bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple Stumbles: A Risk Factor for Falls in Community‐Dwelling Elderly; A Prospective Study
Authors: Teno Joan , Kiel Douglas P. , Mor Vincent 
Published: April 2015

To better understand risk factors for falls among community‐dwelling elderly, we analyzed data from a sample of elderly Medicare beneficiaries interviewed in 1987 and a year later. Demographic, social, medical, and functional information were obtained by telephone interviews with 736 subjects (68% women) whose average age was 76.5 (range, 65–99). At baseline, 63 subjects reported a fall and 67 reported two or more stumbles without a fall in the past month. At the second interview follow‐up information on falls in the past year was obtained on 586 subjects. One hundred twenty‐seven (22%) subjects reported one or more falls. Baseline risk factors that were independent predictors of a fall at the second interview included two or more stumbles (adjusted odds ratio [AOR] 2.3, 95% confidence interval [CI], 1.2–4.5), one or more falls (AOR 5.9, 95% CI 2.9–12.2), having spent 4 or more days in bed in the past month (AOR 7.7, 95% CI 1.9–31.0), and self‐reported declining health status (AOR 2.0, 95% CI 1.1–3.5).Falls and stumbles are prevalent among community‐dwelling elderly. After controlling for covariates, we found subjects who reported two or more stumbles in the past month are at increased risk for a fall in the following year.
Injuries in an Elderly Inner‐City Population
Authors: Grisso Jeane Ann , Schwarz Donald F. , Wishner Amy R. , Weene Barbara , Holmes John H. , Sutton Rudolph L. 
Published: April 2015

Even though injuries are a leading cause of morbidity and mortality among the elderly in the United States, no comprehensive population‐based study of nonfatal and fatal injuries has been carried out in an elderly minority inner‐city population. To study injuries in this population, we developed an active surveillance system as part of a large injury prevention program in a poor urban black community. We report 577 cases of nonfatal and fatal injuries in a community of 12,139 persons 65 years of age and older that resulted in emergency room treatment or death between March 1, 1987, and February 29, 1988.Nearly 5% of the elderly population was treated at an emergency room for, or died as a result of, an injury during the study period; the overall injury rate was 48 injuries per 1,000 persons. Injury rates for older women exceeded those for older men and increased with advancing age in both sexes. Fall injuries accounted for 312 (54%) of all injuries and 75% of all hospitalizations for injury. Motor vehicle incidents and violence were the second and third most common injuries, accounting for 13% and 7% of injuries, respectively. Given the predominance of falls relative to other injuries, prevention of falls should receive major emphasis in injury prevention efforts in inner‐city minority populations.
Imidazole Salicylate Versus Piroxicam in the Treatment of Arthrosis in Elderly Patients;
Authors: Montrone F. , Petrillo M. , Ardizzone S. , Scaricabarozzi I. , Scotti A. , Caruso I. , Porro G. Bianchi 
Published: April 2015

The clinical efficacy and gastroduodenal tolerability of imidazole salicylate (imidazole 2‐hydroxybenzoate, ITF 182), a new synthetic drug with an anti‐inflammatory action, was evaluated endoscopically in comparison with those of piroxicam in elderly patients suffering from osteoarthrosis. Of the 41 patients entering the trial, only 38 completed the protocol (6 men and 32 women; mean age, 71; range, 65–80 years). After upper gastrointestinal endoscopy for the purpose of excluding gastric and duodenal mucosal lesions, the patients were allocated at random, according to a double‐blind, double‐dummy protocol, to treatment either with imidazole salicylate 750 mg three times daily or with piroxicam 20 mg once daily for a period of 4 weeks.Imidazole salicylate proved active in controlling a number of the pain symptoms caused by arthrosis, although its efficacy was inferior to that of piroxicam. Grade 2 gastric mucosal lesions were detected in 1 of 20 patients (5%) treated with imidazole salicylate; lesions corresponding to grades 2, 3, and 4 were found in 6 of 18 (33%) of those treated with piroxicam (P = .034). Painful dyspepsia was reported by 15% of the patients in the imidazole salicylate group and by 28% of those in the piroxicam group.On the basis of these results and under the experimental conditions adopted in this trial, the authors concluded that imidazole salicylate is characterized by good gastric tolerability and can thus be used in the treatment of rheumatic diseases in the elderly. As an anti‐inflammatory drug endowed with probably less marked analgesic activity compared with piroxicam, its use is suggested for the treatment of minor arthropathy. Further study, however, is necessary to define more completely the effects of this new drug on gastric and duodenal mucosa.
Clinicians' Predictions of Nursing Home Placement for Hospitalized Patients
Authors: Hickam David H. , Hedrick Susan C. , Gorton Ann 
Published: April 2015

Identifying patients who will need long‐term care may improve the efficiency and effectiveness of acute hospital care. This prospective study evaluated clinicians' ability to identify patients requiring nursing home care. The study had two principal objectives. The first objective was to measure whether registered nurses, physicians, and social workers made similar estimates of the probability of nursing home placement early in an acute care hospitalization. The second objective was to identify the clinical characteristics of patients for whom the clinicians incorrectly predicted that they would return home. The study subjects were 342 patients older than age 55 who were admitted to the medicine, surgery, and neurology services of two university‐affiliated Veterans Affairs hospitals. Fifteen percent were discharged to nursing homes.The nurses, physicians, and social workers had high agreement in their estimates of the probability of nursing home placement for each patient. However, each of the provider groups assigned low probability estimates to more than 20% of the patients discharged to nursing homes. Examination of the characteristics of patients assigned low probability estimates revealed that mental impairment and functional disability were higher in those patients who ultimately were discharged to nursing homes than in those patients who returned to their homes. These findings suggest that better assessment and interpretation of patient characteristics early in the hospital stay may improve discharge planning. Some clinicians appear to underestimate mental and functional impairment as risk factors for long‐term care needs.
The Metabolic Effects of Calcium Supplementation in the Elderly
Authors: Kochersberger Gary , Westlund Ronald , Lyles Kenneth W. 
Published: April 2015

Because the value of calcium supplementation in age‐related bone loss is controversial, we conducted a study to examine the effects of six months of calcium supplementation on parathyroid hormone (PTH) and other indices of bone metabolism. Calcium carbonate (1.2 grams elemental calcium/day) or placebo was administered for 6 months to a group of 42 healthy, ambulatory men and women with a mean age of 71. Fasting blood samples and 2‐hour urine collections were performed at baseline and at 1 and 6 months. The decline in serum PTH levels from baseline in the calcium‐supplemented group was significant in comparison with the placebo group changes (for the calcium group: 40.9 pg/mL at baseline to 34.0 pg/mL at 1 month and 33.2 at 6 months). This drop in PTH was associated with a decline in 1,25 OH‐Vitamin D levels from a mean of 38.3 pg/mL to 30.4 pg/ml at 1 month and 31.9 at 6 months. During calcium supplementation, no changes were observed in serum bone Gla protein values. A decline in urinary hydroxyproline excretion was observed at 6 months, but this did not reach significant levels.The present study demonstrates suppression of PTH levels with calcium supplementation, an effect which lasts at least 6 months. This change was accompanied by a decrease in serum 1,25 OH‐Vitamin D. The lack of significant changes in either serum bone gla protein or urine hydroxyproline excretion fails to support any significant change in bone turnover occurring with this decrease in PTH.
Is the Serum Cholesterol‐Coronary Heart Disease Relationship Modified by Activity Level in Older Persons?
Authors: Harris Tamara B. , Makuc Diane M. , Kleinman Joel C. , Gillum Richard F. , Curb J. David , Schatzkin Arthur , Feldman Jacob J. 
Published: April 2015

Although coronary heart disease remains a leading cause of death and disability in old age, the relationship of serum cholesterol level to risk of coronary heart disease in old age is controversial. Data for 2,388 white persons aged 65–74 who participated in the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow‐up Study (NHEFS) were examined to determine the relationship of serum cholesterol level to coronary heart disease incidence and whether activity level would modify this relationship.While there was no overall relationship between serum cholesterol level and coronary heart disease risk in either men or women, the relationship between serum cholesterol level and coronary heart disease differed within activity groups. For persons who were more active, serum cholesterol level was associated with a graded increase in risk of coronary heart disease, from 1.3 (95% CI 0.7,2.3) in those with serum cholesterol level of 4.7–5.1 to 1.7 in those with serum cholesterol level of 6.2 mmol/L or more (95% CI 1.0,2.7), when compared with those with serum cholesterol level below 4.7. For the least active persons, all levels of cholesterol were associated with a significant inverse relative risk, including cholesterol of 6.2 mmol/L or more (Relative risk = 0.4 (95% CI 0.2,0.7)).These data suggest that factors such as activity level may modify the serum cholesterol‐coronary heart disease association in old age. The serum cholesterol‐coronary heart disease association in more active older persons resembles that seen in younger populations, whereas the association in less active persons is that of serum cholesterol level and risk of cancer or death. The modification of the serum cholesterol‐coronary heart disease association by activity level may have implications for appropriate clinical management as well as appropriate design of research studies of this association.
Resident Behavior and Staff Distress in the Nursing Home
Authors: Everitt Daniel E. , Fields David R. , Soumerai Stephen S. , Avorn Jerry 
Published: April 2015

Newly enacted Federal regulations have focused increasing attention on the use of psychoactive drugs and on the treatment of disruptive behavior in the nursing home. To study the interaction between resident behavior and staff distress in nursing homes, we measured the frequency of seven types of behavior problems among 346 residents of intermediate care facilities who were receiving some form of psychoactive medication. Nurses were interviewed on two shifts to determine their perception of the frequency and severity of each behavior in each patient as well as the level of distress it caused among caregivers. The most common behavior problems noted were agitation (42%), withdrawal (33%), and noisiness (27%). Only half of the reported instances of behavior disorders were considered distressful by nursing home staff. While physical abuse caused distress 92% of the time and verbal abuse 90% of the time, wandering was seen as distressful to staff only 50% of the time. Nearly a third of “wandering” patients were restrained; they produced less distress than non‐restrained wanderers.There was substantial disagreement, ranging from 6% to 22% for individual residents, over the presence of distress‐causing behavior, although day and evening nursing shifts rated the frequencies of behavior and the degrees of distress equally on average. Residents with higher cognitive function were less likely to cause distress for all behaviors, except for verbal abuse where the reverse was true. Age and dependency in activities of daily living were not associated with problematic behavior or staff distress. These findings indicate that the existence of “problematic” behaviors in a given resident is often perceived differently by different staff, and its impact on staff also differs widely.
A Community Study of Vitamin B12 and Folate Levels in the Elderly
Authors: Hanger H. C. , Sainsbury R. , Gilchrist N. L. , Beard M. E. J. , Duncan J. M. 
Published: April 2015

Objective: To measure the prevalence of low serum vitamin B12, folate, and red cell folate levels and their relationship with other nutritional indices.Design: Prospective survey of elderly subjects using radioisotope dilution assays.Setting: Primary care medical center, Christchurch, New Zealand.Patients: 257 elderly subjects (age 65 years and over), residing in their own homes or in residential homes, were randomly selected. Of these, 204 (79%) participated. The study population was comparable to the elderly population of New Zealand.Main Outcome Measures: Vitamin B12, serum, and red cell folate levels.Results: The prevalence rates for low levels of serum vitamin B12, folate, and red cell folate were 7.3%, 1%, and 3.3%, respectively. The elderly cohort had lower vitamin B12 (P < 0.001) but higher serum and red cell folate levels (P < 0.001) than our normal reference range (age 18–65 years). Red blood cell folate levels showed positive correlations with nutritional indices and mental test scores. No correlations were found between vitamin B12 levels and diet or other nutritional indices.Conclusions: Low folate levels in older people living at home are infrequent findings. In contrast low vitamin B12 levels are more common. Poor diet and undernutrition may contribute to low folate levels, but these factors are less important for the low B12 levels found.
Effects of Short‐Term Administration of Glucocorticoids on Bone Metabolism in Healthy Elderly Men
Authors: Mitchell David R. , Jackson Thomas W. , Lyles Kenneth W. 
Published: April 2015

Objective: To determine the effects of short‐term glucocorticoid administration in healthy elderly men on bone GLA protein (BGP) levels, as well as levels of calcium, phosphorus, immunoreactive parathyroid hormone (PTH), and alkaline phosphatase.Design: Subjects served as own control before and after prednisone treatment.Setting: Male subjects were recruited by telephone from the Duke University Aging Center Volunteer Registry and the Department of Veterans Affairs Medical Center Gerofit Program (a supervised exercise program).Participants: Healthy males age greater than 60 years with no history of diabetes mellitus, glucose intolerance, or prior glucocorticoid use. Subjects could not be taking diuretic agents and could not have osteoporosis. The seven subjects mean age + std dev was 68.6 + 5.3 years.Interventions: Prednisone 40 mg orally for 5 days. Fasting serum was obtained at baseline, on days 7 through 11, 13, 15, and 17. Assays of BGP, calcium, phosphorus, PTH, and alkaline phosphatase were performed.Main Outcome Measures: Changes in serum BGP levels was the primary outcome measure. Changes in serum calcium, phosphorus, PTH, and alkaline phosphatase levels were secondary outcome measures.Results: Treatment caused reduction in BGP levels within 24 hours of first dose of prednisone, with levels dropping an average of 78% during the 5 days of treatment (P = 0.004). Within 24 hours of stopping treatment, BGP was no different from baseline. Other variables did not change with treatment.Conclusion: Glucocorticoid treatment suppresses BGP production in healthy elderly men in the same fashion as it does in younger healthy men.
Effectiveness of Geriatric Psychiatry Consultation in an Acute Care Hospital: A Randomized Clinical Trial
Authors: Cole Martin G. , Fenton Fred R. , Engelsmann Frank , Mansouri Iradj 
Published: April 2015

Objective: To evaluate the effectiveness of geriatric psychiatry consultation in reducing the severity of confusion, anxiety, depression, abnormal behavior, and functional disability among a selected group of aged medical and surgical inpatients.Design: Randomized clinical trial. Cases assessed on enrollment at 2, 4, and 8 weeks later.Setting: Primary acute care hospital.Patients: Eighty hospitalized patients aged 65 or older who were referred to a multi‐disciplinary team and had not received a psychiatric consultation in the month prior to referral. Sixty‐three patients completed the trial.Interventions: Patients in the treatment group received a geriatric psychiatry consultation and, when appropriate, follow‐up at least once per week for 8 weeks. Control patients received usual medical care.Main Outcome Measures: Short Portable Mental Status Questionnaire, Anxiety Status Inventory, Geriatric Depression Rating Scale, and Crichton Geriatric Behavioral Rating Scale.Results: The effect of the consultation on psychiatric symptoms and functional status was positive but small. The differences in scores of all measures between treatment and control groups were not statistically significant, but there were consistent trends for more treatment than control cases to have improved on all measures, significantly so on the Anxiety Status Inventory (P < 0.05). Cases with delirium or depression improved most often. More control than treatment cases were discharged after 4 and 8 weeks, but twice as many treatment cases were discharged home.Conclusions: Geriatric psychiatry consultation, while not highly effective overall, may be beneficial if targeted to those most likely to benefit and compliance by referring physicians can be improved.
Physiological Factors Associated with Falls in an Elderly Population
Authors: Lord Stephen R. , Clark Russell D. , Webster Ian W. 
Published: April 2015

Objective: To determine whether a battery of 13 sensorimotor, vestibular, and visual tests discriminates between elderly fallers and elderly non‐fallers.Design: One‐year prospective study.Setting: Conducted at a 124‐bed Hostel for Aged Persons, in Sydney, Australia.Participants: Ninety‐five persons aged between 59 and 97 years (mean age 82.7 years) took part in the study. Of the 29 non‐participants, four were ill, five were absent (on holidays, etc), and 20 declined. Residents were generally independent in activities of daily living although personal care assistance was available.Results: Eighty‐four participants were available for follow‐up. In the follow‐up year, 40 subjects experienced no falls, 11 subjects fell one time only, 33 residents fell on two or more occasions. There was a total of 145 falls. Discriminant function analysis identified proprioception in the lower limbs, visual contrast sensitivity, ankle dorsiflexion strength, reaction time, and sway with the eyes closed as the variables that significantly discriminated between subjects who experienced multiple falls and subjects who experienced no falls or one fall only. This procedure correctly classified 79% of subjects into multiple faller or non‐multiple faller groups. Quadriceps strength was poorer in the multiple fallers compared with the non‐fallers and once‐only fallers, although the difference was not statistically significant. There was little difference in the mean scores for the tests of vestibular function in the non‐fallers, once‐only fallers, and multiple fallers.Conclusion: It appears that this approach highlights some key physiological factors that predispose elderly individuals to falls.
Benign Prostatic Hyperplasia: Pathogenesis and Medical Therapy
Authors: Geller Jack 
Published: April 2015

Epidemiologic studies in castrates strongly support the key role of the testis in the pathogenesis of benign prostatic hyperplasia (BPH). Since the testis secretes androgen and estrogen, both of these hormones have been implicated in BPH. Much information supports the important role of dihydrotestosterone (DHT) in BPH, including intraprostatic activities of enzymes that regulate DHT. Although controversy still exists, DHT levels in BPH may be higher than in normal prostate tissue. Based upon these findings and the ability to quantitate prostate size and function with reliable new techniques, suppression of androgen‐mediated action has been tested to assess the validity of the DHT theory. A variety of drugs has been demonstrated to decrease prostate size by approximately 30% by either blocking secretion of circulating testosterone and adrenal androgen, inhibiting 5α‐reductase to prevent DHT formation, or blocking DHT binding to androgen receptors. Accompanying these changes in size was significant improvement in clinical symptoms of prostatism in about 50% of patients, when double‐blind, large multicenter studies were conducted with one of these drugs.Although these results suggest a very important role for androgen, particularly DHT, in the pathogenesis of BPH, other abnormalities may coexist since significant numbers of patients do not show a total reversal of disease. There is strong indirect evidence for a possible role for estrogen in the pathogenesis of BPH, and studies are under way to test the effects of estrogen withdrawal on prostate size and symptoms. Similarly, dynamic aspects of prostatic obstruction, which are under alpha‐adrenergic regulation, may also be a component of this disease and amenable to therapy with alpha‐adrenergic blockers. Therefore it would seem that BPH may be multifactorial and require combined therapy. Androgen would certainly appear to be necessary but perhaps not sufficient for the pathogenesis of this disorder.
The Incidence of Attempted CPR in Nursing Homes
Authors: Finucane Thomas E. , Boyer John T. , Bulmash Jack , Fanale James E. , Garrell Marvin , Johnson Larry E. , Katz Paul R. , Pattee James J. , Rappaport Stephen A. , Ryan Joseph J. , Simpson William M. , Tangalos Eric G. 
Published: April 2015

We studied the frequency with which cardiopulmonary resuscitation (CPR) is attempted on residents of American nursing homes. Each author (all members of the Clinical Practice Committee of the American Geriatrics Society) completed a questionnaire in 1989 about policy and practice regarding CPR during 1988 in each of three to seven nursing homes, by questioning the medical or nursing director or the administrator. Because of the vagaries of nursing home record‐keeping, data from some homes were allowed when they were “accurate to within 10%.”Data from 58 nursing homes, totalling 10,836 bed‐years were available. In 33 of these homes, accounting for 5,425 bed‐years, CPR was never attempted. CPR was more likely to be foregone in nursing homes with religious affiliation than in nursing homes without (13 of 17 vs 18 of 38; χ2 = 4.0; P < 0.05). Religious affiliation was unknown for three nursing homes. Academic affiliation (10 of 16 vs 20 of 37 in non‐affiliated nursing homes) and non‐profit status (14 of 19 vs 16 of 23 in for‐profit nursing homes) did not significantly affect the likelihood that CPR would never be used. In 31 of 54 nursing homes with explicit do not resuscitate (DNR) policies, CPR was never performed, compared to 2 of 4 homes without such policies. For nursing homes with complete data, there were 1,196 deaths in 32 facilities where CPR was never attempted compared to 1,294 deaths for 24 nursing homes with CPR. For 22 nursing homes without CPR, there were 2,172 emergency room transfers compared to 1,363 emergency room transfers in 18 nursing homes where CPR was attempted.In this non‐random sample, most nursing home residents who died in 1988 were in nursing homes that never attempted CPR. In homes where CPR was attempted, its utilization was variable, but generally very infrequent.