bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Accurate is the Terminal Prognosis in the Minimum Data Set?
Authors: Finne‐Soveri U. Harriet , Tilvis Reijo S. 
Published: April 2015

OBJECTIVES: To determine the sensitivity and specificity of terminal prognosis in institutional long‐term care (LTC)DESIGN: The Minimum Data Set (MDS 1.0). Data in regard to deaths were collected 6 and 12 months after the assessment.SETTING: A geriatric hospital responsible for all hospital‐based LTC services in one health district (population 71,000) in Helsinki, Finland.PARTICIPANTS: All LTC patients (N = 656; 81% female; mean age = 83 years) in treatment during a 1‐week period.RESULTS: One‐fourth (n = 164) of the 656 LTC patients had a terminal prognosis. Of these patients, 70.7% survived 6 months, and 58.5% were still alive after 1 year. Consequently, terminal prognosis was associated with a four‐fold risk of 6‐month mortality. The sensitivity of the terminal prognosis diagnosis was only 29%, whereas the specificity was 89%. The positive predictive accuracy was 47%, but the negative predictive accuracy was 79%.CONCLUSIONS: Terminal prognosis was clearly overdiag‐nosed. More information is needed about short‐term mortality in terminal prognosis patients and whether this diagnosis affects survival rates. J Am Geriatr Soc 46:1023–1024, 1998.
Paget's Disease of Bone (Osteitis Deformans)
Authors: Ankrom Michael A. , Shapiro Jay R. 
Published: April 2015

Paget's disease of bone is important in geriatric populations because it is the second most common bone disorder after osteoporosis.1 In older people, it may be responsible for chronic back pain and joint pain, skeletal deformities, hearing loss, and cranial nerve compression.2 Paget's disease can reduce both function and mobility in the older people.3In addition to newer tests for assessing the activity of Paget's disease, effective therapy is available in the form of salmon calcitonin for nasal administration and new third generation bisphosphonates.4 Frequently, treatment can reverse the course of the disease. For these reasons, it is feasible for the physician to adopt an aggressive approach to diagnosis and treatment. The objective should be to relieve pain, improve mobility, and forestall debilitating complications. This review will focus on the manifestations and clinical management of Paget's disease. Two cases are presented that illustrate common management problems in older patients. J Am Geriatr Soc 46:1025–1033, 1998.
The Clinical Utility of a Six‐Minute Walk Test in Peripheral Arterial Occlusive Disease Patients
Authors: Montgomery Polly S. , Gardner Andrew W. 
Published: April 2015

OBJECTIVES: To determine the test‐retest reliability of the distance covered and the steps taken to complete a 6‐minute walk test by peripheral arterial occlusive disease (PAOD) patients with intermittent claudication. To determine the relationship between the total distance and steps covered during the 6‐minute walk test and clinical measures of PAOD severity.DESIGN: Cross‐sectional design.SETTING: The Claude Pepper Older Americans Independence Center at the University of Maryland at Baltimore.PARTICIPANTS: Sixty‐four PAOD patients between the ages of 45 and 88 years (age = 68 ± 7 years, ankle/brachial index (ABI) = .61 ± .19) were recruited from the Vascular Clinic at the Baltimore Veterans Affairs Medical Center and from radio and newspaper advertisements.MEASUREMENTS: Patients were assessed on a 6‐minute walk test and a treadmill graded exercise test. A second 6‐minute walk test was administered approximately 1 week later. Patients also were characterized in regard to blood pressure in the arms and legs, ABI, anthropometry, body composition, and physical activity.RESULTS: The distances walked during the two 6‐minute walk tests were similar (350 ± 78 m vs 360 ± 73 m), resulting in a high reliability coefficient (R = .94) and a low coefficient of variation (10.4%). The total steps taken during the 6‐minute walk test also were similar (562 ± 113 steps vs 587 ± 107 steps), resulting in a high reliability coefficient (R = .90) and a low coefficient of variation (11.7%). Furthermore, the 6‐minute walking distance correlated with the distances to onset (r = .346, P = .007) and with maximal claudication pain (r = .525, P < .001) during the treadmill test as well as with ABI (r = .552, P < .001).CONCLUSION: The 6‐minute walk test yields highly reliable measurements, which are related to the functional and hemodynamic severity of PAOD, in patients with intermittent claudication.
Epilepsy in Older Adults: Causes, Consequences and Treatment
Authors: Sirven Joseph I. 
Published: April 2015

OBJECTIVES: Seizures and epilepsy are common problems in older adults. Although, the highest incidence of seizures and epilepsy occurs in individuals more than 65 years of age, the magnitude of this public health problem, and its consequences on the quality of life of older adults, are not appreciated. Moreover, there is no consensus on the most appropriate way to diagnose or manage epilepsy in this population. This report reviews the current literature on all aspects of epilepsy in older people.DESIGN/METHODS: The medical literature was reviewed for all articles pertaining to pathophysiology, diagnosis, and treatment of epilepsy in older people.RESULTS: Epidemiology, etiology, diagnosis, use of diagnostic tests including EEG and imaging, new medical and surgical treatments, and psychosocial issues as they relate to older epilepsy patient are discussed. Several questions that merit future systematic investigation are presented.CONCLUSION: Seizures and epilepsy in older people are much more common than is generally known. There are unique issues related to this population with regard to diagnosis and treatment. Several new medical and surgical therapies are now available for all epilepsy patients, some of which may be helpful for the older epilepsy patient.
Therapy for Acute Myocardial Infarction in Older Persons
Authors: Rich Michael W. 
Published: April 2015

OBJECTIVE: To review the early management of acute myocardial infarction (AMI) in older adults.METHODS: Recently published studies relevant to the early management of AMI were systematically reviewed. When possible, the impact of older age on complication rates and clinical outcomes was evaluated.RESULTS: In general, AMI therapies that are effective in younger patients are also effective in older patients. Conversely, older age is associated with an increased risk of complications from therapy, implying that careful patient selection is required to optimize outcomes while minimizing risks. The principal limitation of currently available data is that relatively few patients older than the age of 80 have been enrolled in prospective randomized clinical trials.CONCLUSIONS: Thrombolysis and primary angioplasty are effective in establishing reperfusion and improving clinical outcomes in older patients with AMI. In the absence of contraindications, aspirin and beta blockers should be considered standard therapy in AMI patients of all ages, whereas heparin, nitrates, and angiotensin converting enzyme inhibitors are indicated in selected subgroups. At the present time, calcium channel blockers, magnesium, and antiarrhythmic agents are not recommended for routine use in the AMI setting, and the role of glycoprotein II/IIIa inhibitors, low molecular weight heparin, and other newer agents await the results of ongoing clinical trials.
Community‐Acquired Pneumonia in the Intensive Care Unit: Epidemiological and Prognosis Data in Older People
Authors: Leroy Olivier , Bosquet Christophe , Vandenbussche Christian , Coffinier Cécile , Georges Hughes , Guery Benoit , Alfandari Serge , Thevenin Didier , Beaucaire Gilles 
Published: April 2015

OBJECTIVES: To compare epidemiological data, etiology, and prognosis of severe community‐acquired pneumonia (CAP) in the intensive care unit (ICU) according to age (< or ≥ 65 years) and to determine prognostic factors of CAP in older people.DESIGN: A retrospective (1987–1992) and prospective (1993‐95) multicenter study.SETTING: Six ICUs in the north of France.PATIENTS: Five hundred five patients admitted to an ICU for severe CAP.MEASUREMENTS: Patient characteristics were compared with regard to age. Prognosis of CAP in older patients was studied by stepwise discriminant analysis.RESULTS: Two hundred seventy‐eight patients (55%) were aged 65 years or older. Comparison of epidemiological data between older and younger patients revealed a higher prevalence of women (38% vs 29%), more severe underlying comorbidities (anticipated death within 5 years: 59% vs 26%), and more frequent chronic respiratory insufficiency (48% vs 33%) in the older patients. In this study group, 224 organisms were isolated from 172 patients (62%); those identified most frequently were Gram‐negative bacilli (34%), S. pneumoniae (32%), and Staphylococcus sp. (19%). Compared with younger patients, no significant differences in bacteriological data were observed. However, crude and attributable mortality rates were significantly higher in the older patients (33% vs 21% and 30% vs 19%, respectively). Prognosis analysis identified four independent predictors of mortality in the older patients: initial septic shock (relative risk (RR) = 3), sepsis‐related complications (RR = 4.3), hospital‐acquired lower respiratory tract superinfections (RR = 2), and nonspecific pneumonia‐related complications (RR = 2.8).CONCLUSION: The bacterial etiology provides some approaches to empirical therapy for older patients with severe community‐acquired pneumonia. In addition, the inappropriateness of withholding intensive care for reasons of age alone is emphasized. J Am Geriatr Soc 47:539–546, 1999.
Changes in Blood Pressure and Risk Factors for Cardiovascular Disease Among Older Mexican‐Americans from 1982–1984 to 1993–1994
Authors: Stroup‐Benham Christine A. , Markides Kyriakos S. , Espino David V. , Goodwin James S. 
Published: April 2015

OBJECTIVE: To determine the 10‐year changes in blood pressure and cardiovascular risk factors among older Mexican‐Americans.DESIGN: Comparative analyses of the Hispanic Health and Nutrition Examination Survey (HHANES) and the Hispanic EPESE (Established Populations for Epidemiologic Studies of the Elderly). Both of these were population‐based studies using a multistage stratified probability sampling design of noninstitutionalized persons.SETTING: Five US states in the southwest: Arizona, California, Colorado, New Mexico, and Texas.PARTICIPANTS: A total of 216 Mexican‐Americans aged 65 to 74 from the 1982–1984 HHANES and 3050 Mexican‐ Americans aged 65+ from the 1993–1994 Hispanic EPESE. MEASUREMENTS: Mean systolic and diastolic blood pressure; cigarette smoking; high levels of alcohol use; body mass index and obesity; self‐reported heart attack, stroke, and diabetes; hypertension.RESULTS: Among 65‐ to 74‐year‐old Mexican‐Americans, there was a decrease over time in the percent of those who smoked cigarettes from 27.60% to 13.96% and a decrease in mean systolic blood pressure level. The percent of subjects categorized as obese or severely obese increased significantly, as did the prevalence of diagnosed diabetes, increasing from 20.06% in 1982–1984 to 29.82% in 1993–1994. Mean diastolic blood pressure increased from 77.15 mm Hg in 1982–1984 to 81.21 mm Hg in 1993–1994.CONCLUSIONS: Our findings suggest major changes in cardiovascular risk factors between 1982–1984 and 1993‐ 1994 among older Mexican‐Americans.
Management of the Older Person with Ventricular Arrhythmias
Authors: Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To review the prognosis and management of ventricular arrhythmias (VA) in persons with and without heart disease, with emphasis on older adults.DATA SOURCES: A computer‐assisted search of the English language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.STUDY SELECTION: Studies on the prognosis and management of VA in persons with and without heart disease were screened for review. Studies in older persons and recent studies were emphasized.DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was placed on studies involving older persons. Relevant articles were reviewed in depth.DATA SYNTHESIS: Available data on the prognosis and management of VA in persons with and without heart disease, with emphasis on studies in older persons, were summarized.CONCLUSIONS: Ventricular arrhythmias in older persons without heart disease should not be treated with antiarrhythmic drugs, nor should Class I antiarrhythmic drugs be used to treat VA in older persons with heart disease. Beta‐blockers should be used to treat complex VA in older persons with ischemic or nonischemic heart disease without contraindications to beta‐blockers. Amiodarone should be reserved for life‐threatening ventricular tachyarrhythmias in older persons who cannot tolerate or who do not respond to beta‐ blockers. Angiotensin‐converting enzyme inhibitors should be used to treat older persons with heart failure, an anterior myocardial infarction, or a left ventricular ejection fraction < 40%. If older persons have life‐threatening recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) resistant to antiarrhythmic drugs, invasive intervention should be performed. The automatic implantable cardioverter‐defibrillator is recommended in older persons who have medically refractory sustained VT or VF.
Effectiveness of Inactivated Influenza Vaccine Among Nursing Home Residents During an Influenza Type A (H3N2) Epidemic
Authors: Ohmit Suzanne E. , Arden Nancy H. , Monto Arnold S. 
Published: April 2015

OBJECTIVES: To evaluate the use of influenza vaccine in nursing homes and its effectiveness in reducing the likelihood of influenza‐like illness.DESIGN: A retrospective case‐control study with active identification of influenza infection.SETTING: All nursing homes in a seven‐county study area in southern lower Michigan were eligible for participation. Analyses were based on data collected from 23 homes with documented influenza transmission.PARTICIPANTS: Persons aged 65 years or older who were residents of the nursing homes under study during the influenza type A(H3N2) outbreak in 1989–1990.MEASUREMENTS: Residents were identified as cases or controls based on occurrence of febrile respiratory illness meeting a case definition. Demographic and underlying illness information were gathered as were data on the use of influenza vaccine, antibiotics, and antivirals. Characteristics of the nursing homes were also recorded. Logistic regression analyses were carried out to determine vaccine effectiveness.MAINRESULTS: Determinants of vaccine use were different from those observed in a parallel community‐based study. In a multivariate model that considered the effects of resident and nursing home characteristics, vaccinated residents were significantly less likely than those who were not vaccinated to have an influenza‐like illness (OR = .58 (95% CI, .43‐.78), P < .001, imputed vaccine effectiveness estimate of 42%). Vaccination was more effective in younger residents (those aged 65 to 84) then in older residents (those older than 84 years).CONCLUSIONS: Influenza vaccination was effective in reducing the likelihood of influenza‐like illness in nursing home residents. Effectiveness appeared to be related to age, which may function as a surrogate for related immunologic factors. Older nursing home residents should be targeted for newer vaccines and/or potential prophylactic use of antivirals. J Am Geriatr Soc 47:165–171, 1999.
Body Mass Index and Mortality Among Older People Living in the Community
Authors: Landi Francesco , Zuccala Giuseppe , Gambassi Giovanni , Incalzi Raffaele Antonelli , Manigrasso Luca , Pagano Francesco , Carbonin PierUgo , Bernabei Roberto 
Published: April 2015

OBJECTIVES: To determine if body mass index (BMI = weight/height2), predictive of mortality in seriously ill hospitalized and institutionalized patients, is also predictive of mortality in a longitudinal epidemiologic study.DESIGN: A prospective cohort study.SETTING: Rovereto, a town in northern Italy.PARTICIPANTS: A consecutive sample of 214 patients aged 81.2 ± 7.3 years receiving community care services.MAIN OUTCOME MEASURES: Malnutrition and mortality.RESULTS: According to logistic regression analysis, malnutrition status, expressed by a BMI < 22 Kg/m2., was correlated with dependency in Activity of Daily Living (odds ratio 1.21; 95% confidence interval (CI) 1.01‐1.45). Only a low BMI was associated with 1‐year survival in Cox regression analysis, after adjusting for potential confounders (relative risk 0.85; 95%CI, 0.74‐0.97). A high BMI (>27 Kg/m2) was not significantly related to risk of mortality.CONCLUSIONS: Nutrition variables are a cardinal component of comprehensive geriatric assessment. Our results suggest that BMI, a simple anthropometric measure of nutritional status, is an important predictor of mortality among older people living in the community. Even when controlling for clinical and functional variables, a low BMI remained a significant and independent predictor of shortened survival. J Am Geriatr Soc 47:1072–1076, 1999.
Intraindividual Variability in Orthostatic Blood Pressure Changes Among Older Adults: The Influence of Meals
Authors: Puisieux Francois , Boumbar Youssef , Bulckaen Helene , Bonnin Eric , Houssin Florence , Dewailly Philippe 
Published: April 2015

OBJECTIVES: To examine the influence of time of day and of meals on postural blood pressure (BP) changes in older adults.DESIGN: Prevalence study of BP changes in response to orthostasis.SETTING: A geriatric short‐stay departmentPARTICIPANTS: A total of 126 inpatients (91 women and 35 men; mean age: 81.4 ± 7.9, range 61–95 years) were included in the study.MEASUREMENTS: Two sets of BP and heart rate measurements were obtained for each subject by one examiner using a standard mercury manometer: (1) in mid‐morning (between 10:00 and 10:30 a.m.) and (2) within 30 to 60 minutes after lunch (between 1:00 and 1:30 p.m.). Orthostatic hypotension (OH) was defined as a systolic blood pressure (SBP) decline ≤ 20 mm Hg within 3 minutes after standing.RESULTS: Sixty‐one participants (48%) experienced significant orthostatic BP decline on at least one reading. Among them, 46 (37%) had OH in the mid‐morning, and 32 (25%) had OH after lunch (P = .05). Only 17 (13%) had OH on both readings (persistent OH). Forty‐four patients (35%) had variable OH. Patients with persistent OH were more likely to exhibit symptoms of dizziness and had a lower body mass index and a higher mean basal supine SBP. There was a positive correlation between basal supine SBP and postural SBP decline.CONCLUSIONS: Because of the variability of postural BP changes, the diagnosis of OH should not be based on a single orthostatic BP measurement but requires repeated testing, at best under circumstances similar to those in which the symptoms occurred. The postprandial period is not particularly favorable to OH, suggesting that the ingestion of a meal does not worsen orthostatic BP changes in most aged patients. J Am Geriatr Soc 47:1332–1336,1999.
SPECIAL POPULATIONS IN GERIATRICS
Authors: Miles Toni P. , Schwartz Ann V. , Villa Marie Luz , Prill Mila , Kelsey Joseph A. , Galinus Jill A. , Delay Romelia Ramirez , Nevitt Michael C. , Bloch Daniel A. , Marcus Robert , Kelsey Jennifer L. 
Published: April 2015

OBJECTIVE: To determine the frequency of falls and identify risk factors for falls among older Mexican‐American women.DESIGN: A prospective cohort study with an average follow‐up of 2.7 years.SETTING: A clinical center at the Palo Alto Veterans Affairs Medical Center, California.PARTICIPANTS: 152 community‐dwelling Mexican‐American Caucasian women aged 59 years or older.OUTCOME MEASURES: Falls and injurious falls, as determined by monthly telephone interviews.RESULTS: The rate of falls was 508 per 1000 person‐years (95% confidence interval (CI), 440–577). Injurious falls requiring medical attention occurred at a rate of 79 per 1000 person‐years (95% CI, 52–107). Factors that were associated independently with an increased risk of falling were older age, a history of arthritis or rheumatism, a history of high thyroid, having fainted at least once in the year before baseline, current use of psychotropic medications, and walking fewer than 5 blocks a day. Those persons with an average time for the chair stand test had a lower risk of falling than those with the slowest times or the fastest times.CONCLUSIONS: The frequency of falls and injurious falls in this cohort of 152 relatively acculturated, healthy, older Mexican‐American women was similar or slightly higher than previously reported rates for non‐Hispanic Caucasian). Many of the factors associated with falls in this study were similar to those reported for non‐Hispanic Caucasian women, suggesting that fall prevention measures tested mainly among non‐Hispanic Caucasian women would also be appropriate for Mexican‐American women. J Am Geriatr Soc 47:1371–1378,1999.
Physical Activity, Functional Limitations, and Disability in Older Adults
Authors: Miller Michael E. , Rejeski W. Jack , Reboussin Beth A. , Ten Have Thomas R. , Ettinger Walter H. 
Published: April 2015

OBJECTIVES: To explore initially how low levels of physical activity influence lower body functional limitations in participants of the Longitudinal Study of Aging. Changes in functional limitations are used subsequently to predict transitions in the activities of daily living/instrumental activities of daily living (ADL/IADL) disability, thus investigating a potential pathway for how physical activity may delay the onset of ADL/IADL disability and, thus, prolong independent living.DESIGN: Analysis of a complex sample survey of US civilian, noninstitutionalized population aged 70 years and older in 1984, with repeated interviews in 1986, 1988, and 1990.SETTING AND PARTICIPANTS: Analyses concentrated on 5151 men and women targeted for interview at all four LSOA interviews.MEASUREMENTS: Characteristics used in analyses: gender, age, level of physical activity, comorbid conditions including the presence of hypertension, diabetes, arthritis, and atherosclerotic heart disease, levels of functional limitations, and ADL/IADL disability.RESULTS: Transitional models provide evidence that older adults who have varying levels of disability and who report at least a minimal level of physical activity experience a slower progression in functional limitations (OR = .45, P < .001 for severe vs less severe limitations). This low level of physical activity, through its influence on changes in functional limitations, is shown to slow the progression of ADL/IADL disability.CONCLUSIONS: Results from analyses provide supporting evidence that functional limitations can mediate the effect that physical activity has on ADL/IADL disability. These results contribute further to the increasing data that seem to suggest that physical activity can reduce the progression of disability in older adults.