bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Activity and the Changes in Maximal Isometric Strength in Men and Women from the Age of 75 to 80 Years
Authors: Rantanen Taina , Era Pertti , Heikkinen Eino 
Published: April 2015

OBJECTIVE: To research the natural changes in maximal isometric strength, over a period of 5 years, in men and women aged 75 at baseline, and to study the effect of everyday physical activity on strength alterations.DESIGN: A 5‐year longitudinal study.SETTING: Exercise laboratoryPARTICIPANTS: The target group in 1989 was the total 75‐year‐old population of Jyväskylä. One hundred one men (81%) and 186 women (75%) participated in baseline strength tests, and after 5 years, 55 men and 111 women (70% and 72% of the survivors) took part in the follow‐up measurements.METHODS: Maximal isometric hand grip, arm flexion, knee extension, trunk flexion, and trunk extension forces were measured using dynamometers. Self‐rated physical activity was recorded using a scale by Grimby (1986). Strength changes were compared between groups based on the amount of everyday physical activity: (1) remained active (AA, 24 men, 24 women); (2) remained sedentary (SS, 11 men, 43 women); (3) decreased activity (AS, 11 women); and (4) increased activity (SA, 32 women). AS and SA could be formed for women only because of the small number of men. All analyses were stratified by gender.MAIN RESULTS: The average percentage change in strength over 5 years among survivors varied from a 4% increase in knee extension strength observed in men and women to a 16% decrease in grip strength in women. The grip strength decrease was greater in women than men. The AA men maintained their trunk extension strength at a higher level than the SS men. Time by group interactions in men were not significant. In women, the rate of decline in AS was 32% in grip and 27% in elbow flexion strength, which was greater than in the other activity groups. The AA women retained their knee extension strength at a higher level than the other groups. Those who died before follow‐up tests exhibited poorer strength test results at baseline. Physical activity decreased over follow‐up.CONCLUSIONS: Strength alterations with age differed between muscle groups. Undertaking everyday physical activities such as household work, walking, and gardening, which are also the most common physically demanding activities of older people, may play an important role in maintaining strength at an adequate level for independent living. J Am Geriatr Soc 45:1439–1445, 1997.
Differences in Psychosocial and Health Correlates of Major and Minor Depression in Medically Ill Older Adults
Authors: Koenig Harold G. 
Published: April 2015

OBJECTIVES: To compare the differences in correlates of different levels of depression in medically ill hospitalized older adults.DESIGN, SETTING, AND PARTICIPANTS: A consecutive series of 542 patients aged 60 or older admitted to the medical inpatient services of Duke Hospital underwent a structured psychiatric evaluation administered by a psychiatrist.MEASUREMENT: A wide range of demographic, social, psychiatric, and physical health data were collected, and associations with major and minor depression were assessed. RESULTS: Compared with patients without depression, those with major depression were more likely to have a history of prior episodes of depression, higher dysfunctional attitude scores, greater overall severity of medical illness, cognitive impairment, and symptoms of pain or other somatic complaints. Specific medical diagnosis was less important a predictor of major depression than overall severity of medical illness. Compared with patients without depression, those with minor depression were more likely to report non‐health‐related stressors during the year before hospital admission, have a diagnosis of immune system disorder, and have greater severity of medical illness. When major and minor depression were compared directly, on the other hand, no significant differences were observed except for history of depression, and that relationship was weak and present only when the etiologic approach to diagnosis was used.CONCLUSION: During hospital admission, certain psychosocial, psychiatric, and physical health characteristics of older medical patients place them at high risk for different levels of depression. Patients with major and minor depression resemble each other more than they do patients without depression. These findings may help clinicians better understand the causes of different types of depression in this setting and lead to improved diagnosis and treatment. J Am Geriatr Soc 45:1487–1495, 1997.
Psychiatric Assessments of Nursing Home Residents Under OBRA‐87: Should PASARR Be Reformed?
Authors: Borson Soo , Loebel J. Pierre , Kitchell Margaret , Domoto Sylvia , Hyde Thomas 
Published: April 2015

OBJECTIVE: As part of nursing home practice reforms, OBRA‐87 mandates formal psychiatric assessments (PASARR) of nursing home residents suspected of having mental disorders, a responsibility it delegates individually to states. We describe the initial year of implementation of the PASARR process in King County, Washington, and characterize the mental disorders and mental health services needs of nursing home residents referred for psychiatric screening.DESIGN: Cross‐sectional study.SETTING: The 54 Medicare‐certified King County nursing homes (total beds = 7013).PARTICIPANTS: All patients referred for psychiatric evaluation under PASARR (n = 510).MEASUREMENTS: A systematic, multidimensional evaluation including a semistructured psychiatric diagnostic examination, validated measures of cognitive dysfunction, depression, and global psychopathology, functional variables relevant to need for nursing home care, and selected mental health services indicators.RESULTS: Fewer than 10% of all nursing home residents were referred for psychiatric evaluation. A primary mental illness, evenly divided between psychoses and mood disorders, was found in 60% of the sample, and a psychiatric disorder associated with dementia or mental retardation was found in 25%. Six percent had complex neuropsychiatric features defying classification, and 4% had no mental disorder. Other disorders, such as substance abuse, were rare. Cognitive impairment and global psychopathology were prevalent in all diagnostic groups, and depressive symptoms were common even in patients without affective diagnoses. Eighty‐eight percent of the sample were appropriately placed, based on their needs for daily care. Fifty‐five percent had unmet mental health services needs.CONCLUSIONS: The PASARR referral process detected a group of seriously mentally ill, functionally disabled patients, most of whom required the level of care that nursing homes provide. Depressed and psychiatrically impaired dementia patients were underrepresented in the referral pool as measured against widely accepted prevalence figures for mental disorders in nursing home populations. The PASARR process as currently configured appears to be most efficient in identifying schizophrenic patients, who represent a small minority of nursing home residents, and the skewed sample it generates fails to provide an adequate basis for estimating overall mental health services needed in nursing homes. The PASARR process should be altered to improve referral rates for depressed and behaviorally disturbed dementia patients.
Development and Testing of a Process Measure of Nursing Home Quality of Care
Authors: Holtzman Jeremy , Degelau John , Meyers Roberta , Christianson Craig , Lurie Nicole 
Published: April 2015

OBJECTIVE: To develop and test quality of care process measures for three medical conditions of nursing home patients: fever, shortness of breath, and chest pain.DESIGN: Flowsheets designed to capture the critical elements of care for the above conditions were developed by an expert panel. Nursing home residents charts were reviewed retrospectively using the flow sheets. The reviews were translated into clinical scenarios, and the quality of care the scenarios represented was rated by an expert panel.SETTING: All nursing homes in Hennepin County, MN, that care for Medicaid patients.PATIENTS: A random sample of 1405 Medicaid nursing home residents from 1984 and 1988.MEASURES: Measures of quality of physician assessment and intervention, quality of nurse assessment and intervention, and global quality were developed and the intra‐ and interrater reliability were tested. The measures' validity was assessed by their ability to predict resident death.RESULTS: Intrarater reliability was measured as the correlation of the ratings of blinded duplicates. The correlation for the global scale and the four subscales ranged from. 74 to. 88 (P <.001 for all). Interrater reliability was tested by examining what percentage of the quality ratings were within one unit (1–5 scale) for all three raters. All three raters were within one unit for more than 72% scenarios for all scales. The subscale of quality of physician assessment was able to predict resident death when the worst episode of care (OR =. 47, 95%CI(.31−.74)) or the mean episode of care (OR. 54, 95% CI(.30−.99)) was used. None of the other subscales or the global measure predicted death.CONCLUSIONS: Through the use of an expert panel, measures of nursing home quality of care were developed for shortness of breath, fever, and chest pain. These measures have reasonable reliability and significant face validity. Their validity is supported further by the ability of one of the measures to predict resident death.
Effect of Genetic Risk Factors and Disease Progression on the Cerebrospinal Fluid Tau Levels in Alzheimer's Disease
Authors: Arai Hiroyuki , Terajima Masanori , Miura Masakazu , Higuchi Susumu , Muramatsu Taro , Matsushita Sachio , Machida Nobuo , Nakagawa Takuma , Lee Virginia M.‐Y. , Trojanowski John Q. , Sasaki Hidetada 
Published: April 2015

OBJECTIVE: This study was undertaken to gain insights into the clinical utility of measuring cerebrospinal fluid tau protein (CSF‐tau) to aid in the diagnosis of Alzheimer's disease (AD).SETTING: AD patients from Tohoku University Hospital, Sendai Japan were sampled.SUBJECTS AND METHODS: CSF‐tau levels were examined by sandwich enzyme‐linked immunosorbent assay in a total of 62 patients carrying different α1 ‐antichymotrypsin (ACT) and presenilin‐1 (PS‐1) polymorphic alleles. Further, the CSF‐tau levels were followed up on two occasions during the progression of the disease in 17 AD patients.RESULTS: There was no evident gradient for tau protein in CSF. Neither the ACT/A allele nor the PS‐1/1 allele affected the CSF‐tau levels. Although CSF‐tau levels changed to a variable extent over time, the CSF‐tau levels were significantly increased (P <.01) during the follow‐up period. Three of the AD patients demonstrated decreasing values, whereas 14 patients showed increasing values. Finally, these temporal changes in CSF‐tau levels were not influenced by the apolipoprotein E ∍4, ACT/A or PS‐1/1 alleles during the progression of AD.CONCLUSION: Regardless of the mechanisms leading to the degeneration of neurons in AD, our findings provide further evidences that monitoring CSF‐tau levels may provide useful information about AD irrespective of the background of genetic risks and disease progression. J Am Geriatr Soc 45:1228–1231,1997.
Over‐the‐Counter Medication Use in an Older Rural Community: The Mo VIES Project
Authors: Stoehr Gary P. , Ganguli Mary , Seaberg Eric C. , Echemen Deborah A. , Belle Steven 
Published: April 2015

OBJECTIVE: To examine the self‐reported use of over‐the‐counter (OTC) medications and the factors associated with OTC use in a rural older population.DESIGN: A cross‐sectional study of an age‐stratified random community sample.SETTING: The mid‐Monongahela Valley, a rural area of Southwestern Pennsylvania.PARTICIPANTS: A total of 1059 older individuals with a mean age of 74.5 (± 5.5) years, 96.9% of whom were white and 57.3% of whom were women.MEASUREMENTS: Self‐reported over‐the‐counter drug use and demographic information, and information about prescription drug use and recent use of health services.RESULTS: The majority (87.0%) of the sample were taking at least one OTC medication; 5.7% reported taking five or more OTCs. Women took significantly more OTCs than did men (P < .001). Individuals with more education took significantly more OTCs than those who had less (P = .018).The OTC category used most commonly was analgesics (66.3% overall), followed by vitamin and mineral supplements (38.1%), antacids (27.9%), and laxatives (9.7%). The use of analgesics decreased significantly (P = .018) with increasing age, whereas the use of laxatives increased significantly (P < .001). Women were more likely than men to be using each of these four major OTC groups.Unlike the associations with prescription drug use we reported previously in the same population, there were no significant associations for overall OTC use with age or with the use of health services. However, although vitamin use (as an example of an OTC drug taken for “preventive” purposes) was not associated with health services use, the use of laxatives (as an example of a “curative” OTC) was significantly associated (P ≤ .002) with a greater number of physician visits, emergency room visits, hospitalizations during the past 6 months, home health care service utilization, and number of prescription medications.CONCLUSIONS: A substantial proportion of our older sample reported using a variety of over‐the‐counter drugs. Analgesics and vitamin/mineral supplements were the most frequently used categories. Women and those with more education were taking more OTC drugs. OTC use was not related to age, but the use of analgesics decreased with age while laxative use increased with age. Unlike prescription drug use, overall OTC drug use was not associated with health services utilization.
Continuity of Do‐Not Resuscitate Orders Between Hospital And Nursing Home Settings
Authors: Ghusn Husam F , Teasdale Thomas A , Jordan Darlene 
Published: April 2015

OBJECTIVE: To determine the relationship between interinstitutional communication and continuity of advance directives from hospital to nursing home (NH) settings.DESIGN: Retrospective chart review of discharges to hospital affiliated or community NHs.SETTING: Teaching Veterans Affairs Hospital and affiliated and community nursing homes.MEASUREMENTS: Demographic characteristics, medical diagnoses, presence of advance directives, and documentation that relates to the topic.RESULTS: A total of 83 patients were discharged to either setting. Before discharge to a NH, the prevalence of chronic obstructive pulmonary disease and cancer was higher among those who had a DNR order. Overall, subsequent discussions about advance directives were equally common in NHs. Having a hospital discussion about advance directives or having a hospital DNR order were associated with a higher rate of advance directive discussions in NHs. Hospital DNR orders were continued for 93% and 41% of patients admitted to the hospital‐affiliated NH compared with community NHs, respectively (P < .001). Specific communication of hospital DNR status to the receiving NH was associated with better continuity of DNR orders (49% vs 9%, P = .001). Factors that predicted continuity of DNR orders in logistic regression analysis correctly included hospital DNR status, communication of advance directives to the receiving NH, and NH advance directive discussions.CONCLUSIONS: There is higher continuation rate of DNR orders between the hospital under study and its affiliated NH than to community NHs despite a similar frequency of confirmation discussions. Completing advance directives before patients are discharged to NHs, communication of advance directives to the receiving NH, and follow‐up discussions at the NH may improve the continuity of advance directives between hospitals and nursing homes.
Research on the Cognitively Impaired: Lessons and Warnings from the Emergency Research Debate
Authors: Karlawish Jason H. T. , Sachs Greg A. 
Published: April 2015

OBJECTIVES: To demonstrate that the recent events in emergency research have broad implications for the conduct of human subjects research with the cognitively impaired. This essay illustrates the similarities between the two kinds of research and suggests how understanding these similarities might help to resolve issues in human subjects research on the cognitively impaired.METHODS: A review of pertinent journal articles, books, regulations, and court cases.RESULTS: The emergency research controversy resulted in large part because of conflicting interpretations of arguably inadequate research regulations. The proposed Food and Drug Administration (FDA) regulations include advance informed consent, a broad role for family in approving a subject's participation, replacement of a threshold of permissible risk, called minimal risk, with a more sensible balancing of risks and benefits, and a role for the community in research approval. The current state of research on the cognitively impaired suggests that many of the same problems exist now that existed in emergency research before the FDA issued its proposed regulations. The ongoing case of T.D. et al. vs N.Y. State Office of Mental Health suggests that unless steps are taken similar to those taken in emergency research, much of clinical research on the cognitively impaired could cease.CONCLUSION: Representatives of the government, medicine, and the public must recognize the unresolved issues and inadequate regulations relating to research on the cognitively impaired. The proposed FDA regulations for emergency research may provide guidance for a settlement of these issues.
Physician Attitudes Concerning Warfarin for Stroke Prevention in Atrial Fibrillation: Results of a Survey of Long‐Term Care Practitioners
Authors: Monette Johanne , Gurwitz Jerry H. , Rochon Paula A. , Avorn Jerry 
Published: April 2015

BACKGROUND: The prevalence of atrial fibrillation (AF) increases dramatically with advancing patient age, and, as a result, this condition is common in persons residing in the long‐term care setting.OBJECTIVES: To assess the knowledge and attitudes of physicians regarding the use of warfarin for stroke prevention in patients with atrial fibrillation in long‐term care facilities.METHODS: We surveyed physicians actively providing primary care to older patients in 30 long‐term care facilities located in New England, Quebec, and Ontario. Physicians were requested to complete a structured questionnaire about use of warfarin therapy for stroke prevention in patients with AF residing in long‐term care facilities. The questionnaire included two clinical scenarios designed to provide substantial contrasts in patient characteristics including underlying comorbidity, functional status, bleeding risk, and stroke risk.RESULTS: A total of 269 physicians were asked to participate in the survey, and 182 (67.7%) completed the questionnaire between February 1, 1995, and July 31, 1995. Only 47% of respondents indicated that the benefits of warfarin therapy “greatly outweigh the risks” in this setting; the remainder of physicians indicated that benefits only “slightly outweigh the risks” (34%) or that risks “outweigh benefits” (19%). The most frequently cited contraindications to warfarin use were: excessive risk of falls (71%), history of gastrointestinal bleeding (71%), history of other non‐central nervous system bleeding (36%), and history of cerebrovascular hemorrhage (25%). Among the 164 physicians who reported using the international normalized ratio to monitor warfarin therapy, 27% indicated a target range with a lower limit less than 2, 71% indicated a target range between 2 and 3, and 2% indicated an upper limit greater than 3. Among respondents who answered questions about the two clinical scenarios, estimates of the risk of a stroke without warfarin therapy and the risk of an intracranial hemorrhage with therapy varied widely.CONCLUSIONS: Our findings suggest that many uncertainties surround the decision to prescribe warfarin to patients with AF in the long‐term care setting, as well as questions about the appropriate intensity of this treatment when it is prescribed. Concerns about the risks of bleeding appear to prevail over stroke prevention when physicians make such prescribing decisions.
Psychotic Symptoms and Physically Aggressive Behavior in Alzheimer's Disease
Authors: Gilley David W. , Wilson Robert S. , Beckett Laurel A. , Evans Denis A. 
Published: April 2015

OBJECTIVE: To examine the relationship between psychotic symptoms and subsequent physically aggressive behavior in outpatients with Alzheimer's disease.DESIGN: This observational study used a time series design to measure the presence and frequency of physically aggressive behavior over a 52‐week period. Multiple regression models were used to evaluate delusions and hallucinations, assessed at baseline, as predictors of physical aggression, controlling for demographic and clinical variables. SETTING AND PARTICIPANTS: Of 315 consecutive eligible outpatients from the Rush Alzheimer's Disease Center, referred for evaluation for dementia, 270 (86%) participated in the study. All participants met NINCDS/ADRDA criteria for probable Alzheimer's disease; Mini‐Mental State Examination scores ranged from 0 to 27, with a mean of 14.9 (SD = 5.6).MEASUREMENTS: Psychotic symptoms, previous episodes of physical aggression, and demographic variables were measured at baseline through a structured interview with an informant living in the same household. Physically aggressive behavior was measured sequentially at 1‐week intervals over a period of 52 consecutive weeks and also through structured informant interviews.RESULTS: A total of 75 persons had one or more episodes of physical aggression during the 52 weeks of observation. The presence of delusions significantly predicted the presence and frequency of physical aggression. Of participants with high rates of physical aggression (>1 episode/month), 80% had delusions. This effect was robust, even after controlling for the effects of other clinical variables. By contrast, hallucinations did not reliably predict episodes of physical aggression.CONCLUSIONS: These data suggest that delusions, but not hallucinations, predict physically aggressive behavior in persons with Alzheimer's disease. In light of the persecutory nature of most delusional ideation in Alzheimer's disease, delusions may be associated with distortions in the perception of threat in common social situations.