bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Cost for Disability: A Longitudinal Observation of National Health Insurance Beneficiaries in Japan
Authors: Tsuji Ichiro , Kuwahara Aya , Nishino Yoshikazu , Ohkubo Takayoshi , Sasaki Atsushi , Hisamichi Shigeru 
Published: April 2015

OBJECTIVES: To measure the impact of disability on the use of medical care and its costs.DESIGN: A 1‐year prospective cohort study of National Health Insurance beneficiaries in a rural Japanese community. Their physical function was examined by the Medical Outcomes Study questionnaire at the end of 1994; medical care and its costs were then monitored for 1 year.SETTING AND PARTICIPANTS: Participants were the 49,364 subjects, aged 40 to 79 years, who were beneficiaries of National Health Insurance and lived in the catchment area of Ohsaki Public Health Center, Miyagi, Japan. The subjects were mainly farmers, self‐employed persons, housewives, or pensioners.MEASUREMENTS: Medical care utilization (number of outpatient visits and days of inpatient care) and the costs for each subject were obtained from National Health Insurance Claim History files. These measurements were collected from January to December 1995, and the relationship between physical functioning levels and medical costs was analyzed.RESULTS: The medical costs per capita increased with poorer physical function. Medical costs among those with limitations in performing self‐care increased by 4 times in men and 3 times in women compared with those with no functional limitation. In this cohort, the 4.3% of the subjects who were dependent in self‐care used 15% of the total inpatient days and 10% of the total medical costs.CONCLUSION: Treatment of patients with disability requires a huge amount of medical resources. There is an urgent need for cost‐effective intervention programs for disability prevention, which could be offset against the cost for treating the disabled.
Recruitment of Older Adults for a Randomized, Controlled Trial of Exercise Advice in a General Practice Setting
Authors: Halbert Julie A. , Silagy Christopher A. , Finucane Paul , Withers Robert T. , Hamdorf Phil A. 
Published: April 2015

OBJECTIVES: The success of any clinical trial depends strongly on recruiting enough participants in a reasonable time period. This paper aims to identify the obstacles, as well as the successful aspects, of recruiting of older participants into an exercise study.DESIGN: This describes the recruitment of 299 older adults into a randomized, controlled trial of exercise advice in a general practice setting. Letters of invitation were sent from two general practices inviting the patients to attend a 15‐ minute screening appointment. Patients considered eligible for enrollment were then scheduled for a baseline appointment and randomized into the trial.SETTING: Two general practices in Adelaide, South Australia.PARTICIPANTS: Healthy, sedentary, community‐dwelling patients aged 60 years or older.RESULTS: A total of 2878 letters of invitation were sent, and 913 patients attended a screening appointment. Of these, 351 (38.4%) were initially eligible, with one‐third excluded because they were already too physically active. Two hundred ninety‐nine participants, approximately 1 of every 10 patients sent letters, were enrolled in the project at the end of a 15‐week period.DISCUSSION: A general practice approach was effective in recruiting 299 older adults to an exercise project within an acceptable time frame. Factors promoting the success of recruitment through general practice included choosing large, well established practices, computerized age‐sex registers, and placing minimal demands on the general practitioners and practice staff. A continuing problem with recruiting participants for a project involving exercise is that the volunteer population tends to be healthy and interested in physical activity.
The Effect of Visual and Hearing Impairments on Functional Status
Authors: Keller Brenda K. , Morton Joy L. , Thomas Vince S. , Potter Jane F. 
Published: April 2015

OBJECTIVES: To describe the prevalence of visual and auditory impairment in frail older persons and to evaluate the association between sensory impairment and overall functional status.DESIGN: Prospective patient evaluation and retrospective analysis of dataSETTING: The outpatient geriatric assessment clinic of a university medical center.PARTICIPANTS: Consecutive patients seen in the University of Nebraska Medical Center Outpatient Geriatric Assessment Clinic from 1986 to 1992 for whom both vision and hearing information were available (n = 576).MEASUREMENTS: Visual acuity was measured by the Lighthouse Near Visual Acuity Test, and auditory acuity was evaluated with the whisper test. Functional status was determined by Lawton‐Brody activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Comoro‐bid illness was classified by the Cumulative Illness Rating Scale, and mental status was assessed by the Feldstein Mini‐Mental State Exam.RESULTS: Eighteen percent of patients had visual impairment of 20/70 or worse. Hearing impairment was found in 64%. The mean ADL and IADL scores were 20/24 and 12/23, respectively, for patients with visual acuity better than 20/70, compared with 18/24 and 8/23 for visually impaired patients (P < .001 for both comparisons). ADL and IADL scores were also higher in hearing intact patients compared with those with hearing impairment: respectively, 21/24 vs 19/24 (P < .001) and 13/23 vs 11/23 (P < .001). The effects of visual acuity and hearing acuity on IADL score are independent of mental status and co morbid illness (P < .001). The effect of visual acuity on ADL score is independent of mental status and co morbid illness (P < .001), whereas the effect of hearing on ADL score is not. Subjects with both hearing and vision impairment had mean IADL (P < = .05) and ADL (P < = .05) scores significantly lower than those with no impairmentCONCLUSIONS: Impairments of vision and hearing are common in this frail older outpatient population. Functional status, as measured by IADL and ADL scores, is diminished for sensory impaired subjects. Combined vision and hearing impairments have a greater effect on function than single sensory impairments and influence functional status independent of mental status and comorbid illness. Overall, these results suggest that interventions to improve sensory function may improve functional independence. J Am Geriatr Soc 47:1319–1325,1999.
Longitudinal Changes in Attitudes of Offspring Concerning Life‐Sustaining Measures for Their Terminally Ill Parents
Authors: Cooper‐Kazaz Rena , Friedlander Yechiel , Steinberg Avraham , Sonnenblick Moshe 
Published: April 2015

OBJECTIVES: To define longitudinal changes in the attitudes of offspring concerning life‐sustaining measures for their older, terminally ill parents and to determine whether experience of a “life event” influences such decisions.DESIGN: An attitudinal survey of three groups.SETTING: The geriatric department of a university‐affiliated general hospital.PARTICIPANTS: Fifty‐one subjects who had been interviewed regarding life‐sustaining treatment for their terminally ill parents were reinterviewed 6 years later. In addition, a control group composed of 116 participants was generated from patients visiting hospital outpatient clinics. The control group had no prior experience involving hospitalization of a first‐degree relative as a result of a life‐threatening situation.INTERVENTIONS: Each subject took part in a personal interview.MAIN OUTCOME MEASURES: Attitudes regarding life‐sustaining measures were assessed, and the subjects' sociode‐mographic and religious characteristics were noted.RESULTS: The attitudes of offspring in the acute phase situation and after the passage of 6 years were strikingly consistent. Twenty‐one percent had requested the initiation of resuscitation in the acute phase (“real time”), and 27.4% said the same 6 years later. The provision of nutrition and medication was requested by approximately 70% of participants both at the acute phase and 6 years later. When comparing each individual's personal views at the interviews with all others, consistency in attitude was found among answers to most questions. When comparing the acute phase group with the control group, a significantly higher percentage of the former requested the initiation of resuscitation (48.3% vs 25%), whereas a smaller percentage preferred that the decision be made by the physician (3.5% vs 21.3%). Active euthanasia was requested by 6.5% of the acute phase group and 12.9% of the control group.CONCLUSIONS: The decisions made by offspring regarding life‐sustaining measures for their terminally ill parent at real time remain unchanged 6 years after the event. Exposure to a life event significantly affects the decision‐making of the offspring of a terminally ill parent. However, the subject's attitude toward extreme solutions‐opposing active euthanasia and requesting the administration of nutrition and medication‐was not influenced by the fact that the subject had undergone a life event. J Am Geriatr Soc 47:1337–1341, 1999.
Physician Orders for Life‐Sustaining Treatment (POLST): Outcomes in a PACE Program
Authors: Lee Melinda A. , Brummel‐Smith Kenneth , Meyer Jan , Drew Nicholas , London Marla R. 
Published: April 2015

OBJECTIVES: To evaluate whether terminal care was consistent with Physician Orders for Life‐Sustaining Treatment (POLST), a preprinted and signed doctor's order specifying treatment instructions in the event of serious illness for CPR, levels of medical intervention, antibiotics, IV fluids, and feeding tubes.DESIGN: Retrospective chart review.SETTING: ElderPlace, a Program of All‐inclusive Care for the Elderly (PACE) site in Portland, Oregon.PARTICIPANTS: All ElderPlace participants who died in 1997 were eligible (n = 58). Reasons for exclusion were no POLST (1), missing POLST (1), and insufficient documentation of care (2).MEASUREMENTS: POLST instructions for each participant and whether or not each of the treatments addressed by the POLST was administered in the final 2 weeks of life.RESULTS: The POLST specified “do not resuscitate” for 50 participants (93%); CPR use was consistent with these instructions for 49 participants (91%). “Comfort care” was the designated level of medical intervention in 13 cases, “limited interventions” in 18, “advanced interventions” in 18, and “full interventions” in 5. Interventions administered were at the level specified in 25 cases (46%); at a less invasive level in 18 (33%), and at a more invasive level in 11 (20%). Antibiotic administration was consistent with POLST instructions for 86% of 28 subjects who had infections in the last 2 weeks of life, and less invasive for 14%. Care matched POLST instructions in 84% of cases for IV fluids and 94% for feeding tubes.CONCLUSIONS: POLST completion in ElderPlace exceeds reported advance directive rates. Care matched POLST instructions for CPR, antibiotics, IV fluids, and feeding tubes more consistently than previously reported for advance directive instructions. Medical intervention level was consistent with POLST instructions for less than half the participants, however. We conclude that the POLST is effective for limiting the use of some life‐sustaining interventions, but that the factors that lead physicians to deviate from patients' stated preferences merit further investigation.
Prevalence, Incidence, and Risk Factors Associated with Hip Fractures in Community‐Dwelling Older Mexican Americans: Results of the Hispanic EPESE Study
Authors: Espino David V. , Palmer Raymond F. , Miles Toni P. , Mouton Charles P. , Wood Robert C. , Bayne Nora S. , Markides Kyriakos P. 
Published: April 2015

OBJECTIVES: To determine the rates and risk factors associated with hip fractures in the community‐dwelling older Mexican‐American population.DESIGN: A prospective survey of a regional probability sample of older Mexican Americans aged 65 and over.SETTING: The 1993–1996 Hispanic Established Population for the Epidemiologic Study of the Elderly (H‐EPESE), a probability sample of noninstitutionalized Mexican Americans, aged 65 and over, living in the Southwestern states of Texas, New Mexico, Colorado, Arizona, and California.PARTICIPANTS: In 1993–1994 and in 1995–1996, 2895 persons, aged 65 and over, considered Mexican American, were selected at baseline as a weighted probability sample. Sample weights were used to extrapolate to the estimated 498,176 older Mexican Americans residing in the Southwest US.MEASUREMENTS: Self‐reported hip fracture and functional measures by in home interviews.RESULTS: Hip fracture prevalence was 4.0% at baseline. The overall incidence of hip fractures for women was 9.1 fractures/1000 person‐years. The incidence rate for men was 4.8 fractures/1000 person‐years. Extrapolation from these data to the entire older Mexican American population indicated that approximately 5162 new fractures occurred in the population during the 2 year study period. In women, hip fractures were associated independently with advanced age, not being married/living alone, having had a stroke, limitations with activities of daily living and instrumental activities of daily living. In men, only the latter limitations were associated independently with hip fracture.CONCLUSIONS: This study indicates that older Mexican American people may have hip fracture incidence rates that place them at highest risk among the Hispanic subgroups. In light of a sparse literature on this population, the fracture estimates derived from this work contributes to our understanding of the true fracture estimates in this population. Based on the extrapolated population rates, hip fracture in this population is a significant public health problem. Adequate preventive measures need to be implemented in this growing US population.
Expert Physician Recommendations and Current Practice Patterns for Evaluating and Treating Men with Osteoporotic Hip Fracture
Authors: Colón‐Emeric Cathleen , Yballe Liza , Sloane Richard , Pieper Carl F. , Lyles Kenneth W. 
Published: April 2015

OBJECTIVES: To develop recommendations for the evaluation and the treatment of men with osteoporotic hip fracture from expert publications in the field of male osteoporosis, and to define the current practice patterns in a tertiary care VA Medical Center in Durham, North Carolina.DESIGN: Survey research; a retrospective cohort study.SETTING: Tertiary care VA Medical Center in Durham, North Carolina.PARTICIPANTS: (1) US physicians who published on the subject of male osteoporosis in the peer‐reviewed literature between 1993 and 1997 identified by MEDLINE database search. (2) All 119 men admitted to the Durham VA Medical Center with ICD9 code for hip fracture between 1994 and 1998.OUTCOME MEASURES: (1) Osteoporosis evaluation and treatment recommendations of published physicians obtained by survey instrument. (2) Actual osteoporosis evaluation completed and therapy prescribed during index hospitalization in a cohort of men with hip fractures, determined by chart and database review.RESULTS: (1) Forty‐three physician‐researchers were surveyed with an 84% response rate. For an osteoporosis evaluation, 89% of respondents recommended measuring serum testosterone, 85% serum calcium, 75% 25‐OH vitamin D levels, 73% myeloma screen, and 61% serum thyroid‐stimulating hormone (TSH). Dual Energy X‐ray Absorptiometry would be obtained by 92%. More than 70% recommended calcium, vitamin D, and bisphosphonates for men with a normal metabolic evaluation, and 60% suggested weight‐bearing exercise. (2) In the cohort of men admitted with hip fractures, 50% had a serum calcium level and 3% had a serum TSH level measured. Vitamin D was prescribed to 25% of patients in the form of a multivitamin, and 4% received calcium. There was no bisphosphonate, testosterone, or calcitonin use.CONCLUSIONS: Physicians who have published on osteoporosis recommended metabolic evaluation and osteoporosis therapy after hip fracture. Only minimal evaluation and treatment occurred in a cohort of men with osteoporotic hip fractures.
The Activities of Daily Vision Scale: A Useful Tool to Assess Fall Risk in Older Adults with Vision Impairment
Authors: Kamel Hosam K. , Guro‐Razuman Samerah , Shareeff Musarat 
Published: April 2015

OBJECTIVE: To evaluate the validity of the Activities of Daily Vision Scale (ADVS) as a tool to assess fall risk in older adults with vision impairment.DESIGN: Cross‐sectional assessments of visual function and retrospective collection of fall data.SETTING: The outpatient medical clinics of an academic tertiary care community hospital.PARTICIPANTS: Randomly selected sample (n = 143) of older (≥65 years) patients seen at the outpatient medical clinics at Nassau County Medical Center in Long Island, New York. These patients had one or more of five ocular conditions: refractive errors (n = 90), cataracts (n = 77), glaucoma (n = 29), diabetic retinopathy (n = 19), and/or macular degeneration (n = 6).MEASUREMENTS: Visual function, assessed using the ADVS, demonstrated scores ranging from 0 (marked visual disability) to 100 (no visual difficulty). Fall history and the presence of eye disease were based on the self‐recall of patients. Fall history was assessed retrospectively over a 1‐year period from the time of the interview.RESULTS: Thirteen percent of the subjects reported having one or more falls during the 1‐year period before the time of the interview. These subjects scored significantly lower on the ADVS compared with the scores of the group that did not report falls (74 ± 22 vs 85 ± 14, P < .01). Using a cutoff score of 90 points (10% loss of visual function on the ADVS), the ADVS had a 67% sensitivity in identifying those patients who had falls. Among the patients with glaucoma and those with diabetic retinopathy, the ADVS had a 100% sensitivity in identifying those patients who reported a history of falls. In patients with cataracts and refractive errors, the ADVS had a sensitivity of 82% and 64%, respectively, in identifying patients with a history of falls. The number of falls reported by the subjects showed no relationship with the ADVS scores.CONCLUSION: The results from this study suggest that the ADVS may prove to be a useful tool to assess fall risk in older adults with vision impairment, especially in those persons with glaucoma, diabetic retinopathy, and/or cataracts.
Glycemic Control of Older Adults with Type 2 Diabetes: Findings from the Third National Health and Nutrition Examination Survey, 1988–1994
Authors: Shorr Ronald I. , Franse Lonneke V. , Resnick Helaine E. , Di Bari Mauro , Johnson Karen C. , Pahor Marco 
Published: April 2015

BACKGROUND: Although nearly half of all people who have diabetes are aged 65 or older, glycemic control of older adults with diabetes has not been well described.METHODS: We conducted a cross‐sectional study of 1,482 participants with self‐reported type 2 diabetes in the Third National Health and Nutrition Examination Survey, 1988–1994 (NHANES III), a nationally representative sample of the US noninstitutionalized civilian population. Variables included in this analysis included age, sociodemographic factors, drug treatment, and level of glycemic control.RESULTS: The mean % (±SE) HbA1c was 7.78 ± 0.21, 7.64 ± 0.18, 7.71 ± 0.14, and 7.27 ± 0.14 in persons aged 20 to 54,55 to 64,65 to 74 and ≥75 years, respectively. The mean mg/dL (±SE) fasting plasma glucose (FPG) was 175.9 ± 7.6,164.5 ± 6.1,183.3 ± 5.3, and 158.5 ± 5.5 in the four age groups and older, respectively. When controlling for race, gender, education, and duration of diabetes, age was not significantly associated with levels of HbA1c [P (trend) = 0 .17] or FPG [P (trend) = 0 .19].Among NHANES III participants aged 65 or older, ADA guidelines for glycemic control (HbA1c < 7%) were achieved by 71%, 44%, and 27% of persons using no drug therapy, oral hypoglycemic agents, and insulin, respectively.CONCLUSIONS: Although many older adults with type 2 diabetes do not achieve targets for glucose control, there is no evidence to suggest that community‐dwelling older adults with diabetes are treated less vigorously than younger persons with diabetes. J Am Geriatr Soc 48: 264–267, 2000.
Rethinking Fundamental Assumptions: SUPPORT'S Implications for Future Reform
Authors: Lynn Joanne , Arkes Hal R. , Stevens Marguerite , Cohn Felicia , Koenig Barbara , Fox Ellen , Dawson Neal V. , Phillips Russell S. , Hamel Mary Beth , Tsevat Joel 
Published: April 2015

BACKGROUND: The intervention in SUPPORT, the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments, was ineffective in changing communication, decision‐making, and treatment patterns despite evidence that counseling and information were delivered as planned. The previous paper in this volume shows that modest alterations in the intervention design probably did not explain the lack of substantial effects.OBJECTIVE: To explore the possibility that improved individual, patient‐level decision‐making is not the most effective strategy for improving end‐of‐life care and that improving routine practices may be more effective.DESIGN: This paper reflects our efforts to synthesize findings from SUPPORT and other sources in order to explore our conceptual models, their consistency with the data, and their leverage for change.RESULTS: Many of the assumptions underlying the model of improved decision‐making are problematic. Furthermore, the results of SUPPORT suggest that implementing an effective intervention based on a normative model of shared decision‐making can be quite difficult. Practice patterns and social expectations may be strong influences in shaping patients' courses of care. Innovations in system function, such as quality improvement or changing the financing incentives, may offer more powerful avenues for reform.CONCLUSIONS: SUPPORT's intervention may have failed to have an impact because strong psychological and social forces underlie present practices. System‐level innovation and quality improvement in routine care may offer more powerful opportunities for improvement.