bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship of Joint Symptoms with Exercise Performance in Older Adults
Authors: Coleman Eric A. , Buchner David M. , Cress M. Elaine , Chan Benjamin K.S. , de Lateur Barbara J. 
Published: April 2015

OBJECTIVES: The objective of this study is to determine if exercise increases joint symptoms in older adults with a history of arthritis or produces symptoms in older adults without such history. In addition, we examine whether joint symptoms explain the large observed variation in strength gain in older adults undergoing vigorous strength training exercise, and report the incidence of musculoskeletal injuries upon initiation of an exercise program.DESIGN: A population‐based, single blinded, randomized controlled trial with three exercise groups and one control group.SETTING: A large urban health maintenance organization.PARTICIPANTS: Older men and women (N = 105) aged 68 to 85, with leg strength below the 50th percentile for their age, sex, height, and weight and without neuromuscular disease or active cardiovascular disease.INTERVENTIONS: Supervised exercise in 1‐hour sessions, three times each week, for 24 to 26 weeks. One exercise group did strength training (ST) using weight machines (n = 25); another group did endurance training (ET) using stationary cycles (n = 25); and the third group did combined strength training and endurance training (ST+ET) (n = 25). The control group (n = 30) received no intervention.MEASUREMENTS: Strength was measured at the ankle, knee, hip, and elbow using an isokinetic dynamometer. Joint symptoms were rated on a 6‐point scale (0 = none, 5 = severe). Arthritis severity was based on self‐reported use of arthritis medication. Health status was measured with sub‐scales of the SF‐36 and Sickness Impact Profile (SIP).RESULTS: Joint symptoms fluctuated over time in all exercise groups, but they did not improve or worsen significantly in any group. The physical dimension of the SIP and SF‐36 subscale scores, including Bodily Pain Scores, did not change over time in any group. Subjects with arthritis and joint symptoms gained as much strength with strength training as did subjects without joint symptoms. Adjustment for age, gender, baseline strength, adherence, and exercise group did not affect this finding. The rate of minor musculoskeletal injuries was 2.2 injuries per 1000 exercise hours.CONCLUSIONS: Moderate intensity stationary cycle exercise and vigorous intensity strength training do not appear to produce or exacerbate joint symptoms in older adults. Joint symptoms did not explain the large variation in gains in strength in older adults participating in a standardized strength training exercise program. Musculoskeletal injuries occurred relatively infrequently, and no major injuries occurred. In evaluating joint pain that occurs in older adults in well regulated exercise programs, clinicians should consider other etiologies before attributing pain to exercise per se. J Am Geriatr Soc 44:14–21, 1996.
Reporting Mistreatment of Older Adults: The Role of Physicians
Authors: Rosenblatt Dorrie E. , Cho Kyung‐Hwan , Durance Paul W. 
Published: April 2015

OBJECTIVE: To characterize elder mistreatment reporting patterns over time and by reporting source with specific focus on physician reporting. To determine whether demographic or socioeconomic factors influenced the reporting of elder abuse in Michigan between 1989 and 1993 and whether these factors affected physician reporting rates.DESIGN: Analysis of the State of Michigan's records of reported cases of suspected adult abuse for the years 1989–1993.MEASUREMENTS: Counties were categorized by size, urbanization, and average income. The study population was analyzed as four age groups: 18–64, 65–74, 75–84, and 85–99. Physician to population ratios were calculated for the county types and compared with physician reporting rates.MAIN RESULTS: A total of 27,371 cases of possible abuse were reported, 17,238 in persons older than age 65. Physicians reported only 2% of cases, and physician reporting rates did not increase over the 5‐year period. Physician reporting rates were highest in small counties with low physician to population ratios. There was a high percentage of primary care physicians in these counties. Forty‐seven percent of all reported cases were substantiated. There was no difference in substantiation rate for physician‐reported cases compared with other professional reporting sources.CONCLUSION: Physician reports average only 2% of all reports of suspected elder mistreatment. Primary care physicians in counties with low physician to population ratios appear to be more active in reporting mistreatment of older people. Increasing physician awareness of the problem of elder mistreatment and providing physicians with the tools to screen for mistreatment should increase the number of cases that are reported to the agencies responsible for assisting mistreated older people. J Am Geriatr Soc 44:65–70, 1996.
Effect of Pharmacologic Lipid Lowering on Health‐Related Quality of Life in Older Persons: Results from the Cholesterol Reduction in Seniors Program (CRISP) Pilot Study
Authors: Santanello Nancy C. , Barber Beth L. , Applegate William B. , Elam Janet , Curtis Carolyn , Hunninghake Donald B. , Gordon David J. ,   For the CRISP Collaborative Study Group
Published: April 2015

OBJECTIVE: To determine the effect of lovastatin therapy on health‐related quality of life in older persons.DESIGN: A prospective, randomized, double blind clinical trial.SETTING: Four university medical center research clinics.PARTICIPANTS: There were 431 men and women, primarily 65 years of age or older, with low density lipoprotein levels greater than 159 mg/dL and less than 221 mg/dL. Exclusion criteria included a Mini‐Mental state score less than 24 or presence of recent cardiovascular events or other serious chronic disease likely to shorten survival.INTERVENTION: All participants were administered the National Cholesterol Education Program step one diet and were then randomized to placebo, 20 mg lovastatin, or 40 mg lovastatin.MEASUREMENTS: Areas of health‐related quality of life assessed in the Cholesterol Reduction in Seniors Program (CRISP) included: (1) physical functioning, (2) sleep behavior, (3) social support, (4) depression, (5) cognitive function, and (6) health perception. Three global change questions asked the patients to judge change in general health since starting the study diet or the study medication and change in ability to function or care for self. Although some patients were followed for a total of 12 months, all participants were followed for 6 months, and 6‐month data have been used for the primary analysis in this paper.RESULTS: Patients treated with 20 mg of lovastatin had a 17% and 24% reduction in total cholesterol and LDL‐cholesterol, respectively. Patients treated with the 40‐mg lovastatin dose achieved reductions of 20% for total cholesterol and 28% for LDL‐cholesterol. Complaints of possible adverse events were remarkably similar in the two active treatment groups and the placebo group. At 6 months of follow‐up there were no statistically significant differences found in mean change scores from baseline between treatment groups on the health‐related quality of life measures (physical functioning, sleep, social support, depression, cognitive function scales, health perception) or global questions.CONCLUSIONS: This study demonstrates that lovastatin was extremely well tolerated in an older cohort, both with regard to symptoms and to health‐related quality of life.
A Clinical Trial to Reduce Restraints in Nursing Homes
Authors: Evans Lois K. , Strumpf Neville E. , Allen‐Taylor S. Lynne , Capezuti Elizabeth , Maislin Greg , Jacobsen Barbara 
Published: April 2015

OBJECTIVE: To investigate the relative effects of two experimental interventions on the use of physical restraints.DESIGN: Prospective 12‐month clinical trial in which three nursing homes were randomly assigned to restraint education (RE), restraint education‐with‐consultation (REC), or control (C).SETTING: Three voluntary nursing homes in the Philadelphia area providing both skilled and intermediate care.PARTICIPANTS: A total of 643 nursing home residents over the age of 60 were enrolled at baseline, and 463 remained to completion (1 year).INTERVENTIONS: Both RE and REC homes received intensive education by a masters‐prepared gerontologic nurse to increase staff awareness of restraint hazards and knowledge about assessing and managing resident behaviors likely to lead to use of restraints. In addition, the REC home received 12 hours per week of unit‐based nursing consultation to facilitate restraint reduction in residents with more complex conditions.MEASUREMENTS: Restraint status was observed systematically at baseline, immediately after the 6‐month intervention, and again at 9 and 12 months. Staff levels, psychoactive drug use, and injuries were also determined.RESULTS: Compared with baseline, the REC home had a statistically significant reduction in restraint prevalence, whereas RE and C homes did not. At 9 months (3 months post‐intervention), absolute decline in the percents restrained were 7% RE, 7% C, and 20% REC; at 12 months (6 months post‐intervention) declines were 4% RE, 6% C, and 18% REC. However, relative to baseline, these declines represent an average reduction in restraint use of 23% RE, 11% C, and 56% REC. The differences in changes over time were consistently significant (P = .01), whether considering survivors or those present at each time point, and also when controlling for differences between groups at baseline. Further, given any change in restraint use, REC residents were between 25% and 40% more likely than either RE or C residents to experience decreased restraint use. Results were achieved without increased staff, psychoactive drugs, or serious fall‐related injuries.CONCLUSION: A 6‐month‐long educational program combined with unit‐based, resident‐centered consultation can reduce use of physical restraints in nursing homes effectively and safely. Whether extending the intervention will achieve greater reduction is not known from these results.
The Barthel Activities of Daily Living Index: Self‐Reporting Versus Actual Performance in the Old‐Old (≥ 75 years)
Authors: Sinoff Gary , Ore Liora 
Published: April 2015

BACKGROUND AND PURPOSE: The Barthel Index for assessing activities of daily living (ADL) was developed particularly for young stroke patients, but it now has a wider application in the geriatric assessment profile. This study tests the validity of the Barthel Index by self‐report in the old‐old (≥ 75 years). If more than 10% of the studied population assessed themselves incorrectly (≥ 15‐point discrepancy), the test may have limitations. We set out to try to quantify and explain this discrepancy.METHODS: During a 3‐month period, we tested 126 old‐old patients, both geriatric medical inpatients and subjects from the community, in a cross‐sectional study. Using the Barthel Index, their functional status was assessed by self‐report and by observation of performance. A measure of the magnitude of discrepancy between the two methods (discrepancy score) was calculated as the difference between the self‐report and performance total scores.RESULTS: Comparing the self‐report with actual ADL performance scores, the mean score for self‐report was higher (90 vs 88). There was a low Kappa score in all areas of the scale (range 0.103–0.398). Twenty of the 126 patients (15.9%) scored 15 or more points in the discrepancy score. By running a multiple linear regression, we were able to explain only 21% of the variance in the discrepancy score (R2 = .21). Significant explanatory variables were the presence of cognitive impairment, source of patients from acute geriatric ward, and age (very old ≥ 85 years).CONCLUSION: For the purpose of this study, use of the Barthel Index by self‐reporting was found to have its limitations in the old‐old (≥ 75 years), particularly with regard to the very old (≥ 85 years) medical geriatric inpatients. Therefore, we suggest that the older people may have to be assessed by the rehabilatation services using a performance‐based measure or a different self‐report test for documenting their activities of daily living, bearing in mind that self‐reported and performance‐based measures capture physical abilities differently.
Cross‐Validation of Anthropometric and Bioelectrical Resistance Prediction Equations for Body Composition in Older People Using the 4‐Compartment Model as a Criterion Method
Authors: Goran Michael I. , Toth Michael J. , Poehlman Eric T. 
Published: April 2015

OBJECTIVE: To cross‐validate existing equations in the literature for their accuracy and precision for estimating body fat in older people from anthropometric measures and height2/resistance, using the 4‐compartment model as a criteria method, and to propose new practical equations with improved accuracy and precision.DESIGN: Measurement of body composition in a cross‐sectional cohort of healthy men and women and comparison by cross‐validation techniques against existing prediction equations.SETTING: The study was performed on subjects admitted to a General Clinical Research Center.PARTICIPANTS: The subjects were 41 healthy women (68.2 ± 6.6 years; 64.1 ± 10.2 kg) and 41 healthy men (70.2 ± 7.0 years; 74.9 ±11.0 kg).MEASUREMENTS: The criteria method for total body composition was the 4‐compartment model based on measurement of total body density by underwater weight, total body water by isotope dilution, and total bone mineral from dual energy X‐ray absorptiometry. The other techniques examined for accuracy and validity were body fat estimates derived by skinfolds using the Durnin and Womersley Equations; waist circumference and age using the Lean Equations; and bio‐electrical resistance using five published equations, including two derived in the older population.RESULTS: When compared with data derived from the 4‐compartment model, the skinfold equation of Durnin and Womersley was cross‐validated successfully in women but not in men. The Baumgartner equation was the only bioelectrical resistance equation that met the criteria for successful cross‐validation in men and women, although in women the intercept (4.0 ±2.1 kg) was close to significantly different from zero (P = .06). Error in the estimates of body fat using the Durnin and Womersley and the Baumgartner equations was significantly and inversely related to fat mass (r = ‐.39 to r = ‐.56). In our data, the significant predictors of fat mass were hip circumference, calf skinfold, gender, body weight, height2/resistance, and biceps skinfold, explaining 84% of the variance.CONCLUSIONS: The Durnin and Womersley equation is accurate for women and the Baumgartner equation is accurate for both men and women if a correction of +4 kg is made in women; however, for both equations the error in the estimate is inversely related to fat mass. We suggest new anthropometric equations for estimating body fat in older people, which may improve accuracy and precision. The new equations will need to be tested in independent cross‐validation studies.
Atrial Fibrillation in Older Stroke Patients: Association with Recurrence and Mortality After First Ischemic Stroke
Authors: Kaarisalo Minna M. , Immonen‐Räihä Pirjo , Marttila Reijo J. , Lehtonen Aapo , Salomaa Veikko , Sarti Cinzia , Sivenius Juhani , Torppa Jorma , Tuomilehto Jaakko 
Published: April 2015

OBJECTIVES: The objective of this study was to determine the association of atrial fibrillation (AF) with stroke recurrence and mortality and with the causes of death in ischemic stroke patients aged 75 years and older.DESIGN: A population‐based study.SETTING: The cities of Turku and Kuopio in Finland.PARTICIPANTS: The study cohort consisted of 2635 consecutive patients aged 75 years and older, with a first ischemic stroke, registered in the FINMONICA Stroke Register.MEASUREMENTS: 28‐day and 1‐year stroke mortality, causes of death, and recurrence of stroke.RESULTS: There were 767 stroke patients with AF (mean age 82.2) and 1868 patients without AF (mean age 81.4). Mortality was higher in the AF group both 28 days (33.9% vs 28.1%, P = .003) and 1 year after the attack (52.7% vs 43.0%, P < .001). The age‐and sex‐adjusted relative risk of death at 28 days was 1.25 in the AF group (95% confidence interval (CI) 1.04–1.50, P = .018), and at 1 year it was 1.41 (95% CI 1.18–1.67, P < .001). In a Cox proportional hazards model, 1‐year mortality risk comparing the AF‐group with non‐AF group was 1.24 (95% CI 1.10–1.39, P < .001). The strongest risk factor predicting 1‐year mortality was recent myocardial infarction (MI) (RR 1.90, 95% CI 1.49–2.42). Myocardial infarction was more often the underlying cause of death in the AF group during the period of 28 days, but not from 28 days up to 1 year. The 1‐year recurrence rate among those alive at day 28 was 11.5% in the AF group and 9.4% in the non‐AF group (P = .240).CONCLUSION: Recent MI and AF are independent negative prognostic factors in older patients with stroke. Although the relative risk estimates attributable to AF are of the same magnitude in older as in middle‐aged stroke patients, the much higher prevalence of AF in the older patients emphasizes its absolute impact on the mortality and recurrence after the first ischemic stroke in the age group 75 years and older. The treatment of coexisting cardiac disease also has the potential to prevent deaths and recurrent stroke events in older persons. J Am Geriatr Soc 45:1297–1301, 1997.
What Is Wrong With End‐of‐Life Care? Opinions of Bereaved Family Members
Authors: Hanson Laura C. , Danis Marion , Garrett Joanne 
Published: April 2015

OBJECTIVE: To describe family perceptions of care at the end of life.METHODS: In a representative sample of older people who died from chronic diseases, family members were interviewed about satisfaction with treatment intensity, decision‐making, and symptom relief in the last month of life, and gave suggestions to improve care.RESULTS: Interviews were completed with 461 family members, 80% of those contacted. They reported that 9% of decedents received CPR, 11% ventilator support, and 24% intensive care during their last month of life. Family members could not recall a discussion of treatment decisions in 23% of cases. Presence or absence of a living will did not affect the likelihood of no discussion (22% vs 24%, P = .85).Family informants desired more treatment to sustain life in 8% of deaths. They or the decedent wanted treatments doctors did not recommend in 6% of deaths but refused recommended therapies in 18% of deaths. They believed more care to relieve pain or other symptoms was indicated in 18% of deaths. Asked to make positive or negative comments about any aspect of terminal care, 91% of comments on hospice were positive. Nursing home care received the smallest proportion of positive comments (51%). Family members recommendations to improve end of life care emphasized better communication (44%), greater access to physicians' time (17%), and better pain management (10%).CONCLUSION: Bereaved family members are generally satisfied with life‐sustaining treatment decisions. Their primary concerns are failures in communication and pain control. Discussions that focus on specific treatment decisions may not satisfy the real needs of dying patients and their families. J Am Geriatr Soc 45:1339–1344, 1997.
Diuretic Usage and Withdrawal Patterns in a Dutch Geriatric Patient Population
Authors: van Kraaij Dave J.W. , Jansen René W.M.M. , Bruijns Elly , Gribnau Frank W.J. , Hoefnagels Willibrord H.L. 
Published: April 2015

OBJECTIVES: To describe diuretic usage and withdrawal patterns in a population of very old geriatric patients and to evaluate the long‐term probability of remaining free from diuretic therapy after withdrawal.DESIGN: Retrospective analysis of medical records and 1‐year follow‐up study.SETTING: University Hospital Nijmegen and Rijnstate Hospital Arnhem, a non‐academic teaching hospital, The Netherlands.PARTICIPANTS: All 1547 patients, aged 75 years or older, visiting geriatric medicine departments in the two hospitals for the first time in the years 1990 through 1993.MEASUREMENTS: Data on medical history, physical examinations, and medication use were obtained from medical records. Diuretic withdrawal and motivation was recorded as reported. Record review indicating diuretic withdrawal prompted a 1‐year follow‐up investigation and collection of additional updated information from family care and/or nursing‐home physicians.RESULTS: A total of 593 three patients (38.3%) were using diuretics. Use of diuretics increased with age from 33.6% in patients aged 75 to 79 years to 47.4% in patients aged 90 years or older (P < .05). Diuretics were withdrawn in 218 patients (36.8%), in 101 patients because of doubts about the initial or persistent indication for diuretic use and in 91 patients because of adverse effects. No reasons for withdrawal were reported in 26 patients. Withdrawal of diuretics was attempted more often in cases of diuretic prescriptions for unknown reasons (51.2%) or ankle edema without heart failure (45.0%) than when prescriptions were for heart failure (28.5%) or hypertension (35.4%). The overall probability of remaining free of diuretic therapy for 1 year was 0.41. Success of diuretic withdrawal was significantly less when congestive heart failure was the initial indication for prescription (probability 0.24). We did not find other clinical parameters related to the success of withdrawal.CONCLUSIONS: Our study demonstrates that diuretic therapy can be withdrawn for at least a 1‐year period in a substantial number of very old geriatric patients receiving these medications, regardless of the initial indications for prescription. However, withdrawal is performed without application of uniform criteria. Future prospective studies should be directed at developing clear guidelines for diuretic withdrawal in order to facilitate identification of eligible patients and to further improve the success of withdrawal attempts.