bluuebunny/crossref_metadata_2025_split huggingface dataset:
Who Dies at Home? Determinants of Site of Death for Community‐Based Long‐Term Care Patients
Authors: Fried Terri R. , Pollack Daphna M. , Drickamer Margaret A. , Tinetti Mary E. 
Published: April 2015

OBJECTIVE: To determine characteristics associated with site of death in a cohort of long‐term homecare patients.DESIGN: Cohort study.SETTING: Community‐based long‐term care program.SUBJECTS: All patients 65 years of age or older who died within 1 year of admission during 1989 and 1990.MAIN OUTCOME MEASURE: Site of death.RESULTS: Of 620 subjects, site of death was hospital for 302 (49%), home for 132 (21%), nursing home for 124 (20%), and inpatient hospice for 45 (7%). Among patients living at home before death, factors associated with dying at home rather than in a hospital or inpatient hospice included female gender (relative risk (RR) 1.40, 95% confidence interval (CI) 1.00, 1.90); severely dependent functional status (RR 2.38, CI 1.39, 4.17) and cognitive status (RR 1.51, CI 1.10, 2.06); and dying of cancer (RR 1.68, CI 1.11, 2.55), chronic lung disease (AOR 1.75, CI 1.04, 2.95), or coronary artery disease (RR 1.93, CI 1.21, 3.09). Living with a child (RR 1.45, CI .99, 2.11) showed a trend toward association with dying at home.CONCLUSIONS: Even among a subgroup of older persons receiving community‐based long‐term care, the frequency of home death is low. The finding of an association between functional, social, and disease status and site of death suggests that the relationship between these factors and patients' preferences and care needs must be examined in order to understand how to optimize the site of terminal care.
Drugs and Falls in Older People: A Systematic Review and Meta‐analysis: II. Cardiac and Analgesic Drugs
Authors: Leipzig Rosanne M. , Cumming Robert G. , Tinetti Mary E. 
Published: April 2015

OBJECTIVES: To evaluate critically the evidence linking specific classes of cardiac and analgesic drugs to falls in older people.DESIGN: Fixed‐effects meta‐analysis.DATA SOURCES: English‐language articles in MEDLINE (1966 – March 1996) indexed under accidents or accidental falls and aged or age factors; bibliographies of retrieved papers.STUDY SELECTION: Systematic evaluation of cardiac or analgesic drug use and any fall in people aged 60 years and older.DATA EXTRACTION: Study design, inclusion and exclusion criteria, setting, sample size, response rate, mean age, method of medication verification and fall assessment, fall definition, and the number of fallers and nonfallers taking specific classes of cardiac and analgesic drugs.RESULTS: Twenty nine studies met inclusion criteria. None were randomized controlled trials. For one or more falls, the pooled Odds Ratio (95% Confidence Interval) was 1.08 (1.02‐1.16) for diuretic use, 1.06 (0.97‐1.16) for thiazide diuretics, 0.90 (0.73‐1.12) for loop diuretics, 0.93 (0.77‐1.11) for beta‐blockers, 1.16 (0.87‐1.55) for centrally acting antihypertensives, 1.20 (0.92‐1.58) for ACE inhibitors, 0.94 (0.77‐1.14) for calcium channel blockers, 1.13 (0.95‐1.36) for nitrates, 1.59 (1.02‐2.48) for type la antiarrhythmics, and 1.22 (1.05‐1.42) for digoxin use. For analgesic drugs, the pooled OR was 0.97 (0.78‐1.20) for narcotic use, 1.09 (0.88‐1.34) for nonnarcotic analgesic use, 1.16 (0.97‐1.38) for NSAID use, and 1.12 (0.80‐1.57) for aspirin use. There was no statistically significant heterogeneity of pooled odds ratios. There were no differences between the pooled odds ratios for studies with mean subject age <75 versus ≥75 years old or for studies in communities with <35% versus ≥35% fallers. In studies of the relationship between psychotropic, cardiac, or analgesic drugs and falls, subjects reporting the use of more than three or four medications of any type were at increased risk of recurrent falls.CONCLUSION: Digoxin, type IA antiarrhythmic, and diuretic use are associated weakly with falls in older adults. No association was found for the other classes of cardiac or analgesic drugs examined. The evidence to date, however, is based solely on observational data, with minimal adjustment for confounders, dosage, or duration of therapy. Older adults taking more than three or four medications were at increased risk of recurrent falls. As a result of the incidence of falls and their consequences in this population, programs designed to decrease medication use should be evaluated for their impact on fall rates.
Barriers to Effective Communication in Skilled Nursing Facilities: Differences in Perception between Nurses and Physicians
Authors: Cadogan Mary P. , Franzi Cheryl , Osterweil Dan , Hill Terry 
Published: April 2015

BACKGROUND: Effective communication between nurses and physicians is central to the clinical care of nursing home residents. Anecdotal evidence suggests that communication between the groups is unsatisfactory, but no empirical data exist with which to validate assumptions. The purpose of this pilot study was to compare perceptions of potential communication barriers among nurses and physicians in four California nursing homes.METHODS: Registered nurses (n = 59), and physicians (n = 47) involved in the direct clinical care of nursing home residents completed a 12‐item questionnaire designed to elicit perceptions about potential communication barriers. Five specific categories of barriers were identified. These included nurse competence, time burden of calls, necessity of calls, professional respect, and language comprehension. Responses were compared using t test analysis.RESULTS: Significant differences in perceived communication barriers were identified. Physicians, but not nurses, perceive nursing competence to be a significant barrier. Nurses perceive physicians to be unpleasant. Both physicians and nurses perceive that physicians do not value nurses' opinions. Neither group perceived language expression, language comprehension, or time burden of phone calls to be barriers to communication.CONCLUSIONS: Issues related to the perceived competency of nurses by physicians is consistent with existing data from other clinical settings. Differences in awareness about scope of practice and regulatory requirements between the groups may offer a partial explanation for the discordant perceptions. Perceptions by nurses (but not physicians) of unpleasantness and/or disrespect during telephone encounters may reflect the broader ongoing differences in professional culture, social status, and gender inequality between the two groups. Further clarification of the causes of barriers to effective communication is essential in order to plan appropriate interventions.
What is the Quality of the Reporting of Research Ethics in Publications of Nursing Home Research?
Authors: Karlawish Jason H.T. , Hougham Gavin W. , Stocking Carol B. , Sachs Greg A. 
Published: April 2015

OBJECTIVE: To assess the quality of reporting of research ethics in published clinical research that involves a particularly vulnerable population: nursing home residents.DESIGN: A structured review of publications researched from 1992 to 1996 that involve nursing home residents. The review instrument assessed each publication's compliance with four common standards for research that involves nursing home residents or the cognitively impaired: justification of the use of nursing home residents, Institutional Review Board (IRB) review, nursing home committee review, and informed consent. For each publication, these results were summed into a quality score. The research ethics requirements contained in the journals' instructions for authors that corresponded with each publication were categorized in order to compare whether an association exists between the average quality score for each category and the detail of its research ethics instructions.RESULTS: Forty‐five publications were identified. The four quality measures of research ethics showed that (1) all 45 publications reported justification of use of nursing home residents, (2) 36 publications reported that informed consent was obtained or waived, (3) 18 publications reported IRB review, and (4) six publications reported nursing home committee review. Of the 35 publications reporting informed consent was obtained, 16 reported assessing subjects' decisional capacity, and 24 reported whether cognitively impaired subjects were included (19) or excluded (5). The research ethics requirements of each publication's instructions for authors ranked it in one of four categories: (A) None (9); (B) Less than “Uniform Requirements (UR) for Manuscripts Submitted to Biomedical Journals” (7); (C) UR (24); (D) UR plus Additional Instructions (5). A positive association exists between the detail of a research ethics instructions category and the average research ethics quality score for each category (Kruskal‐Wallis χ2 = 11.2, P = .01). That is, the more detailed the instructions, the greater the quality score.CONCLUSION: In publications of research that involves nursing home residents, basic standards of research ethics are not typically reported. However, the positive association between research ethics instructions category and research ethics quality score suggests that a journal's instructions for authors or other features of peer review and editing can affect the quality of reporting research ethics.
Life‐Sustaining Treatment Decisions for Nursing Home Residents: Who Discusses, Who Decides and What Is Decided?
Authors: Levin Jennifer R. , Wenger Neil S. , Ouslander Joseph G. , Zellman Gail , Schnelle John F. , Buchanan Joan L. , Hirsch Susan H. , Reuben David B. 
Published: April 2015

OBJECTIVE: To evaluate whether nursing home residents and their families reported discussions about life‐sustaining treatment with their physicians, the relationship between such discussions and orders to limit therapy, and predictors of physician‐patient communication about life‐sustaining treatment.DESIGN: Cross‐sectional interviews and retrospective chart abstraction.SETTING: Three regions: West Coast, New England, Western.SAMPLE: A total of 413 nursing home residents, 363 family/ surrogate interviews, and 192 resident interviews.MAIN OUTCOME MEASURES: Measured were (1) physician‐resident communication about life‐sustaining treatment and (2) presence of an advance directive or do not resuscitate (DNR) order in resident's chart.RESULTS: Seventy‐four percent of residents had DNR orders, and 32% had advance directives; only 29% of residents reported discussions about life‐sustaining treatment. Of residents with DNR orders who could have participated in discussions about life‐sustaining treatment, nearly half reported they had not discussed CPR with their caregivers. Older age, longer duration of time living in nursing home, location in a New England nursing home, physician‐family member discussion, and the presence of an advance directive in the medical chart were positively associated with having DNR orders. Physician‐resident discussion was not associated with having a DNR order. For the subsample of interviewed residents, age and a diagnosis of cognitive impairment were negatively associated with a physician‐resident discussion about life‐sustaining treatment, whereas the likelihood of having a discussion increased with increasing numbers of medical diagnoses.CONCLUSIONS: Chart orders to limit therapy are common, but physician‐resident discussions about life‐sustaining treatments are not. Far more family members than residents report such discussions with the resident's physicians.
The Renal Effects of Nonsteroidal Anti‐inflammatory Drugs in Older People: Findings from the Established Populations for Epidemiologic Studies of the Elderly
Authors: Field Terry S. , Gurwitz Jerry H. , Glynn Robert J. , Salive Marcel E. , Gaziano J. Michael , Taylor James O. , Hennekens Charles H. 
Published: April 2015

OBJECTIVE: To determine whether older people who use nonsteroidal anti‐inflammatory agents (NSAIDs) have increased levels of blood urea nitrogen (BUN), serum creatinine, and BUN:serum creatinine ratio.DESIGN: Cross‐sectional, secondary data analysis.SETTING: Older people living in the communities of East Boston, MA, New Haven, CT, and Washington and Iowa Counties, Iowa.PARTICIPANTS: A total of 4099 people aged 70 years or older who were participants in the National Institute on Aging's Established Populations for Epidemiologic Studies of the Elderly project, had survived to the 6‐year follow‐up interview and had consented to the blood drawing.MEASUREMENTS: We assessed use of the NSAIDs at the 3‐and 6‐year interviews through a drug inventory and visual review of medication containers. Markers of renal function assessed through analysis of blood samples drawn at the time of the interview included BUN and creatinine.RESULTS: Fifteen percent of the cohort reported use of NSAIDs during the 2 weeks preceding the 6‐year interview. Controlling for age, sex, and a range of potential confounding variables, NSAID users had significant prevalence odds ratios of 1.9 (95% confidence interval (CI), 1.5‐2.3) for being in the highest quartile of BUN (>23), 1.3 (CI 1.1‐1.7) for the highest quartile of serum creatinine (≥1.4), and 1.7 (CI 1.4‐2.1) for the highest quartile of the BUN:creatinine ratio (≥19.4). Chronic NSAID users (those who reported NSAID use at both the 3‐year and 6‐year interviews) accounted for the increased risk of high serum creatinine levels.CONCLUSION: Community‐dwelling older people who use NSAIDs tend to have higher levels of common laboratory markers of renal dysfunction. This hypothesis requires further testing in prospective cohort studies designed a priori to evaluate these issues. J Am Geriatr Soc 47:507–511, 1999.
The Relationship Between Clinical Assessments of Nutritional Status and Adverse Outcomes in Older Hospitalized Medical Patients
Authors: Covinsky Kenneth E. , Martin Gay E. , Beyth Rebecca J. , Justice Amy C. , Sehgal Ashwini R. , Landefeld C. Seth 
Published: April 2015

BACKGROUND: Malnutrition is common in hospitalized older people and may predict adverse outcomes. Previous studies of the relationship between nutritional status and hospital outcomes are limited by inadequate accounting for other potential predictors of adverse outcomes, the failure to consider functional outcomes, and the omission of clinical assessments of nutritional status.OBJECTIVE: To measure the relationship between a clinical assessment of nutritional status on hospital admission and subsequent mortality, functional dependence, and nursing home use.DESIGN: Prospective cohort study SETTING: A tertiary care hospitalPATIENTS: A total of 369 patients at least 70 years old (mean age 80.3, 62% women) admitted to a general medical serviceMEASUREMENTS: Nutritional status was measured with the Subjective Global Assessment, a validated measure of nutritional status based on historical and physical exam findings. Patients were classified as severely malnourished (generally at least a 10% weight loss over the previous 6 months and marked physical signs of malnutrition), moderately malnourished (generally a 5 to 10% weight loss and moderate physical signs), or well nourished. Vital status, independence in activities of daily living, and nursing home use were determined through patient or surrogate interview at admission and 90 days and 1 year after discharge. Indices of comorbidity and illness severity were determined from chart review.RESULTS: 219 patients (59.3%) were well nourished, 90 (24.4%) were moderately malnourished, and 60 (16.3%) were severely malnourished. Severely malnourished patients were more likely than moderately malnourished or well nourished patients to die by 90 days (31.7%, 23.3%, and 12.3%, respectively, P < .001) and 1 year (55.0%, 35.6%, and 27.9%, P < .001) after discharge. In logistic regression models controlling for acute illness severity, comorbidity, and functional status on admission, severely malnourished patients were more likely than well nourished patients to die within 1 year of discharge (OR = 2.83, 95% CI, 1.47‐5.45), to be dependent in activities of daily living 3 months after discharge (OR = 2.81, 1.06–7.46), and to spend time in a nursing home during the year after discharge (OR = 3.22, 1.05–9.87).CONCLUSION: Malnutrition was common in hospitalized patients with medical illness and was associated with greater mortality, delayed functional recovery, and higher rates of nursing home use. These adverse outcomes were not explained by greater acute illness severity, comorbidity, or functional dependence in malnourished patients on hospital admission. J Am Geriatr Soc 47:532–538, 1999.
Cross‐Sectional Versus Longitudinal Estimates of Cognitive Change in Nondemented Older People: A CERAD Study
Authors: Unger Joseph M. , van Belle Gerald , Heyman Albert 
Published: April 2015

OBJECTIVES: To investigate the effect of increasing age on cognition in nondemented older people.DESIGN: A cross‐sectional and longitudinal analysis.PARTICIPANTS: A total of 454 control subjects for Alzheimer's cases from the cohort assembled by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD).MEASUREMENT: The Mini‐Mental State Examination (MMSE) to assess cognitive function.RESULTS: Cross‐sectional estimates were derived by generalized linear models and longitudinal estimates by generalized estimating equations. The cross‐sectional model indicated a small but significant decline in MMSE of ‐.4 points per 10 years. The longitudinal model indicated a small but significant increase in MMSE of about +.6 points per 10 years. Evidence of an early learning effect and nonrandom dropout exists.CONCLUSIONS: The question of “normal” aging can be approached by considering cross‐sectional information and, usually separately, longitudinal information. This study does both using recently developed statistical methods. We conclude that there is a small but significant decline in scores on the MMSE with increasing population age. The effect can be masked in longitudinal cohorts by a learning effect (especially early in follow‐up) and other factors associated with repeated testing. J Am Geriatr Soc 47:559–563, 1999.
The Influence of Physician Race, Age, and Gender on Physician Attitudes Toward Advance Care Directives and Preferences for End‐Of‐Life Decision‐Making
Authors: Mebane Eric W. , Oman Roy F. , Kroonen Leo T. , Goldstein Mary K. 
Published: April 2015

OBJECTIVE: To determine whether physicians' preferences for end‐of‐life decision‐making differ between blacks and whites in the same pattern as patient preferences, with blacks being more likely than whites to prefer life‐prolonging treatments.DESIGN: A mailed survey.SETTING AND PARTICIPANTS: American Medical Association (AMA) and National Medical Association (NMA) databases. To enrich the sample of black physicians, we targeted physicians in the AMA database practicing in high minority area zip codes and graduates of the traditionally black medical schools.MAIN OUTCOME MEASURES: Self‐reported physician attitudes toward end‐of‐life decision‐making and preference of treatment for themselves in persistent vegetative state or organic brain disease compared by race, controlling for age and gender.RESULTS: The 502 physicians (28%) who returned the questionnaire included 280 white and 157 black physicians. With regard to attitudes toward patient care, 58% of white physicians agreed that tube‐feeding in terminally ill patients is “heroic,” but only 28% of black physicians agreed with the statement (P < .001). White physicians were more likely than black physicians to find physician‐assisted suicide an acceptable treatment alternative (36.6% vs 26.5% of black physicians) (P < .05).With regard to the physicians preferences for future treatment of themselves for the persistent vegetative state scenario, black physicians were more than six times more likely than white physicians to request aggressive treatments (cardiopulmonary resuscitation, mechanical ventilation, or artificial feeding) for themselves (15.4% vs 2.5%) (P < .001). White physicians were almost three times as likely to want physician‐assisted suicide (29.3% vs 11.8%) (P < .001) in this scenario. For a state of brain damage with no terminal illness, the majority of all physicians did not want aggressive treatment, but black physicians were nearly five times more likely than white physicians (23.0% vs 5.0%) (P < .001) to request these treatments. White physicians, on the other hand, were more than twice as likely to request physician‐assisted suicide (22.5% vs 9.9%), P < .001 in this scenario.CONCLUSIONS: Physicians preferences for end‐of‐life treatment follow the same pattern by race as patient preferences, making it unlikely that low socioeconomic status or lack of familiarity with treatments account for the difference. Self‐denoted race may be a surrogate marker for other, as yet undefined, factors. The full spectrum of treatment preferences should be considered in development of guidelines for end‐of‐life treatment in our diverse society. J Am Geriatr Soc 47:579–591, 1999.
A Randomized Clinical Trial of Outpatient Comprehensive Geriatric Assessment Coupled with an Intervention to Increase Adherence to Recommendations
Authors: Reuben David B. , Frank Janet C. , Hirsch Susan H. , McGuigan Kimberly A. , Maly Rose C. 
Published: April 2015

BACKGROUND: Although comprehensive geriatric assessment (CGA) has been demonstrated to confer health benefits in some settings, its value in outpatient or office settings is uncertain.OBJECTIVE: To assess the effectiveness of outpatient CGA consultation coupled with an adherence intervention on 15‐month health outcomes.DESIGN: A randomized controlled trial.SETTING: Community‐based sites.PATIENTS: 363 community‐dwelling older persons who had failed a screen for at least one of four conditions (falls, urinary incontinence, depressive symptoms, or functional impairment)INTERVENTION: A single outpatient CGA consultation coupled with an intervention to improve primary care physician and patient adherence with CGA recommendations.MEASUREMENTS: Medical Outcomes Study Short Form‐36 (MOS SF‐36), restricted activity and bed days, Physical Perfomance Test, NIA lower‐extremity battery.RESULTS: In complete case analysis (excluding the five control group subjects who died during the follow‐up period), the adjusted difference in change scores (4.69 points) for physical functioning between treatment and control groups indicated a significant benefit of treatment (P = .021). Similar benefits were demonstrated for number of restricted activity days and MOS SF‐36 energy/fatigue, social functioning, and physical health summary scales. In analyses assigning scores of 0 to those who died, these benefits were greater, and significant benefits for the Physical Performance Test and MOS SF‐36 emotional/well being, pain, and mental health summary scales were also demonstrated.CONCLUSIONS: A single outpatient comprehensive geriatric assessment coupled with an adherence intervention can prevent functional and health‐related quality‐of‐life decline among community‐dwelling older persons who have specific geriatric conditions.