bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Urge Urinary Incontinence on Quality of Life: Importance of Patients' Perspective and Explanatory Style
Authors: DuBeau Catherine E. , Levy Becca , Mangione Carol M. , Resnick Neil M. 
Published: April 2015

OBJECTIVES: The impact of urinary incontinence (UI) on health‐related quality of life (QoL) is significant yet variable, but little is known about patient‐defined content areas regarding the influence of UI on QoL and whether patient‐specific factors correlate with specific content areas of UI‐related QoL. In order to identify the most valid content areas for a new UI‐related QoL questionnaire, our primary goal was to determine the content areas of greatest concern regarding UI‐related QoL among older persons with urge incontinence. The second goal was to examine the possible role of patients' explanatory style as a mediator of UI impact on health‐related QoL. Data on the questionnaire will be presented elsewhere.DESIGN: Focus groups comprising urge‐incontinent persons were used to obtain verbatim descriptions of the impact of UI on QoL.SETTING: A university‐affiliated tertiary hospital.PARTICIPANTS: Community‐dwelling women (n = 25) and men (n = 5) more than 60 years of age, with urge incontinence, recruited from newspaper, newsletter, and radio advertisements.MEASUREMENTS: Qualitative content analysis of focus group transcripts was used to determine QoL items. These were compared with previously described UI‐related QoL items obtained from the literature. Subjects' statements regarding causes of UI were evaluated for predominant explanatory style.RESULTS: Thirty‐two UI‐related QoL items were identified, more than half of which were not described previously. Compared with expert‐defined UI‐related QoL items from the literature, patient‐defined items focused more on coping with embarrassment and interference from UI than on prevention of actual activity performance. Explanatory statements were made frequently by patients talking about their UI. Although positive style explanatory statements were most common, they did not correlate with any QoL items. By contrast, there was a significant correlation between negative explanatory style and six specific UI‐related QoL items.CONCLUSIONS: Focus groups of older persons with urge incontinence suggest that experts and patients view the impact of urge UI on QoL differently. Whereas experts focus more on functional impact, patients more often cite the impact of UI on their emotional well‐being and on the interruption of activities. In addition, the association between negative explanatory style and specific UI‐related QoL items suggests that explanatory style may be an important mediator of patients' perceptions of UI‐related QoL.
A Two‐Year Follow‐Up of Geriatric Consults in the Emergency Department
Authors: Sinoff G. , Clarfield A.M. , Bergman H. , Beaudet M. 
Published: April 2015

OBJECTIVE: To characterize the population and provide a 2‐year follow‐up for those patients for whom a geriatric consult was requested in the emergency department (ED) of an acute care hospital.BACKGROUND: Older people tend to use health services, including the ED, disproportionately. This phenomenon has implications for medical services as the number of older people continues to increase. To our knowledge, long‐term follow‐up of patients for whom ED geriatric consultation was requested has not been described.SETTING: The emergency department of a 628‐bed tertiary care university hospital in Montreal, Canada.SUBJECTS: 326 older patients examined in the ED by a geriatric consult team (GCT).METHODS: The records kept by the GCT during a 12‐month period were reviewed retrospectively, and the patient cohort was followed for 2 years by telephone or review of hospital charts. Mortality, rate of revisit to ED, readmission to hospital, and final disposition were examined.RESULTS: The study revealed a particularly high hospital admission rate (63.5%) among those older people consulted by the GCT. The high prevalence rates for the classic geriatric syndromes of falls, incontinence, iatrogenic events, and confusional states suggest a need to address these problems early in their presentation, preferably beginning in the ED. A 2‐year follow‐up exhibited high mortality rates (33.7%) as well as a long‐term institutionalization rate of 52%.CONCLUSION: The older patients seen in the ED of the acute care hospital for whom multidisciplinary geriatric consult is requested constitute a high‐risk population. Within 2 years after initial consultation, many are dead and more than half have been institutionalized. The results of our follow‐up imply the need for multidisciplinary intervention early on in the course of an older patient's ED visit as well as close follow‐up after hospital discharge.
Underutilization of Angiotensin‐Converting Enzyme Inhibitors in Older Patients with Q‐Wave Anterior Myocardial Infarction in an Academic Hospital‐Based Geriatrics Practice
Authors: Mendelson Gad , Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To investigate the prevalence of angiotensinconverting enzyme (ACE) inhibitors use in older persons without contraindications to ACE inhibitors and with prior Q‐wave anterior myocardial infarction (MI), anterior MI with congestive heart failure (CHF), and with anterior MI and a left ventricular ejection fraction (LVEF) ≥ 40% in an academic hospital‐based geriatrics practice.DESIGN: A retrospective analysis of charts from all older patients seen from January 1996 through July 1997 at an academic hospital‐based geriatrics practice was performed to investigate the prevalence of ACE inhibitor use in older patients with prior Q‐wave anterior MI, anterior MI with CHF, and anterior MI with LVEF ≤ 40% without contraindications to ACE inhibitors.SETTING: An academic hospital‐based primary care geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.PATIENTS: Ninety‐six women and 65 men, mean age 82 ± 8 years (range 65 to 96), were included in the study.MEASUREMENTS AND RESULTS: Of 161 patients with Q‐wave anterior MI and no contraindications to ACE inhibitors, LVEF was measured in 58 patients (36%), 56 (35%) of whom were receiving ACE inhibitors. Of 45 patients with Q‐wave anterior MI and CHF, 30 patients (67%) were receiving ACE inhibitors. Of 15 patients with Q‐wave anterior MI and asymptomatic LVEF ≤ 40%, four patients (27%) were receiving ACE inhibitors.CONCLUSIONS: There is a marked underutilization of use of ACE inhibitors in treating older patients with Q‐wave anterior MI in an academic hospital‐based geriatrics practice.
Association of Electrocardiographic Left Ventricular Hypertrophy with the Incidence of New Congestive Heart Failure
Authors: Aronow Wilbert S. , Ahn Chul 
Published: April 2015

OBJECTIVE: To investigate the association of electrocardiographic (ECG) left ventricular hypertrophy (LVH) with the incidence of new congestive heart failure (CHF) in older people.DESIGN: In a prospective study of 2638 older people, ECGs were obtained at study entry, at 1 month after study entry, when clinically indicated, and at least yearly after study entry. ECG LVH was diagnosed if the point score of Romhilt and Estes was ±5. Persistent LVH was diagnosed if all of the ECGs showed LVH. New LVH was diagnosed if the baseline ECG showed no LVH but LVH was present on the last ECG. Regression of LVH was diagnosed if the baseline ECG showed LVH but no LVH was present on the last ECG. No LVH was diagnosed if all of the ECGs showed no LVH. Persistent LVH, new LVH, regression of LVH, and no LVH were correlated with the incidence of new CHF at follow‐up.SETTING: A large long‐term health care facility.PATIENTS: The patients included 1805 women and 833 men, mean age 81 ± 9 years (range 60 to 103).MEASUREMENTS AND MAIN RESULTS: Of the 2,638 older persons studied, 281 (11%) had persistent ECG LVH, 31 (1%) had new ECG LVH, 12 (0.5%) had regression of ECG LVH, and 2314 (88%) had no ECG LVH. At 42 ± 24 months (range 1 to 154 months) follow‐up, new CHF developed in 168 of 281 persons (60%) with persistent LVH, in 16 of 31 persons (52%) with new LVH, in 4 of 12 persons (33%) with regression of LVH, and in 507 of 2314 persons (22%) with no LVH. Kaplan‐Meier survival curves showed that the development of new CHF was higher in persons with persistent LVH versus regression of LVH (P = .013), in persons with persistent LVH versus no LVH (P = .001), in persons with new LVH versus regression of LVH (P = .039), and in persons with new LVH versus no LVH (P = .001).CONCLUSION: Older persons with persistent or new ECG LVH have a higher incidence of new CHF and an earlier time to the development of new CHF than older persons without ECG LVH.
Plasma Antioxidants and Cognitive Performance in Middle‐Aged and Older Adults: Results of the Austrian Stroke Prevention Study
Authors: Schmidt R. , Hayn M. , Reinhart B. , Roob G. , Schmidt H. , Schumacher M. , Watzinger N. , Launer L. J. 
Published: April 2015

OBJECTIVES: To study the association between cognitive status and plasma concentrations of various antioxidants in middle‐aged and older individuals without neuropsychiatric disease.DESIGN: Evaluation of cross‐sectional data from a cohort study.SETTING: The Austrian Stroke Prevention Study.PARTICIPANTS: A total of 1769 subjects aged 50 to 75 years, with no history or signs of neuropsychiatric disease, selected randomly from the community register.MEASUREMENTS: The score on the Mattis Dementia Rating Scale (MDRS) was dichotomized according to age‐and education‐specific lowest quartile cut‐off points. Reversedphase high performance liquid chromatography measurements of the plasma concentrations of lutein/zeaxanthin, cryptoxanthin, canthaxanthin, lycopene, alpha‐carotene, beta‐carotene, retinol, gamma‐tocopherol, alpha‐tocopherol, and ascorbate were measured.RESULTS: Individuals with MDRS results below the lowest quartile cut‐off point had lower levels of beta‐carotene and alpha‐tocopherol than their counterparts with test performance above this limit (0.44 ± .33 μmol/L vs 0.51 ± .48 μmo/L, P < .001; and 29.50 ± 7.98 μmol/L vs 30.93 ± 11.10 μmol/L, P < .001, respectively). Only alpha‐tocopherol remained significantly associated with cognitive functioning when logistic regression analysis was used to adjust for possible confounders including age, sex, month of blood sampling, years of education, smoking, lipid status, and major risk factors for stroke (P = .019).CONCLUSION: These observations are compatible with the view that some dietary antioxidants may protect against cognitive impairment in older people.
The Effect of Aging on Bone Mineral Metabolism and Bone Mass in Native American Women
Authors: Perry Horace M. , Bernard Marie , Horowitz Michael , Miller Douglas K. , Fleming Shantiel , Baker Mary Zoe , Flaherty Joseph , Purushothaman Raj , Hajjar Ramzi , Kaiser Fran E. , Patrick Ping , Morley John E. 
Published: April 2015

OBJECTIVE: To examine the effect of age on mineral metabolism and bone mineral density (BMD) of the hip and spine in Native American women.DESIGN: A cross‐sectional study.SETTING: The Sac and Fox Nation in rural OklahomaMEASUREMENTS: Serum measurements were made of 25 hydroxyvitamin D (250HD), osteocalcin, and immunoreactive parathyroid hormone. Bone mineral density of the hip and spine was assessed by dual energy X‐ray absorptiometry.PARTICIPANTS: A total of 77 Native American women aged 19 to 85 years.RESULTS: Serum 25 hydroxyvitamin D was related inversely to age (r = −0.32; P < .05) and was less than 15 ng/mL in 7% of the subjects. Serum osteocalcin was higher (P < .001) in postmenopausal than in premenopausal subjects. In postmenopausal subjects, serum osteocalcin was related to age (r = .59, P < .001). BMD was lower (P < .001) in postmenopausal than in premenopausal subjects. There was no evidence of bone loss before age 50 in either the femur or the spine. Age (r > −0.48, P < .001) and body mass index (BMI) (r ≥ 0.41, P < .005) were independent determinants of both femoral and lumbar BMD. Serum 250HD was a significant independent determinant of both lumbar (r = .26, P < .05) and femoral (r = .41, P < .01) BMD. Age, BMI, and serum 250HD together accounted for 70% of the variance in BMD at these sites. The use of t scores indicated femoral bone density was higher (P < .05) in premenopausal Native American women, and lower (P < 0.05) in postmenopausal subjects, compared with white women.CONCLUSIONS: In Native American women, there is a reduction in bone density and a sustained increase in bone turnover postmenopausally. BMI and serum 250HD are significant determinants of BMD. Peak BMD may be higher, and the postmenopausal rate of bone loss greater, than that in white women.
Management of Older Persons After Myocardial Infarction
Authors: Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To review the management of the older person after myocardial infarction (MI).DATA SOURCES: A computer‐assisted search of the English language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.STUDY SELECTION: Studies on the management of persons after MI were screened for review. Studies in persons older than 60 years and recent studies were emphasized.DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving older persons. Relevant articles were reviewed in depth.DATA SYNTHESIS: Available data about therapy of persons after MI, including control of risk factors, use of aspirin and beta‐blockers, and indications for use of angiotensin‐converting enzyme inhibitors, long‐term anticoagulant therapy, nitrates, calcium channel blockers, hormone replacement therapy, antiarrhythmic drugs, the automatic implantable cardioverter‐defibrillator, and revascularization, with emphasis on studies involving older persons, were summarized.CONCLUSIONS: Risk factors for coronary artery disease should be controlled after MI in older persons. A serum low‐density lipoprotein (LDL) cholesterol > 125 mg/dL after MI should be treated with lipid‐lowering drug therapy to decrease the serum LDL cholesterol to < 100 mg/dL. Aspirin in a dose of 160 mg to 325 mg daily should be given indefinitely. Indications for long‐term anticoagulant therapy with warfarin after MI to maintain an international normalized ratio between 2.0 and 3.0 include secondary prevention of MI in persons unable to tolerate daily aspirin, persistent atrial fibrillation, and left ventricular thrombus. Beta‐blockers should be given indefinitely. Angiotensin‐converting enzyme inhibitors should be given to persons who have congestive heart failure, an anterior MI, or a left ventricular ejection fraction ≤ 40%. Calcium channel blockers should not be used unless there is persistent angina pectoris despite beta‐blockers and nitrates. Antiarrhythmic drugs other than beta‐blockers should not be used. An automatic implantable cardioverter‐defibrillator should be used in persons who have a history of ventricular fibrillation or serious sustained ventricular tachycardia or who are at very high risk for developing sudden cardiac death. Until data from the Heart Estrogen/Progestin Replacement Study are available, use of an estrogen/progestin regimen is recommended in the treatment of postmenopausal women after MI unless they are at increased risk for developing breast cancer. The two indications for revascularization in older persons after MI are prolongation of life and relief of unacceptable symptoms despite optimal medical management.
Aging‐Related Clinical and Health Services Research in Canada
Authors: Rockwood Kenneth , Bergman Howard , Hogan David B. , McCracken Peter 
Published: April 2015

Research by Canadian geriatricians has grown significantly since the Canadian Society of Geriatric Medicine was founded in 1981. Most research has been clinical or related to health service use. More recently, the Canadian Study of Health and Aging (CSHA) has proved an important focus for population‐based research, and research on dementia.An increasing number of Canadian geriatricians have undertaken formal research training, and the CSHA study team and other groups are providing opportunities for multicentre, multi‐disciplinary, collaborative studies. These developments point to continued growth in research by Canadian geriatricians, most likely research with a clinical and population focus and employing multicenter designs. J Am Geriatr Soc 46:1469–1472, 1998.
Oral Cobalamin for Pernicious Anemia: Back from the Verge of Extinction
Authors: Lederle Frank A. 
Published: April 2015

BACKGROUND: High dose oral cobalamin therapy was shown to be effective for pernicious anemia and other cobalamin deficiency states 30 years ago, and physicians and patients state that they would find oral therapy useful, but a survey conducted in 1989 found that physicians were generally unaware of it.OBJECTIVE: To assess physician awareness and use of oral cobalamin since 1989.DESIGN, SETTING, AND PARTICIPANTS: Minneapolis area internists not listed as having subspecialties or academic business addresses were surveyed in 1989 and in 1996.MEASUREMENTS AND RESULTS: There were 245 responses to the 1989 survey and 223 responses to the 1996 survey for response rates of 68% and 69%, respectively. The percentage of internists who ever used oral cobalamin to treat pernicious anemia increased from 0 in 1989 to 19% in 1996 (P < .001). The percentage who were aware of an effective oral cobalamin preparation for treating cobalamin deficiency states also increased significantly from 4 to 29% (P < .001). The percentage of internists who agreed with the incorrect view that sufficient quantities of cobalamin cannot be absorbed when given orally declined from 91% in 1989 to 71% in 1996 (P < .001).CONCLUSION: /b Minneapolis internists' awareness and use of oral cobalamin treatment for pernicious anemia increased substantially between 1989 and 1996, but the majority of internists remained unaware of this treatment option.
Exercise‐Induced Silent Myocardial Ischemia and Future Cardiac Events in Healthy, Sedentary, Middle‐Aged and Older Men
Authors: Katzel Leslie I. , Sorkin John D. , Goldberg Andrew P. 
Published: April 2015

OBJECTIVESBefore men older than age 45 participate in vigorous exercise programs, the American Heart Association and the American College of Sports Medicine recommend they undergo a screening maximal exercise treadmill test. We examined the predictive value for subsequent cardiac events of exercise‐induced silent myocardial ischemia (SI) during the exercise treadmill test in healthy, sedentary, obese, middle‐aged and older men recruited for research studies.DESIGNA cohort study with 7 years of follow‐upSETTINGOut‐patient research at a tertiary hospitalPARTICIPANTS170 healthy, sedentary, obese, middle‐aged and older (ages 45–79 years) men with no prior history of coronary artery disease (CAD) recruited for research studiesMEASUREMENTSCardiac risk factors, exercise‐induced SI (ST segment depression on the electrocardiogram during a maximal exercise treadmill test), maximal aerobic capacity (V̇O2max), and 7‐ year follow‐up data on incident CADRESULTSAt baseline, 37 of the men (22%) had exercise‐induced SI on their treadmill tests. Seven‐year follow‐up data was obtained in 97% of the patients. In the interim, 31 men had cardiac endpoints (sudden cardiac death, myocardial infarction, angioplasty, coronary artery bypass graft surgery, angina), and four had noncardiac deaths. Seventeen of the 37 men (46%) with exercise‐induced SI on their baseline exercise tests had cardiac endpoints compared with 14 of 133 (11%) men with normal exercise tests (P < .001). Compared with the men with no cardiac endpoints, the men with subsequent cardiac endpoints were older (63 ± 1 vs 58 ± 1 years, mean ± SEM, P < .001) and had a lower maximal aerobic capacity (V̇O2max) (24 ± 1 vs 29 ± 1 mL/kg/min, P < .001). In Cox proportional hazards analysis, exercise‐induced SI and a low V̇O2max were independent predictors of subsequent cardiac endpoints.CONCLUSIONIn a healthy population of obese, sedentary, middle‐aged and older men, exercise‐induced SI and low V̇O2max were predictors of incident CAD. This suggests that exercise treadmill testing is beneficial in assessing risk for future cardiac events in obese, sedentary individuals. J Am Geriatr Soc 47:923–929, 1999.
Aging Versus Disease: The Opinions of Older Black, Hispanic, and Non‐Hispanic White Americans About the Causes and Treatment of Common Medical Conditions
Authors: Goodwin James S. , Black Sandra A. , Satish Shiva 
Published: April 2015

BACKGROUNDLittle is known about how older people interpret disease and how those interpretations might relate to use of medical services.OBJECTIVETo assess opinions of older subjects about the cause and treatment of common diseases and how they are related to health behaviors.DESIGNIn‐home interview of a population‐based sample (n = 601) of noninstitutionalized black, Hispanic, and non‐Hispanic white American men and women aged 75 and older in Galveston County, Texas.RESULTSSubstantial proportions of the subjects considered heart disease, arthritis, or difficulty sleeping to be a normal part of aging. In multivariate analyses including age, gender, education, marital status, living arrangement, global self‐rating of health, and comorbidity, older black subjects were less likely to view heart disease (OR = 0.41; 95% CI, 0.26–0.64), arthritis (OR = 0.48; 95% CI, 0.31–0.73), or sleep problems (OR = 0.50; 95% CI, 0.32–0.77) as a normal part of aging than were non‐Hispanic whites. Blacks were more than three times as likely to attribute heart disease to overwork or stress than were non‐Hispanic whites. In multivariate analyses, subjects who considered all three of the medical conditions to be a normal part of aging (“fatalistic”) were less likely to have received preventive medical services in the previous year (OR = 0.13; 95% CI, 0.02–0.96), and subjects who felt that nothing could be done to treat any of the conditions (“nihilistic”) were less likely to have a regular physician (OR = 0.24; 95% CI, 0.08–0.74).CONCLUSIONSSubstantial numbers of older subjects are fatalistic about the cause of disease and/or nihilistic about its treatment. These attitudes are associated with decreased utilization of health services. Attempts to improve the health of underserved groups should employ interventions that are sensitive to the health beliefs of the targeted group.