bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Aerobic Exercise and T'ai Chi on Blood Pressure in Older People: Results of a Randomized Trial
Authors: Young Deborah Rohm , Appel Lawrence J. , Jee SunHa , Miller Edgar R. 
Published: April 2015

OBJECTIVE: To compare the effects on blood pressure of a 12‐week moderate‐intensity aerobic exercise program and a T'ai Chi program of light activity.DESIGN: A randomized clinical trial.SETTING: A suburban clinic in the Baltimore, MD, area.PARTICIPANTS: Sixty‐two sedentary older adults (45% black, 79% women, aged > 60 years) with systolic blood pressure 130–159 mm Hg and diastolic blood pressure < 95 mm Hg (not on antihypertensive medication).INTERVENTION: Participants were randomized to a 12‐week aerobic exercise program or a light intensity T'ai Chi program. The goal of each condition was to exercise 4 days per week, 30 minutes per day.MEASUREMENTS: Blood pressure was measured during three screening visits and every 2 weeks during the intervention. Estimated maximal oxygen uptake and measures of physical activity level were determined at baseline and at the end of the intervention period.RESULTS: Mean (SD) baseline systolic and diastolic blood pressures were 139.9 (9.3) mm Hg and 76.0 (7.3) mm Hg, respectively. For systolic blood pressure, adjusted mean (SE) changes during the 12‐week intervention period were −8.4 (1.6) mm Hg and −7.0 (1.6) mm Hg in the aerobic exercise and T'ai Chi groups, respectively (each within‐group P < .001; between‐group P = .56). For diastolic blood pressure, corresponding changes were −3.2 (1.0) mm Hg in the aerobic exercise group and −2.4 (1.0) mm Hg in the T'ai Chi group (each within‐group P < .001; between‐group P = .54). Body weight did not change in either group. Estimated maximal aerobic capacity tended to increase in aerobic exercise (P = .06) but not in T'ai Chi (P = .24).CONCLUSIONS: Programs of moderate intensity aerobic exercise and light exercise may have similar effects on blood pressure in previously sedentary older individuals. If additional trials confirm these results, promoting light intensity activity could have substantial public health benefits as a means to reduce blood pressure in older aged persons.
Angiotensin‐Converting Enzyme Inhibitor Use in Older Patients with Heart Failure and Renal Dysfunction
Authors: Philbin Edward F. , Santella Robert N. , Rocco Thomas A. 
Published: April 2015

OBJECTIVE: To examine the relationship between angiotensin‐converting enzyme (ACE) inhibitor use and clinical outcomes among recently hospitalized patients with congestive heart failure (CHF) and coexisting renal insufficiency.DESIGN: A prospective cohort study.SETTING: Ten community hospitals in upstate New York.PARTICIPANTS: A total of 1076 hospital survivors identified from a consecutive series of CHF inpatients.MEASUREMENTS: Patients were followed prospectively for 6 months after hospital discharge to track mortality, hospital readmission, and quality of life. Clinical outcomes were stratified by ACE inhibitor use among those with renal dysfunction, defined as serum creatinine > 2.0 mg/dL, and among the remaining patients, whose serum creatinine was > 1.9.RESULTS: ACE inhibitor use was lower among 187 patients with renal dysfunction than among 889 patients with preserved function (41 vs 69%, P < .001). Age and sex were among the significant determinants of drug use in both groups. After adjustment for covariables, ACE inhibitor use among those with abnormal renal function was not associated with a lower risk for death or readmission, or better quality of life. By comparison, ACE inhibition conferred meaningful clinical benefit among those whose creatinine was < 1.9 mg/dL.CONCLUSION: Convincing evidence of clinical benefit from ACE inhibitor use is not readily detectable among a sample of 187 unselected older patients with CHF and moderate or severe renal insufficiency. Further studies to identify subsets of this group who might benefit are warranted.
Effectiveness of Behavioral Therapy to Treat Incontinence in Homebound Older Adults
Authors: McDowell B. Joan , Engberg Sandra , Sereika Susan , Donovan Nancy , Jubeck Mary Ellen , Weber Elizabeth , Engberg Richard 
Published: April 2015

OBJECTIVES: To examine the (1) short‐term effectiveness of behavioral therapies in homebound older adults and (2) characteristics of responders and nonresponders to the therapies.DESIGN: Prospective, controlled clinical trial with crossover design.SETTING: Adults aged 60 and older with urinary incontinence and who met Health Care Financing Administration criteria for being homebound were referred to the study by homecare nurses from two large Medicare‐approved home health agencies in a large metropolitan county in southwestern Pennsylvania.MEASURES: Structured continence and medical history, OARS Physical and Instrumental Activities of Daily Living scales, Folstein Mini‐Mental State Examination Score, Clock Drawing Test, Geriatric Depression Scale, Performance‐Based Toileting Assessment, bladder diaries, and physical examination.RESULTS: One hundred five subjects were randomized to biofeedback‐assisted pelvic floor muscle training (53 to the treatment group and 52 to the control groups). Control subjects with complete pre‐ and post‐control data (n = 45) experienced a median 6.4% reduction in urinary accidents in contrast to a median 75.0% reduction in subjects with complete pre‐ and post‐treatment data (n = 48, P < .001). Following the control phase, subjects crossed over to the treatment protocol. Eighty‐five subjects completed treatment, achieving a median 73.9% reduction in UI. Exercise adherence was the most consistent predictor of responsiveness to the behavioral therapy.CONCLUSIONS: Clinically significant reductions in urinary incontinence are achievable with behavioral therapies in many cognitively intact homebound older adults despite high levels of co‐morbidity and functional impairment.
Age‐related Brain Changes Associated with Motor Function in Healthy Older People
Authors: Camicioli Richard , Moore M.M. , Sexton G. , Howieson D.B. , Kaye Jeffrey A. 
Published: April 2015

OBJECTIVE: To identify the MRI imaging findings associated with motor changes in healthy older people.DESIGN: A cross‐sectional study.SETTING: A study of neurologic function in very healthy older people, the Oregon Brain Aging Study.PARTICIPANTS: Clinical and MRI data were examined in 50 very healthy older subjects (mean age = 85.1, SD = 7.2 years).MEASUREMENTS: Clinical measures (finger tapping, hand opening and closing, steps and time to walk 30 feet and timed standing on one foot) were dependent variables in multiple regression analyses using age and the following MRI measures as independent variables: total brain volume (TBV)/intracranial volume; ventricular volume/TBV; periventricular high signal/TBV; deep high signal/TBV.RESULTS: The number of steps and the time to walk 30 feet were each associated with periventricular high signal (steps: r = .58, P < .001; time: r = .60, P < .001) and ventricular volume (steps: r = .54, P < .001; time: r = .58, P < .001). These associations remained significant after adjusting for age. None of the other clinical variables was associated with the MRI volumes.CONCLUSIONS: Gait measures were associated significantly with periventricular high signal and ventricular volume. These CNS changes contribute to the cause of these important markers of aging.
Risk Factors for Lack of Recovery of ADL Independence After Hospital Discharge
Authors: Hansen Kurt , Mahoney Jane , Palta Mari 
Published: April 2015

OBJECTIVE: To determine risk factors for lack of recovery of independent functioning after hospitalization for acute medical illness.DESIGN: Secondary analysis of cohort study of patients receiving home nursing after discharge.SETTING: Evaluations performed in the home after discharge and 1 month later.PARTICIPANTS: A total of 73 adults aged 65 years and older who were independent in activities of daily living (ADLs) before hospitalization and dependent at discharge.MEASUREMENTS: Self‐report and objective measures of function, mobility, and cognition.OUTCOME: Return to independence in ADLs 1 month after discharge.RESULTS: Fifty‐nine percent of patients did not return to previous ADL independence by 1 month postdischarge. The likelihood for not recovering was 87% (95% CI, 70–100%) if a patient had a Mini‐Mental State Examination score (MMSE) < 24 at discharge (P = .015). Among patients with good cognition, 85% (95% CI, 66–100%) of those who used an assistive device indoors before hospitalization did not recover (P = .007). Among patients with good cognition and no previous assistive device use, 73% (95% CI, 47–99%) of those with a Timed “Up and Go” of > 40 seconds did not recover (P = .012). The likelihood of recovery was high (76%, 95% CI 56–96%) if a patient had no assistive device prehospital, a good MMSE, and a Timed “Up and Go” of < 20 seconds.CONCLUSION: We hypothesize that a classification strategy using cognition, prehospital mobility, and discharge physical performance will predict patients who are less likely to recover functional independence after hospitalization. If this is validated in future study, it may help clinicians identify patients who are more likely to benefit from additional intervention.
Incidence of New Thromboembolic Stroke in Persons 62 Years and Older with Chronic Atrial Fibrillation Treated with Warfarin Versus Aspirin
Authors: Aronow Wilbert S. , Ahn Chul , Kronzon Itzhak , Gutstein Hal 
Published: April 2015

OBJECTIVE: To investigate the incidence of new thromboembolic (TE) stroke in older persons with chronic atrial fibrillation treated with oral warfarin versus aspirin.DESIGN: In an observational study of 312 older persons with chronic atrial fibrillation, long‐term aspirin 325 mg daily was administered to 187 persons, and oral warfarin, in a dose adjusted to maintain the international normalized ratio (INR) between 2.0 and 3.0, was administered to 115 persons. The incidence of new TE stroke was analyzed in persons treated with warfarin versus aspirin at 36 ± 17 months (1 to 99 months) follow‐up.SETTING: A large, long‐term healthcare facility.PATIENTS: The patients included 208 women and 104 men, mean age 84 ± 7 years (range 62 to 101 years).MEASUREMENTS AND MAIN RESULTS: Four of 125 persons (3%) on warfarin stopped taking warfarin compared with four of 187 persons (2%) on aspirin who stopped taking aspirin because of adverse effects (P not significant). In persons with prior stroke, the incidence of new TE stroke was 40% (27 of 67) in persons treated with warfarin versus 81% (56 of 69) in persons treated with aspirin (P < .001). In persons with no prior stroke, the incidence of new TE stroke was 22% (13 of 58) in persons treated with warfarin versus 56% (66 of 118) in persons treated with aspirin (P < .001). The incidence of new TE stroke in all subjects was 32% (40 of 125) in persons treated with warfarin versus 65% (122 of 187) in persons treated with aspirin (P < .001). Cox regression analysis showed that persons taking warfarin had a 76% less chance of developing a new TE stroke than those taking aspirin after controlling the confounding effects of other risk factors.CONCLUSION: In an observational study of older persons with chronic atrial fibrillation, persons treated with oral warfarin to maintain an INR between 2.0 and 3.0 had a significantly lower incidence of new TE stroke than persons treated with oral aspirin 325 mg daily.
Chronic Care Clinics: A Randomized Controlled Trial of a New Model of Primary Care for Frail Older Adults
Authors: Coleman E. A. , Grothaus L. C. , Sandhu N. , Wagner E. H. 
Published: April 2015

OBJECTIVE: To determine whether a new model of primary care, Chronic Care Clinics, can improve outcomes of common geriatric syndromes (urinary incontinence, falls, depressive symptoms, high risk medications, functional impairment) in frail older adults.DESIGN: Randomized controlled trial with 24 months of follow‐up. Physician practices were randomized either to the Chronic Care Clinics intervention or to usual care.SETTING: Nine primary care physician practices that comprise an ambulatory clinic in a large staff‐model HMO in western Washington State.PARTICIPANTS: Those patients aged 65 and older in each practice with the highest risk for being hospitalized or experiencing functional decline.INTERVENTION: Intervention practices (5 physicians, 96 patients) held half‐day Chronic Care Clinics every 3 to 4 months. These clinics included an extended visit with the physician and nurse dedicated to planning chronic disease management; a pharmacist visit that emphasized reduction of polypharmacy and high‐risk medications; and a patient self‐management/support group. Control practices (4 physicians, 73 patients) received usual care.MEASUREMENTS: Changes in self‐reported urinary incontinence, frequency of falls, depressive symptoms, physical function, and satisfaction were analyzed using an intention‐ to‐treat analysis adjusted for baseline differences, covariates, and practice‐level variation. Prescriptions for high‐risk medications and cost/utilization data obtained from administrative data were similarly analyzed.RESULTS: After 24 months, no significant improvements in frequency of incontinence, proportion with falls, depression scores, physical function scores, or prescriptions for high risk medications were demonstrated. Costs of medical care including frequency of hospitalization, hospital days, emergency and ambulatory visits, and total costs of care were not significantly different between intervention and control groups. A higher proportion of intervention patients rated the overall quality of their medical care as excellent compared with control patients (40.0% vs 25.3%, P =. 10).CONCLUSIONS: Although intervention patients expressed high levels of satisfaction with Chronic Care Clinics, improved outcomes for selected geriatric syndromes were not demonstrated. These findings suggest the need for developing greater system‐wide support for managing geriatric syndromes in primary care and illustrate the challenges of conducting practice improvement research in a rapidly changing delivery system.
Relationship of Age and Simulated Flight Performance
Authors: Yesavage Jerome A. , Taylor Joy L. , Mumenthaler Martin S. , Noda Art , O'Hara Ruth 
Published: April 2015

OBJECTIVE: To determine the relationship between age and aviator performance on a flight simulator.DESIGN: A cross‐sectional observational study.PARTICIPANTS: The sample consisted of 100 aviators aged 50 to 69 (mean = 58)MAIN OUTCOME MEASURES: Pilots were tested on a Frasca 141 flight simulator (Urbana, IL), linked to a UNIXbased IRIS 4D computer (Silicon Graphics, Mountain View, CA), which both generated graphics of the environment in which the pilots flew and collected data concerning the aircraft's flight conditions.RESULTS: We found that increased age was significantly associated with decreased aviator performance on a flight simulator.CONCLUSIONS: Although there was a significant relationship between increased age and decreased aviator performance, age explained 22% or less of the variance of performance on different flight tasks; hence, other factors are also important in explaining the performance of older pilots.
Treatment for the Secondary Prevention of Stroke in Older Patients: The Influence of Dementia Status
Authors: Moroney Joan T. , Tseng Chin‐Lin , Paik Myunghee C. , Mohr J. P. , Desmond David W. 
Published: April 2015

OBJECTIVE: To investigate the influence of dementia status on treatment for the secondary prevention of stroke in older patients.DESIGN: Based on patient examinations and medical record review, we investigated the frequency of aspirin and/or warfarin use at hospital discharge for the prevention of recurrent stroke in older patients hospitalized with acute ischemic stroke.SETTING: A large academic medical center. PARTICIPANTS: A cohort of 272 patients, mean age 72.1 ± 8.5 years.MEASUREMENTS: We performed neurologic examinations and reviewed medical records to investigate the effects of a clinical diagnosis of dementia and other potentially relevant factors on treatment with aspirin or warfarin at hospital discharge.RESULTS: Thirty‐one patients (11.4%) were not prescribed aspirin or warfarin at hospital discharge. Logistic regression determined that dementia (odds ratio (OR) = 2.57, 95% confidence interval (CI), 1.04–6.30) was a significant independent determinant of nontreatment with aspirin or warfarin, adjusting for abnormal gait (OR = 2.01, CI,. 88–4.59); discharge to a nursing home or other institutional residence (OR = 2.55, CI,. 83–7.81); cardiac disease (OR =. 39, CI,. 16−.95); cortical infarct location (OR =. 45, CI,. 18–1.10); male sex (OR =. 47, CI,. 20–1.15); age 80+ (OR = 1.14, CI,. 46–2.82) and age 70–79 (OR =. 96, CI,. 32–2.88) versus age 60–69.CONCLUSIONS: Our results suggest that dementia is a significant independent determinant of nontreatment with aspirin or warfarin when otherwise indicated for the prevention of recurrent stroke. The underutilization of aspirin and warfarin in older stroke patients with dementia may be a modifiable basis for their increased risk of recurrence and death.
Reporting of Dementia on Death Certificates: A Community Study
Authors: Ganguli Mary , Rodriguez Eric G. 
Published: April 2015

OBJECTIVE: To determine the extent to which conditions suggesting dementia are reported on death certificates of older adults and to identify the factors associated with reporting of dementia.DESIGN: A prospective epidemiological study in which community‐dwelling subjects with and without dementia were identified and followed until death, after which their death certificates were examined.POPULATION: A total of 527 individuals who died during 8 years of follow‐up of a population‐based cohort of 1422 persons aged 65 and older at study entry. MEASUREMENTS: Demographic; study diagnoses, including Clinical Dementia Rating (CDR) Scale stages and diagnoses of Probable and Possible Alzheimer's disease (AD) by NINCDS‐ADRDA criteria; disorders listed on death certificates as immediate, underlying, or contributory causes of death.RESULTS: Of 172 deceased subjects with study diagnoses of dementia, 30.2% had CDR =. 5 and 69.8% had CDR ≥ 1. Of 168 subjects in which dementia subtype could be diagnosed, Probable AD was diagnosed in 31.0% and Possible AD in 38.7%. On their death certificates, conditions indicating or suggesting dementia were reported in 23.8% of dementias overall; in 1.9% of those with CDR =. 5 and 33.3% of those with CDR ≥ 1; in 36.5% of those with Probable AD and 21.5% of those with Possible AD. In a multiple logistic regression model, variables associated independently with the reporting of dementia in demented individuals were: higher CDR stage of dementia (odds ratio (OR) 22.6; 95% confidence interval (CI), 2.9–174.7); likely etiology of dementia, Probable AD (OR = 3.5; CI, 1.1–10.6); and place of death, long‐term care institution (OR = 3.8; 95% CI, 1.6‐ 9.0).CONCLUSIONS: Although Alzheimer's disease is widely regarded as a leading cause of death, dementias are reported on the death certificates of only a quarter of demented individuals in the population at large. Reporting is more likely in those with more advanced dementia, with Probable Alzheimer's disease, and those who die in long‐term care institutions.
Comparison Based on Age of Baseline Electrocardiographic Abnormalities in Non‐Q‐Wave Myocardial Infarction
Authors: Stratmann Henry G. , Kleiger Robert E. , Ferry David R. , Zoble Robert G. , Chow Bruce K. , Lavori Philip W. , Boden William E. ,   The VANQWISH Trial Research Investigators
Published: April 2015

OBJECTIVE: To compare the incidence of electrocardiographic abnormalities between older (age > 70 years) and younger patients presenting with acute non‐Q‐wave myocardial infarction.DESIGN: Retrospective review of qualifying electrocardiograms in 918 patients enrolled in the multicenter Veterans Affairs Non‐Q‐Wave Infarction Strategies In‐ Hospital (VANQWISH) study.SETTING: Seventeen Department of Veterans Affairs medical centers.PARTICIPANTS: A total of 918 patients (224 > 70 years old) with acute non‐Q‐wave myocardial infarction. MEASUREMENTS: Comparison of electrocardiograms in patients aged > 70 years and younger patients for presence of left ventriculary hypertrophy, widened QRS complex, ST and T wave abnormalities, rhythm other than sinus, heart rate > 80 beats/minute, and location of acute non‐Q‐wave myocardial infarction.RESULTS: Left ventricular hypertrophy and ST depression > 1 mm were significantly more frequent in older than in younger patients.CONCLUSIONS: Older patients presenting with non‐Q‐wave myocardial infarction have a greater incidence of left ventricular hypertrophy and ST depression on their electrocardiograms than younger patients. Both of these electrocardiographic findings have previously been associated with increased risk of death and recurrent myocardial infarction and may help account for the worse prognosis of non‐Q‐wave myocardial infarction in older patients.
Factors Influencing the Proportion of Food Consumed by Nursing Home Residents with Dementia
Authors: Amelia Elaine J. 
Published: April 2015

BACKGROUND: Assessment of and interventions for promoting eating in persons with late‐stage dementia have primarily focused on facilitation of safe feeding and methods to promote ingestion of nutrients via several routes. Using Social Exchange Theory, this study examined how the quality of the interaction between care giver and care receiver influenced the proportion of food consumed by persons with late‐stage dementia.METHODS: Fifty‐three dyads composed of nursing home residents with late‐stage dementia and Certified Nursing Assistants (CNAs) were observed during the breakfast meal. The proportion of food consumed by the residents was measured by weight. The study included measures of the quality of interaction between the resident and the CNA (Interaction Behavior Measure‐Modified (IBM‐M) and the IBM), CNA empathy (Interpersonal Reactivity Index), and CNA power (Control subscale of the FIRO‐B).RESULTS: Specific resident behaviors and the CNA's ability to allow another person to control a relationship were most predictive of the variance in the proportion of food consumed (R2 =. 41; F3,49 = 12.54; P <. 001). The quality of the resident‐CNA interaction accounted for 32% of the variance in the proportion of food consumed. One aspect of power was correlated significantly to the proportion of food consumed whereas CNA empathy was not.CONCLUSIONS: Because eating is the most social of all ADLs and is culturally bound, clinicians need to examine the interactional components of meals within the caregiving dyad when a person with late‐stage dementia fails to ingest adequate nutrients.