bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Significance of Subnormal Serum Vitamin B12 Concentration in Older People: A Case Control Study
Authors: Metz J. , Bell A.H. , Flicker L. , Bottiglieri T. , Ibrahim J. , Seal E. , Schultz D. , Savoia H. , McGrath K.M. 
Published: April 2015

OBJECTIVES: To determine the clinical significance of subnormal serum vitamin B12 concentration in older people by comparing the hematological, neurological, and biochemical findings in patients with subnormal serum B12 with a control group with normal B12 levels.DESIGN: Clinical and laboratory assessment of hospital patients selected to represent a wide range of serum B12 levels.SETTING: Patients in the medical wards of two hospitals, one a general hospital and the other a geriatric hospital.PARTICIPANTS: Ninety‐four older patients, 43 with subnormal (<150 pmol/L) and 51 with normal serum B12 concentrations.MEASUREMENTS: Mini‐Mental State Examination, neurological score, full blood examination, mean neutrophil lobe count; serum B12, holotranscobalamin II, total homocysteine, folate, creatinine and gastrin red cell folate; parietal cell antibodies, intrinsic factor antibodies.RESULTS: Of all the measurements, only mean neutrophil lobe count and mean serum total homocysteine were significantly different in the low serum B12 compared with the control group. There was a significant correlation between serum B12 and homocysteine levels. Eighty‐eight percent of patients in the test group compared with 76% in the control group showed at least one of the following; elevated serum total homocysteine, neutrophil hypersegmentation, or elevated MCV. This overlap was much reduced when patients with borderline values for serum B12 (150–250 pmol/L) were included in the low B12 group. Most of the older subjects had little or no B12 on transcobalamin II, irrespective of the serum B12 level.CONCLUSION: Almost 90% of older patients with serum B12 < 150 pmol/L show evidence of tissue vitamin B12 deficiency. Deficiency becomes manifest in older patients at relatively higher concentrations of serum B12 than in younger subjects, possibly because of lower levels of holotranscobalamin II in the older patients. J Am Geriatr Soc 44:1355–1361, 1996.
Clinical Variables Influencing Treatment Decisions for Agitated Dementia Patients: Survey of Physician Judgments
Authors: Colenda Christopher C. , Rapp Stephen R. , Leist James C. , Poses Roy M. 
Published: April 2015

OBJECTIVE: To better understand primary treatment recommendations and the variables that might influence treatment decisions of physicians who treat agitated dementia patients.DESIGN: A written cross‐sectional survey of three physician groups (geriatric psychiatrists, primary care physicians, and neurologists) who typically treat agitated dementia patients in community settings. We used a written clinical vignette describing a home‐bound, agitated dementia patient to ask respondents to provide information regarding their primary treatment recommendation and to estimate the degree to which clinically relevant variables might influence their treatment recommendation. Using principal component analysis, the original set of clinical variables was collapsed into a smaller set of composite factors that better defined the fundamental constructs of the variables that influenced decision making. Analyses compared primary treatment recommendations and factors influencing treatment recommendations by physician groups.PARTICIPANTS: The pool of survey respondents consisted of a random selection of 207 primary care physicians from western North Carolina, 147 geriatric psychiatrists obtained from the roster of the 1991 American Association for Geriatric Psychiatry, and 120 neurologists obtained from the roster of the American Board of Medical Specialties. The response rate was 65% for geriatric psychiatrists, 38% for primary care physicians, and 33% for neurologists.RESULTS: Differences in primary treatment recommendations by physician group were not found. Physicians, regardless of specialty, recommended neuroleptic medications as their primary intervention. When medication classes were collapsed into a single category, medications as a primary intervention exceeded 55% for all physician groups. Twenty‐two percent of all respondents recommended psychosocial interventions as primary treatment strategies. The principal component analysis of clinical variables influencing treatment recommendations solved for five components that accounted for 64% of the variance. Comparing the five components by specialty groups failed to find significant differences, except for Factor 5, the “Hassle Factor.” Primary care physicians were more likely to indicate that this component influenced their decision making than were the other physician groups.CONCLUSIONS: The findings indicate that physicians, regardless of specialty, are likely to use medication and to weight clinically relevant information in a similar fashion when managing agitated dementia patients. J Am Geriatr Soc 44:1375–1379, 1996.
Do Rehabilitative Nursing Homes Improve the Outcomes of Care?
Authors: Kane Robert L. , Chen Qing , Blewett Lynn A. , Sangl Judith 
Published: April 2015

OBJECTIVES: To compare the differences in outcomes of Medicare patients discharged from hospital to two types of nursing homes, rehabilitative and regular, and to rehabilitative facilities.DESIGN: Criteria for distinguishing rehabilitative nursing homes (RNHs) from ordinary nursing homes (NH), based on staffing criteria, were developed by an expert panel and validated on a national sample of nursing homes. Those criteria that significantly discriminated the two types of NHs were then applied to a sample of nursing homes from a study of the outcomes of care for more than 2500 Medicare patients to classify the nursing homes to which patients were discharged. Actual discharge outcomes were compared with optimal outcomes based on predictive equations for different types of treatment (ordinary NH care, RNH care, and formal rehabilitative care).PARTICIPANTS: Medicare patients with strokes and hip fractures discharged from 52 hospitals in three cities.MEASUREMENTS: A disability scale that weights components of ADL measures was used as the primary outcome indicator. Nursing homes were classified as rehabilitative on the basis of the extent of staffing in rehabilitative areas.RESULTS: Patients discharged to various types of care varied on several parameters. After adjusting for these differences, stroke patients fared better when treated in rehabilitative facilities; there was no substantial benefit for RNH care over NH care. Healthier hip fracture patients who received RNH care fared better, but functional change for sicker hip fracture patients was not different among the three groups.CONCLUSIONS: The study suggests that at least a preliminary distinction among NHs can be made on the basis of staffing patterns and that the benefits of the additional staffing may vary with the problem under consideration. More work is needed to establish just what sorts of patients are most likely to benefit from the higher level of NH care.
A Home‐based Exercise Program for Nondisabled Older Adults
Authors: Jette Alan M. , Harris Bette Ann , Sleeper Lynn , Lachman Margie E. , Heislein Diane , Giorgetti Marie , Levenson Claudia 
Published: April 2015

OBJECTIVES: This paper describes a videotaped, home‐based, strength training program, titled Strong‐for‐Life and reports on its effectiveness in improving muscle strength, psychological well‐being, and health status in a sample of older persons.DESIGN AND SETTING: We enrolled 102 nondisabled, community‐dwelling older people aged 66 to 87, identified from the Medicare beneficiary list, into a randomized, controlled trial.MEASUREMENTS: Effectiveness was based on change in isokinetic upper and lower extremity muscle strength, psychologic well‐being, and health status.RESULTS: Results revealed several statistically significant short‐term benefits after 12 to 15 weeks of exercise, especially for men. Younger older adults demonstrated a 10% improvement in knee extensor strength relative to control subjects. Older male exercisers achieved significant differences relative to controls in perceived anger, tension, and overall social functioning. Male exercisers, in general, achieved significant improvement in perceived vigor. Women did not report psychological benefits following participation in the program.CONCLUSION: Study results reveal that the Strong for Life program, designed to be widely disseminated to the nondisabled older population, has many short‐term positive benefits.
Medical Screening of Older Drivers as a Traffic Safety Measure—A Comparative Finnish‐Swedish Evaluation Study
Authors: Hakamies‐Blomqvist Liisa , Johansson Kurt , Lundberg Catarina 
Published: April 2015

OBJECTIVES: To evaluate the safety effect of age‐related medical screening of older drivers by comparing the licensing laws and accident rates for older road users in Finland and Sweden.DESIGN: Post hoc comparison of Sweden and Finland with respect to three different risk variables.SETTING: Nationwide Swedish and Finnish accident, licensing, and population data from the year 1990 were provided for the present study by the local authorities responsible for tabulating these data.PARTICIPANTS: Data about all citizens born in 1960 or earlier, i.e., aged 30 years or more in the year of measurement, are included.MEASUREMENTS: Rates of police‐reported private car accidents leading to personal injury, fatality rates of private car drivers and passengers, and fatality rates of unprotected road users.RESULTS: The age‐related variation in private car accident and private car fatality trends was similar in both countries. Fatalities among unprotected road users (i.e., pedestrians, cyclists, and mopedists) increased more sharply with age among the older Finnish population than among the Swedish population.CONCLUSION: We found no safety‐related reasons to implement age‐related medical screening of older drivers of the kind practiced in Finland. On the contrary, by producing a modal shift toward a more risky mode of travelling, this screening may indirectly lead to higher fatality rates among older road users.
Measuring Capacity to Complete an Advance Directive
Authors: Molloy D. William , Silberfeld Michel , Darzins Peteris , Guyatt Gordon H. , Singer Peter A. , Rush Bonnie , Bédard Michel , Strang David 
Published: April 2015

OBJECTIVE: To validate reference standards for the assessment of capacity to complete an advance directive and to develop and test three simple screening instruments.METHODS: We administered five measures of capacity to 96 older subjects from nursing homes, retirement homes, and homes for the aged. The measures included two reference standard evaluations: an assessment by a specially trained nurse in collaboration with a multidisciplinary team (Competency Clinic assessment) and geriatrician assessment using a decisional aid. Three screening instruments were also included: a Generic Instrument designed for any advance directive, a Specific Instrument designed for the “Let Me Decide” advance directive, and the Standardized Mini‐Mental Status Examination (SMMSE). The screening instruments and the geriatrician's assessment were administered twice to half of the respondents to determine interrater agreement.RESULTS: The chance‐corrected agreement for the assessment by two geriatricians was 0.78, and for agreement between the geriatricians and Competency Clinic assessments it was 0.82. Agreement for the Generic and Specific screening instrument assessments by two observers was 0.77 and 0.90, respectively. The areas under the Receiver Operating Characteristic curve relating the results of the three screening instruments to the Competency Clinic assessment were 0.82 for the Generic Instrument, 0.90 for the Specific Instrument, and 0.94 for the SMMSE; chance is an unlikely explanation for the difference between these three values (P ≤ .01).CONCLUSIONS: Using rigorous methods, health workers can make reproducible and valid assessments of capacity to complete an advance directive. The SMMSE accurately differentiates people who can learn about and ultimately complete advance directives from those who cannot.
Age, Education, and Changes in the Mini‐Mental State Exam Scores of Older Women: Findings from the Nun Study
Authors: Butler Steven M. , Ashford J. Wesson , Snowdon David A. 
Published: April 2015

OBJECTIVE: To describe the relationship of Mini‐Mental State Exam (MMSE) scores and changes over time in MMSE scores to age and education in a population of older women.DESIGN: A prospective study of a defined population.SETTING: Various motherhouses and church‐run health care facilities in the Eastern, Midwestern, and Southern regions of the United States.PARTICIPANTS: Catholic sisters (nuns) participating in the Nun Study, a study of aging and Alzheimer's Disease. The 678 participants were 75 to 102 years old (mean 83.3, standard deviation 5.5, median 82.3) at the time of the first functional assessment. Second assessments were obtained an average of 1.6 years later on 575 survivors.MEASUREMENTS: The outcome variables were MMSE scores at the first assessment (Time‐one), and MMSE scores at the second assessment (Time‐two). The independent variables were age at Time‐one, and education (bachelor's degree or no bachelor's degree).RESULTS: Time‐one MMSE scores decreased with age at Time‐one. The decrease in MMSE scores with age was less in sisters with bachelor's degrees than in sisters without bachelor's degrees. The changes in MMSE scores had a “U‐shaped” relationship with Time‐one score, where the greatest declines occurred in sisters with intermediate Time‐one scores. Stratified analysis by age, education, and Time‐one MMSE score was feasible only in sisters with Time‐one MMSE scores of 20 or greater because of the small numbers of sisters with Time‐one scores less than 20. In sisters with Time‐one MMSE scores in the categories 20 to 23, 24 to 26, or 27 to 30, older ages at Time‐one were associated with greater decline in those with bachelor's degrees, but not in those without bachelor's degrees. Also, lower education was associated with greater decline in sisters aged 75 to 84 years at Time‐one, but this education effect disappeared or reversed in sisters who were 85 years of age or older at Time‐one.CONCLUSIONS: Cognitive function as measured by the MMSE decreased with age at Time‐one, most steeply as a function of age in those without bachelor's degrees. Cognitive function declined over 1.6 years within individuals, and the extent of decline increased with age in the sisters with bachelor's degrees. The extent of decline varied with age and education in an interactive manner, which may have been attributable to a hardy survivor effect in lower educated sisters. It may be necessary to consider such interactions whenever changes in function are studied, particularly when analyses are stratified by the initial level of function.
The Utilization of Antithrombotic Prophylaxis for Atrial Fibrillation in a Geriatric Rehabilitation Hospital
Authors: Lawson Fiona , McAlister Finlay , Ackman Margaret , Ikuta Roland , Montague Terrence 
Published: April 2015

OBJECTIVE: To determine the utilization of anticoagulant and antithrombotic agents in older patients with atrial fibrillation.DESIGN: Retrospective chart review.SETTING: A geriatric rehabilitation hospital.PATIENTS: Subjects were 102 patients with atrial fibrillation as an intermittent or prevailing cardiac rhythm during a hospital admission in the 1993 fiscal year.MEASUREMENTS: Age, sex, and mental status of the patients; duration and etiology of atrial fibrillation; presence of contraindications to anticoagulants or antithrombotic agents; and utilization of these agents in this population.RESULTS: Of 102 older patients with atrial fibrillation at admission, only 51 were taking some form of anticoagulant or antithrombotic therapy proven effective for stroke prophylaxis (19 warfarin and 32 aspirin). Although 67 patients had relative contraindications to anticoagulation with warfarin, only 25 of the 35 with no contraindications were taking warfarin at the time of discharge. In addition, of the 43 patients with contraindications to warfarin but no contraindications to aspirin, only 28 were prescribed antithrombotic therapy.CONCLUSIONS: Although anticoagulation or antithrombotic therapies for atrial fibrillation appear to be relatively widely used, there are still significant windows of opportunity for the improvement of clinician practice patterns and clinical outcomes in older patients.
Improved Reliability of the Standardized Alzheimer's Disease Assessment Scale (SADAS) Compared with the Alzheimer's Disease Assessment Scale (ADAS)
Authors: Standish Tim I. M. , Molloy D. William , Bédard Michel , Layne Elizabeth C. , Murray E. Ann , Strang David 
Published: April 2015

OBJECTIVES: To compare the interrater and intrarater reliability of the Alzheimer's Disease Assessment Scale (ADAS) with the Standardized Alzheimer's Disease Assessment Scale (SADAS).DESIGN: A randomized, double blind trial. Sixteen university students were randomized to administer either version of the instrument. Subjects were randomized to three assessments, at 2‐week intervals, using the ADAS or the SADAS. Each subject's first and third tests were administered by the same rater, the second by a different rater.SETTING: A geriatric outpatient clinic in a university teaching hospital.PARTICIPANTS: Fifty‐four patients with possible or probable Alzheimer's disease living in the community or in a long‐term care facility.MEASUREMENTS: The primary outcome was the interrater reliability of total ADAS and SADAS scores. Secondary outcomes were ADAS and SADAS cognitive scores, noncognitive scores, duration of testing, and sample size estimates.RESULTS: The interrater reliability of the SADAS total score was significantly better than that of the ADAS (interrater ICC 0.93 SADAS vs 0.83 ADAS), and the interrater standard deviation of the total SADAS score was lower than that of the ADAS (38%, P < .05). The SADAS cognitive subscale inter‐ and intrarater reliability, although higher than the ADAS, was not significantly different when used by different raters (interrater ICC 0.91 SADAS vs 0.90 ADAS; intrarater ICC 0.88 SADAS vs 0.86 ADAS). The SADAS noncognitive subscale was significantly more reliable than the ADAS (interrater ICC 0.89 SADAS vs 0.42 ADAS; intrarater ICC 0.87 SADAS vs 0.70 ADAS; P ≤ .05) and had a lower standard deviation between raters (59%; P < .01) and within raters (40%; P < .05) compared with the ADAS.CONCLUSION: The improved reliability of the SADAS total score means that investigators can now use this score as a primary outcome measure, and important behavioral symptomatology can be included as a marker for treatment efficacy in AD. The smaller standard deviation of the SADAS means that clinical trials using the SADAS as a primary outcome will demonstrate differences, if present, with smaller sample sizes than with the ADAS.
Apolipoprotein‐E Genotyping of Diabetic Dementia Patients: Is Diabetes Rare in Alzheimer's Disease?
Authors: Nielson Kristy A. , Nolan Jennifer H. , Berchtold Nicole C. , Sandman Curt A. , Mulnard Ruth A. , Cotman Carl W. 
Published: April 2015

OBJECTIVES: To determine whether diabetes is rare in Alzheimer disease (AD) relative to other types of dementia and whether diabetics with dementia have a low frequency of the Apolipoprotein‐E E4 genotype.DESIGN: Observational survey study.SETTING: An Irvine, California, outpatient dementia assessment center.PARTICIPANTS: A total of 123 patients with AD, 51 with vascular dementia, 57 with “mixed” vascular dementia and AD, and 34 with “other” dementias (non‐vascular non‐AD).MEASUREMENTS: Demographic data; histories and evidence of diabetes, hypertension, heart disease, stroke; and Apolipoprotein‐E genotype for 95 cases distributed across the groups.RESULTS: There were 15 diabetics in the sample (5.7%), all of whom had extensive vascular disease. Diabetes was rare in AD patients (0.8%) relative to vascular dementia (11.8%), mixed vascular/AD dementia (8.8%), and “other” dementia patients (8.8%). In addition, the E4 allele of apolipoprotein‐E, associated with high risk for AD, was frequent in the AD group (71.4%), but in the diabetic group it was only as frequent as in the general population (38.5%). In the diabetics with E4, 60% (3/5) had mixed dementia.CONCLUSIONS: Diabetics with dementia rarely have AD except as a component of mixed dementia. Apo‐E genotyping showed only average E4 allele frequency in diabetics compared with the high E4 frequency found in AD patients. However, mixed dementia in diabetics may be associated with the E4 allele, suggesting that close control of diabetes may be particularly important for those with E4 since they may be more likely than others to develop both diseases. J Am Geriatr Soc 44:897–904, 1996.
The Relationship Between Ethnicity and Advance Directives in a Frail Older Population
Authors: Eleazer G. Paul , Hornung Carlton A. , Egbert Carolyn B. , Egbert John R. , Eng Catherine , Hedgepeth Jennifer , McCann Robert , Strothers Harry , Sapir Marc , Wei Ming , Wilson Malissa 
Published: April 2015

OBJECTIVE: To assess the relationship between ethnicity and Health Care wishes, including Advance Directives, in a group of frail older persons in PACE (Program For All Inclusive Care Of The Elderly).DESIGN: Retrospective chart review of 1193 participants in the PACE program.SETTING: Program of All Inclusive Care Of The Elderly (PACE), 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. There were 385 non‐Hispanic whites, 364 blacks, 156 Hispanics, and 288 Asians.MEASUREMENTS: Presence or absence of advance directives, type of health care wishes selected including living will, durable power of attorney, and health care proxy.RESULTS: Frail older white, black, Hispanic and Asian Americans differ significantly in their health care wishes and how they choose to express them. Blacks were significantly more likely to select aggressive interventions and less likely than non‐Hispanic whites and Hispanics to utilize a written instrument for expressing health care wishes. Whites were significantly more likely to utilize written documents for advance directives, whereas Asians were more likely to select less aggressive interventions but were unlikely to use written advance directives.CONCLUSIONS: In this population, we found significant ethnic variations in choice of health care wishes. Although health care wishes are an individual decision, an awareness of cross cultural patterns can assist practitioners in addressing the concerns of their patients, as well as assisting Health Care Policy Development. J Am Geriatr Soc 44:938–943, 1996.