bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nursing Assistants Detect Behavior Changes in Nursing Home Residents that Precede Acute Illness: Development and Validation of an Illness Warning Instrument
Authors: Boockvar Kenneth , Brodie H. Daniel , Lacks Mark 
Published: April 2015

BACKGROUND: Acute illness causes considerable morbidity and mortality in nursing home residents but is often difficult to recognize early. Nursing assistants often notice early signs of acute illness but do not methodically document or communicate their observations with medical staff.OBJECTIVE: To enhance nursing assistants' observation and documentation of signs of acute illness by developing a validated, standardized instrument for communication with medical staff.DESIGN: Observational cohort study.SETTING: Urban not‐for‐profit nursing home.SUBJECTS AND METHODS: Candidate instrument items were generated in focus group interviews with nursing home staff. Twenty‐three nursing assistants completed the instrument on 74 nursing home residents over 4 weeks. Acute illness, the primary outcome, was identified by nurse report and chart review and determined according to preset criteria.MEASUREMENTS: Predictive validity was assessed by determining the relationship between instrument responses and development of acute illness within 7 days. Interobserver agreement was calculated between morning and afternoon nursing assistants' responses. Convergent validity was assessed by comparing instrument responses with three standard status indicators.RESULTS: The instrument consisted of 12 items that assessed behavioral and functional status changes. Residents with an instrument‐recorded change were more likely to develop an acute illness within 7 days than those with no change (risk ratio 4.1, 95% confidence interval 2.6, 6.3). A final five‐item instrument had a sensitivity of 53% and a specificity of 93% for acute illness. Nursing assistants' documentation of signs of illness preceded chart documentation by an average of 5 days. Interobserver agreement between morning and afternoon nursing assistants was 76%. Correlation of responses with standard indicators of functional, mental, and global status was high.CONCLUSIONS: A new instrument developed for nursing assistants to document behavioral and functional status changes in nursing home residents demonstrates fair sensitivity and high specificity for acute illness. Close monitoring of patients with a positive instrument might avert morbidity and mortality from acute illness by allowing earlier treatment.
Idiopathic Senile Gait Disorders Are Signs of Subclinical Disease
Authors: Bloem B. R. , Gussekloo J. , Lagaay A. M. , Remarque E. J. , Haan J. , Westendorp R. G. J. 
Published: April 2015

OBJECTIVES: To evaluate survival and causes of death in subjects with idiopathic senile gait disorders.DESIGN: A population‐based longitudinal study.SETTING: Survival analysis of the oldest old within the Leiden 85‐plus Study.PARTICIPANTS: We distinguished three different groups according to their gait: subjects with a normal gait (n = 25), subjects with senile gait disorders (n = 14), and subjects with gait disorders due to known disease (n = 87). The mean age was 90 years in all groups (range 87 to 97 years).MEASUREMENTS: The risk of all cause mortality and cardiovascular mortality was estimated over 5 years of follow‐up in a Cox‐proportional hazards model, adjusted for age and sex.RESULTS: Eighty‐nine of 126 subjects died during follow‐up. Mean survival differed among the three groups (P log‐rank = .01). All cause mortality risk was increased in subjects with senile gait disorders compared with subjects with a normal gait (RR = 2.8; 95% CI, 1.1–7.3, P = .03) and was similar to subjects with gait disorders caused by known disease (RR = 1.2; 95% CI: .6–2.5, P = .6). Mortality caused by cardiovascular disease also differed among the three groups (P log‐rank = .03). The risk of cardiovascular death in subjects with senile gait disorders was twofold greater than in subjects with a normal gait (RR = 2.1; 95% CI, 0.4–10.3).CONCLUSIONS: Senile gait disorders are related to subclinical, perhaps cardiovascular, disease. Senile gait disorders should not be accepted as an inevitable, benign concomitant of the normal aging process.
Characteristics of Nondisabled Older Persons Who Perform Poorly in Objective Tests of Lower Extremity Function
Authors: Ferrucci Luigi , Penninx Brenda W. J. H. , Leveille Suzanne G. , Corti Maria‐Chiara , Pahor Marco , Wallace Robert , Harris Tamara B. , Havlik Richard J. , MD Jack M. Guralnik 
Published: April 2015

OBJECTIVES: It has been suggested that nondisabled older persons with poor performance of lower extremity function are ideal targets for interventions of disability prevention. However, health‐related factors associated with poor performance are largely unknown. Using data from a representative sample of nondisabled older persons, this study identifies the diseases and biological markers that characterize this group of the population.DESIGN AND PARTICIPANTS: A total of 3381 persons aged 71 or older, interviewed and administered a battery of physical performance tests at the sixth annual follow‐up of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), who reported no need for help in walking 1/4 mile or climbing stairs.MEASUREMENTS: Lower extremity performance was measured using a short battery of tests including assessment of standing balance, a timed 2.4‐m walk, and timed test of rising 5 times from a chair. Chronic conditions were ascertained as self‐report of a physician diagnosis. Data on previous hospitalizations were obtained from the Medicare database. Nonfasting blood samples were obtained and processed with standard methods.RESULTS: In a multivariate analysis, older age, female gender, higher BMI, history of hip fracture and diabetes, one or more hospital admissions for acute infection in the last 3 years, lower levels of hemoglobin and albumin, and higher leukocytes and γ‐glutamyl transferase were all associated independently with poor performance.CONCLUSIONS: Screening for older patients who are not disabled but have poor lower extremity performance selects a subgroup of the population with a high percentage of women, high prevalence of diabetes and hip fracture, and high levels of biological markers of inflammation. This group represents about 10% of the US population 70 to 90 years old. These findings should be considered in planning specifically tailored interventions for disability prevention in this subgroup.
Cellular Ionic Alterations with Age: Relation to Hypertension and Diabetes
Authors: Barbagallo Mario , Gupta Raj K. , Dominguez Ligia J. , Resnick Lawrence M. 
Published: April 2015

BACKGROUND: Cytosolic free calcium (Cai) and magnesium (Mgi) are vital to cellular homeostasis and function.OBJECTIVE: To evaluate cellular divalent cations in normal subjects at different ages and their relationship to ion levels in essential hypertension and diabetes.DESIGN: A cross‐sectional study.SETTING: A university hospital in New York.PARTICIPANTS: A total of 103 subjects (32 older, 71.1 ± 1.2 y/o, and 71 young/middle aged subjects, 51.1 ± 2.3 y/o).INTERVENTION: Oral glucose tolerance test.MEASUREMENTS: 19F and 31P NMR spectroscopy were used to measure Cai and Mgi levels in erythrocytes from normal (>65 y/o, n = 11; <65 y/o, n = 26), hypertensive (EH) (>65 y/o, n = 9; <65 y/o, n = 30), and type 2 diabetic (DM) (>65 y/o, n = 12; <65 y/o, n = 15) subjects; these levels were also compared with glucose and insulin levels before and after oral glucose loading.RESULTS: Fasting Mgi levels were lower (207 ± 7.8 vs 236 ± 7.5 μM; P < .05) and Cai higher (32.2 ± 3.0 vs 20.3 ± 1.8 nM; P < .05) in older than in younger normal subjects. For all normal subjects, the greater the age, the higher the Cai (r = 0.622, P = .004) and the lower the Mgi (r = –0.423; P = .011). However, no significant (P = NS) differences in Mgi or Cai levels were observed between older normal and young/middle‐aged subjects with EH (Mgi = 189.7 ± 5.9 vs 182.6 ± 9.8 μM; Cai = 33.8 ± 4.9 vs 35.6 ± 4.0 nM) or DM (Mgi = 182.8 ± 10.9 vs 180.8 ± 8.1 μM; Cai = 33.6 ± 4.3 vs 39.7 ± 5.9 nM). Significant relationships were also found between cellular ion content, blood pressure, and glycemic indices.CONCLUSIONS: Aging is associated with the onset of altered Cai and Mgi levels, indistinguishable from those observed in hypertension and diabetes, independent of age. We suggest that these ionic changes may be clinically significant, underlying the predisposition of older subjects to cardiovascular and metabolic diseases.
Geographic Variation in Hospice Use Prior to Death
Authors: Virnig Beth A. , Kind Sara , McBean Marshall , Fisher Elliott 
Published: April 2015

OBJECTIVES: To examine national variation in use of the Medicare hospice benefit by older individuals before their death, and to identify individual characteristics and local market factors associated with hospice use.DESIGN: Retrospective analysis of Medicare administrative data.SETTING: Hospice care.PARTICIPANTS: Older Medicare enrollees who died in 1996.MEASUREMENTS: Rate of hospice use per 1000 older Medicare beneficiary deaths.RESULTS: Overall, 155 of every 1000 older Medicare beneficiaries who die use hospice before death. This rate is significantly higher among younger older persons (P < .001), non‐blacks (P < .001), persons living in wealthier areas (P < .001), and persons in urban areas (P < .001). Areas with a higher proportion of non‐cancer diagnoses among hospice users have higher rates of hospice use for both cancer and non‐cancer reasons than areas with a majority of hospice users having cancer diagnoses (P < .001). Hospice use is higher in areas with fewer hospital beds per capita (P < .001), areas with lower in‐hospital death rates (P < .001), and areas with higher HMO enrollment (P < .001). Rates of hospice use are also positively related to average reimbursements for health care (P < .001) and to physicians per capita (P < .001). In the largest metropolitan statistical areas (MSAs), rates of hospice use vary more than 11‐fold from a low of 35.15 (Portland, ME) to a high of 397.2 per 1000 deaths (Ft. Lauderdale, FL).CONCLUSIONS: The wide variation in hospice use suggests that there is great potential to increase the number of users of the Medicare hospice benefit.
Emotional Well‐Being Predicts Subsequent Functional Independence and Survival
Authors: Ostir Glenn V. , Markides Kyriakos S. , Black Sandra A. , Goodwin James S. 
Published: April 2015

OBJECTIVE: To determine whether positive affect has an independent effect on functional status, mobility, and survival in an older Mexican American sample.DESIGN: A 2‐year prospective cohort study.SETTING: Five Southwestern states: Texas, California, Arizona, New Mexico, and Colorado.PARTICPANTS: A population‐based sample of 2282 Mexican Americans aged 65 to 99 who reported no functional limitations at baseline interview.MEASUREMENTS: In‐home interviews in 1993–1994 and again in 1995–1996 assessed demographic variables, health conditions, activities of daily living, performance‐based mobility, survival, and a rating of positive and negative affect.RESULTS: In multivariate analyses, there was a direct relationship between positive affect scores at baseline and mobility, functional status, and survival 2 years later, controlling for functional status, sociodemographic variables, major chronic conditions, body mass index (BMI), smoking status, drinking status, and negative affect at baseline. Subjects with high positive affect were half as likely (odds ratio (OR) = 0.48; 95% confidence interval (CI) 0.29, 0.93) to become disabled in activities of daily living (ADLs), two‐thirds as likely (OR = 0.64; 95% CI 0.51, 0.79) to have a slow walking speed, and half as likely (OR 0.53; 95% CI 0.30, 0.93) to have died during the 2‐year follow‐up compared to those with lower positive affect scores.CONCLUSIONS: Our results support the concept that positive affect, or emotional well‐being, is different from the absence of depression or negative affect. Positive affect seems to protect individuals against physical declines in old age. J Am Geriatr Soc 48: 473–478, 2000.
Improvement in Quality‐of‐Life Measures and Stimulation of Weight Gain After Treatment with Megestrol Acetate Oral Suspension in Geriatric Cachexia: Results of a Double‐Blind, Placebo‐Controlled Study
Authors: Yeh Shing‐Shing , Wu Suh‐Yuh , Lee Tai‐Ping , Olson Jeffery S. , Stevens Michael R. , Dixon Troy , Schuster Michael W. 
Published: April 2015

BACKGROUND: Weight loss among older patients is a severe problem, associated with an increased incidence of infections, decubiti, and death. Megestrol acetate (MA) causes weight gain in cachectic cancer and AIDS patients, but its effects in older cachectic patients are unknown.OBJECTIVE: To compare the effects of MA oral suspension (O.S.), 800 mg/day, versus placebo on weight in geriatric nursing home patients with weight loss or low body weight.DESIGN: Twelve‐week, randomized, double‐blind, placebo‐controlled trial with a 13‐week follow‐up period.SETTING: Veterans Administration Medical Center (VMAC) nursing home.PATIENTS: Nursing home patients with weight loss of ≥5% of usual body weight over the past 3 months, or body weight 20% below their ideal body weight.INTERVENTIONS: Patients were randomly assigned to receive placebo or MA 800 mg/day for 12 weeks and were then followed for 13 weeks off treatment.MEASUREMENTS: Primary outcome was measured by weight and appetite change. Secondary outcome measures included sense of well‐being, enjoyment of life, change in depression scale, laboratory nutrition parameters, energy intake counts, body composition, and adverse events.RESULTS: At 12 weeks there were no significant differences in weight gain between treatment groups, whereas MA‐treated patients reported significantly greater improvement in appetite, enjoyment of life, and well‐being. Body composition was not statistically different between the two groups. At Week 25 (3 months after treatment), 61.9% of MA‐treated patients had gained ≥1.82 kg (4 lbs) compared to 21.7% of placebo patients.CONCLUSIONS: In geriatric patients with weight loss or low body weight MA improves appetite and well‐being after 12 weeks of treatment. During the 3 months of MA treatment, there was no statistically significant weight gain (≥4 lbs). Three months after treatment, weight gain (≥4 lbs) was significantly increased in MA‐treated patients. J Am Geriatr Soc 48: 485–492, 2000.
The Effects of Physical Activity on Mortality in the Jerusalem 70‐Year‐Olds Longitudinal Study
Authors: Stessman J. , Maaravi Y. , Hammerman‐Rozenberg R. , Cohen A. 
Published: April 2015

OBJECTIVE: To study the association between physical activity and mortality in older men and women.DESIGN: A community‐based cohort study: the Jerusalem 70‐Year‐Olds Longitudinal Study.PARTICIPANTS: A systematically selected and representative sample of all residents of the western part of Jerusalem born in 1920–1921: 456 subjects, 25% of the total population.MEASUREMENTS: An extensive social and medical profile was developed by extensive interview and physical and ancillary examination. Medical diagnoses were established and subjects reported their level of regular physical activity.RESULTS: Unadjusted mortality at 6‐year follow‐up was significantly greater for subjects reporting no regular exercise than for those walking as little as 4 hours weekly (23.4% vs 9.9%, odds ratio (OR) = 2.77; 95% confidence interval (CI), 1.64–4.69). The significance of these benefits was demonstrated for males as well as for females (30.28% vs 12.14%, P < .001, 16.19% vs 6.86%, P = .036, respectively). Logistic regression analysis demonstrated the survival advantage to be independent of gender, smoking, subjective economic hardship, or preexisting medical conditions (hypertension; diabetes; coronary artery, cerebrovascular, renal, and respiratory diseases; anemia; and malignancy). Increased regularity of activity correlated with declining mortality. The odds ratios for mortality compared to the sedentary group were 0.73 (CI, 0.33–1.62) for those doing sports activity at least twice weekly, 0.41 (CI, 0.19–0.91) for those walking at least 4 hours weekly, 0.14 (CI, 0.04–0.50) for those exercising daily, and 0.40 (CI, 0.22–0.72) for all levels of physical activity combined.CONCLUSIONS: These results suggest that regular physical activity confers increased survival in the aged. It is proposed that older people be encouraged to engage in regular, moderate physical activity. J Am Geriatr Soc 48: 499–504, 2000.
Reasons Given by Older People for Limitation or Avoidance of Leisure Time Physical Activity
Authors: Satariano William A. , Haight Thaddeus J. , Tager Ira B. 
Published: April 2015

OBJECTIVES: This study investigates reasons given by older people for limitation or avoidance of physical exercise.DESIGN: Community‐based longitudinal study of free‐living persons age 55 years or older in Sonoma, California.METHODS: Baseline standardized interviews were conducted (n = 2046) as part of a longitudinal study of aging and physical performance. Seventeen reasons for limitation or avoidance of physical activities were evaluated, with responses grouped as: no limitations, medical, non‐medical, and combined medical and non‐medical reasons. Patterns of physical activity and medical conditions and direct measures of physical function were evaluated in relation to reasons for activity limitation by multinomial logistic regression.RESULTS: Women reported more limitations/avoidance of physical activity than men (81.0% vs 73.5%). Medical reasons increased with age. Reduced walking speed and depressive symptomatology were associated with a combination of medical and non‐medical reasons in both sexes. Living arrangements were associated with non‐medical reasons for women but were not for men. Non‐medical reasons were associated with a 20 to 30% reduction in the number of subjects who reported physical activity at recommended levels.DISCUSSION: Non‐medical factors are important determinants of activity limitation and should serve as targets for patient care providers and future interventions to improve participation in physical activity by older people. J Am Geriatr Soc 48: 505–512, 2000.
Community Characteristics Associated with Elder Abuse
Authors: Jogerst Gerald J. , Dawson Jeffrey D. , Hartz Arthur J. , Ely John W. , Schweitzer L. A. 
Published: April 2015

OBJECTIVES: To help define the relationship between elder abuse rates and counties' demographics, healthcare resources, and social service characteristics.DESIGN: County‐level data from Iowa were analyzed to test the association between county characteristics and rates of elder abuse between 1984 and 1993 using univariate correlation analysis and stagewise linear regression.SETTING: Ninety‐nine counties in Iowa.PARTICIPANTS: Iowa residents aged 65 years and older.MEASUREMENTS: County‐level population‐adjusted numbers of abused elderly, abused children, children in poverty, high school dropouts, physicians and other healthcare providers, hospital beds, social workers and caseworkers in the Department of Human Services (DHS).RESULTS: Community characteristics that had a positive association with rates of reported or substantiated elder abuse at the P < .001 level were population density, children in poverty, and reported child abuse. Lower substantiated elder abuse rates were associated at P < .05 with higher community rates of high school dropouts, number of chiropractors, and number of nurse practitioners. After adjusting for number of DHS caseworkers and reported child abuse rates (a surrogate for workload) a district effect persists for substantiated elder abuse cases (P = .002).CONCLUSION: County demographics are risk factors for reported and substantiated elder abuse. The strongest risk factor for reported elder abuse was reported child abuse. The difference in districts may reflect differences in resources and/or differing characteristics of caseworkers who substantiate elder abuse. The risk factors may reflect conditions that influence the amount of elder abuse or the detection of existing elder abuse. J Am Geriatr Soc 48: 513–518, 2000.
A Prospective Study of the Effect of Fracture on Measured Physical Performance: Results from the MacArthur Study – MAC
Authors: Greendale Gail A. , DeAmicis Tracy A. , Bucur Alexander , Bretsky Phil , Rowe John W. , Reuben David B. , Seeman Teresa 
Published: April 2015

OBJECTIVE: To examine the impact of fractures on measured physical performance and to assess whether specific fractures have unique sequelae.SUBJECTS: 762 men and women, aged 70 to 79 at baseline, who were part of the MacArthur Study of Successful Aging.DESIGN: A longitudinal case‐cohort: those with prevalent fractures at baseline were excluded; cases were persons with a medically diagnosed hip, arm, spine, or wrist fracture during the follow‐up period (1988–1995).MEASURES: Eight physical performance tests: turning a circle, walking fast, chair stands, timed tap, tandem stand, grip strength, single leg stand, and balance (average of single leg and tandem stands) measured at baseline and follow‐up.ANALYSIS: Two fracture groups were defined: (1) those with incident wrist fractures (n = 7) and (2) those with a fracture of the hip, arm, or spine (combined fractures group, n = 16). Change in physical performance was analyzed using crude, age‐adjusted, and multiply‐adjusted ANCOVA models.RESULTS: The combined fracture group demonstrated statistically significant (P < .05) declines seven of eight of the performance tests compared with individuals without fractures. In contrast, individuals with wrist fractures did not experience a statistically significant decline in any performance measure compared with the no fracture group.CONCLUSIONS: Relative to those without fractures, individuals with a hip, arm, or clinical spinal fracture show similar global declines in physical performance, whereas those with wrist fracture demonstrate no physical performance decrements. J Am Geriatr Soc 48: 546–549, 2000.
Testosterone Improves Rehabilitation Outcomes in Ill Older Men
Authors: Bakhshi Virat , Elliott Marjorie , Gentili Angela , Godschalk Michael , Mulligan Thomas 
Published: April 2015

OBJECTIVES: To determine whether testosterone supplementation improves rehabilitation outcomes in ill older men.DESIGN: A randomized, placebo‐controlled, double‐blind study.SETTING: A Geriatric Evaluation and Management (GEM) unit based at a university‐ affiliated Veterans Affairs Medical Center.PARTICIPANTS: Fifteen men aged 65 to 90 years admitted to the GEM for rehabilitation.INTERVENTION: Subjects were randomized to receive weekly intramuscular injections with testosterone enanthate 100 mg or placebo.MEASUREMENTS: Task‐specific performance using the Functional Independence Measure (FIM) and grip strength was measured at the onset of the study and at the time of discharge from the GEM.RESULTS: At baseline, FIM scores were similar between the placebo and the testosterone group (73.7 vs 70.7, P = .637), as was grip strength (49.7 vs 55.3 pounds, P = .555). At discharge from the GEM, testosterone‐treated patients had improved FIM scores compared with baseline (93.6 vs 70.7; P = .012) and grip strength (68.7 vs 55.3 pounds; P = .033). In the placebo group there was no significant improvement of FIM scores compared with baseline (78.0 versus 73.7; P = .686) or of grip strength (48.9 vs 49.7 pounds; P = .686).CONCLUSIONS: Testosterone supplementation may improve rehabilitation outcomes in ill older men. J Am Geriatr Soc 48: 550–553, 2000.