bluuebunny/crossref_metadata_2025_split huggingface dataset:
The High Prevalence of Depression and Dementia in Elder Abuse or Neglect
Authors: Dyer Carmel Bitondo , Pavlik Valory N. , Murphy Kathleen Pace , Hyman David J. 
Published: April 2015

BACKGROUND: The risk factors for mistreatment of older people include age, race, low income, functional or cognitive impairment, a history of violence, and recent stressful events. There is little information in the literature concerning the clinical profile of mistreated older people.OBJECTIVES: To describe the characteristics of abused or neglected patients and to compare the prevalence of depression and dementia in neglected patients with that of patients referred for other reasons.DESIGN: A case control study.SETTING: Baylor College of Medicine Geriatrics Clinic at the Harris County Hospital District (Houston, Texas).PATIENTS: Forty‐seven older persons referred for neglect and 97 referred for other reasons.INTERVENTION: Comprehensive geriatric assessment.MEASUREMENTS: Standard geriatric assessment tools.RESULTS: There was a statistically significant higher prevalence of depression (62% vs 12%) and dementia (51% vs 30%) in victims of self‐neglect compared to patients referred for other reasons.CONCLUSIONS: This is the first primary data study that highlights a high prevalence of depression as well as dementia in mistreated older people. Geriatric clinicians should rule out elder neglect or abuse in their depressed or demented patients. J Am Geriatr Soc 48: 205–208, 2000.
Nutritional Intake Monitoring for Nursing Home Residents: A Comparison of Staff Documentation, Direct Observation, and Photography Methods
Authors: Simmons Sandra F. , Reuben David 
Published: April 2015

BACKGROUND: The current approach to assessing nutritional intake requires nursing home (NH) staff to document total percentage of food and fluid consumed at each meal. Because NH staff tend to significantly overestimate total food intake, methods need to be developed to improve the accuracy of food intake measurement.OBJECTIVE: To compare three methods of assessing the nutritional intake of NH residents.RESEARCH DESIGN: Validation Study.SUBJECTS: Fifty‐six NH residents in one facility.MEASURES: Total percentage of food and fluid intake of each resident for each of nine meals, or all three meals for 3 consecutive days, was assessed by: (1) Nursing home staff chart documentation, (2) Research staff documentation according to direct observations, and (3) Research staff documentation according to photographs of residents' trays before and after each meal.RESULTS: Research staff documentation of total intake and intake of all individual food and fluid items was similar for the direct observation and photography methods. In comparison with these two methods, NH staff documentation reflected a significant overestimate (22%) of residents' total intake levels. In addition, NH staff failed to identify the more than half (53%) of those residents whose intake levels were equal to or below 75% for most meals.CONCLUSIONS: The photography method of nutritional assessment yielded the same information as direct observations by research staff, and both of these methods showed the intake levels of NH residents to be significantly lower than the intake levels documented by NH staff. The photography method also has several advantages over a documentation system that relies on an observer to be present to record food and fluid intake levels. J Am Geriatr Soc 48: 209–213, 2000.
Combined Behavioral and Drug Therapy for Urge Incontinence in Older Women
Authors: Burgio Kathryn L. , Locher Julie L. , Goode Patricia S. 
Published: April 2015

OBJECTIVE: The purpose of this study was to examine the effects of combining behavioral treatment and drug treatment for urge incontinence in community‐dwelling older women.DESIGN: Modified crossover design (extension of a randomized clinical trial). Eligible subjects were stratified according to type and severity of incontinence and randomized to behavioral treatment, drug treatment, or a control condition (placebo). Subjects not totally continent or not satisfied after 8 weeks of a single treatment were offered the opportunity to cross over into combined therapy.SETTING: A university‐based outpatient geriatric medicine clinic.PARTICIPANTS: Subjects in the clinical trial were 197 ambulatory, nondemented, community‐dwelling women (age 55 years or older) with persistent urge urinary incontinence. Thirty‐five subjects participated in combined treatment.INTERVENTION: One group of subjects received four sessions (over 8 weeks) of biofeedback‐assisted behavioral training followed by 8 weeks of behavioral training combined with drug therapy (oxybutynin chloride individually titrated from 2.5 mg to 15 mg daily). The second group received drug therapy first, followed by 8 weeks of drug therapy combined with behavioral training.MEASUREMENTS: Bladder diaries completed by subjects before and after each treatment phase were used to calculate change in the frequency of incontinent episodes.RESULTS: Eight subjects (12.7%) crossed from behavioral treatment alone to combined behavioral and drug therapy. Additional benefit was seen in improvement from a mean 57.5% reduction of incontinence with single therapy to a mean 88.5% reduction of incontinence with combined therapy (P = .034). Twenty‐seven subjects (41.5%) crossed from drug therapy alone to combined drug and behavioral treatment. They also showed additional improvement, from a mean 72.7% reduction of incontinence with single therapy to a mean 84.3% reduction of incontinence with combined therapy (P = .001).CONCLUSIONS: This study shows that combining drug and behavioral therapy in a stepped program can produce added benefit for patients with urge incontinence. J Am Geriatr Soc 48: 370–374, 2000.
Binocular Vision in Older People with Adventitious Visual Impairment: Sometimes One Eye Is Better than Two
Authors: Faubert Jocelyn , Overbury Olga 
Published: April 2015

PURPOSE: To determine the effect of adventitious visual impairment (low vision) on monocular and binocular spatial contrast sensitivity of older people.DESIGN: A between‐within repeated measures design.PARTICIPANTS: Fifty‐nine older adults between the ages of 50 and 96; 49 of the observers had age‐related macular degeneration (AMD).MEASURES: Visual acuity screening and spatial contrast sensitivity.RESULTS: In almost half of the population with AMD, the sensitivity to spatial information, as measured by spatial contrast sensitivity, is worse when both eyes are used than when the stimuli are viewed with only one eye. This “binocular inhibition” is not related to the contrast sensitivity of the better eye or to acuities. Furthermore, this inhibition process is reflected primarily in images with medium to low spatial frequency components (medium to large size bars).CONCLUSIONS: These results have important implications for understanding the functional impact of low vision in older people. They suggest that almost one‐half of older people with AMD view the world best using only one of their eyes, whereas for the other half, there is an advantage to using binocular vision for certain visual tasks. J Am Geriatr Soc 48: 375–380, 2000.
Atrial Fibrillation and Cognitive Disorders in Older People
Authors: Sabatini Tony , Frisoni Giovanni B. , Barbisoni Piera , Bellelli Giuseppe , Rozzini Renzo , Trabucchi Marco 
Published: April 2015

OBJECTIVES: To find a correlation between chronic non‐rheumatic atrial fibrillation (CNRAF) and cognitive impairment in a group of older, nondemented patients.SETTING: Acute Care Unit for the Elderly, Poliambulanza Hospital, Brescia (Italy).METHODS: Two hundred fifty‐five hospital in‐patients older than 70 years (42 with CNRAF and 213 controls with normal sinus rhythm) were assessed by complete clinical history, physical examination, ECG, serum albumin levels, APACHE II score, mental status (Mini‐Mental State Exam [MMSE] and Geriatric Depression Score [GDS]), functional status (Barthel Index and instrumental activities of daily living [IADL]), number of prescribed drugs, and comorbidity (Charlson Index).RESULTS: The group of patients with CNRAF had MMSE scores significantly lower than that of the reference group with normal sinus rhythm. Chronic nonrheumatic atrial fibrillation retained an independent relation to cognitive impairment also after adjusting for those variables associated with mental decline in univariate models (GDS, IADL, and APACHE II scores).CONCLUSIONS: The results of this study support the relationship between nonrheumatic atrial fibrillation and impaired cognitive function. Independent of etiopathogenetic mechanisms (thromboembolic or hemodynamic hypotheses), prevention of cognitive impairment in older persons should take into account the treatment of atrial fibrillation and its consequences. J Am Geriatr Soc 48: 386–390, 2000.
A Cross‐National Survey of Tube‐Feeding Decisions in Cognitively Impaired Older Persons
Authors: Mitchell Susan L. , Berkowitz Randi E. , Lawson Fiona M. E. , Lipsitz Lewis A. 
Published: April 2015

OBJECTIVES: Many factors affect the decision to institute long‐term tube‐feeding in older persons. The objectives of this cross‐national survey are to examine the tube‐feeding decision‐making process for cognitively impaired older persons from the perspective of the substitute decision‐makers (SDM) and to contrast this process in US and Canadian healthcare settings.DESIGN: SurveySETTING: Chronic care facilities in Ottawa and nursing homes in BostonPARTICIPANTS: Patients more than age 65 who were tube‐fed for at least 2 months and who were unable to make their own healthcare decisions at the time of tube placement were identified at both sites. The SDMs of 46 patients in Ottawa and 48 patients in Boston were surveyed.MEASUREMENTS: The survey asked questions relating to the following categories: health status of the patient, advance directives, communication with the healthcare team, perceived goals of tube‐feeding, decision satisfaction, and sociodemographic data.RESULTS: Tube‐fed patients in Boston were more likely to have a diagnosis of dementia than those in Ottawa (60.4% vs 10.9%, P < .001) and were less likely to have had an acute neurological event (35.4% vs 71.7%, P < .001). There was a greater likelihood in Boston than in Ottawa (68.7% vs 6.5%, P < .001) for tube‐feeding decisions to be made in a nursing home (vs an acute hospital). In the combined cohort, 19.1% of patients had a living will, and only 47.9% of SDMs felt confident that the patients would want to have a feeding tube. The majority of SDMs at both sites felt they understood the benefits (83.0%), but not the risks (48.9%), of tube‐feeding. The most commonly perceived reasons for tube‐feeding were to “prolong life” (84.0%) and to “prevent aspiration” (67.0%). Approximately half of all SDMs felt they had received adequate support from the healthcare team. A minority of SDMs (38.3%) at both sites stated that they would want a feeding tube for themselves, and only 40% of SDMs felt the feeding tube had improved the patients' quality of life.CONCLUSIONS: A greater proportion of patients have feedings tubes inserted because of a degenerative dementia in Boston compared with an acute neurological event in Ottawa. Despite the difference in diagnostic indication for tube‐feeding, the substitute decision‐making process was seriously limited at both sites by poor implementation of the principle of substituted judgement, a need for broader advance directives, and improved transfer of knowledge between clinicians and decision‐makers. J Am Geriatr Soc 48: 391–397, 2000.
A Drug Use Evaluation of Selected Opioid and Nonopioid Analgesics in the Nursing Facility Setting
Authors: Cramer Gena W. , Galer Bradley S. , Mendelson Marilyn A. , Thompson Gregory D. 
Published: April 2015

OBJECTIVES: To determine the medical conditions for which selected analgesics are most frequently prescribed in nursing facilities (NFs), describe the use of pharmacologic and nonpharmacologic pain therapies, and determine the frequency and quality of pain assessment in NF residents.DESIGN: A multicenter, 3‐month retrospective drug use evaluation conducted by consultant pharmacists.SETTING: Eighty‐nine NFs having no more than 25% of their patient census representing special populations (e.g., head trauma).PARTICIPANTS: A total of 2065 adult NF residents who received at least one selected analgesic.MEASUREMENTS: Primary indication for analgesics, pain type, method of pain assessment, nonpharmacologic therapies for pain, prescribed analgesics and regimens, and comorbid conditions were recorded.RESULTS: A total of 54.3% of residents had one indication for analgesic therapy, 31.0% had two indications, and 14.7% had three or more indications. Arthritis was the most prevalent indication for analgesics (41.7% of residents), followed by bone fracture (12.4%) and other musculoskeletal conditions (9.7%). More residents (76.8%) were reported to have chronic pain than acute pain (19.9%), and 3.0% had both chronic and acute pain. Pain type was unknown for 0.2% of residents. Observational pain assessments were used more frequently (for 55.9% of residents) than objective methods (16.6%), and pain was not assessed in 40.6% of residents. Most residents (69.4%) received no nonpharmacologic treatment for pain. Of the 2542 opioid and nonsteroidal anti‐inflammatory drug (NSAID) prescriptions, 67.6% were for opioids, 24.8% were for NSAIDs, and 7.6% were for tramadol. Propoxyphene‐containing drugs were the most frequently prescribed opioid group, and propoxyphene with acetaminophen was the most frequently prescribed analgesic (35.6% of all analgesics). Most analgesics (63.2%) were prescribed on an as‐needed (prn) basis.CONCLUSIONS: The findings show a lack of adequate pain assessments, little use of nonpharmacologic interventions, and inappropriate use of analgesic medication. The small percentage of residents with chronic pain assessed objectively suggests the difficulty of monitoring pain progression in NFs. The prescribing of analgesic for most residents (with propoxyphene used most often, long‐acting opioids used infrequently, and frequent prn use) was inconsistent with recommended pain therapy in older people and attests to the urgent need to educate NF practitioners on the appropriate use of analgesics. J Am Geriatr Soc 48: 398–404, 2000.
Health, Functional, and Psychological Outcomes Among Older Persons with Chronic Dizziness
Authors: Tinetti Mary E. , Williams Christianna S. , Gill Thomas M. 
Published: April 2015

OBJECTIVE: The recommended clinical strategy for a health condition should depend both on the known causes of and outcomes associated with the condition. The aim of this study was to determine the range of adverse outcomes associated with chronic dizziness.DESIGN: Population‐based prospective cohort studySETTING AND PARTICIPANTS: A probability sample of 1087 persons, age 72 and older, living in the community.MEASUREMENTS: The following were measured: chronic dizziness, death, hospitalizations, falls, syncope, basic and instrumental activities of daily living, depressive symptoms, self‐rated health, falls self‐efficacy, and social activities.RESULTS: Of the 1087 participants, 261 (24%) reported chronic dizziness. Over 1 year of follow‐up, chronic dizziness was not associated with mortality, hospitalization for any reason, or change in basic or instrumental activities of daily living, but was associated with risk of falling (unadjusted relative risk [RR] 1.35; 95% confidence interval [CI] 1.06–1.72) and with experiencing syncope (RR 2.31; 95% CI 1.24–4.30). After adjustment for baseline level, chronic dizziness also was associated with worsening of depressive symptoms, self‐rated health, falls efficacy, and social activities. The relationship remained significant, after adjustment for potential confounding factors, for self‐rated health (T‐statistic −2.95, P = .003) and falls efficacy (T‐statistic −2.68; P = .008), and was of marginal significance for depressive symptoms (T‐statistic‐1.73; P = .085).CONCLUSIONS: These results suggest that the goals of care for older persons with chronic dizziness should be redirected from solely identifying and treating discrete diseases—an often expensive and unrewarding task—toward reducing the symptoms of chronic dizziness and alleviating the resulting physical, psychological, and social disability. J Am Geriatr Soc 48: 417–421, 2000.
Physician Perceptions of HMO Care for Older Persons
Authors: Dixon Melissa K. , Kirschner Pamela B. , Edelberg Helen K. , Ayanian John Z. , Wei Jeanne Y. 
Published: April 2015

OBJECTIVE: Physician attitudes may be a key factor in effective managed care for older patients. We sought to explore physicians' views of the influence of health maintenance organization (HMO) policies on the care of their older patients.DESIGN: A self‐administered one‐page questionnaire consisting of questions about physician demographics, the impact of HMOs on physician practice, patient care, HMO policies, and respondents' personal use of managed health care plans.PARTICIPANTS: The survey was mailed to 838 randomly selected primary care physicians affiliated with two large, nonprofit, academically‐oriented, Medicare HMOs in Massachusetts.RESULTS: Completed surveys were received from 516 of 797 eligible primary care physicians, affiliated with either Secure Horizons (Tufts Associated Health Plan) or First Seniority (Harvard Pilgrim Health Care). About half (55%) of the physician respondents reported they had sufficient time to spend with their older patients. Most (81%) respondents indicated that overall, patients aged 65 and older received either better care or no change in care after joining an HMO. The majority of physicians reported that HMO affiliation had increased the frequency with which they addressed geriatric issues with their older patients. There were several patterns of response that emerged with respect to beliefs about key HMO policies.CONCLUSIONS: The majority of physicians working in two nonprofit, academically oriented Medicare HMOs in Massachusetts believed that the overall quality of care that older patients received after joining an HMO either did not change or improved. J Am Geriatr Soc 48:607–612, 2000.
Epidemiology of Sarcopenia
Authors: III L. Joseph Melton , Khosla Sundeep , Crowson Cynthia S. , O'Connor Michael K. , O'Fallon W. Michael , Riggs B. Lawrence 
Published: April 2015

OBJECTIVES: To examine patterns of muscle mass change with aging and to estimate the prevalence of sarcopenia.DESIGN: Cross‐sectional survey.SETTING: Population‐based study in Rochester, Minnesota.PARTICIPANTS: Age‐stratified sample of men and women from the community.MEASUREMENTS: Muscle mass estimated from total body scans by dual‐energy X‐ray absorptiometry. Sarcopenia was defined as muscle mass more than 2 standard deviations below the sex‐specific young‐normal mean.RESULTS: Total lean body mass (exclusive of bone) and total skeletal muscle mass both were greater in men than women and declined linearly with age as judged from these cross‐sectional data. Adjustment for height reduced the gender difference. The age‐ and sex‐adjusted prevalence of sarcopenia varied from 6 to 15% among subjects 65 years of age or over, depending on the muscle mass parameter that was evaluated, but prevalence rates were quite sensitive to the normal values used to define cutoff levels. Subjects with sarcopenia appeared to have more physical limitations than the others.CONCLUSIONS: Late in life, a substantial portion of the population reaches low levels of muscle mass that are associated with increased physical disability. However, additional efforts are needed to validate an operational definition of sarcopenia. J Am Geriatr Soc 48:625–630, 2000.
Silent Ischemia During Voluntary Detraining and Future Cardiac Events in Master Athletes
Authors: Begum Suraiya , Katzel Leslie Ira 
Published: April 2015

OBJECTIVES: To determine whether exercise‐induced silent ischemia in older master athletes following a 3‐month period of deconditioning is a predictor of future cardiovascular events.DESIGN: A longitudinal study of a cohort of master athletesSETTING: The Geriatric Research Education and Clinical Center (GRECC), Baltimore VA Medical Center, Baltimore, Maryland.PARTICIPANTS: Ten older (59 ± 8 years, mean ± SD), highly conditioned (maximal aerobic capacity Vo2max 50 ± 5 mL/kg/min), aerobically trained athletes.INTERVENTION: Five to eight years of longitudinal follow‐up of athletes who had previously participated in a 3‐month‐long detraining intervention.MEASUREMENTS: At baseline, all 10 athletes had their history taken and underwent physical examinations, metabolic testing, electrocardiogram at rest, exercise treadmill tests, exercise thallium scintigrams, and exercise multigated acquisition scans. After 3 months of deconditioning, they had repeat maximal exercise stress tests. After 5 to 8 years of follow‐up, they were re‐evaluated, including history and physical examination and measurement of their Vo2max.RESULT: All 10 master athletes had normal studies at baseline. At the end of 3 months of detraining, three of these athletes had exercise‐induced silent ischemia, which disappeared after retraining in two subjects and persisted at a higher heart rate in one subject. Over a 5‐ to 8‐year period of observation, two of these three athletes with silent ischemia experienced major cardiac events (sudden death, cardiac bypass surgery). The other seven athletes did not have any cardiovascular events.CONCLUSIONS: Exercise‐induced silent ischemia after a short period of detraining in highly trained older athletes may be a predictor of future cardiac events. A study with a larger cohort is warranted. J Am Geriatr Soc 48:647–650, 2000.
Racial Variations in End‐of‐Life Care
Authors: Hopp Faith P. , Duffy Sonia A. 
Published: April 2015

OBJECTIVES: To identify differences in advanced care planning and end‐of‐life decision‐making between whites and blacks aged 70 and older.DESIGN: The Asset and Health Dynamics Among the Oldest Old (AHEAD) study is a nationally representative survey of adults who were aged 70 and older in 1993. Relatives (proxy respondents) for 540 persons who died between the first (1993) and second (1995) waves of the study were surveyed about advanced care planning and end‐of‐life decisions that were made for their family member who died.SETTING: Respondents were interviewed at home by telephone (n = 444) or in person (n = 95).PARTICIPANTS: The 540 proxy respondents included 454 whites and 86 blacks.MEASUREMENTS: Questions were asked about advance care planning and end‐of‐life decisions.RESULTS: Whites were significantly more likely than blacks to discuss treatment preferences before death (P = .002), to complete a living will (P = .001), and to designate a Durable Power of Attorney for Health Care (DPAHC) (P = .032). The treatment decisions for whites were more likely to involve limiting care in certain situations (P = .007) and withholding treatment before death (P = .034). In contrast, the treatment decisions for blacks were more likely to be based on the desire to provide all care possible in order to prolong life (P = .013). Logistic regression models revealed that race continued to be a significant predictor of advance care planning and treatment decisions even after controlling for sociodemographic factors.CONCLUSIONS: These findings suggest that there are important differences between blacks and whites regarding advanced care planning and end‐of‐life decision‐making. Health professionals need to understand the diverse array of end‐of‐life preferences among various racial and ethnic groups and to develop greater awareness and sensitivity to these preferences when helping patients with end‐of‐life decision‐making. J Am Geriatr Soc 48:658–663, 2000.