bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relationship Between Physical Performance Measures and Independence in Instrumental Activities of Daily Living
Authors: Judge James O. , Schechtman Kenneth , Cress Elaine , Group FICSIT 
Published: April 2015

OBJECTIVES: Understanding the relationship between physical capacity and functional status is required to design exercise interventions to maintain independent living. This study assessed the importance of physical performance in maintaining independence in Instrumental Activities of Daily Living (IADL).DESIGN: A pre‐planned meta‐analysis of cross‐sectional data from six sites of the Frailty and Injury: Cooperative Studies of Intervention Trials (FICSIT). Linear regression was used to estimate the relationship between physical performance and IADL.PARTICIPANTS: 2190 community‐dwelling older subjects.MEASUREMENTS: IADL was the dependent variable; gait velocity, balance function, grip strength and chair rise time were the predictor variables. Age, gender, education, falls self‐efficacy, and cognitive status were covariates.RESULTS: Gait velocity, balance function, and grip strength were independently related to IADL deficits, after correcting for covariates. The linear slopes were relatively steep. For gait, a decrease of 0.1 m s−1 was associated with 0.10 (95% CI: 0.17, 0.04) increase in IADL deficits, which is equivalent to 1 ADL deficit in 10 subjects. The linear slopes for hand grip and balance were similar or steeper. In the sites where chair stand time was measured, an increase of 1 second in the time to rise was associated with a 0.14 (0.04, 0.24) increase in IADL deficits. The relationships found in the meta‐analytic analysis were consistent across sites which enrolled subjects with widely varying levels of physical performance.CONCLUSION: Simple measures of physical performance were strongly associated with IADL independence after correcting for many previously identified predictors of functional status. The data from this meta‐analysis support testing interventions designed to improve physical performance to determine whether improved performance can maintain or improve independence in IADLs. J Am Geriatr Soc 44:1332–1341, 1996.
Good Nutritional Oral Intake Is Associated with Equal Survival in Demented and Nondemented Very Old Patients
Authors: Franzoni Simone , Frisoni Giovanni B. , Boffelli Stefano , Rozzini Renzo , Trabucchi Marco 
Published: April 2015

OBJECTIVE: To evaluate the association of oral food intake with survival in very old demented nursing home patients.DESIGN: A prospective cohort study.SETTING: A nursing home in northern Italy.MEASUREMENTS: Anthropometric and laboratory nutritional indicators and nutrient intake were assessed in 33 demented (age 85.7 ± 5.7 years) and 25 nondemented (age 84.9 ±5.7 years) patients. Mortality data were collected over a 28‐month follow‐up period. Association of survival with dementia was estimated by Kaplan‐Meyer analysis and multivariate Cox proportional hazard models.RESULTS: Nutrient intake and nutritional status were good compared with data in the literature and were similar in demented and nondemented patients, except for smaller triceps skinfold thickness in the demented. The cumulative annual death rate was 0.23 deaths per subject per year, similar in the demented (0.23) and the nondemented (0.22). Unadjusted survival by Kaplan‐Meyer analysis was similar in the two groups, and correction for age, gender, cognition, triceps skinfold thickness, and number of drugs in a Cox model did not alter the relationship.CONCLUSIONS: Dementia developing in very old age is not necessarily associated with malnutrition and decreased life expectancy. J Am Geriatr Soc 44:1366–1370, 1996.
Restrictive Left Ventricular Filling Patterns in Very Old Patients with Congestive Heart Failure: Clinical Correlates and Prognostic Significance
Authors: Lipsitz Lewis A. , Byrnes Narelle , Hossain Montr , Douglas Pamela , Waksmonski Carol A. 
Published: April 2015

OBJECTIVES: In certain younger patients with congestive heart failure (CHF), Doppler/echocardiography has identified a “restrictive” pattern of early diastolic ventricular filling characterized by very rapid early filling and a steep deceleration slope. We asked whether a similar restrictive pattern can be identified in very old patients with CHF, and if so, what are its clinical correlates and prognostic implications.DESIGN: Retrospective cohort with prospective follow‐up.SETTING: Academic long‐term care facilityPARTICIPANTS: Thirty‐nine residents with clinical CHF (age 89 ± 5 (SD) years)MEASUREMENTS: Transmitral Doppler flow, clinical characteristics, recurrent CHF episodes, hospitalizations, and mortality were measured.RESULTS: Fifteen (38%) of the subjects had restrictive filling patterns, characterized by a ratio of early to late flow (E/A) > 1.00 and 24 (62%) had nonrestrictive patterns. The restrictive pattern was associated with a longer duration of CHF, more angina, and higher rate of symptomatic recurrences of CHF.CONCLUSION: A restrictive diastolic filling pattern may represent a late stage in the evolution of congestive heart failure when left ventricular filling pressure is markedly increased. The treatment of CHF in older patients may need to account for different patterns of diastolic filling.
Iatrogenic Congestive Heart Failure in Older Adults: Clinical Course and Prognosis
Authors: Rich Michael W. , Shah Atul S. , Vinson Janice M. , Freedland Kenneth E. , Kuru Tunay , Sperry Jane C. 
Published: April 2015

OBJECTIVE: To determine the prevalence, risk factors, clinical course, and prognosis of iatrogenic congestive heart failure in older patients.DESIGN AND SETTING: Prospective observational study at a university teaching hospital.PARTICIPANTS: A total of 401 patients 70 years of age or older hospitalized with congestive heart failure. The mean age was 80 ± 6 years; 59% were female, and 65% were white.MEASUREMENTS: Comprehensive data, including an assessment of the etiology and precipitating factors leading to the development of heart failure, were collected at the time of diagnosis. Iatrogenic heart failure was defined as heart failure precipitated by medications or excessive fluid administration, or occurring as a procedural complication. All patients were followed for 1 year, and the primary outcome measure was total mortality.RESULTS: Using strict criteria, 28 patients (7.0%) were considered to have iatrogenic heart failure. Compared with noniatrogenic patients (n = 373), iatrogenic cases had less severe premorbid cardiac disease but more marked noncardiac disability and longer hospital stays (29 ± 24 vs 13 ± 12 days, P < .001). Hospital mortality was 32% in iatrogenic heart failure patients compared with 9% in noniatrogenic cases (P < .001). Cumulative mortality at 1 year was 68% in iatrogenic patients versus 39% in noniatrogenic patients (P < .01). Using a Cox proportional hazards model, iatrogenic congestive heart failure was associated with a relative mortality risk during follow‐up of 2.5 (95% confidence interval 1.5–4.3) after adjusting for age, sex, prior history of heart failure, New York Heart Association class, diabetes mellitus, systolic blood pressure, hemoglobin, blood urea nitrogen, and serum albumin.CONCLUSIONS: Frail, debilitated older patients are at increased risk for developing iatrogenic heart failure, even in the absence of clinically evident cardiac disease. In this population, iatrogenic heart failure serves as a marker for poor short‐ and long‐term prognosis, but further study is required to determine the optimal approach to management of these patients.
Patterns of Diagnoses, Comorbidities, and Treatment in Late‐Middle‐Aged and Older Affective Disorder Patients: Comparison of Mental Health and Medical Sectors
Authors: Moos Rudolf H. , Mertens Jennifer R. 
Published: April 2015

OBJECTIVE: To compare the diagnoses, psychiatric and medical comorbidities, and prior and current treatment received by late‐middle‐aged and older affective disorder patients in mental health and medical service settings and to identify predictors of these patients' length of inpatient care.DESIGN: Department of Veterans Affairs (VA) nationwide databases are used to examine the prevalence, diagnoses, and inpatient and outpatient treatment received by affective disorder patients in mental health and medical units in Fiscal Year 1990.RESULTS: Compared with late‐middle‐aged and older index medical patients (n = 11,701), index mental health patients (n = 9039) were more likely to have affective psychoses and major depressive disorder and less likely to have depressive disorder NOS. Almost 60% of affective disorder patients in mental health settings had comorbid psychiatric diagnoses; this was true of 30% of patients in medical settings. Moreover, more than 80% of affective disorder patients in mental health settings had concomitant medical disorders. Affective disorder patients also had very high rates of prior mental health and medical care. Patients who had more severe affective disorders and comorbid psychiatric and medical diagnoses had longer episodes of inpatient care; in contrast, more intensive prior medical and mental health outpatient care was associated with shorter episodes of inpatient care.CONCLUSIONS: The findings highlight affective disorder patients' high rates of comorbidity and intensive use of health care resources, emphasize the value of outpatient care in reducing the amount of subsequent inpatient care, and underscore the need for closer integration of mental health and medical care.
1H‐MRS, MRI‐Based Hippocampal Volumetry, and 99mTc‐HMPAO‐SPECT in Normal Aging, Age‐Associated Memory Impairment, and Probable Alzheimer's Disease
Authors: Parnetti Lucilla , Lowenthal David T. , Presciutti Otello , Pelliccioli GianPiero , Palumbo Renato , Gobbi Gianni , Chiarini Pietro , Palumbo Barbara , Tarducci Roberto , Senin Umberto 
Published: April 2015

OBJECTIVE: To better understand how to differentiate the “in vivo” normal aging brain from pathological conditions, namely dementia of the Alzheimer type (DAT), by means of magnetic resonance imaging (MRI), single photon emission computerized tomography (SPECT), and proton magnetic resonance spectroscopy (1H‐MRS), to show neuroanatomical, perfusional and neurochemical details, respectively.DESIGN: 1H‐MRS, MRI‐based hippocampal volumetry and 99mTc‐HMPAO SPECT were performed in healthy older subjects as well as patients suffering from age‐associated memory impairment (AAMI) and dementia of Alzheimer type (DAT).SUBJECTS AND SETTING: Eighteen subjects were selected from those referred to an outpatient clinic for diagnostic evaluation of cognitive impairment entered the study. Six patients fulfilled NINCDS‐ADRDA diagnostic criteria for DAT, six subjects were affected by AAMI, and six cognitively healthy subjects, selected from among relatives of the patients, were defined as controls.METHODS: The 1H‐MRS and MRI studies were performed on a 1.5 Tesla NMR‐imaging system equipped with a spectroscopy research package. SPECT scans were performed on a Gamma 11 computer system.FINDINGS: 1H‐MRS showed significantly lower N‐acetyl‐aspartate concentration in DAT and AAMI compared with controls. Conversely, mean inositol concentration was significantly higher in DAT than in controls, whereas AAMI subjects registered intermediate values. MRI measurements showed significantly reduced volumes of hippocampal formations in DAT and AAMI groups compared with controls. Finally, 99mTc‐HMPAO SPECT showed a significant frontal, temporo‐parietal, and occipital hypoperfusion in DAT patients only.CONCLUSIONS: These findings support the hypothesis of a continuum among the three conditions studied, or at least between AAMI and DAT, where AAMI seems to be an early, monosymptomatic stage of Alzheimer disease. Accepting this view, it would be questionable to maintain the term “age‐associated memory impairment” as a discrete entity. J Am Geriatr Soc 44:133–138, 1996.
Falls Leading to Femoral Neck Fractures in Lucid Older People
Authors: Nyberg Lars , Gustafson Yngve , Berggren Diana , Brännström Benny , Bucht Gösta 
Published: April 2015

OBJECTIVE: To analyze the mechanisms of falls that result in femoral neck fractures among lucid older people.DESIGN: A cross‐sectional study.SETTING: An orthopedic university hospital department.PARTICIPANTS: A consecutive series of 123 lucid patients, 65 years of age or more, who were admitted for femoral neck fractures.MEASUREMENTS: On admission, the subjects were interviewed about fracture accident characteristics, and falling mechanisms were classified. An arterial blood gas sample was taken from each patient soon after admission. Based on data regarding drug consumption and social and medical characteristics, a fall‐risk index was calculated for each subject.RESULTS: It was ascertained that 95% of the fractures were caused by falls and <2% were spontaneous. Most accidents (68%) took place indoors, 47% of the falls were classified as extrinsic, 24% as intrinsic, 7% as nonbipedal, and 22% remained unclassified. Almost all outdoor falls were extrinsic; however, intrinsic falls were as common as extrinsic falls indoors (P < .001). Extrinsic fallers presented a significantly lower fall‐risk index score than subjects with fractures caused by intrinsic, nonbipedal, and unclassifiable falls. A large proportion of subjects (24%) were hypoxemic (pO2 < 8 kPa) on admission, and patients who sustained fractures at night had lower oxygen tension than that of daytime fallers (P = .006).CONCLUSIONS: Accidental falls are the primary cause of femoral neck fractures. Preventive actions should be directed toward intrinsic, as well as extrinsic, risk factors for falls. Hypoxemia might be a risk factor for falls, especially those falls that occur at night. J Am Geriatr Soc 44:156–160, 1996.
Clinical Presentation and Results of Thrombolytic Therapy in Older Patients with Massive Pulmonary Embolism: A Comparison with Non‐Elderly Patients
Authors: Gisselbrecht Mathilde , Diehl Jean‐Luc , Meyer Guy , Collignon Marie Anne , Sors Hervé 
Published: April 2015

OBJECTIVE: To assess the clinical presentation and effectiveness of thrombolytic therapy in older patients suffering from massive pulmonary embolism.DESIGN: Analysis of a previously reported study of patients with massive pulmonary embolism using a dichotomous classification of age.SETTING: A medical intensive care unit in one hospital center.PARTICIPANTS: All subjects had massive pulmonary embolism as evidenced by scintigraphic and/or angiographic assessment. The 54 patients included in this study were divided into two groups according to age: 28 patients were less than 75 years old and 26 patients were 75 years old or older.INTERVENTION: All patients received a bolus regimen of single‐chain recombinant tissue‐type plasminogen and were subsequently treated by heparin and warfarin.MEASUREMENTS: Clinical symptoms at admission, resolution of scintigraphic vascular obstruction, death rate, hemorrhagic complications, recurrent pulmonary embolism, and long‐term follow‐up were compared between both groups.RESULTS: Clinical symptoms at admission were similar in both groups. The mean absolute improvement in the lung scan perfusion defect, the rate of major bleeding, and the long‐term evolution were not statistically different between older and younger patients.CONCLUSION: Clinical symptoms, including hemodynamic condition, did not differ between elderly and non‐elderly patients suffering from massive pulmonary embolism. Old age should not preclude thrombolytic therapy in massive pulmonary embolism, provided there is no other contraindication for thrombolytic treatment. J Am Geriatr Soc 44:189–193, 1996.
Depression and Medical Illness in Late Life: Report of a Symposium
Authors: Lyness Jeffrey M. , Bruce Martha L. , Koenig Harold G. , Parmelee Patricia A. , Schulz Richard , Lawton M. Powell , Reynolds Charles F. 
Published: April 2015

Clinically significant depression in older people is an important public health problem. Medical illness is the most consistently identified factor associated with the presence of late‐life depression and is the most powerful predictor of poor depressive outcome. Closer examination of these associations holds promise for revealing insights into depressive pathogenesis at biological, psychological, and social levels of organization.This paper considers conceptual and methodological issues critical to the study of the medical illness‐depression interface, including (1) problems with case identification, which is made difficult by both the high prevalence of clinically meaningful “subsyndromal” depressive symptoms and by potential confounds in assessing somatic or neurovegetative symptoms of depression in the medically ill, and (2) the biases produced by different sample sites, each of which offers unique leverages and limitations.Recommendations for clinical researchers that address these issues are provided. As well, investigators must use multidimensional study methodology, guided by testing specific theories of putative causal pathways, to successfully extend our current knowledge base and conceptual models.Clinicians working with older persons must recognize the prognostic import of comorbid medical illnesses in late‐life depression and must understand how the subtleties of case identification can affect treatment planning. At a policy level, routine psychiatric assessment of older people in general medical settings is clearly warranted, although further study is needed to identify more specific approaches to therapeutic interventions. J Am Geriatr Soc 44:198–203, 1996.
Alcohol Consumption and Risk of Deep Venous Thrombosis and Pulmonary Embolism in Older Persons
Authors: Pahor Marco , Guralnik Jack M. , Havlik Richard J. , Carbonin Pierugo , Salive Marcel E. , Ferrucci Luigi , Corti Maria‐Chiara , Hennekens Charles H. 
Published: April 2015

OBJECTIVESTo assess whether low to moderate alcohol consumption decreases the risk of deep venous thrombosis and pulmonary embolism.DESIGNProspective cohort study.SETTINGThree communities of the Established Populations for Epidemiologic Studies of the Elderly.PARTICIPANTSA total of 7959 persons aged 68 years or older.MEASUREMENTSThe incidence of deep venous thrombosis and pulmonary embolism was assessed by surveying hospital discharge diagnoses and deaths from 1985 through 1992. Those participants who estimated they used alcohol less than 1 time, on average, in the past month, less than 1 ounce per day, and 1 ounce or more per day were compared with those who reported no alcohol intake in the past year. Age, gender, race, body mass index, smoking, education, income, disability, cognitive function, arterial pressure, medication use, baseline chronic conditions, number of hospital admissions in past year, and occurrence of disease during follow‐up were examined as possible confounders.RESULTSDuring 48,038 person‐years of follow‐up, 155 events were observed (35 deep venous thromboses and 123 pulmonary emboli). Compared with non‐drinkers, after adjusting for potential confounding variables, the relative risks (95% confidence interval) for deep venous thrombosis and pulmonary embolism associated with increasing alcohol consumption levels were 0.7 (0.4–1.1), 0.6 (0.4–0.9), and 0.5 (0.2–1.1), respectively (Pfor trend = .004). The results were unchanged after stratifying on health status and disability.CONCLUSIONSLow to moderate alcohol consumption is associated with a decreased risk of deep venous thrombosis and pulmonary embolism in older persons.
Charles Bonnet Syndrome: An Early Marker for Dementia?
Authors: Pliskin Neil H. , Kiolbasa Theresa A. , Towle Vernon L. , Pankow Laura , Ernest J. Terry , Noronha Avertano , Luchins Daniel J. 
Published: April 2015

OBJECTIVETo clarify the neuropsychological function in patients with Charles Bonnet Syndrome.DESIGNControl group comparison study.SETTINGUniversity of Chicago Hospitals.PARTICIPANTSThe neuropsychological function of 15 older adults with presenting complaints of visual hallucinations who met criteria for Charles Bonnet Syndrome (CBS) were compared with 11 demographically matched controls to determine if there was any evidence of functional brain impairment. CBS patients were screened for focal brain lesions and epileptic disturbance via MRI and EEG and also received pattern visual evoked potentials and ophthalmological examinations.MEASUREMENTSScores from the Wechsler Adult Intelligence Scale‐Revised, Mattis Dementia Rating Scale, Wechsler Memory Scale, and the Auditory Verbal Learning Test were compared.RESULTSSignificant differences were found between the two groups on the neuropsychological measures. Moreover, 14 of 14 subjects had ocular abnormalities and six of eight had abnormal age‐corrected pattern visual evoked potentials indicative of dysfunction in the visual system.CONCLUSIONSThe results of the study indicate that patients diagnosed with Charles Bonnet Syndrome evidence neuropsychological changes commonly associated with the early stages of dementia. Therefore, in patients with impaired vision, the appearance of cognitive deficits, albeit subtle, occur with the onset of visual hallucinations. We propose that isolated visual hallucinations in the older adult may be an indication of the early stages of dementia.
Chair Design Affects How Older Adults Rise from a Chair
Authors: Alexander Neil B. , Koester Daniel J. , Grunawalt Julie A. 
Published: April 2015

OBJECTIVE: To determine how modifications of key chair design aspects, such as seat height, posterior seat tilt, backrest recline, seat compressibility, and armrest placement, affect how older adults rise from a chair and the seating comfort they experience.DESIGN: Cross‐sectional comparisonSETTING: Congregate housing facility and university laboratorySUBJECTS: Two groups of volunteers, Old (n = 29, mean age 84) and Young (n = 21, mean age 23).MEASUREMENTS: Analysis of time to rise, body motion (determined by use of digitized videotaping), and self‐reported difficulty when subjects rose from a variety of controlled chair settings thought to represent important chair design specifications encountered by older adults. Subjects also reported their comfort while being seated in these settings.RESULTS: Lowered seat height, increased posterior seat tilt and backrest recline, and perhaps increased seat compressibility cause increased time to rise, increased body motion, and increased self‐reported ratings of rise difficulty in both Young and Old groups. Under the most challenging conditions, the effect appears to be stronger in the Old than in the Young: a few Old were unable to rise, and the Old took disproportionately longer to rise and used disproportionately greater neck motion (P generally < 0.001) compared with the Young. Arm rest placement did not alter rise performance or ratings significantly. The conditions in which rise difficulty increases or decreases do not correspond exactly to conditions in which comfort increases or decreases. Some aspects that increase rise difficulty, such as tilt/recline and seat compressibility, may also increase comfort.CONCLUSIONS: Aspects of chair design such as lowered seat height, increased posterior seat tilt, increased back recline, and increased compressibility interfere with chair egress in older adults. While decreasing ease of egress, however, these same factors may increase seating comfort. Furniture designers and manufacturers must find a balance between degree of sitting comfort, ease of egress, and the degree to which the seating device facilitates functional independence, particularly to meet the needs of disabled older adults. J Am Geriatr Soc 44:356–362, 1996.