bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of Medications That Cause Cognitive Impairment in Older People: The Case of Oxybutynin Chloride
Authors: Katz Ira R. , Sands Laura Prouty , Bilker Warren , DiFilippo Suzanne , Boyce Alice , D'Angelo Kristina 
Published: April 2015

OBJECTIVES: To evaluate the cognitive effects of acute challenges with the antispasmodic agent oxybutynin hydrochloride in normal older volunteers and to compare these effects with those attributable to diphenhydramine, another commonly used medication with anticholinergic (muscarinicblocking) activity.DESIGN: A double‐blind, placebo‐controlled cross‐over study.SETTING: Laboratory evaluations of community subjects.PARTICIPANTS: A convenience sample of 12 volunteers, average age 69.17 years.INTERVENTION: Baseline assessment was followed by randomized administration of a placebo, oxybutynin hydrochloride (5 and 10 mg), and diphenhydramine hydrochloride (50 mg) in test sessions separated by 1 week.MEASUREMENTS: Evaluation of cognitive performance with a 1‐hour battery of pencil and paper, interviewer‐administered, and computer‐administered tests beginning 90 minutes after drug (or placebo) administration.RESULTS: Random regression analyses demonstrated that oxybutynin caused significant cognitive decrements on seven of 15 cognitive measures, and diphenhydramine caused decrements on five measures. The most sensitive measures for detecting the effects of oxybutynin hydrochloride were the Buschke Selective Reminding Test and Reaction Time.CONCLUSIONS: These findings demonstrate that oxybutynin can cause cognitive impairment and suggest that physicians prescribing it should monitor their patients to facilitate the early recognition of those who experience drug‐related cognitive deficits. More generally, the findings demonstrate that systematic research with normal volunteers can identify cognitive toxicity not recognized during the process of drug development or postmarketing surveillance.
Strength, Physical Activity, and Body Mass Index: Relationship to Performance‐Based Measures and Activities of Daily Living Among Older Japanese Women in Hawaii
Authors: Davis James W. , Ross Philip D. , Preston Steven D. , Nevitt Michael C. , Wasnich Richard D. 
Published: April 2015

OBJECTIVES: Remaining strong, lean, and physically active may contribute to successful aging, both by maintaining function and by enabling more independent living. The study objective was to investigate this hypothesis among a long‐lived population of older Japanese women.DESIGN: A cross‐sectional study.SETTING: The island of Oahu, Hawaii.PARTICIPANTS: A total of 705 community‐dwelling women (mean age, 74; range, 55–93).MEASUREMENTS: As outcomes, 7 physical performance measures including walking speed, the Get Up and Go test, chair stands, functional reach, and hand and foot reaction times, and 8 questions regarding activities of daily living (ADL). As possible predictors, physical activity, body mass index, and quadriceps, grip, and triceps strength.RESULTS: In multivariable models, one or more of the strength tests was associated positively with six of the seven performance‐based measures. Among the significant associations, 1‐SD increases in strength were associated with 2 to 4% increases in performance compared with the sample mean. Physical activity was independently, and positively associated with the most complex of the tests, the Get Up and Go test. Body mass index (BMI), in contrast to strength and physical activity, was negatively associated with five of the seven performance tests. Among the significant associations, 1‐SD increases in BMI were associated with 3 to 8% reductions in performance. In multivariable models strength was also associated positively with seven of the eight ADLs. In the same models, physical activity was positively associated with five and BMI was negatively associated with six of the ADLs.CONCLUSION: The results suggest that remaining strong, lean, and physically active provided wide‐ranging benefits for this population of older Japanese women.
Ethnicity and Decision‐Makers in a Group of Frail Older People
Authors: Hornung Carlton A. , Eleazer G. Paul , III Harry S. Strothers , Wieland G. Darryl , Eng Catherine , McCann Robert , Sapir Marc 
Published: April 2015

OBJECTIVE: To assess the relationship between ethnicity and decision‐makers expressing healthcare wishes in a group of frail older persons enrolled in the Program of All‐inclusive Care for the Elderly (PACE).DESIGN: A retrospective chart review of 1193 participants in the PACE program.SETTING: Program of All‐inclusive Care for the Elderly, a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation.PARTICIPANTS: A total of 1193 older adults, all of whom met state criteria for nursing home level of care. Three hundred were non‐Hispanic whites, 364 were black, 156 were Hispanic, and 288 were Asian.MEASUREMENTS: Demographic characteristics of the patients and the presence or absence of an alternative decision‐maker; the characteristics of alternative decision‐makers included the relationship to the participant as recorded in the patient's medical record.RESULTS: Ninety‐one percent of white patients expressed their own healthcare wishes in contrast to only 85% of Hispanic, 83% of Asian, and 67% of black patients. An alternative decision‐maker was identified for about 15% of Asians and Hispanics and for one‐third of blacks, but only about 8% of whites had an alternative decision‐maker. Black and Hispanic patients were most likely to have a daughter as an alternative decision‐maker, Asians were most likely to have a son, and whites patients were most likely to have a spouse as an alternative decision‐maker. Blacks, particularly black men, were the most likely to have a relative other than a spouse or child as an alternative decision‐maker.CONCLUSIONS: In this population, we found significant ethnic variation in the person identified to be the decision‐maker in a group of frail older people. Ethnic variation reflected sociodemographic as well as cultural differences. However, there are important limitations to this study, and caution should be used in extrapolating the results to other populations or in attributing the results to ethnicity alone. An awareness of cross‐cultural patterns in identified or de facto decision‐makers can be significant for healthcare workers when they approach patients and their families about issues surrounding end of life decisions.
Screening for Dementia in the Outpatient Setting: The Time and Change Test
Authors: Froehlich Tanya E. , Robison Julie T. , Inouye Sharon K. 
Published: April 2015

OBJECTIVE: To develop and validate the Time and Change (T&C) test, a simple, standardized method for detecting dementia in a diverse older outpatient population with varying levels of education.DESIGN: A prospective cohort validation study.SETTING: Two outpatient clinics at an urban teaching hospital.PARTICIPANTS: The concurrent validation sample consisted of 100 consecutive outpatients 70 years of age or older who were 58% non‐white and had a 16% dementia prevalence rate and educational levels ranging from 0 to 17+ years. Reliability was tested in a sample of 42 consecutive outpatients 75 years of age or older with a 36% dementia prevalence rate.MEASUREMENTS: T&C ratings were validated against a reference standard based on the Blessed Dementia Rating Scale and the Mini‐Mental State Examination. Reliability, contribution to physician recognition of dementia, and ease of use were assessed.RESULTS: In the outpatient setting, the T&C had a sensitivity of 63%, specificity of 96%, a negative predictive value of 93%, a positive predictive value of 77%, and test‐retest and inter‐observer reliability agreement rates of 95% and 100%, respectively. When T&C results were added to the physician's documentation of dementia, the number of missed cases decreased from 44% to 19%, and the number of overcalled cases decreased by 100%. When timed cut points were added, the T&C test had a sensitivity of 94 to 100%, specificity of 37 to 46%, negative predictive value of 98 to 100%, positive predictive value of 23 to 25%, and test‐retest and inter‐observer agreement rates of 82% and 70 to 75%, respectively.CONCLUSION: The T&C test is a simple, accurate, reliable, performance‐based tool that can improve physician ability to recognize dementia in diverse outpatient populations.
Equivalence of Two Screens of Cognitive Functioning: The Short Portable Mental Status Questionnaire and the Orientation‐Memory‐Concentration Test
Authors: Fillenbaum Gerda G. , Landerman Lawrence R. , Simonsick Eleanor M. 
Published: April 2015

OBJECTIVE: To determine the equivalence of two screens of cognitive functioning: the Short Portable Mental Status Questionnaire (SPMSQ) and the Orientation‐Memory‐Concentration (OMC) test.DESIGN: The design was cross‐sectional and longitudinal.SETTING: Four rural and one urban county in the Piedmont region of North Carolina (n = 3210).PARTICIPANTS: A stratified random cluster sample (n = 3210) of people 68 years of age and older.MEASUREMENTS: SPMSQ and OMC at the fourth wave of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE); disability, depression, and death measurements from the fourth through seventh waves of EPESE; demographic characteristics.RESULTS: On the SPMSQ and the OMC (r = .80), 15.3% and 38.4%, respectively, of those tested were rated cognitively impaired. Poorer scores were associated with older age, black race, and less education. These associations were attenuated on the dichotomized SPMSQ but not on the OMC. Both measures predicted disability and depressive symptomatology currently and 3 years hence and death.CONCLUSIONS: The SPMSQ and OMC, although highly correlated, are not equivalent. Association with race and education are greater for the OMC, whereas an association with age exists for both measures. The milder level of impairment identified by the OMC increases predictive capacity.
Functional Outcomes of Posthospital Care for Stroke and Hip Fracture Patients Under Medicare
Authors: Kane Robert L. , Chen Qing , Finch Michael , Blewett Lynn , Burns Risa , Moskowitz Mark 
Published: April 2015

BACKGROUND: Medicare's introduction of the Prospective Payment System for hospitals has led to tremendous growth in ways of providing posthospital care. Despite substantial differences in costs per episode of care, the type of posthospital care that produces the best results for specific types of patients is not clear. This study analyzed the outcomes of different types of posthospital care for a cohort of older Medicare patients (who had diagnoses associated with the use of a range of posthospital care modalities) for up to a year after hospital discharge.METHODS: Medicare patients hospitalized with strokes and hip fractures were enrolled consecutively just before discharge from 52 hospitals in three cities in 1988–1989. These diagnosis‐related groups were chosen because patients were discharged to all three major types of Medicare‐supported posthospital care. Patients were interviewed in‐person before discharge and again at 6 weeks, 6 months, and 1 year after discharge. The functional outcomes of posthospital care were evaluated by the instrumental variables estimation approach to correct for selection bias caused by nonrandom treatment assignment The impacts of discharge locations on the functional outcomes were examined by one‐way analyses of variance (ANOVA).RESULTS: In general, the more disabled patients went to nursing homes and rehabilitation, but the overlap in distribution was sufficient to conduct the analyses. Stroke patients discharged to nursing homes had the highest mortality rate (P < .01). Stroke patients discharged to home health had the lowest rehospitalization rates (P < .05) Hip fracture discharged to home health care had the highest adjusted rehospitalization rate, whereas those discharged to nursing homes had the lowest adjusted rehospitalization rate (P < .05). For stroke patients, posthospital care in rehabilitation facilities or home health care was associated with significantly better functional improvement compared with stroke patients discharged elsewhere. However, functional outcomes deteriorated by 1 year posthospitalization among stroke patients who received their posthospital care at nursing homes or received no formal posthospital care. For hip fracture patients, all four types of posthospital care were associated with functional improvement, but patients discharged to rehabilitation facilities experienced the most functional improvement.CONCLUSIONS: The choice of posthospital care can influence the course of Medicare patients. Careful attention should be paid to how hospital discharge decisions are made and to the financial incentives for different types of posthospital care provided under the current payment system. The current supply of nursing homes is not well suited to the demands of posthospital care.
Detecting Balance Deficits in Frequent Fallers Using Clinical and Quantitative Evaluation Tools
Authors: Cho Chiung‐Yu , Kamen Gary 
Published: April 2015

OBJECTIVE: This investigation sought to determine whether older idiopathic frequent fallers could be distinguished from healthy older adults on the basis of balance and movement coordination tests. A secondary objective was to determine the relationships among clinical balance test scores, balance performance data obtained by accelerometry, and quantitative motor coordination tests.DESIGN: Two group comparison designs.SETTING: A motor control research laboratory in a university setting.PARTICIPANTS: The 16 subjects recruited for this study included eight healthy older subjects and eight age‐matched idiopathic fallers.MEASUREMENTS: Each participant's balance performance was assessed by accelerometry, as well as by coordination and clinical tests. Accelerometry scores, obtained by 1g accelerometers placed at the hip and on the head, were made with eyes open or closed, either standing on the floor or on a wedge of compliant foam. Clinical balance scores were obtained using variants of Romberg's test and the functional reach test. Motor coordination tests obtained included the heel‐to‐toe transition and rapid stepping tests.MAIN RESULTS: Statistically significant differences were obtained between groups for all accelerometry variables except root mean square. All accelerometry variables were successful in discriminating between head and hip sites. Moreover, the amplitude of sway obtained from accelerometry data identified significant differences among the four test conditions. The Romberg test, using right leg alone with eyes open, showed a significant difference between fallers and healthy older subjects. Walking velocity was significantly faster for normal older subjects than for fallers (1.10 m/sec vs 0.80 m/sec). No significant between‐group differences were obtained using the functional reach test. Coordination skills yielded significant between‐group differences using the rapid stepping test but no significant differences between groups with the heel‐toe transition test.CONCLUSION: Accelerometry is an inexpensive and clinically useful technique that can distinguish between healthy older people and idiopathic frequent fallers. In conjunction with clinical procedures and commercially available tests to assess motor coordination, these techniques can identify older individuals susceptible to frequent falls.
Assessing the Impact of Neuropsychiatric Symptoms in Alzheimer's Disease: The Neuropsychiatric Inventory Caregiver Distress Scale
Authors: Kaufer Daniel I. , Cummings Jeffrey L. , Christine Dianne , Bray Tim , Castellon Steve , Masterman Donna , MacMillan Audrey , Ketchel Patrick , DeKosky Steven T. 
Published: April 2015

OBJECTIVES: To develop an adjunct scale to the Neuropsychiatric Inventory (NPI) for assessing the impact of neuropsychiatric symptoms in Alzheimer's disease (AD) patients on caregiver distress.DESIGN: Cross‐sectional descriptive and correlational study.SETTING: University out‐patient memory disorders clinics.PARTICIPANTS: Eighty‐five AD subjects and their caregivers (54 spouses, 31 children).MEASUREMENTS: The NPI and NPI Caregiver Distress Scale (NPI‐D) were used to assess neuropsychiatric symptoms in AD patients and related caregiver distress, respectively. Criterion validity of the NPI‐D was examined (N = 69) by comparison with an abridged version of the Relatives' Stress Scale (RSS'), a general measure of caregiver stress, using item clusters that had previously been correlated to behavioral disturbances in demented patients. Test‐retest (n = 20) and inter‐rater reliability (n = 16) of the NPI‐D were also assessed.RESULTS: Test‐retest and interrater reliability of the NPI‐D were both adequate. Overall, caregiver NPI‐D distress ratings were correlated significantly with the RSS' (r = .60, P < .001). RSS' ratings correlated strongly with NPI scores (r = .64, P < .001), even after controlling for degree of cognitive impairment based on the Mini‐Mental State Exam (MMSE) score (r = .61). MMSE scores showed a moderate correlation to RSS' ratings (‐.30, P = .02), but this association was markedly attenuated when controlling for the degree of neuropsychiatric disturbance based on the NPI score (r = −.14). NPI‐D ratings for 9 of 10 NPI symptom domains correlated most strongly with either NPI symptom severity or total (frequency × severity) scores. Agitation, dysphoria, irritability, delusions, and apathy were the symptoms most often reported to be severely distressing to caregivers.CONCLUSIONS: The NPI‐D provides a reliable and valid measure of subjective caregiver distress in relation to neuropsychiatric symptoms measured by the NPI. Neuropsychiatric alterations are more strongly associated than cognitive symptoms to caregiver distress. The NPI‐D may be useful in both clinical and research settings for assessing the contribution to caregiver distress of neuropsychiatric symptoms in AD patients.
Risk Factors for Colonization with Yeast Species in a Veterans Affairs Long‐term Care Facility
Authors: Hedderwick Sara A. , Wan Jim Y. , Bradley Suzanne F. , Sangeorzan Jon A. , Terpenning Margaret S. , Kauffman Carol A. 
Published: April 2015

OBJECTIVES: To assess colonization and serious infection with yeasts and the risk factors that are associated with colonization by these organisms.DESIGN: Monthly surveillance for colonization and infection over a period of 2 years.SETTING: A long‐term‐care facility (LTCF) attached to an acute‐care Veterans Affairs Medical Center.PARTICIPANTS: The 543 men and 10 women in the facility.MEASUREMENTS: Colonization and serious infection rates with yeasts. Analysis of risk factors associated with yeast colonization of residents.RESULTS: Colonization rates were relatively stable during the 2‐year period (53 ± 1.8% patients colonized per month). Candida albicans was the most common colonizer, found in 35 ±.9% of patients colonized per month. The pharynx was the most commonly colonized site, with 41 ± 1.4% of patients per month with pharyngeal colonization. Eighty‐four percent of patients remaining in the facility for 3 or more months were colonized by yeast at some time during their stay. Presence of neurogenic bladder, leg amputation, or a low serum albumin were independently associated with yeast colonization; neither diabetes mellitus nor functional status was a risk factor for colonization by yeasts. Only four serious yeast infections in four patients (esophagitis and three urinary tract infections) were found during the 2‐year period; all infections occurred in patients who were colonized by yeasts previously.CONCLUSION: In our LTCF, colonization of patients by yeasts occurred commonly in those residents remaining in the facility for 3 or more months. However, serious yeast infections occurred infrequently. It is likely that colonization of residents of LTCFs by yeasts may only become clinically important when the patient is transferred to an acute‐care hospital where additional risk factors may allow the development of serious yeast infection.
Environmental Correlates of Resident Agitation in Alzheimer's Disease Special Care Units
Authors: Sloane Philip D. , Mitchell C. Madeline , Preisser John S. , Phillips Charles , Commander Charlotte , Burker Eileen 
Published: April 2015

OBJECTIVE: To determine the point prevalence of agitated behaviors in a representative sample of Alzheimer's disease Special Care Units, and to determine the extent to which agitation is associated with aspects of the treatment environment.DESIGN: A cross‐sectional study in which nonparticipant observers recorded 3723 observations of resident behaviors in 53 Alzheimer's disease Special Care Units. Observational data were gathered on the physical environment and staff treatment in these settings, and resident characteristics were extracted from a data base developed in the study states by the Health Care Financing Agency. Analyses studied the association between aspects of the staff and physical environment and resident agitation levels, controlling for resident cognitive and functional status.SETTING: Special Care Units in nursing homes in Kansas, Maine, Mississippi, and South Dakota.PARTICIPANTS: All residents and staff of the participating units.MAIN OUTCOME MEASURES: Eight specific agitated behaviors and two indexes of resident agitation were measured by direct observation by research assistants on three to four data collection walk‐throughs in each of the study facilities.RESULTS: The most common agitated behaviors noted were repetitive mannerisms (4.5% of resident observations) and non‐loud verbal excess (3.8%). Wandering, which frequently reflects agitation, was noted in 6.5% of resident observations. The proportion of residents exhibiting an agitated behavior varied from none in some units to 38% in one unit. Independent correlates of low unit agitation levels included favorable scores on measures of the physical environment and of staff treatment activities, low rates of physical restraint use, a high proportion of residents in bed during the day, small unit size, low levels of resident functional dependency, and fewer numbers of comorbid conditions.CONCLUSIONS: While the prevalence of agitation tends to increase as Alzheimer's disease progresses, modifiable treatment factors appear to have a strong influence on the prevalence of agitation. Both physical design and staff treatment appear to influence agitation rates, as do some measures consistent with a low stimulus approach to Alzheimer's care.