bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clock Drawing Test in Very Mild Alzheimer's Disease
Authors: Esteban‐Santillan Concepcion , Praditsuwan Rungnirand , Veda Hideki , Geldmacher David S. 
Published: April 2015

OBJECTIVES: The primary objective of this study was to determine the efficacy of the clock drawing test to predict the presence of very mild Alzheimer's disease (AD). A secondary objective was to identify elements of clock drawing that were most useful in differentiating cognitively intact older adults from those with mild Alzheimer's disease.DESIGN: Cohort based comparison of retrospective data.SETTING: Academic research center.PARTICIPANTS: Clock drawings from 41 outpatient cases of mild AD with Mini‐Mental State Exam scores of 24 or higher and 39 age‐ and education‐matched older adults were scored.MEASUREMENTS: Clock drawings were blindly and independently scored by two raters using the Clock Drawing Interpretation Scale and the scoring system reported by Rouleau et al. Predictive values for positive and negative tests were calculated using cut‐off scores for total score and component subscores from each of these two systems.RESULTS: Two or more errors in the depiction of the clock hands on the Clock Drawing Interpretation Scale had a positive predictive value for AD of 100% and a negative predictive value of 51%. A score of 2 or less on the 4‐point hand‐placement component of the Rouleau et al. scoring system provided a positive predictive value for AD of 94% and was associated with a negative predictive value of 62%.CONCLUSION: An individual who commits two errors or more in drawing the clock hands deserves further investigation for a possible dementia. Normal hand placement on the clock drawing test does not exclude AD. However, when prevalence rates of dementia in community‐dwelling older adults are considered, these results argue that normal clock hand placement indicates that dementia is unlikely.
Contribution of Individual Items to the Performance of the Norton Pressure Ulcer Prediction Scale
Authors: Perneger Thomas V. , Gaspoz Jean‐Michel , Raë Anne‐Claire , Borst François , Héliot Céliane 
Published: April 2015

OBJECTIVES: To assess the specific contribution to overall scale performance of each of the five items that constitute the Norton pressure ulcer prediction scale.DESIGN: A comparison of statistical models based on cross‐sectional surveys of hospitalized patients.SETTING: An urban teaching hospital in Geneva, Switzerland.PARTICIPANTS: 2373 hospitalized patients who were free of pressure ulcers on admission.MEASUREMENTS: Norton scale items measuring activity, mobility, physical condition, mental condition, and incontinence on a 4‐point scale were examined as predictors of stage 1 or greater pressure ulcers.RESULTS: A total of 245 new pressure ulcers occurred between admission and patient observation. After adjustment for other independent predictors in proportional hazards models, only the activity and mobility items remained associated significantly with the risk of pressure ulcer. A simplified 2‐item scale was more strongly associated with pressure ulcer risk than was the classic 5‐item Norton scale.CONCLUSIONS: Our study suggests that the activity and mobility items of the Norton scale are sufficient to express the risk of pressure ulcers in hospitalized patients. Confirmation of this finding in prospective studies is warranted.
On the Number of Automated Timed Manual Performance Trials to Administer
Authors: Busby‐Whitehead Jan , Robinson Pamela S. , Matteson Elizabeth S. , Rosemond Cherie , PhD William L. Dunn 
Published: April 2015

OBJECTIVE: To determine the number of trials needed to obtain satisfactory results when evaluating function in older subjects using the automated version of the Williams short (three‐door) Timed Manual Performance (TMP) test.DESIGN: Administration of from one to five trials in succession on a given test date.SETTING: A Continuing Care Retirement Community (CCRC), assisted living centers, nursing homes, and a community residence, all located in central North Carolina.PARTICIPANTS: The subject population consisted of 182 older volunteers, aged 63 to 100 years. One hundred nineteen lived independently in a CCRC, 33 were assisted‐living residents, 29 lived in nursing homes, and one lived independently in the community. Each subject was administered at least three trials in succession on his or her first test date; 23 of the independently living CCRC residents were given three trials on a second test date. The community‐dwelling volunteer was administered from one to five trials on each of 26 test dates over an approximately 16‐month period.MEASUREMENTS: The time it takes to perform five door opening and closing operations as measured by the three‐door Cognatemp® Automated Timed Manual Performance (ATMP) system.MAIN RESULTS: Average ATMP time for the subjects living independently decreased approximately 10% between the first two trials but negligibly between trials two and three. The more dependent groups continued to improve between trials two and three. The community‐dwelling subject tended to improve in the first three or four trials and to decline by the fifth trial.CONCLUSIONS: It is recommended that two trials be administered and the best time used; if neither trial results in a time less than 10 seconds, one or two more trials should be administered. It is generally not necessary nor advantageous to administer more than four trials.
A Prospective Study of the Use of Liquid Oral Dietary Supplements in Nursing Homes1
Authors: Kayser‐Jones Jeanie , Schell Ellen S. , Porter Carol , Barbaccia Joseph C. , Steinbach Catherine , Bird William F. , Redford Maryann , Pengilly Kathryn 
Published: April 2015

OBJECTIVE: To investigate the use of liquid oral dietary supplements among nursing home residents who were eating poorly and losing weight.DESIGN: A prospective, descriptive, anthropological study.SETTING: Two proprietary nursing homes with 105 and 138 beds.PARTICIPANTS: Purposive sampling was used to select 40 residents from among the 100 residents who were not eating well. Dietary data were collected on this sub‐sample of 40 residents.MEASUREMENTS: Participant observation, in‐depth interviews, event analysis, bedside dysphagia screenings, oral health examinations, body weight, body mass index (BMI), and chart review were used to collect data. Dietary data were collected over a 3‐day period, and data were gathered on how supplements were ordered, served, and consumed.RESULTS: Supplements had been ordered for 29 of the subsample of 40 residents. Only nine of 29 residents were served the correct number and type of supplements as ordered by their physicians, and only two residents consumed the full amount of supplement as ordered. The overall mean percentage of supplement consumed compared with that ordered was 55.1%. Although supplements were ordered primarily to prevent weight loss and to facilitate weight gain, nearly half (n = 14) of the residents continued to lose weight. Supplements were ordered without investigating the underlying factors contributing to weight loss, such as inadequate staffing and lack of supervision at mealtime, undiagnosed dysphagia, and poor oral health. Without evaluation of these factors, it is unknown which residents might benefit from oral supplements.CONCLUSION: Findings indicate that supplements were used nonspecifically as an intervention for weight loss in nursing home residents without regard to dose, diagnosis and management of underlying problem(s), amount of supplement consumed, and outcome. Further research is needed to establish when supplements should be ordered, how to ensure that they will be taken, and whether they are effective.
Reproductive and Hormonal Risk Factors for Urinary Incontinence in Later Life: A Review of the Clinical and Epidemiologic Literature
Authors: Thorn David H. , Brown Jeanette S. 
Published: April 2015

OBJECTIVES: To review and integrate the current literature on the role of reproductive factors in the development of urinary incontinence in later life.DESIGN: An extensive literature review using Medline and Science Citation Index for the period 1966 through 1997 was undertaken to identify published studies of the association between parturition events, hysterectomy, menopause, estrogen therapy, and later urinary incontinence.RESULTS: Vaginal delivery is an established risk factor for both transient postpartum incontinence and the development of incontinence in later life. Several studies have found evidence of nerve and muscle damage that provide a physiologic basis for this association. Prospective studies of incontinence after hysterectomy have generally found no increased risk in the first few years. In contrast, cross‐sectional epidemiologic studies have consistently found an increased risk many years after hysterectomy. Although menopause is often considered a risk factor for urinary incontinence, epidemiological studies have generally not found an increase in the prevalence of incontinence in the perimenopausal period. Oral estrogen replacement therapy seems to have little short‐term clinical benefit in regard to incontinence and is associated consistently with increased risk of incontinence in women aged 60 years and older in epidemiologic studies.CONCLUSIONS: This review provides a framework for further investigation of the complex relationships between reproductive risk factors and urinary incontinence. Integration of physiologic, clinical, and epidemiologic studies is needed to address the compelling health care issue of urinary incontinence. Suggestions are made for further areas of research.
Treatment of Pain in Cognitively Impaired Compared with Cognitively Intact Older Patients with Hip‐Fracture
Authors: Feldt Karen S. , Ryden Muriel B. , Miles Steven 
Published: April 2015

OBJECTIVE: To compare the experience of pain and treatment of pain in cognitively impaired and cognitively intact older adults after surgical repair of a hip fracture.DESIGN: Prospective comparative survey design.PARTICIPANTS: A convenience sample of 88 hip fracture patients (53 cognitively impaired, 35 cognitively intact) from three Midwestern urban hospital orthopedic units was interviewed between days 2 and 5 postoperatively. Subjects whose Folstein Mini‐Mental State Exam (MMSE) score was less than or equal to 23 were categorized as impaired.RESULTS: Pain report and intensity did not differ significantly between the two groups. One‐third of the subjects in both groups rated pain as severe or worse. Cognitively impaired subjects scored significantly higher on the Checklist of Nonverbal Pain Indicators observed with movement (CNPI‐m) than did cognitively intact subjects. Cognitively impaired subjects received significantly less opioid analgesics than cognitively intact subjects in the first and second 48 hours postoperatively. Both groups received less than 25% of the mean prescribed amount of opioid analgesics. Age, MMSE, and CNPI‐m score accounted for 27% of the variance in the amount of opioid analgesic administered in the first 48 hours postoperatively.CONCLUSIONS: Pain is treated poorly in older postoperative patients. Cognitive impairment and age strongly influence the amount of analgesic nurses administer to older patients after surgical repair of hip fracture. Provision for patient comfort is a fundamental ethical obligation of healthcare providers. Clinicians need to pursue this goal more aggressively, especially for cognitively impaired, postoperative older adults.
A Prospective Study of the Efficacy of the Physician Order Form for Life‐Sustaining Treatment
Authors: Tolle Susan W. , Tilden Virginia P. , Nelson Christine A. , Dunn Patrick M. 
Published: April 2015

OBJECTIVES: The Physician Orders for Life‐Sustaining Treatment (POLST), a comprehensive, one‐page order form, was developed to convey preferences for life‐sustaining treatments during transfer from one care site to another. This study examined the extent to which the POLST form ensured that nursing home residents' wishes were honored for Do Not Resuscitate (DNR) and requests for transfer only if comfort measures fail.DESIGN: The study used chart record data to follow prospectively a sample of nursing home residents with the POLST.SETTING: Eight geographically diverse, long‐term, adult‐care facilities in Oregon in which the POLST was in use.PARTICIPANTS: Nursing home residents (n = 180), who had a POLST recording DNR designation and who indicated a desire for transfer only if comfort measures failed, were followed for 1 year.MEASUREMENTS: For all subjects: treatment and disposition after significant health status changes; orders for narcotics and for provision or limitation of aggressive interventions. For hospitalized subjects: diagnosis, medical interventions, and DNR orders. For those who died: cause and location of death, life‐sustaining treatments attempted, and comfort measures provided.RESULTS: No study subject received CPR, ICU care, or ventilator support, and only 2% were hospitalized to extend life. Of the 38 subjects who died during the study year, 63% had an order for narcotics, and only two (5%) died in an acute care hospital. A total of 24 subjects (13%) were hospitalized during the year. Hospitalized subjects' mean length of stay was 4.9 days, and the mean rate of hospitalizations for all subjects was 174 per 1000 resident years. In 85% of all hospitalizations, patients were transferred because the nursing home could not control suffering. In 15% of hospitalizations (n = 4), the transfer was to extend life, overriding POLST orders.CONCLUSIONS: POLST orders regarding CPR in nursing home residents in this study were universally respected. Study subjects received remarkably high levels of comfort care and low rates of transfer for aggressive life‐extending treatments.
Underutilization of Measurement of Serum Low‐Density Lipoprotein Cholesterol Levels and of Lipid‐Lowering Therapy in Older Patients with Manifest Atherosclerotic Disease
Authors: Mendelson Gad , Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To investigate the prevalence of measurement of serum lipids and of utilizing lipid‐lowering therapy, when appropriate, in older persons without contraindications to lipid‐lowering drugs and with myocardial infarction (MI), stroke, peripheral arterial disease (PAD), and no coronary artery disease (CAD), stroke, or PAD.DESIGN: A retrospective analysis of charts of all older patients seen from January 1, 1997, through October 15, 1997, was performed to investigate the prevalence of measurement of serum lipids and utilization of lipid‐lowering therapy, when appropriate, in older persons without contraindications to lipid‐lowering drugs and with MI, stroke, PAD, and no CAD, stroke, or PAD. Patients with life‐limiting comorbidities were not included in the study.SETTING: An academic, hospital‐based geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.PARTICIPANTS: A total of 373 men and 1119 women, mean age 80 ± 8 years (range 59 to 103 years), were included in the study.MEASUREMENTS AND MAIN RESULTS: Serum low‐density lipoprotein (LDL) cholesterol was measured in 201 of 391 patients (51%) with MI, in 78 of 187 patients (42%) with stroke, in 58 of 115 patients (50%) with PAD, and in 396 of 926 patients (43%) with no CAD, stroke, or PAD. In patients with elevated serum LDL cholesterol levels, lipid‐lowering drug therapy was given to eight of 15 patients (53%) <70 years of age with MI, to 34 of 63 patients (54%) 70 to 80 years of age with MI, and to 38 of 81 patients (47%) > 80 years of age with MI (P not significant); to three of seven patients (43%) <70 years of age with stroke, to 12 of 26 patients (46%) 70 to 80 years of age with stroke, and to 13 of 32 patients (41 %) >80 years of age with stroke (P not significant); to two of four patients (50%) <70 years of age with PAD, to seven of 17 patients (41%) 70 to 80 years of age with PAD, and to 10 of 25 patients (40%) >80 years of age with PAD (P not significant); and to six of 15 patients (40%) <70 years of age with no CAD, stroke, or PAD, to 26 of 70 patients (37%) 70 to 80 years of age with no CAD, stroke or PAD, and to 14 of 47 patients (30%) >80 years of age with no CAD, stroke, or PAD (P not significant). None of the other patients with MI, stroke, PAD, or no CAD, stroke, or PAD was treated with diet or lipid‐lowering drugs.CONCLUSIONS: Measurement of serum LDL cholesterol and of appropriate use of lipid‐lowering drugs and diet in older patients with MI, stroke, PAD, and no CAD, stroke, or PAD is underutilized in an academic, hospital‐based geriatrics practice.
GERIATRICS IN MANAGED CARE
Authors: Brummel‐Smith Kenneth , Joseph Abe , Boult Chad 
Published: April 2015

OBJECTIVE: To measure the rates of hospital use and mortality of nursing homes residents who received their primary care from nurse practitioner‐physician teams.DESIGN: A cohort study.SETTING: Thirty nursing homes in Southern California.PATIENTS: Older, long‐term residents of nursing homes enrolled in a Medicare HMO (n = 307).INTERVENTION: Primary care by an accessible interdisciplinary team supported by clinical guidelines, continuous quality improvement techniques, and increased availability of clinical services at the nursing homes.RESULTS: The residents (mean age 83.5 years, 69.0% women) had a high prevalence of dementia (83.5%) and functional disability (87.2% were dependent in two or more activities of daily living). About half (50.8%) expressed a preference for “no hospitalization and no resuscitation.” Compared with other nursing homes populations, this cohort experienced a lower annual rate of hospital use (518 days/1000 residents) and a similar rate of mortality (23.8%).CONCLUSIONS: Integration of the efforts of physicians, nurse practitioners, and nursing home staff can lead to low rates of hospital use by nursing home residents. The effects on residents' quality of life and mortality require further study.
Correlates and Management of Nonmalignant Pain in the Nursing Home
Authors: Won Aida , Lapane Kate , Gambassi Giovanni , Bernabei Roberto , Mor Vince , Lipsitz Lewis A. ,   on behalf of the SAGE Study Group
Published: April 2015

OBJECTIVENonmalignant pain is a common problem among older people. The prevalence of pain in the nursing home is not well studied. We looked at the association between nonmalignant pain, psychological and functional health, and the practice patterns for pain management in the nursing home.DESIGNA cross‐sectional study.SETTINGNursing Home in four US states.PARTICIPANTSA total of 49,971 nursing home residents from 1992 to 1995.MEASUREMENTSWe used the SAGE database (Systematic Assessment of Geriatric drug use via Epidemiology), which linked information from the Minimum Data Set and nursing home drug utilization data. The MDS items measured included pain, activities of daily living (ADL) function, mood, and time involved in activities. The use of analgesics, anxiolytics, and antidepressants was also documented.RESULTSDaily pain was reported in 26% of nursing home residents. The prevalence was lower among men, persons more than age 85, and racial minorities. Persons suffering pain daily were more likely to have severe ADL impairment, odds ratio (OR) (2.47 (95% CI, 2.34–2.60)), more depressive signs and symptoms (OR 1.66 (95% CI, 1.57–1.75)), and less frequent involvement in activities (OR 1.35 (95% CI, 1.29–1.40)). Approximately 25% of persons with daily pain received no analgesics. Residents who were more than 85 years old (OR 1.15 (95% CI 1.02–1.28)), cognitively impaired, (OR 1.44 (95% CI, 1.29–1.61)), of male gender (OR 1.17 (95% CI, 1.06–1.29)), or a racial minority (OR 1.69 (95% CI, 1.40–2.05) and OR 1.56 (95% CI, 0.70–1.04) for blacks and Hispanics, respectively) were at greater risk of not receiving analgesics. Approximately 50% of those in pain used physical and occupational therapies, which was more than two times higher (OR 2.44 (95% CI, 2.34–2.54)), than use for those not in pain.CONCLUSIONSDaily nonmalignant pain is prevalent among nursing home residents and is often associated with impairments in ADL, mood, and decreased activity involvement. Even when pain was recognized, men, racial minorities, and cognitively impaired residents were at increased risk for undertreatment. More education and research is necessary to improve the recognition and management of pain in the nursing home, remembering that attention should be paid to populations at increased risk for underrecognition and undertreatment.
Platelet Hyperactivity in Hypertensive Older Patients Is Controlled by Lowering Blood Pressure
Authors: Riondino Silvia , Pignatelli Pasquale , Pulcinelli Fabio M. , Lenti Luisa , Veroli Claudio Di , Marigliano Vincenzo , Gazzaniga Pier Paolo 
Published: April 2015

OBJECTIVEPatients with hypertension tend to have a high prevalence of atherothrombotic accidents. Platelet hyperactivity is frequently associated with hypertension. Because the vascular disease associated with hypertension evolves over the years, we investigated platelet activity parameters in a population of older hypertensive patients with no other risk factors for cardiovascular disease.PARTICIPANTSWe studied 34 older, nonsmoking patients (mean age 74 ± 5 years) with uncomplicated hypertension before and after the normalization of blood pressure (BP) was achieved with the angiotensin‐converting enzyme inhibitor quinapril alone or in combination with the Ca2+ antagonist nifedipine.MEASUREMENTSPlatelet aggregation, P‐selectin (CD62) expression on the platelet surface, serum levels of Interleukin‐1β (IL‐1β) and of Interleukin‐6 (IL‐6), as well as plasma levels of soluble P‐selectin and Endothelin‐1 (ET‐1), were analyzed.RESULTSAll platelet hyperactivity parameters were reduced significantly with the normalization of BP at the end of antihypertensive drug treatment (systolic/diastolic: 186.2 ± 2.7/103.4 ± 1.1 mm Hg vs 135.0 ± 1.3/85.9 ± 1.9 mm Hg; P < .001). Those factors more strictly associated with endothelium injury, such as ET‐1 and IL‐6, did not show variations. A significant correlation (Spearman Rank test) was observed among all platelet function parameters and blood pressure values.CONCLUSIONSThis study demonstrated that even in a population of older hypertensive patients with no other risk factor for atherogenic disease, normalization of blood pressure induces a significant reduction of the parameters of enhanced platelet hyperactivity independent of the action exerted, at the platelet level, by the antihypertensive drugs.