bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lipoprotein(a) Is a Risk Factor for Diabetic Retinopathy in the Elderly
Authors: Morisaki Nobuhiro , Yokote Koutaro , Tashiro Jun , Inadera Hidekuni , Kobayashi Junji , Kanzaki Tetsuto , Saito Yasushi , Yoshida Sho 
Published: April 2015

OBJECTIVE: To assess whether serum lipoprotein(a) is a risk factor for diabetic retinopathy in the elderly.DESIGN: A cross‐sectional study.SETTING: Outpatient diabetic clinic.PATIENTS: One hundred four noninsulin‐dependent diabetic patients (35 males, 69 females). Twenty‐three were less than 60 years of age (middle‐aged), and 81 were 60 years or older (elderly).MEASUREMENT: Levels of lipoprotein(a) (Lp(a)) and lipids were measured in fasting serum. HbA1c was also measured as an indicator of diabetic control. Other indicators possibly related to retinopathy were also checked. Retinopathy was estimated by photographs of fundi.RESULTS: Significantly higher indicators in the group with retinopathy than in the group without were: HbA1c, Lp(a), duration of diabetes, and systolic blood pressure (BP) in the total cases; HbA1c, duration of diabetes, and Lp(a) in the middle‐aged; HbA1c, systolic BP, and Lp(a) in the elderly. Multiple logistic regression analysis showed that only HbA1c and Lp(a) were independent risk factors for retinopathy in all cases and in the elderly. The incidence of retinopathy was positively correlated to serum Lp(a) levels.CONCLUSION: Lp(a) is an independent risk factor for diabetic retinopathy.
Projecting Patients' Preferences from Living Wills: An Invalid Strategy for Management of Dementia with Life‐Threatening Illness
Authors: Reilly Rebecca B. , Teasdale Thomas A. , McCullough Laurence B. 
Published: April 2015

OBJECTIVE: To examine variation in elders' choices of therapies in different clinical scenarios and to assess the validity of extending preferences expressed in scenarios of usual health, terminal illness, and coma to preferences in a scenario of moderately advanced Alzheimer disease.DESIGN: Questionnaire study of community‐dwelling elders.SETTING: Houston metropolitan area.PARTICIPANTS: 218 community‐dwellers age 60 years and older.MEASUREMENTS: Responses regarding choices of 10 interventions in 4 scenarios. Interventions were: cardiopulmonary resuscitation (CPR), ventilator, total parenteral nutrition (TPN), IV medication and hydration, any medication, enteral feeding, dialysis, ICU admission, hospitalization, and antibiotics. Interventions were selected “never,” “always,” or a “trial of intervention to assess efficacy.” Independent variables were responses in scenarios of usual state of health with a life‐threatening illness, irreversible coma, and terminal illness causing pain. Dependent variables were responses in a scenario of moderately advanced Alzheimer disease with a life‐threatening illness. Frequencies of responses were calculated using “never,” “trial,” and “always.” Subsequently “trial” and “always” were collapsed into a category of “accepting intervention” for dichotomous analysis with “refusing intervention” (the “never” category). Logistic regression was used to assess validity of predicting responses in one scenario from the others.MAIN RESULTS: Preferences regarding medical therapies varied across scenarios (P < 0.01). In the Usual Health scenario, all interventions were accepted more frequently than refused. In Terminal Illness and Coma scenarios, CPR, ventilator, TPN, enteral feedings and dialysis were refused more frequently than accepted. In the Alzheimer scenario, medications, ICU admission, hospitalization, and antibiotics were accepted more often than rejected. Trial was preferred to always in 90% of all choices across all scenarios. Preferences expressed in Terminal Illness, Coma, and Usual Health scenarios predicted choices in the Alzheimer disease scenario poorly.CONCLUSIONS: (1) Use of a scenario‐based advance directive may be limited to the precise scenario described. (2) The common acceptance of interventions in the Alzheimer disease scenario differs from findings in earlier studies, possibly because of differences in populations surveyed or the stage of the disease described, highlighting the variability of preferences in this scenario. (3) Trial of intervention is attractive to many respondents, perhaps because it allows the advantage of potentially beneficial therapies without commitment to a course of therapy not leading to cure. (4) Results of this study should be interpreted in light of the study population, consisting largely of well educated, healthy Caucasians. Findings are likely not to be generalizable to other populations.
Flight Simulator Performance of Younger and Older Aircraft Pilots: Effects of Age and Alcohol
Authors: Yesavage Jerome A. , Dolhert Nancy , Taylor Joy L. 
Published: April 2015

Objective: To determine if older pilots forgot more about a learned flight task after a 10‐month delay than did younger pilots and if the anticipated greater skill loss led older pilots' performance to be more disrupted by alcohol.Design: Repeated measures comparative group design examining the effects of alcohol versus placebo in two age groups (younger and older) and at two timepoints: acute intoxication, at a Blood Alcohol Concentration (BAC) of 0.10%, and 8 hours post‐drink.Setting: University medical center research laboratory.Subjects: Fourteen younger (mean age = 27; SD = 4.21; range 21–34) and 13 older (mean age = 60; SD = 6.27; range 51–69) pilots, recruited from local flying clubs, with current FAA medical certificates.Methods: We examined the effects of alcohol versus placebo in the two age groups and at two times, ie, acute intoxication (target BAC 0.10%) and 8‐hour post‐drink. Subjects flew a Frasca 141 simulator in a flight task that they had previously learned but not practiced for several months. After completing a baseline flight, pilots were tested during either an alcohol or a placebo condition at the two timepoints. The main outcome measure was a composite measure of flight performance based upon the mean of eight component standardized scores from different aspects of the flight task.Results: We found detrimental effects of alcohol on the main outcome measure both at the acute and 8‐hour post‐drink testing. There was also no significant difference between the older and younger pilots' performance of the flight task or in susceptibility to alcohol either while intoxicated or during hangover.Conclusions: This study replicates the findings of earlier studies that an 8‐hour waiting period from “Bottle‐to‐Throttle” is insufficient but finds little difference according to age in recollection of a previously learned task or in susceptibility to either acute or hangover effects of alcohol.
Impact of Special Care Unit for Patients with Advanced Alzheimer's Disease on Patients' Discomfort and Costs
Authors: Volicer Ladislav , Collard Ann , Hurley Ann , Bishop Christine , Kern Donald , Karon Sarita 
Published: April 2015

Objective: To compare outcomes in patients with the clinical diagnosis of probable dementia of the Alzheimer type (DAT) cared for in a Dementia Special Care Unit (DSCU) with those in traditional long‐term care (TLTC).Design: Two‐year prospective cohort study.Setting: Two Veterans Administration Hospitals. The DSCU concentrated on assuring patients' comfort instead of promoting maximal survival; in some patients this excluded transfer to acute medical settings, the use of antibiotics, and tube feeding.Measurements: Data were collected regarding disease severity, patient discomfort, use of medical resources, and mortality rate.Results: Patients at both settings were similar on baseline measures, and most were severely demented. The monthly levels of observed discomfort were lower in DSCU than in TLTC patients. The costs of medications, radiology, and laboratory procedures were lower in DSCU than in TLTC patients. DSCU patients were also transferred less frequently to an acute medical setting. The average 3‐month cost for a DSCU patient was $1477 less than the cost of care for a TLTC patient. However, DSCU patients with lower severity of DAT had a higher mortality rate then TLTC patients.Conclusions: These results suggest that management of patients with advanced DAT on a DSCU using a palliative care philosophy may result in less patient discomfort and lower costs than management on a TLTC.
Carbamazepine Treatment of Agitation in Nursing Home Patients with Dementia: A Preliminary Study
Authors: Tariot Pierre N. , Erb Rosemary , Leibovici Adrian , Podgorski Carol Ann , Cox Christopher , Asnis Jamie , Kolassa John , Irvine Carrie 
Published: April 2015

OBJECTIVE: To determine the effects of carbamazepine versus placebo on ratings of behavior in agitated nursing home patients with dementia.DESIGN: Nonrandomized, placebo‐controlled, crossover trial conducted in 25 patients in two nursing homes.INTERVENTION: Carbamazepine and placebo were administered during two 5‐week periods separated by a 2‐week washout. The carbamazepine dose was determined for each patient by a nonblinded physician who did not participate in ratings (modal dose 300 mg/day).MEASUREMENTS: The primary outcome measures were Brief Psychiatric Rating Scale scores and Clinical Global Impression of Change, rated by blind observers. Secondary measures of behavior, adversity, cognition, and functional status were also included.MAIN RESULTS: Median total Brief Psychiatric Rating Scale score decreased 7 points on carbamazepine versus 3 on placebo (P = 0.03). Sixteen subjects were rated as improved globally on carbamazepine versus four on placebo (P = 0.001). Secondary measures of behavior showed similar changes at significant or suggestive (P <0.10) levels. One subject developed carbamazepine‐induced tics, and one died with a pneumonia. There was minimal other adversity.CONCLUSION: This preliminary study suggests that carbamazepine in low doses can reduce agitated behaviors in some patients, with limited adversity resulting. Further research is required to confirm and extend this finding before it can be considered routine clinical practice.
Dizziness in Elderly Men
Authors: Davis Larry E. 
Published: April 2015

OBJECTIVE: To evaluate the causes of dizziness in elderly men.DESIGN: A descriptive study involving the clinical and laboratory features of elderly men with dizziness.SETTING: A university‐affiliated Veterans Affairs medical center.PATIENTS: One hundred seventeen consecutive men more than 50 years of age attending a general neurology clinic with the chief complaint of dizziness.RESULTS: The median duration of dizziness at first office visit was 45 weeks. Forty‐nine percent of patients had more than one diagnosis that contributed to their dizziness. Dysfunctions of the peripheral vestibular system were found in 71% and were the principal causes in 56%. Benign positional vertigo was present in 34%. Disorders of the visual system were found in 26% but were the major cause in only 1%. Diagnoses involving the proprioceptive system were present in 17% and were the principal cause in 7%. Structural lesions of the brainstem or cerebellum or metabolic disorders that affected normal brainstem function were identified in 59% and were the major diagnoses in 22%. A psychophysiologic diagnosis was made in 6% but was the major diagnosis in only 3%. At the 6‐months follow‐up, 55% of patients improved, 34% were unchanged, 4% worsened, and 7% were lost to follow‐up.CONCLUSIONS: Contrary to reports in the literature, dizziness in the elderly is more persistent, has more causes, is less often due to a psychophysiologic cause, and seems to be more incapacitating than dizziness in younger patients. J Am Geriatr Soc 42:1184–1188, 1994.
Use of a Portable Ultrasound Device To Measure Post‐Void Residual Volume Among Incontinent Nursing Home Residents
Authors: Ouslander Joseph G. , Simmons Sandi , Tuico Edward , Nigam Jennifer Glatler , Fingold Susan , Bates‐Jensen Barbara , Schnelle John F. 
Published: April 2015

OBJECTIVE: To determine the accuracy of a portable ultrasound device for the assessment of post‐void residual (PVR) volume among incontinent nursing home (NH) residents.DESIGN: Prospective, clinical series.SETTING: Seven community‐based nursing homes.STUDY POPULATION: Two hundred one consecutively assessed incontinent NH residents who were participating in a larger clinical trial.MEASUREMENTS: PVR volumes measured by trained research associates using a portable ultrasound device and by in‐and‐out catheterization were compared. The accuracy of the ultrasound was calculated using the volume obtained by catheterization as the gold standard.RESULTS: The ultrasound demonstrated excellent test‐retest and interrater reliability. For low PVRs, the device was highly sensitive (.90 for PVR <50 mL and .95 for PVR < 100 mL) and moderately specific (.71 for PVR <50 mL and .63 for PVR < 100 mL). For PVRs of more than 200 mL (n = 26), the ultrasound had a sensitivity of .69 and a specificity of .99.CONCLUSION: The portable ultrasound we used was reliable and reasonably accurate for assessing PVR in a representative sample of incontinent NH residents. Because the sensitivity for clinically significant urinary retention (PVR >200 mL) was only .69, repeated measurements may be necessary to exclude high PVR in individual NH residents. Recent changes in ultrasound design should improve its ease of use and accuracy. Although measuring PVR by ultrasound is much easier and more comfortable than catheterization for both NH residents and staff, the cost of the device may be a barrier to its widespread use in the NH setting.
Seven Consecutive Days of Exercise Lowers Plasma Insulin Responses to an Oral Glucose Challenge in Sedentary Elderly
Authors: Cononie Carmen C. , Goldberg Andrew P. , Rogus Ellen , Hagberg James M. 
Published: April 2015

Objective: To assess the effects of 1 and 7 consecutive days of exercise on glucose and insulin responses to an oral glucose challenge.Design: Intervention group assessed at baseline and after 1 and 7 days of exercise.Setting: Academic medical institution.Participants: Nine healthy 60 to 80‐year‐old men and women.Intervention: Seven days of 50 minutes of exercise at 70% VO2 max.Measurements: Body weight, body composition, and glucose and insulin levels and responses to an oral glucose challenge at baseline and after 1 and 7 days of exercise.Main Results: Fasting plasma insulin levels and plasma insulin responses to an oral glucose challenge were reduced by 15% and 20%, respectively, with 7 consecutive days of exercise that resulted in no change in body weight or body composition. No changes in glucose or insulin levels or responses to the oral glucose challenge were evident after a single day of exercise.Conclusion: The hyperinsulinemia associated with aging can be blunted significantly by repeated bouts of exercise in the elderly, independent of any changes in body composition.
Clean Intermittent Catheterization: Safe, Cost‐Effective Bladder Management for Male Residents of VA Nursing Homes
Authors: Duffy Linda M. , Cleary James , Ahern Sharon , Kuskowski Michael A. , West Melissa , Wheeler Lenea , Mortimer James A. 
Published: April 2015

OBJECTIVES: To compare the safety and cost of clean versus sterile intermittent bladder catheterization in male nursing home residents. To provide evidence to support the hypothesis that intermittent catheterization is a valid, alternative method of bladder management in male residents of long‐term care in whom urinary retention is a documented problem.DESIGN: Randomized clinical trial.SETTING: Three long‐term care sites having predominantly male populations.PARTICIPANTS: Eighty male veterans, residents of three long‐term care facilities, ranging in age from 36 to 96 years with a mean age of 72.INTERVENTIONS: Standardized procedures for clean and sterile intermittent catheterization (IC) were implemented by staff nurses at each site. Patients were randomized into clean and sterile IC groups. Nursing time and catheterization equipment usage were recorded using bar code readers. Clinical data were collected from the medical chart. Treatment of urinary tract infection was prescribed by the medical personnel responsible for each individual resident.MEASUREMENTS: We compared the number of treatment episodes for symptomatic bacteriuria between groups randomized to receive either clean or sterile intermittent catheterization. Laboratory analysis of blood and urine was done on predetermined days. Control variables were research site and patient history of urinary tract infection within the last 6 months. A cost comparison of nursing time and equipment usage for the two catheterization techniques was also performed.RESULTS: No significant differences were found between clean and sterile groups with regard to number of treatment episodes, time to first infection, type of organism cultured, or cost of antibiotic treatment. The cost of sterile technique was considerably higher both in terms of nursing time and supplies.CONCLUSIONS: Findings from this study demonstrate that clean technique intermittent catheterization is a safe and cost‐effective bladder management technique with male, nursing home residents, despite the frailty of this high risk population. An annual savings of approximately $1460 per patient in nursing time and catheterization supplies could be anticipated if a patient were catheterized an average of four times per day substituting clean IC technique for sterile IC technique. J Am Geriatr Soc 43:865–870, 1995.
Developing a New Metric for ADLs
Authors: Finch Michael , Kane Robert L. , Philp Ian 
Published: April 2015

BACKGROUND: Most ADL summary measures add up the number of dependencies. They assume an equal weighting among items and require an arbitrary definition of dependency.METHODS: A panel of experts in geriatrics was asked to rate a set of ADL and IADL components in terms of the contribution of each to overall dependency using a magnitude estimation (ME) technique. The ratings were done for both domains and for levels of function within each domain. The resultant scores were compared with the usual dependency count approach.RESULTS: The distribution of weighted items appears to have face validity. The pattern of dependency traced by the ME model was intermediate between those created by simple counts with two different definitions of dependency. The ME approach has stronger statistical properties than the ordinal scoring approach.CONCLUSIONS: The ME approach appears to be a reasonable and workable method for creating a measure that permits meaningful statements about the mean value of functional dependencies. This result can be used for any comparison of means, such as across individuals, across aggregates of individuals, or across time. J Am Geriatr Soc 43:877–884, 1995.
Effect of Season and Climate on Choice of Therapy for Breast Cancer in Older Women
Authors: Goodwin James S. , Nattinger Ann B. 
Published: April 2015

OBJECTIVES: We and others have previously found a relative underutilization of breast‐conserving surgery with adjuvant radiation therapy in older women diagnosed with early stage breast cancer. Because adjuvant radiotherapy involves daily trips to a facility for 6 weeks, we reasoned that season and climate might influence choice of therapy. Specifically we hypothesized that in northern states, a lower proportion of women would receive breast‐conserving surgery plus radiation in the winter months than in summer, whereas in sunbelt states there would be no relationship between season and therapy.DESIGN: Analysis of national Medicare billing tapes for 1990 and SEER tumor registry data for 1983–1990.PARTICIPANTS: 43,083 women aged 65 to 79, diagnosed with local or regional breast cancer in 50 states or Washington, DC, who underwent mastectomy or breast‐conserving surgery in 1990, and 32,502 women aged 65 to 79 who underwent mastectomy or breast‐conserving surgery from 1983 to 1989 at any of the nine SEER sites.RESULTS: Using a variety of analytical approaches, we could find no consistent effect of cold winter climate on choice of breast cancer therapy.CONCLUSION: Bad weather does not appear to discourage the choice of breast‐conserving treatment. It is not known if bad weather influences actual receipt of radiotherapy.
Implications of the Most Bothersome Prostatism Symptom for Clinical Care and Outcomes Research
Authors: DuBeau Catherine E. , Yalla Subbarao V. , Resnick Neil M. 
Published: April 2015

OBJECTIVES: Because treatment of benign prostatic hyperplasia (BPH) is based largely on patients' symptoms, understanding and measuring the impact of these symptoms from the patient's perspective is critically important for clinical care. Such knowledge also is crucial for comparing patient‐weighted outcomes because the increasing array of medical and surgical BPH treatments differ in their impact on specific symptoms. Our purpose was to determine the most bothersome symptom in older men seeking evaluation for symptomatic BPH and to examine whether age, comorbidity, or urodynamic evidence of prostatic obstruction were important covariates.DESIGN: Prospective evaluation of a consecutive series.SETTING: Veterans Affairs urology clinic.PARTICIPANTS: 115 men (age 69 ± 6 years) presenting for initial evaluation of prostatism.MEASUREMENTS: Scores on standard symptom index and patients' reports of the most bothersome symptom. Bladder outlet obstruction was assessed by multichannel videourodynamic evaluation.RESULTS: An “irritative” symptom (frequency, urgency, or nocturia) was cited as most bothersome significantly more often than an “obstructive” symptom (weak stream, hesitancy, etc.) (53 vs. 35%, P < .05); older men were significantly more likely to name an irritative symptom as most bothersome (x2 for trend = 6.63, P < .025). Even among men with prostate obstruction, most cited an irritative symptom as the most bothersome, regardless of the severity of obstruction. These associations were not confounded by comorbid conditions or medications that independently may cause symptoms.CONCLUSIONS: Because irritative symptoms are most bothersome, have a diverse differential diagnosis, and do not respond as well to BPH treatment, neither providers nor researchers should rely solely on global assessments of symptom severity and bother in assessing men with voiding symptoms. Additional focus on individual symptom impact and etiology is needed, especially in older men.