bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Protective Effect of Emotional Vitality on Adverse Health Outcomes in Disabled Older Women
Authors: Penninx Brenda W.J.H. , Guralnik Jack M. , Bandeen‐Roche Karen , Kasper Judith D. , Simonsick Eleanor M. , Ferrucci Luigi , Fried Linda P. 
Published: April 2015

OBJECTIVE: Although the adverse physical health consequences of negative emotions have been studied extensively, much less is known about the potential impact of positive emotions. This study examines whether emotional vitality protects against progression of disability and mortality in disabled older women.DESIGN: A community‐based study, The Women's Health and Aging Study.PARTICIPANTS: A total of 1002 moderately to severely disabled women aged 65 years and older living in the community.MEASUREMENTS: Emotional vitality was defined as having a high sense of personal mastery, being happy, and having low depressive symptomatology and anxiety. The onset of new disability was determined by semiannual assessments of disability in performing activities of daily living (ADLs), walking across a room, walking ¼ mile, and lifting/carrying 10 pounds. Mortality status was determined by proxy interviews and linkage with death certificates. Survival analyses with time to onset of specific disabilities (among those not disabled at baseline) and time to mortality were performed and adjusted for age, baseline level of difficulty, physical performance, and chronic conditions.RESULTS: Three hundred fifty‐one of the 1002 older disabled women studied were emotionally vital. Among women without the specific disability at baseline, emotional vitality was associated with a significantly decreased risk for incident disability performing ADLs (RR = 0.81, 95% CI = 0.66–0.99), for incident disability walking one‐quarter mile (RR = 0.73, 95% CI = 0.59–0.92), and for incident disability lifting/carrying 10 pounds (RR = 0.77, 95% CI = 0.63–0.95). Emotional vitality was also associated with a lower risk of dying (RR = 0.56, 95% CI = 0.39–0.80). These results were not simply caused by the absence of depression since protective health effects remained when emotionally vital women were compared with 334 women who were not emotionally vital and not depressed.CONCLUSIONS: Emotional vitality in older disabled women reduces the risk for subsequent new disability and mortality. Our findings suggest that positive emotions can protect older persons against adverse health outcomes.
Geriatric‐Based Versus General Wards for Older Acute Medical Patients: A Randomized Comparison of Outcomes and Use of Resources
Authors: Asplund Kjell , Gustafson Yngve , Jacobsson Catrine , Bucht Gösta. , Wahlin Anders , Peterson Jonas , Blom Jan‐Olof , Ängquist Karl‐Axel 
Published: April 2015

BACKGROUND: The effects of residence in an acute geriatrics‐based ward (AGW) with emphasis on early rehabilitation and discharge planning for older patients with acute medical illnesses were assessed. Outcome and use of resources were compared with those of patients treated in general medical wards (MWs). A per‐protocol rather than intention‐to‐treat analysis was performed.METHODS: A randomized trial with 3‐months follow‐up. A total of 190 patients aged 70 years and older were randomized to an acute geriatrics‐based ward, and 223 patients were randomized to general medical wards.RESULTS: The two groups were comparable at inclusion. However, after care in the AGW, 71% of patients could be discharged directly home compared with 64% of those treated in MWs (relative risk 1.17; 95% CI, 0.93–1.49). The length of stay was shorter in the AGW (mean 5.9 vs 7.3 days; P = .002). The proportion of patients in geriatric or other hospital wards or in nursing homes did not differ, but the proportion of AGW patients in sheltered living tended to be lower (P = .085). At the follow‐up, case fatality, ADL function, psychological well‐being, need for daily personal assistance, drug consumption, need for readmission to hospital, and total health care costs after discharge did not differ between the two groups. Poor global outcome was observed in 37% of AGW and 34% of MW patients.CONCLUSIONS: A geriatric approach with greater emphasis on early rehabilitation and discharge planning in the AGW shortened the length of hospital stay and may have reduced the need for long‐term institutional living. This occurred despite patients in an acute geriatric ward not having better medical or functional outcome than older acute patients treated in general medical wards.
Outcomes of Older Persons Receiving Rehabilitation for Medical and Surgical Conditions Compared with Hip Fracture and Stroke
Authors: Johnson Marie F. , Kramer Andrew M. , Lin Michael K. , Kowalsky Jacqueline C. , Steiner John F. 
Published: April 2015

OBJECTIVE: Older persons with general medical and surgical conditions increasingly receive posthospital rehabilitation care in nursing homes and rehabilitation hospitals. This study describes the characteristics of such patients, contrasted with patients with traditional rehabilitation diagnoses of hip fracture and stroke.DESIGN: Prospective cohort study.SETTING: Seventeen skilled nursing facilities and six rehabilitation hospitals in seven states.PARTICIPANTS: Medicare patients age 65 or older receiving posthospital rehabilitation.METHODS: A total of 290 medical/surgical patients were compared with 336 hip fracture and 429 stroke patients. Data were collected prospectively from charts, nursing assessments, and patient interviews. Patient characteristics associated with functional recovery and mortality were estimated using multivariate regression.RESULTS: Medical/surgical patients had greater premorbid activities of daily living (ADL) (P < .001) and instrumental activities of daily living (IADL) (P < .01) disability, but suffered less decline with the acute event than hip fracture or stroke patients (P < .001). Medical/surgical patients were more likely to recover premorbid ADL function (P < .05) but 1‐year mortality was significantly greater (30% vs. 14% hip fracture; 18% stroke; P < .001). Predictors of functional recovery and mortality differed between the three groups. Among medical/surgical patients, premorbid ADL difficulty, cognitive impairment, a pressure ulcer at rehabilitation admission, and depression were associated with failure to recover premorbid function whereas increasing comorbidity and incontinence were associated with mortality.CONCLUSIONS: Medical/surgical patients represent a unique rehabilitation population. They experienced greater premorbid functional disability, less acute decline, but greater mortality than patients with traditional rehabilitation diagnoses. Further study of this distinct rehabilitation population may help identify patients most likely to benefit from rehabilitation.
Stepping Performance During Obstacle Clearance in Women: Age Differences and the Association with Lower Extremity Strength in Older Women
Authors: Berg William P. , Blast Eileen R. 
Published: April 2015

OBJECTIVE: To compare stepping performance during obstacle clearance in younger and older women, and to examine the relationship between lower extremity strength and stepping performance during obstacle clearance in older women.DESIGN: Correlational study.SETTING: A small community.PARTICIPANTS: Twenty‐four older women (mean age = 74.4), and 16 younger women (mean age = 20.7). The older participants lived independently in the community and were able to walk unaided.MEASUREMENTS: Lower extremity muscle strength, measures of stepping performance including reaction time, movement time, extent of obstacle clearance, time to clear obstacle, among others.MAIN RESULTS: The older women were far slower in stepping than the younger women. Toe trajectories differed between older and younger women during the initial portion of the step. The younger women tended to lift the toe straight up, whereas the older women tended to move the toe backward, away from the obstacle, passing farther from the obstacle when the toe cleared the obstacle height. There was little, if any, association between relative lower extremity strength and stepping performance during obstacle clearance in older women.CONCLUSIONS: Dramatic differences in the speed of volitional stepping performance were found between younger and older women. Among the older women, lower extremity strength was not related to volitional stepping performance.
Memory Complaint in a Community Sample Aged 70 and Older
Authors: Turvey Carolyn L. , Schultz Susan , Arndt Stephan , Wallace Robert B. , Herzog Regula 
Published: April 2015

OBJECTIVES: The ability of older people to estimate their own memory, often referred to as “metamemory,” has been evaluated in previous studies with conflicting reports regarding accuracy. Some studies have suggested that an older person's metamemory is mostly accurate, whereas others have demonstrated little relationship between memory complaint and actual impairment. This study examines memory complaint in a large national sample of older people aged ≥70.DESIGN: A longitudinal cohort study with two waves of data collection spaced 2 years apart.SETTING: A nationwide random sample of community‐dwelling older persons.PARTICIPANTS: A total of 5444 community‐dwelling persons aged ≥70 and their spouses.MEASUREMENTS: Participants were asked if they believed their memory was excellent, very good, good, fair, or poor. They were then administered a cognitive assessment derived from the Mini‐Mental Status Exam.RESULTS: In general, people's assessment of their memory corresponded with their actual performance on cognitive measures. However, large portions of the sample inaccurately assessed their memory skills. People who reported depressive symptoms and had impairment in activities of daily living were more likely to state that their memory was impaired, although they performed very well on cognitive measures.CONCLUSIONS: The conditions that skew people's self‐assessment are the ones most likely to bring them into contact with healthcare professionals. This may give clinicians the general impression that older people cannot assess their own cognitive skills. However, poor metamemory appears to be a characteristic of a specific subgroup of older persons, not necessarily characteristic of the general population.
Clinical Characteristics and Prognosis of Myasthenia Gravis in Older People
Authors: Evoli Amelia , Batocchi Anna Paola , Minisci Cristiana , Di Schino Chiara , Tonali Pietro 
Published: April 2015

OBJECTIVES: To investigate the characteristics of myasthenia gravis (MG) in older people and to evaluate the benefits of immunosuppressive treatments at this age.BACKGROUND: Myasthenia gravis in older adults has not been extensively studied. In patients with disease onset after the age of 60, treatment mainly relies on medical therapy because thymectomy is generally not performed unless a thymoma is present.METHODS: Of 837 myasthenic patients followed since 1978, we identified 172 cases with onset after age 60. All patients were treated with anticholinesterases. In the decade from 1978 to 1988, immunosuppressive therapy was performed mainly with corticosteroids (prednisone); since 1989, azathioprine alone or, more often, associated with prednisone, has been increasingly used in MG patients. Long‐term outcome was evaluated in 149 cases with follow‐up longer than 1 year. Remission, pharmacological remission, and marked improvement with reduction in drug dosage were considered good results.RESULTS: Patients older than age 60 at onset of the disease were 20.5% of our series, male/female ratio was 1.9, age at onset ranged from 61 to 86 years, 87.2% patients had generalized disease, thymoma was detected in 37 patients (21.5%). Of 149 cases with sufficient follow‐up data, 9 were in remission, 111 achieved good results, 3 died of MG, and 120 required immunosuppressive therapy at some time. Sixty‐seven patients had been treated with prednisone for 0.5–16 years (mean, 5 years); good results were recorded in 51 patients (76.1%) and severe side effects in 12 (17.9%). Forty‐six patients had received combined therapy with prednisone and azathioprine for 1 to 12 years (mean, 3.9 years); good results were recorded in 41 patients (89.1%) and severe side effects in six (19.5%). Seven patients had been treated with azathioprine alone for 1 to 4 years (mean, 2.3 years) with good results in five and with no side effects.CONCLUSIONS: The prognosis of MG in older people seems to be favorable, although full remission is rare and MG weakness, treatment side effects, and associated thymoma can contribute to mortality rate. In our experience, the combined therapy with prednisone and azathioprine was more effective than prednisone alone, and steroid‐related side effects were more frequent than those related to azathioprine.
What's the Basis for Treating Infections Your Way? Quality Assessment of Review Articles on the Treatment of Urinary and Respiratory Tract Infections in Older People
Authors: Lutters Monika , Vogt Nicole 
Published: April 2015

OBJECTIVE: To assess the quality of readily available review articles on urinary and respiratory tract infections in older people.METHODS: Data sources were articles identified by MEDLINE search (1988–1998), review of the bibliographies of identified publications, textbooks from the library of a geriatric university hospital, and booklets with general guidelines on antibiotic therapy. Selection was made of review articles or book chapters about urinary and/or respiratory tract infections in older people that were readily available, ie, in Swiss medical libraries. Quality was assessed according to clinical applicability of the recommendations, methodology of the review, type of literature cited in the bibliography, and age of the population included in these reference articles.RESULTS: Only 13 of 29 (45%) review articles about urinary tract infections and seven of 29 (24%) articles about respiratory tract infections satisfied our criteria of applicability. Specifically, dosage, route of administration, and treatment duration were often not described. The overall methodological quality was low (mean score 1.9 ± 1.0 on a scale of 9). No review specified the methods used to identify, select, and validate included information. Authors of the review articles quoted an important number of other review articles and only a small number of clinical trials. Less than one‐quarter of these clinical trials actually comprised primarily an older population.CONCLUSIONS: Review articles on treatment of common infectious diseases in older people are often neither clinically applicable nor of good methodological quality. Therefore, more systematic review articles regarding treatment of older patients, as well as evidence‐based practice guidelines, are needed.
Morbidity and Comorbidity in Relation to Functional Status: A Community‐Based Study of the Oldest Old (90+ Years)
Authors: von Strauss Eva , Fratiglioni Laura , Viitanen Matti , Forsell Yvonne , Winblad Bengt 
Published: April 2015

OBJECTIVES: To describe health and functional status in the oldest old; to explore the relationships of morbidity and functional status; and to verify whether this relationship was modified by gender.DESIGN AND SETTING: A community‐based survey including all inhabitants aged ≥90 living in central Stockholm, Sweden. All participants were clinically examined by physicians, cognitively assessed by psychologists, and interviewed by nurses. Diagnoses were made according to the International Classification of Diseases‐Ninth Revision (ICD‐9), the DSM‐III‐R criteria for dementia, and Katz index of activities of daily living.PARTICIPANTS: Of the 698 subjects in the study population, 99 (14%) had died and 29 (4%) moved before examination. Of the remaining subjects, 502 (88.1%) were examined, and the refusal rate was 11.9%.MEASUREMENTS: Age‐ and gender‐specific prevalence figures, and age‐, gender‐ and education‐adjusted odds ratios (OR) were used.RESULTS: Of 502 examined subjects, 19% had no disease and 73% were functionally independent. Dementia was the most prevalent disease among women (42.2%), and cardio‐and cerebrovascular diseases were the most frequent among men (42.4%). Women had higher prevalences of dementia (adjusted OR = 2.1, 95% confidence interval (CI) 1.2–3.7) and fractures and musculoskeletal diseases (adjusted OR = 2.8, 95% CI 1.1–7.3), whereas men had a higher prevalence of malignancy (OR = 0.2, 95% CI 0.1–0.7). Women were more disabled than men independent of age, education, and number of diseases (adjusted OR = 2.2, 95% CI 1.1–4.3).CONCLUSIONS: A great proportion of nonagenarians were functionally independent despite their advanced age. Further studies are needed to clarify the excess of disability among very old women.
Mortality and Institutionalization Following Hip Fracture
Authors: Cree Marilyn , Soskolne Colin L. , Belseck Elaine , Hornig Joshua , McElhaney Janet E. , Brant Rollin , Suarez‐Almazor Maria 
Published: April 2015

OBJECTIVES: To identify determinants of mortality and institutionalization after hip fracture and to identify those older hip fracture patients at high risk of death or institutionalization after hip fracture.DESIGN: Population‐based prospective inception cohort study of hip fracture patients; patients were assessed in the hospital and at 3 months following the hip fracture.SETTING: Edmonton area hip fracture patients admitted to one of two Edmonton, Alberta, Canada, acute care centers between July 10, 1996, and August 31, 1997.PARTICIPANTS: Patients were residents of the Edmonton area and over the age of 64. Those who had previously fractured the same hip within the past 5 years or had some pathological condition underlying the hip fracture were excluded. Of 610 eligible patients, 558 contributed some, baseline information and were included in the mortality analysis; the institutionalization analysis was restricted to the 338 patients who lived in the community before fracture, survived the 3‐month period postfracture, and had completed a 3‐month follow‐up interview.MEASUREMENTS: The baseline interview was done in the hospital to assess mental status, prefracture physical function, prefracture health perception, and prefracture social support. The 3‐month follow‐up interview was done by phone to assess physical function, health perception, and social support 3 months postfracture. Demographic and comorbidity information was collected from medical records.RESULTS: Low mental status in hospital was found to increase the chances of mortality and institutionalization, and male gender was found to increase mortality risk fourfold. Each additional 10 years of age increased the risk of institutionalization approximately 2.5 times. Patients with lower postfracture physical function had at least five times the risk of institutionalization compared to patients with high postfracture physical function.CONCLUSIONS: Cognitive impairment, older age, and gender were associated with increased risk of poor outcome following hip fracture. The socioeconomic variables — social support and health perception — did not contribute significant additional information in explaining mortality or institutionalization risk. While demographic factors cannot be modified, physical function 3 months postfracture may be amenable to intervention and may reduce the risk of institutionalization. Intervening to increase postfracture physical function may be particularly beneficial to older patients, or to those who are cognitively impaired. J Am Geriatr Soc 48: 283–288, 2000.
Extent and Determinants of Hospitalization in a Cohort of Older Disabled People
Authors: Kliebsch Ulrike , Siebert Harald , Brenner Hermann 
Published: April 2015

OBJECTIVES: The purpose of this prospective cohort study was to determine the extent and determinants of hospitalization in a population sample of older disabled people.DESIGN: A longitudinal cohort study.SETTING: Noninstitutionalized disabled people in the region of Augsburg, South Germany.PARTICIPANTS: The study population included 2427 persons, aged 60 years and older, who, between 1991 and 1993, applied for benefits from the statutory health insurance system provided to the most severely handicapped noninstitutionalized persons.MEASUREMENTS: Baseline variables were derived from a standardized medical examination. Information about hospitalization and mortality until June 30, 1996, was extracted from records of the pertinent health insurance plan. Rate ratios (RRs) of hospitalization were derived from a multivariable Poisson regression model corrected for the correlation of multiple hospitalizations for each person.RESULTS: The overall absolute hospitalization rate was 6.7 hospitalizations per 10 person‐years at risk, with a mean length of stay per hospitalization of 19.2 days. Multivariable analysis showed an inverse association of age and hospitalization. Persons cared for primarily by their children had a lower rate of hospitalization (RR = 0.83) than persons relying mainly on professional home care. Medical causes of disability and dependency with respect to activities of daily living were unrelated to the hospitalization rate. A total of 1415 persons (58.3%) died during follow‐up. The rate of hospitalization was twice as high among these subjects compared with others. The hospitalization rate increased rapidly during the last year of life, with a peak increase in the last 3 months.CONCLUSIONS: This study expands the current inadequate database on hospitalization in Europe. Further expansion is necessary for the efficient allocation of medical resources to older people, a group steadily increasing in numbers. J Am Geriatr Soc 48: 289–294, 2000.
Risk Factors for Symptomatic Peripheral Arterial Disease in Older Persons in an Academic Hospital‐Based Geriatrics Practice
Authors: Ness Jose , Aronow Wilbert S. , Ahn Chul 
Published: April 2015

OBJECTIVE: To investigate risk factors for symptomatic peripheral arterial disease (PAD) in older persons.DESIGN: A retrospective analysis of charts from all older persons seen from January 1, 1998, through June 15, 1999, at an academic, hospital‐based geriatrics practice.SETTING: An academic, hospital‐based geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.PATIENTS: A total of 467 men, mean age 80 ± 8 years, and 1444 women, mean age 81 ± 8 years, were included in the study.MEASUREMENTS AND MAIN RESULTS: Symptomatic PAD was present in 93 of 467 men (20%) and in 191 of 1444 women (13%) (P = .001). Significant risk factors for symptomatic PAD by univariate analysis were: age (P = .021 in women); cigarette smoking, hypertension, diabetes mellitus, serum total cholesterol, serum high‐density lipoprotein (HDL) cholesterol (inverse association), and serum low‐density lipoprotein (LDL) cholesterol (P < .001 in men and women); obesity (P = .013 in men and .002 in women); and serum triglycerides (P = .027 in women). Significant independent risk factors for symptomatic PAD by stepwise logistic regression analysis were: age (odds ratio = 1.052 in men and 1.025 in women); cigarette smoking (odds ratio = 2.552 in men and 4.634 in women); hypertension (odds ratio = 2.196 in men and 2.777 in women); diabetes mellitus (odds ratio = 6.054 in men and 3.594 in women); serum HDL cholesterol (odds ratio = .948 in men and .965 in women); and serum LDL cholesterol (odds ratio = 1.019 in men and women).CONCLUSIONS: Significant independent risk factors for symptomatic PAD in older men and women were age, cigarette smoking, hypertension, diabetes mellitus, serum HDL cholesterol (inverse association), and serum LDL cholesterol. J Am Geriatr Soc 48: 312–314, 2000.