bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Trials in Cognitively Impaired Older Adults: Home versus Clinic Assessments
Authors: Bédard Michel , Molloy D. William , Standish Tim , Guyatt Gordon H. , D'Souza Joseph , Mondadori Cesare , Darzins Peteris J. 
Published: April 2015

OBJECTIVE: To compare the reliability of instruments used in clinical trials involving cognitively impaired older adults when the instruments are administered in‐home rather than in‐clinic and to compare withdrawal rates is these two groups.DESIGN: This study was part of a larger n‐of‐1 clinical trial to investigate the efficacy and safety of a MAO/A inhibitor (Brofaromine) in patients with Alzheimer's disease. Participants were initially assessed at the clinic (baseline) and then randomly allocated to in‐home or in‐clinic assessments for the remainder of the trial. The baseline and second assessment (performed before initiation of the treatment) were used for the reliability analysis. Withdrawal rates were examined over the course of the 6‐month trial.SETTING: Assessments took place at a geriatric clinic in an urban university teaching hospital and at residences of some of the patients.PARTICIPANTS: Forty‐six Alzheimer's disease patients participated in the study, of which, 22 were randomized to in‐home assessments and 24 to in‐clinic assessments.MEASUREMENTS: Test‐retest reliability was measured for all five instruments used in the study and was based on the first two assessments. Sample size requirements, based on within‐group variance, were calculated. Withdrawal rates were obtained for the total duration of the trial.RESULTS: Test‐retest reliability of the instruments, as determined by intraclass correlations, was good in both groups but favored in‐clinic for all but one instrument (range: 0.47–0.90 for in‐home vs 0.57–0.92 for in‐clinic). Sample size requirements based on reliability assessment data were found to be larger for some instruments when administered in‐home. Only four in‐home patients withdrew before completion of the study, compared with eight in‐clinic patients.CONCLUSION: The results suggest the in‐home assessments in cognitively impaired older adults may result in lower withdrawal rates but may necessitate larger sample sizes to offset larger test‐retest variability.
Limiting Treatment In Nursing Homes: Knowledge and Attitudes of Nursing Home Medical Directors
Authors: Ghusn Husam F. , Teasdale Thomas A. , Skelly Jerome R. 
Published: April 2015

OBJECTIVE: To determine nursing home medical directors' knowledge about cardiopulmonary resuscitation outcome and their support of treatment limitation requests and policies.DESIGN: Mailed questionnaire, followed by telephone interview.PARTICIPANTS: Forty‐six medical directors of 70 community nursing homes in Harris County, Texas.MEASUREMENTS: Medical directors were asked to estimate the CPR survival rate to discharge of all nursing home residents and that of two case scenarios. They were asked to indicate on a Likert scale their support for mandatory Do‐Not‐Resuscitate orders and for requests by nursing home patients to withhold other life support measures.RESULTS: Responses were received from 33 directors. Overall CPR survival rate of older nursing home residents after cardiac arrest was thought to be 10.7%. The average CPR survival rate for healthy older people with witnessed arrests was believed to be 13.8%. The perceived rate for unwitnessed arrests in terminal patients was 4.6%, significantly lower than estimates for healthy older people (P = .003) and estimates of the overall survival rate (P = .02). Medical directors were split regarding mandatory Do‐Not‐Resuscitate orders for patients in vegetative states, with terminal illness, with an unwitnessed arrest, or in those older than 90 years of age. Mandatory use of Do‐Not‐Resuscitate orders for all nursing home residents was strongly opposed. Assuming a 2% survival rate did not significantly influence medical directors' opinions about mandatory DNR orders in these groups. Medical directors were more willing to support requests by stable nursing home residents to withhold resuscitation, mechanical ventilation, or hospitalization than requests to withhold antibiotics, intravenous fluids, or tube feedings (P < .005). The majority of medical directors were willing to withhold all such measures for terminal patients.CONCLUSIONS: Health care professionals who are responsible for educating patients about the efficacy of cardiopulmonary resuscitation in nursing homes overestimate its benefit and may benefit from further education about its outcome. Although mandatory Do‐Not‐Resuscitate orders were favored for terminal or vegetative patients, medical directors are not supportive of such orders across the board. Medical directors are more willing to honor requests for treatment limitation by terminal patients than others.
Use of Unproven Therapies by People with Alzheimer's Disease
Authors: Coleman Laurel M. , Fowler Lauren L. , Williams Mark E. 
Published: April 2015

OBJECTIVE: To describe the use of unproven therapies for Alzheimer's disease.DESIGN: Descriptive survey using a written questionnaire.PARTICIPANTS: 101 primary caregivers of people with Alzheimer's disease who attended Alzheimer's disease support group meetings.RESULTS: Fifty‐five percent of caregivers reported that they had tried at least one alternative therapy to improve the patient's memory. Twenty percent of caregivers tried three or more unproven therapies. Vitamins were used most frequently (84%), and health foods (27%), herbal medicines (11%), “smart pills” (9%), and home remedies (7%) were also tried. Most caregivers reported trying the therapies in the early stage of the illness and did not notice significant improvement in the patient's memory. Twenty‐five percent of caregivers had tried unproven therapies for behavior problems. There was no correlation between the use of alternative therapies and the sex of the caregiver, age of the caregiver, level of caregiver frustration, presence of problem behaviors, or perceived level of physician support.CONCLUSIONS: The use of unproven therapies by people with early Alzheimer's disease is common and cannot be predicted by characteristics of the primary caregiver. Although this use may be understandable, it exposes vulnerable people to possible side effects, increased costs, and possible exploitation. Health care workers should actively inquire about the use of alternative therapies, and explore the reasons behind their use, so that they can better understand and meet the needs of their patients and their caregivers.
Influence of Acute Inflammation on Iron and Nutritional Status Indexes in Older Inpatients
Authors: Chiari Maria Maddalena , Bagnoli Roberto , De Luca Paolo , Monti Massimo , Rampoldi Erica , Cunietti Ettore 
Published: April 2015

OBJECTIVE: To investigate the relations between acute inflammation, as shown by high C‐reactive protein (CRP) serum levels, and laboratory indexes of iron and nutritional status and to ascertain whether the presence of acute inflammation affects the diagnostic reliability of these indexes.DESIGN: Cross‐sectional study.SETTING: Geriatric ward for rehabilitation.PARTICIPANTS: A total of 163 patients, 77 men and 86 women aged 60 years or older.MEASUREMENTS: CRP values > 1 mg/dL were considered to indicate the presence of acute inflammation. Iron status was explored by measuring erythrocyte mean cell volume (MCV), hemoglobin (Hb), serum iron (Fe), TIBC, percent transferrin saturation (% TS) and ferritin (SF). Nutritional status was determined by albumin (Alb) and prealbumin (pre‐Alb) serum levels.MAIN RESULTS: In the whole series, CRP correlated significantly with all iron status variables except erythrocyte MCV (directly with SF, inversely with the others) and correlated inversely with Alb and pre‐Alb. Mean values of iron status variables were significantly different in patients with inflammation and those without: SF was higher and the other variables lower. Patients with low % TS (<16%) showed a pattern consistent with iron deficiency. Compared to the group with normal values, they had more severe anemia, lower MCV, Fe, and SF, and higher TIBC; mean Alb, pre‐Alb, and CRP values were not significantly different. The prevalence of inflammation was 50% (39.5% in the group with normal % TS). A similar pattern was observed in patients with microcytosis (MCV < 84 fL) associated with low % TS; dividing this subgroup according to SF values (low, <30 μg/L) did not provide more information because patients with acute inflammation were excluded.CONCLUSIONS: Patients with acute inflammation present altered iron status indexes that resemble those observed in the anemia of chronic disease. Fe, TIBC and SF lose diagnostic value. The concomitant presence of microcytosis and low % TS, and to a lesser extent the presence of one of these alterations, is suggestive of iron deficiency associated with inflammation and may warrant gastrointestinal tract investigations and ferrous salt treatment. Protein‐calorie malnutrition seems to enhance the effects of inflammation on iron status indexes.
Assessing Risk for the Onset of Functional Dependence Among Older Adults: The Role of Physical Performance
Authors: Gill Thomas M. , Williams Christianna S. , Tinetti Mary E. 
Published: April 2015

BACKGROUND: Approximately 10% of nondisabled, community‐dwelling adults aged 75 years and older lose independence in basic activities of daily living (ADLs) each year. The purpose of this study was to evaluate whether simple tests of physical performance could identify older adults, independent in their basic ADLs, who were at increased risk for the onset of functional dependence.METHODS: Among a representative cohort of 1103 community‐dwelling adults aged 72 years and older, we evaluated the 664 subjects who were cognitively intact and independent in their basic ADLs at the baseline interview. All cohort members had undergone a comprehensive assessment, including a battery of qualitative and timed performance tests. The main outcome event was the onset of functional dependence, defined as a new disability in one or more of the seven basic ADLs at the 1‐year follow‐up.RESULTS: Functional dependence developed in 53 (9%) of the 563 subjects who had complete data at the 1‐year follow‐up. Eight of the 12 qualitative tests and all six of the timed tests were significantly associated (P < .05) with the onset of functional dependence. Both qualitative and timed performance tests demarcated subjects into groups at low and high risk for functional dependence. Four timed tests—chair stands, rapid gait, 360° turn, and bending over—showed a threshold phenomenon, where the rate of new dependence increased slowly with worsening performance until a critical point (or threshold) was reached, and the rate of dependence increased substantially. For timed chair stands, for example, the rates of functional dependence within quarters of worsening performance were 5.3%, 6.3%, 6.7%, and 16%. The risk of functional dependence was markedly elevated (30%‐50%) for subjects who were unable to perform the timed tests.CONCLUSIONS: Several simple tests of physical performance were strongly associated with the onset of functional dependence. These results support the potential use of physical performance tests to develop a risk assessment strategy that could identify subgroups of older persons, independent in all ADLs, who are at increased risk for functional dependence.
Epidemiologic and Diagnostic Aspects of Bacteriuria: A Longitudinal Study in Older Women
Authors: Monane Mark , Gurwitz Jerry H. , Lipsitz Lewis A. , Glynn Robert J. , Choodnovskiy Igor , Avorn Jerry 
Published: April 2015

OBJECTIVE: To examine month‐by‐month variability of bacteriuria in a cohort of older women and to evaluate the performance of rapid diagnostic tests commonly used to indicate the presence of significant bacteriuria.DESIGN: Prospective, observational study.SETTING: Community housing sites and a long‐term care institution.PARTICIPANTS: Sixty‐one women, mean age 77.6, took part in the study.MEASUREMENTS: Midstream clean‐catch urine samples and medical information on subjects were collected at baseline, and then monthly for 6 months.RESULTS: Bacteriuria alone (≥105 organisms per mL) occurred in 17% of all urine samples (28% of patients), bacteriuria with pyuria in 15% (26% of patients), and bacteriuria with symptoms in 3% (10% of patients). Spontaneous clearance of bacteriuria with pyuria was common (P = .30), as were new occurrences (P = .12) over 6 months of follow‐up. For the outcome of bacteriuria with symptoms, sensitivity of urinary diagnostic tests such as bacteria and pyuria on microscopic analysis, and leukocyte esterase on dipstick testing, ranged from 79 to 93%. Negative predictive values of these tests approached 100%.CONCLUSIONS: Bacteriuria was a very common event, occurring in almost one‐fifth of all urine samples and one‐third of all subjects during 6 months of follow‐up. Month‐by‐month follow‐up indicates that the natural history of bacteriuria is marked by frequent spontaneous alternation between positive and negative events. The high negative predictive value of many simple diagnostic tests commonly used for urinary tract disease suggests that they can quickly and cost‐effectively rule out bacteriuria in the older female patient.
Age‐Related Differences in the Utilization of Therapies Post Acute Myocardial Infarction
Authors: Malone Michael L. , Sial Shahid H. , Battiola Richard J. , Nachodsky John P. , Solomon David J. , Goodwin James S. 
Published: April 2015

OBJECTIVE: To describe the effect of age on the care of patients hospitalized with acute myocardial infarction (MI).DESIGN: Retrospective chart review of all cases with a primary or secondary discharge diagnosis of acute MI.SETTING: Two large community hospitals in Milwaukee, Wisconsin, from July 1, 1990 to June 30, 1991.PATIENTS: There were 771 charts reviewed, of which, 149 cases were aged 54 years or younger, 203 were 55 to 64 years, 224 were 65 to 74 years, and 195 were aged 75 years or older.MEASUREMENTS: Hospital charts were examined for use of diagnostic and therapeutic interventions, including medications and procedures, as well as length of stay and inhospital mortality.RESULTS: Older patients were more likely to be female (18%, 20%, 38%, and 56% for the four age groups, respectively, P < .001 chi‐square for linear trend), more likely to present with congestive heart failure (31%, 39%, 51%, and 72%, P < .001), and had a higher in‐hospital mortality rate (5%, 7%, 10%, and 18%, P < .001). Older patients had a longer length of stay in the hospital. The use of cardiac catheterization in these post‐MI patients was high and did not decrease until after age 75 (85%, 88%, 88%, and 47%, P < .001). The percentage of patients receiving balloon angioplasty decreased with age (51%, 51%, 43%, and 20%, P < .001), whereas the percentage of patients receiving myocardial revascularization did not significantly differ with age (15%, 22%, 25%, and 19%, P = .46). Aspirin was less likely to be prescribed to older patients at discharge (79%, 82%, 70%, and 62%, P < .001).CONCLUSION: A surprisingly high percentage of those older than age 65 received invasive tests and interventions. This high utilization rate coexists with our continued ignorance about the efficacy of these tests and interventions in older adults.
Age as a Determinant of Cardiopulmonary Resuscitation Outcome in the Coronary Care Unit
Authors: Brymer Chris , Gangbar Eric , O'Rourke Keith , Naglie Gary 
Published: April 2015

OBJECTIVE: To determine whether age is associated with the outcome of cardiopulmonary resuscitation (CPR) in the coronary care unit (CCU).DESIGN: Retrospective chart review.SETTING: The coronary care units of two Canadian tertiary care teaching hospitals.PATIENTS: Two hundred sixty‐four coronary care unit patients undergoing cardiopulmonary resuscitation between January 1, 1985 and June 30, 1992.RESULTS: There was no significant difference in survival to discharge after CPR between patients less than 70 years of age (17.0%) and patients 70 years of age and older (17.2%) (odds ratio = 0.99; 95% confidence interval = 0.46, 1.80). Patients 70 years of age and older who survived to discharge after CPR had significantly greater lengths of stay (28.1 vs 19.3 days, P = .008).CONCLUSIONS: Age was not associated with a difference in survival to discharge after CPR in the CCU, although a clinically significant difference could not be excluded because of limited power.
Contractures and Loss of Function in Patients with Alzheimer's Disease
Authors: Souren Liduïn E. M. , Franssen Emile H. , Reisberg Barry 
Published: April 2015

OBJECTIVE: To investigate the prevalence of contractures in patients with Alzheimer's disease and to assess possible associations between contractures and cognitive and functional decline in Alzheimer's disease.DESIGN: Case series.SETTING: Subjects from an outpatient, university‐based, dementia research center, followed, when necessary, into residential home and nursing home settings.PATIENTS: A consecutive sample of 161 patients (48 men, 113 women; mean age 75.3 ± 8.6 years) with a clinical diagnosis of probable Alzheimer's disease and with deficits in basic activities of daily living or more severe functional impairment.MAIN OUTCOME MEASURES: For cognition, the Mini‐Mental State Examination (MMSE); for functioning, the Functional Assessment Staging Scale (FAST); contracture is defined as a decrease of 50% or more of the normal passive range of motion of the joint.RESULTS: Prevalence of contractures was correlated highly with degree of functional impairment (r = .70, P < .001). More than three quarters of patients who had lost the ability to walk manifested contractures; however, contractures were found in fewer than 11% of all ambulatory patients examined. When present, contractures involved more than one extremity in 97% of cases and involved all four extremities in more than two‐thirds of patients.CONCLUSION: Joint contractures are very common in the severe stages of Alzheimer's disease. More than a quarter of a million institutionalized residents in US nursing homes are likely to be afflicted by this potentially painful and disfiguring condition. Possible pathophysiology and contributing factors and possible means of intervention for this major source of disability are discussed.
Mechanisms of Constipation in Older Persons and Effects of Fiber Compared with Placebo
Authors: Cheskin Lawrence J. , Kamal Neel , Crowell Michael D. , Schuster Marvin M. , Whitehead William E. 
Published: April 2015

OBJECTIVE: To investigate the mechanisms of constipation and the effect of fiber supplementation on physiology, mechanisms, stool parameters, and colonic transit times in a group of constipated older patients.DESIGN: Single‐blind, randomized, placebo‐controlled fiber intervention with crossover.SETTING: A university‐based outpatient center.PATIENTS: Ten community‐living older men and women, healthy except for chronic constipation.INTERVENTIONS: Patients were given either 24 g psyllium fiber or placebo fiber daily for 1 month, then crossed over to the other arm for an additional month. Structured testing, including total gut transit time and rectal and colonic manometry, was performed at the end of each intervention month. Patients recorded stool frequency, consistency, and weights daily.RESULTS: The predominant mechanism for constipation in these patients was outlet delay caused by pelvic dyssynergia. Fiber decreased total gut transit time from 53.9 hours (placebo condition) to 30.0 hours (P < .05). Stool weights and consistency were not significantly improved by fiber, though there was a trend toward an increase in stool frequency (1.3 vs 0.8 bowel movements per day.) Pelvic floor dyssynergia was not remedied by fiber, even when constipation was clinically improved.CONCLUSIONS: Fiber supplementation appeared to benefit constipated older patients clinically, and it improved colonic transit time, but it did not rectify the most frequent underlying abnormality, pelvic floor dyssynergia.
Thyroid Autoantibodies in Hospitalized Chronic Geriatric Patients: Prevalence, Effects of Age, Nonthyroidal Clinical State, and Thyroid Function
Authors: Szabolcs István , Bernard Wolfdieter , Horster Franz A. 
Published: April 2015

OBJECTIVE: To investigate the effect of age, clinical condition, and thyroid function on the prevalence of thyroid autoantibody positivity in hospitalized chronic geriatric patients.DESIGN: A screening study of hospitalized chronic geriatric patients.PARTICIPANTS: 249 non‐selected, hospitalized, chronic geriatric patients more than 60 years of age and 81 20 to 40‐year‐old healthy persons.MEASUREMENTS: Thyrotropin (TSH); thyroxine (T4) and free thyroxine (FT4); and triiodothyronine (T3), thyroglobulin (Tg), antibodies against thyroid peroxidase (AbTPO) and antibodies against thyroglobulin (AbTg) estimation in a screening study.RESULTS: AbTPO positivity (AbTPO+) was found more often than AbTg positivity (AbTg+) (15.3% vs 9.2%, P = .04), one being positive (Ab+) in 19.3%. The occurrence was higher in females than males (Ab+:27.1% vs 7.1%, P < .001; AbTPO+:21.9% vs 5.1%, P < .001; AbTg+:13.2% vs 3.1%, P = .0052). Among the Ab+ patients, AbTPO was more often positive than AbTg (40/48 vs 21/48, P < .001). The sensitivity, specificity, and positive predictive value of Ab positivity to detect a thyroid disorder were 0.35, 0.85 and 0.38, respectively. Within the population of euthyroid geriatric patients, the occurrence of AbTg+ (χ2(2) = 8.65, P = .013) and Ab+ (χ2(2) = 8.02, P = .018) correlated positively with the age of the patients, and there was also a female predominance (AbTPO+ 18% vs 3.7% in the males; AbTg+ 13% vs 2.4%; Ab+ 25.8% vs 6.1%). When compared with 20 to 40‐year‐old subjects, only the euthyroid ≥ 80‐year‐old patients showed a significantly higher occurrence of Ab+ (26.2% vs 9.9% χ2(1) = 5.64, P = .017). In the euthyroid ≥80‐year‐old females, AbTPO+ was 25%, AbTg:22.2%, and Ab+: 36.1%!. The nonthyroidal clinical state of the euthyroid patients did not correlate with the antibody prevalence.CONCLUSIONS: In hospitalized chronic geriatric patients, AbTg and especially AbTPO positivity is frequent, even in euthyroid patients without goiter. This aspecific Ab positivity in the euthyroid state correlates to the age, but not to the severity of the nonthyroidal clinical condition of the patients and explains why the Ab positivity is not predictive enough for thyroid dysfunction in this subpopulation. Thus, in hospitalized chronic geriatric patients the AbTg and AbTPO titers should be examined only in cases where thyroid screening (TSH) reveals abnormal results.