blood flow studies were performed before and during the acute response to an oral 25‐mg dose of captopril, selected to induce a maximal response, after 5 to 7 days on a metabolic ward, sufficient time to have achieved external balance on a fixed low‐salt (10 mEq/day) or high salt (200 mEq/day) diet. Blood flow was measured as radioxenon transit through the kidney.SETTING: The study was performed on a metabolic ward, the Clinical Research Center, and in the Cardiovascular Radiology Laboratories of the Brigham and Women's Hospital in Boston.PARTICIPANTS: The participants, all community dwellers, were potential kidney donors, in a renal transplant program. They were thought to be sufficiently healthy to consider donation of a kidney. The age range was 18 to 69 years.RESULTS: Renal blood flow showed the anticipated decline with increasing age, whether the subjects were on a restricted or a liberal salt intake. Captopril induced an acute increase in RBF, averaging 88 ± 7 mL/100 g/min in subjects on a low‐salt diet, and 49 ± 9 mL/100 g/min in subjects on a high‐salt diet, but no influence of age was identified on the renal vasodilator response on either diet. Increasing age did not limit the renal vasodilator response, although subjects beyond the sixth decade were not studied.CONCLUSIONS: The limited renal vascular response to vasodilators we had documented in earlier studies does not extend to ACE inhibitors. Although ACE inhibitors lack the pharmacological specificity required to prove a role for angiotensin II (Ang II), the data are compatible with a contribution of Ang II to the maintenance of renal vascular tone that does not change with increasing age, at least to 70 years of age.
Delirium in Hospitalized Older Persons: Outcomes and Predictors
Authors: Pompei Peter , Foreman Marquis , Rudberg Mark A. , Inouye Sharon K. , Braund Victoria , Cassel Christine K. 
Published: April 2015

OBJECTIVE: The purpose of this study was fourfold: to determine the rate of delirium among hospitalized older persons, to contrast the clinical outcomes of patients with and without delirium, to identify clinical predictors of delirium, and to validate the predictive model in an independent sample of patients.DESIGN: Two prospective cohort studiesSETTING: Medical and surgical wards of 2 university teaching hospitalsPATIENTS: In the derivation cohort, 432 patients were enrolled from the University of Chicago Hospitals. Patients 65 years of age or older admitted to 1 of 4 wards were eligible. Subjects were excluded if they were discharged within 48 hours of admission, unavailable to the research assistants during the first 2 days of hospitalization, or judged too impaired to participate in the daily interviews. In the test cohort, 323 patients 70 years of age or older admitted to Yale‐New Haven Hospital were studied.MEASUREMENTS: Subjects were screened for delirium daily and referred to experienced clinician investigators if acute mental status changes were observed. The clinician investigators assessed the patient for delirium based on DSM‐III‐R criteria. Duration of hospitalization was adjusted for diagnosis‐related groups (DRG) and mortality rates were determined at discharge and 90 days after discharge. Socio‐demographic characteristics, cognitive and functional status, comorbidity, depression, and alcoholism were examined as predictors of delirium.MAIN RESULTS: The rate of delirium in the derivation cohort was 15%; subjects with delirium had longer hospital stays and an increased risk of in‐hospital death. Cognitive impairment, burden of comorbidity, depression, and alcoholism were found to be independent predictors of delirium. The ability of the model to stratify patients as low, moderate, or high risk for developing delirium was validated in the test cohort in which the rate of delirium was 26%.CONCLUSIONS: This study confirms the high rate of delirium among hospitalized older persons and the associated adverse outcomes of prolonged hospital stays and increased risk of death. Patients can be stratified according to their risk for developing delirium using relatively few clinical characteristics which should be assessed, on all hospitalized older persons.
Functional Status and Mobility Among Elderly Women with Lower Extremity Arterial Disease: The Study of Osteoporotic Fractures
Authors: Vogt Molly T. , Cauley Jane A. , Kuller Lewis H. , Nevitt Michael C. 
Published: April 2015

OBJECTIVE: To investigate the relationship between lower extremity arterial disease, functional status, and mobility among elderly women.DESIGN: Cross‐sectional study.SETTING: Community.PARTICIPANTS: 1492 healthy white women, 65 years of age or older, residing in a rural community, able to walk without the assistance of another person, and enrolled in the Pittsburgh clinic of the multicenter Study of Osteoporotic Fractures. Those with bilateral hip replacement were excluded.MEASUREMENTS: Ankle/arm index (AAI); instrumental activities of daily living (IADLs); measures of recent physical activity, muscle strength, gait and balance; general demographic, lifestyle, and physical variables.RESULTS: Women with lower extremity arterial disease (defined as an AAI of 0.9 or less) were more likely to report difficulty with one or more IADLs than were women free of this disease. After adjusting for age and other potential confounders, only difficulty with walking 2–3 blocks remained highly correlated with disease (relative risk (RR) 2.8, 95% confidence interval (CI) 1.6, 4.8). Several measures of physical activity were inversely and independently related to a low AAI. Muscle strength in the hip, arm, knee, and hand and measures of static and dynamic balance were correlated with low AAI in the univariate analysis, but most of these trends were not statistically significant after adjustment for age and other confounders. Exclusion of women with symptomatic arterial disease did not substantially affect the results obtained.CONCLUSION: Women with mild, predominantly subclinical, lower extremity arterial disease living in the community have decreased functional status and mobility.
Constipation: Assessment and Management in an Institutionalized Elderly Population
Authors: Harari Danielle , Gurwitz Jerry H. , Avorn Jerry , Choodnovskiy Igor , Minaker Kenneth L. 
Published: April 2015

OBJECTIVES: To examine prescribing and utilization patterns of laxatives, stool softeners, and enemas in a large, long‐term care facility, to compare self‐reports of constipation with specific, bowel‐related symptoms in residents of this facility, and to examine concordance between bowel symptoms reported by residents and the assessments of the nursing staff.DESIGN: Cross‐sectional study.SETTING AND SUBJECTS: All individuals residing in an academically oriented long‐term care facility in the United States for at least 1 month (n = 694).MEASUREMENTS: Clinical, functional, and medication data were abstracted from the medical and nursing records. Individual interviews regarding bowel‐related symptoms were conducted with all able participants (n = 456 (66%)) and their respective primary nurses, and concordance was determined. The study definition of symptom‐specific constipation was no more than 2 bowel movements per week and/or straining on more than 1 in 4 bowel movements.RESULTS: Fifty percent (n = 367) of all residents used at least 1 daily laxative, stool softener or enema during a 1‐month study period. Over half of all laxative users (n = 200) took more than 60 doses per month. Stool softeners were most commonly prescribed, followed by saline laxatives, stimulant laxatives, hyperosmolar laxatives, and bulk laxatives. Forty‐seven percent (n = 213) of the 456 interview responders reported constipation (“self‐reporters”), but only 62% of self‐reporters met the study criteria for symptom‐specific constipation. Concordance between resident's and nurse's report regarding specific bowel symptoms was only fair to slight (kappa 0.12–0.38). Self‐reporters of constipation took almost twice as many laxatives, stool softeners, and enemas as residents who did not report constipation.CONCLUSION: Our findings emphasize the need for a more systematic approach to the assessment of constipation in the long‐term care setting, particularly when pharmacologic treatment is being considered.
Falls Among Nursing Home Residents: An Examination of Incident Reports Before and After Restraint Reduction Programs
Authors: Ejaz Farida K. , Jones James A. , Rose Miriam S. 
Published: April 2015

OBJECTIVE: To examine changes in the rate of falling of an experimental group of restrained subjects who underwent restraint reduction, and to compare their rate of falling with a group of subjects who did not have restraint orders during the study period.DESIGN: A quasi‐experimental, multiple time‐series study utilizing the principles of single‐subject design. Each subject was followed for 25 weeks before and 25 weeks after initiation of the intervention.SETTING: Seven nursing homes.INTERVENTION: Formal programs aimed at reducing all bed and chair restraints were initiated in all sites after staff received education and training. Multidisciplinary teams implemented the restraint reduction process on a case‐by‐case basis, beginning with 1 unit/floor at a time in each site. Most experimental subjects reached their optimum restraint‐elimination/reduced status within 2 weeks of intervention initiation. The implementation periods ranged from 4 months to more than a year.PARTICIPANTS: Subjects with chart orders for restraints at the start of the study comprised the experimental group and participated in the restraint reduction program (184 subjects). Subjects with no orders for restraints during the study period comprised the nonequivalent control group (111 subjects) and, therefore, did not undergo the intervention.MEASUREMENTS: Incident reports documenting all falls during the study period were examined. Falls, the dependent variable, were classified as serious or nonserious. The independent variable (intervention) was the restraint reduction program offered to experimental subjects. Based on the principles of single subject design, the impact of the intervention on falls was calculated before and after the date the restraint reduction process was initiated for an individual (experimental group) subject. For the control group, the pre‐ and posttest period was calculated from the start date of the restraint reduction program on the unit on which each subject resided.RESULTS: Serious falls did not increase, but nonserious falls increased significantly after restraints were removed or reduced in experimental subjects. The total mean weekly fall rate for this group increased from 1.87% of residents falling per week during preintervention to 3.01% during postintervention. The mean weekly fall rate of the control group was 3.18% at pretest and did not change statistically over time.CONCLUSIONS: The increase in nonserious falls among the experimental group may be attributed to restraint reduction. The mean weekly fall rate in the experimental group postintervention (25 weeks) became comparable to the mean weekly fall rate for the control group during the entire study period (50 weeks). In light of such findings, policy makers have to confront the ethical choice between tying some frail, elderly subjects to beds and chairs versus exposing them to the risks of freedom in their old age.