bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes Toward Life‐Sustaining Treatment of Older Persons in Hong Kong
Authors: Hui Elsie , Ho Suzanne C. , Tsang June , Lee S.H. , Woo Jean 
Published: April 2015

OBJECTIVES: There have been few studies of the attitudes of older Asians toward life‐sustaining therapy. This paper presents the knowledge of and attitudes toward cardiopulmonary resuscitation (CPR) and life support in a group of subjects in Hong Kong.DESIGN: Cross‐sectional, desciptive study.PARTICIPANTS: Of the 543 subjects, 382 were old‐age home residents and 161 were in‐patients of geriatric wards.MEASURMENTS: Sociodemographic data, functional ability (using the Barthel Index), self‐perceived health scale, knowledge of life‐sustaining procedures, and subjects' preferences for such treatments were studied. They were also asked to give the most important reason for wanting or declining CPR, and to indicate who they believe should be the decision‐maker(s) regarding whether they should receive life‐ sustaining treatment.RESULTS: Approximately 80% of old‐age home residents and 60% of hospitalized patients had no knowledge of life‐sustaining therapy. The success rate of CPR was overestimated by older subjects, and most wished to be resuscitated. However, up to 20% changed their minds and declined CPR after they knew the true outcome of the procedure. Half of the subjects wanted life support. Univariate analysis found that advanced age and not having a spouse were associated significantly with CPR preference, whereas subjects' knowledge was associated with preference for life support. Multivariate analysis revealed that advanced age, not having a spouse, and female sex were independently associated with a tendency to decline CPR. A considerable proportion of older people wished to be involved in decision‐making regarding life‐sustaining treatment.CONCLUSION: Knowledge of life‐sustaining procedures was poor among older people in Hong Kong compared with their counterparts in western countries. Although most older subjects wanted CPR, a number of them changed their minds after they knew the poor outcome. Therefore, older patients should be given more information about life‐sustaining therapy and encouraged to take part in their treatment plans.
The Prevalence of Potentially Remediable Urinary Incontinence in Frail Older People: A Study Using the Minimum Data Set
Authors: Brandeis Gary H. , Baumann Margaret M. , Hossain Monir , Morris John N. , Resnick Neil M. 
Published: April 2015

OBJECTIVES: To use the Minimum Data Set (MDS) to describe the frequency and correlates of potentially treatable causes of urinary incontinence among a representative sample of American nursing home residents. To describe current management practices of urinary incontinence in the same population.DESIGN: Cross‐sectional study using the dataset that was part of the Health Care Financing Administration (HCFA) evaluation of the MDS.SETTING: 270 Medicaid‐certified nursing homes in 10 states.PARTICIPANTS: A total of 2014 nursing home residents 60 years or older (mean = 84.3 ± 8.7), 75.5% women, 81.9% white, who lived in a nursing home during the fall of 1990 were randomly selected to sample a fixed number of residents for each facility based on facility size.MEASUREMENTS: Incontinence was defined as the presence of at least two episodes of urinary leakage per week in the previous 2 weeks. Management techniques (toileting, pads/briefs, catheters) were those listed in the MDS. Potentially remediable causes of urinary incontinence available in the MDS were: medications (antipsychotics, antidepressants, and antianxiety/hypnotics); congestive heart failure; diabetes mellitus; pedal edema; delirium; depression; and impairments in activities of daily living (ADLs) (transferring, locomotion, dressing, toileting; bedrails; trunk restraints; and chair restraints).RESULTS: Forty‐nine percent of residents were incontinent. Of these, 84.0% were managed by pads/briefs, 38.7% by scheduled toileting, 3.5% by indwelling catheter, and 1.2% by external catheter. Of the potentially reversible causes, bivariate analysis revealed associations (P < .1) with use of antidepressants, antipsychotics, and antianxiety/hypnotics; delirium; bedrails; trunk restraints; chair restraints; and ADL impairment. Dementia was also associated with incontinence (P < .1). Multivariate analysis revealed that urinary incontinence was independently associated with impairment in ADLs (OR = 4.2; CI = 3.2, 5.6), dementia (OR = 2.3; CI = 1.8, 3.0), restraints‐trunk (OR = 1.7; CI = 1.5, 2.0), chair (OR = 1.4; CI = 1.2, 1.6), bedrails (OR = 1.3; CI = 1.1, 1.5), and use of antianxiety/hypnotic medications (OR = .7; CI = .5, 1.0) (all P < .04).CONCLUSIONS: Current management practices for urinary incontinence are inconsistent with advocated guidelines. These data also confirm the association between incontinence and several potentially remediable conditions and suggest that, even in the nursing home setting, urinary incontinence may respond to efforts to improve conditions not directly related to bladder function. This study underscores the need to examine the impact on urinary incontinence of strategies to address such conditions.
Predictors of Perceived Health in Hospitalized Older Persons: A Cross‐Sectional and Longitudinal Study
Authors: Kim Seung H. , Wolde‐Tsadik Girma , Reuben David B. 
Published: April 2015

OBJECTIVES: To identify the predictors of perceived health and predictors of changes in perceived health in frail hospitalized older persons during the year after hospitalization.DESIGN: Both cross‐sectional and longitudinal multivariate analysis of data from a cohort followed for 1 year.SETTING: Six hospitals in a group practice model health maintenance organization (HMO) in Southern California.PARTICIPANTS: A total of 1889 persons aged 65 or older who met at least one of 13 inclusionary criteria for a randomized trial of Comprehensive Geriatric Assessment consultation at admission and completed three Functional and Health Status Questionnaires (FHSQ) during a 12‐month period.MEASUREMENTS: Functional and health status measures included basic and intermediate activities of daily living (BADL and IADL) and social activities (SA) scales from the Functional Status Questionnaire as well as the mental health index (MHI) and current health perception (CHP) scales from the Medical Outcomes Study short form. Subject's severity of disease was measured by the Resource Demand Scale (RD Scale).RESULTS: In the cross‐sectional analyses, MHI score, IADL score, RD Scale, history of falls during the 3 months before hospitalization, and female gender were significant predictors of perceived health in all models for each time point. BADL score, age, presence of incontinence, and ethnicity were significant in the model for baseline only, and SA score was significant in models for 3 months and 12 months only. In the longitudinal analyses, the baseline CHP score and the changes in MHI, IADL, and BADL score predicted CHP change from 0 to 3 months and from 3 to 12 months.CONCLUSIONS: Functional and psychosocial health indicators are the most important and most consistent predictors of perceived health. Our study showed that several predictors of perceived health in cross‐sectional analysis did not predict changes in perceived health over a 1‐year period. Hence, to fully understand the medical and social contributors to perceived health, a comprehensive approach using both cross‐sectional and longitudinal analyses is necessary.
Circadian Rest‐Activity Rhythms in Demented and Nondemented Older Community Residents and Their Caregivers
Authors: Pollak Charles P. , Stokes Peter E. 
Published: April 2015

OBJECTIVE: Disruptive nocturnal behaviors (DNBs) of older people often threaten the caregiving arrangements on which their community tenure depends. Dementing disorders are especially prone to result in disrupted sleep and agitated behaviors (“sundowning”). The objective here was to develop an objective correlate of DNBs, by which their severity and effects on caregivers can be measured.DESIGN: Quantitative comparison of subjective sleep and motor activity patterns in older people and their caregivers. It was hypothesized that older people with reported DNBs would be more motorically active at night than their caregivers.SETTING: Subjects' homes.PARTICIPANTS: Twenty‐five demented and 18 nondemented older day‐care participants and their paired caregivers.MEASUREMENTS: Older subjects and caregivers simultaneously kept daily sleep logs and recorded wrist motor activity every .5 minute for 9 days. A novel method was devised to identify and exclude from analysis periods when the activity monitor was not being worn. Such periods were common. Activity data were analyzed by computing hourly means and by fitting cosine models by least squares.RESULTS: Demented older people were not significantly more active at night than their caregivers, though group differences varied by time of night. They were significantly less active in the daytime than were their caregivers. Nondemented older people were significantly more active at night than their caregivers and were as active by day as their caregivers. The caregivers of demented and nondemented older people had similar rest‐activity patterns. The mean amplitudes of cosine models were smaller in the older adults. Acrophases (peaks) fell between 2 and 3 pm and did not differ significantly among the groups.CONCLUSIONS: As a result of increased nighttime motor activity and decreased daytime activity, rest‐activity rhythms were flatter in older adults than in caregivers. This was not explained fully by age and does not necessarily imply that the output of a circadian pacemaker was low. Decreased daytime activity may have resulted from deficient physical stimulation or frailty. Frailty may also explain why nighttime activity was not more elevated in the demented older people. Increased nighttime activity is probably explained by depression, sleep‐schedule disturbances, restless legs, or other sleep disorders. Judging by their shared variations of activity, caregivers interacted mainly with the demented older people at bedtime and at rising time in the morning.
To Treat Or Not To Treat: Issues in Decisions Not To Treat Older Persons with Cognitive Impairment, Depression, and Incontinence
Authors: Silverman Myrna , McDowell B. Joan , Musa Donald , Rodriguez Eric , Martin David 
Published: April 2015

OBJECTIVES: To examine decisions not to treat problems identified during outpatient geriatric assessment, particularly problems of cognitive impairment, depression, or urinary incontinence.DESIGN: A descriptive study using patients' medical charts and survey data and interviews with clinical staff. SETTING: Four hospital‐based, ambulatory, geriatric assessment clinics in Allegheny County, PA. PARTICIPANTS: The sample comprised 128 older adults, recruited to a randomized, controlled clinical trial, who had problems associated with cognitive impairment, depression, or urinary incontinence.RESULTS: Although treatment was recommended for most of the problems relating to cognitive impairment, depression, and/or incontinence experienced by this group, slightly more than one‐third of cognitive impairment and depression problems and nearly one‐half of incontinence did not receive treatment recommendations. Treatment rates varied considerably by condition and combination of comorbidity. Decisions not to treat are classified into six categories: patient or family refused treatment, the assessment was not completed, an intervention was already in place, concurrent problems or comorbities might have interfered with treatment, there was no documented diagnosis or there was a documented consideration and rule out of the problem, or no documented reason.CONCLUSION: Outpatient geriatric assessment units are designed to deal with the multiple problems experienced by their geriatric patients, and they identify successfully most problems presented by their frail constituents. However, identification of the patient's problems is only the first step in the assessment process and does not necessarily lead to either a documented diagnosis or to a treatment recommendation. Multiple social, cultural, environmental, and medical factors complicate the assessment process and, hence, the decision clinicians face when they decide whether to make recommendations to treat. These clinicians must weigh all medical and non‐medical factors, including the patient's receptivity to treatment, when prioritizing the problems they deem to be treatable and making recommendations to treat. J Am Geriatr Soc 45:1094–1101, 1997.
Can Money Buy Happiness? Depressive Symptoms in an Affluent Older Population
Authors: West Catherine G. , Reed Dwayne M. , Gildengorin Ginny L. 
Published: April 2015

OBJECTIVES: To determine if the inverse association between depressive symptoms and income reported in predominantly low‐ and middle‐income older populations is present in a more affluent population of older adults and to determine if this pattern is independent of other known correlates of depressive symptoms such as medical problems, physical disability, and social support.DESIGN: Cross‐sectional analysis within a prospective cohort study.SETTING: An ongoing, community‐based cohort study conducted by an independent research institution in an affluent Northern California county.PARTICIPANTS: A total of 1948 randomly selected, noninstitutionalized county residents 55 years of age and older who completed the baseline questionnaire and physical performance tests.MEASUREMENTS: The outcome measure was high level of depressive symptoms (score ≥ 16) using the Center for Epidemiologic Studies‐Depression scale (CES‐D).RESULTS: The prevalence of high levels of depressive symptoms (CES‐D score ≥ 16) was lower than in most other population‐based samples using an identical CES‐D scale. In age‐adjusted, sex‐specific analyses, increasing income level was associated significantly with lower levels of depressive symptoms, but the nature of the relationship appeared quadratic rather than linear (Men: odds ratio (OR) income .80, 95% confidence interval (CI) .68–.94; income2 OR 1.006, 95% CI 1.001–1.011. Women: OR income .80, 95% CI .69–.91; income2 OR 1.007, 95% CI 1.002–1.011). In multivariate regression analyses including potential confounding risk factors, the magnitude of the association between depressive symptoms and income decreased and was not statistically significant when measures of health conditions, physical disability, and social support were included in the model (Men: OR income .90, 95% CI .75–1.06; income2 OR 1.003, 95% CI .998–1.009. Women: OR income .90, 95% CI .78–1.05; income2 OR 1.003, 95% CI .998–1.008).CONCLUSION: These findings suggest that poor health, physical disability, and social isolation are the major factors responsible for the observed inverse relationship between income and symptoms of depression in affluent, as well as economically disadvantaged, older populations.
Prognostic Factors in Very Old Demented Adults: A Seven‐Year Follow‐Up From a Population‐Based Survey in Stockholm
Authors: Agüero‐Torres Hedda , Fratiglioni Laura , Guo Zhenchao , Viitanen Matti , Winblad Bengt 
Published: April 2015

OBJECTIVE: To detect prognostic factors in very old demented subjects with Alzheimer's disease (AD), vascular dementia (VaD), and other types of dementia (OD).DESIGN: Follow‐up clinical examinations of dementia patients from a population‐based study after 3‐ and 7‐year intervals.SETTING AND PARTICIPANTS: In an established population aged 75 years and older in Stockholm, Sweden, there were 133 cases of AD, 52 of VaD, and 38 of OD.MAIN OUTCOME MEASURES: Predictors of survival at 3‐and 7‐year follow‐up examinations were evaluated by Cox proportional hazard models. Progression was measured as the annual rate of change in Mini‐Mental State Examination (MMSE) scores. Linear models were used to evaluate predictors of progression.RESULTS: Older age, male gender, low education, comorbidity, and functional disability predicted shorter 7‐year survival in the 223 prevalent dementia cases. Other factors, including type of dementia, dementia severity, and duration of the disease were not significant. The average rate of cognitive decline in the 81 mild to moderate demented subjects who survived 3 years was 2.4 MMSE points per year. Type of dementia (AD vs OD), higher baseline cognitive function, and greater functional disability predicted faster decline. Despite similar survival probability, predictors of death varied as a function of dementia type: Older age (for AD and VaD), comorbidity (for AD and OD), and functional dependency (for VaD). In AD, prognostic factors were similar to those described for the combined dementia groups, with the exception of an accelerated cognitive decline among women.CONCLUSIONS: Although methodological difficulties exist, it is possible to identify demented subjects with worse prognoses (shorter survival and faster cognitive decline) by using clinical and demographic data. Clinicians and healthcare planners should be aware of the potential usefulness of functional dependence as a prognostic indicator. Finally, the need for careful clinical examinations of demented subjects is stressed by the increased mortality found among those demented who are also affected by other chronic conditions.
Nighttime Urinary Incontinence and Sleep Disruption Among Nursing Home Residents
Authors: Ouslander Joseph G. , Buxton William G. , Al‐Samarrai Nahla R. , Cruise Patrice A. , Alessi Cathy , Schnelle John F. 
Published: April 2015

OBJECTIVE: To examine the relationship of urinary incontinence episodes to sleep disruption in a sample of nursing home residents.DESIGN: Descriptive, case series.SETTING: Three community nursing homes.PARTICIPANTS: Seventy‐three incontinent residents of three nursing homes participating in a trial of a behavioral intervention for nighttime urinary incontinence.MEASUREMENTS: Data were collected during a baseline and repeat baseline period about 2 months later in nursing homes serving as controls for the intervention homes. Incontinence episodes were identified by incontinence pads, which were wired to detect wetness of 10 mL or more. Sleep was monitored by wireless wrist actigraphs. Noise and light changes were monitored by bedside recording devices.MAIN RESULTS: Recordings covered 403 nights, during which 1715 awakenings from 10 consecutive minutes of sleep were detected as were 1168 incontinent episodes. Only 4% of the awakenings were associated with an incontinence episode, and only 23% of the incontinence episodes occurred during periods of at least 10 consecutive minutes of sleep. Of the latter episodes, only 12% appeared to awaken the resident.CONCLUSIONS: Our data raise questions about the relevance of incontinence episodes to sleep disruption among chronically incontinent nursing home residents. Our findings must be interpreted cautiously because of limitations in the technologies and definitions we used to identify sleep, awakenings, and incontinence episodes. Although logistically and technically difficult to perform, studies using polysomnographic recordings of sleep are needed to examine further these important associations.
Factors Associated With Six‐Month Mortality in Recipients of Community‐Based Long‐Term Care
Authors: Fried Terri R. , Pollack Daphna M. , Tinetti Mary E. 
Published: April 2015

OBJECTIVES: To determine factors associated with short‐term mortality in recipients of community‐based long‐term care (CBLTC).DESIGN: A cohort study.SETTING: A Medicaid home‐ and community‐based waiver and state‐funded homecare program.PARTICIPANTS: All persons age 65 and older newly admitted to the program from January 1, 1988, to March 31, 1991.MEASUREMENTS: Demographics, functional, cognitive, and health status, depression, and social support were obtained in an admission assessment. Six‐month mortality data were obtained by linking assessment data to a state mortality registry.RESULTS: There were 718 deaths among 6784 CBLTC clients. Male sex (AOR 1.8, 95% CI 1.5–2.1), the presence of cancer (AOR 3.2, CI 2.6–3.9), heart disease (AOR 1.3, CI 1.1–1.5), chronic obstructive pulmonary disease (AOR 1.8, CI 1.4–2.2), or nutritional problems (AOR 1.7, CI 1.4–2.0), functional impairment (AOR for lowest compared to highest quartile 2.9, CI 2.0–4.1), severe cognitive impairment (AOR 1.6, CI 1.3–2.1), self‐assessment of health as poor (AOR 1.5, CI 1.1–2.0), feeling depressed (AOR 1.2, CI 1.1–1.3), and hospitalization (AOR 2.7, CI 2.2–3.2) were independently associated with 6‐month mortality in bivariate and multivariate analyses.CONCLUSIONS: Clinical data obtained during routine assessment of CBLTC clients can be used to assess short‐term mortality. Six‐month mortality is associated with poor functional and cognitive status, the presence of cancer, heart disease, COPD, and nutritional problems, depression, perception of poor health, and hospitalization.
Urinary Antibody Level and Survival in Bacteriuric Institutionalized Older Subjects
Authors: Nicolle L. E. , Duckworth H. , Brunka J. , Urias B. , Kennedy J. , Murray D. , Harding G.K.M. 
Published: April 2015

OBJECTIVE: In a previous study, elevated urine antibody levels in institutionalized subjects with asymptomatic bacteriuria were associated with decreased survival. This study was undertaken to confirm the previous observation in a prospective study in a larger cohort and to explore selected other variables that may be associated with survival.DESIGN: A prospective, 24‐month, observational cohort study.SETTING: Three large nursing homes in Winnipeg, Manitoba.PARTICIPANTS: Permanent residents were identified by initial screening urine cultures and subjects with bacteriuria were enrolled. The median age of subjects was 76 years, 51% were women, and the median duration of residence before enrollment was 26 months. Subjects were highly functionally impaired.MEASUREMENTS: Monthly urine specimens were collected for culture, leukocyte count, and urine antibody. Serum specimens for antibody to uropathogens and IL6 were obtained at enrollment and every 6 months. Anthroporphometric tests of nutritional status and functional and mental status were also measured every 6 months. Residents were stratified as having elevated or not elevated urine antibody, based on the initial urine specimen. The mean urine antibody for all of each subject's specimens was also calculated, and subjects were stratified as low, intermediate, or elevated urine antibody. Outcomes measured included mortality, infection and antibiotic use, and functional, mental, and nutritional decline.RESULTS: Ninety‐eight bacteriuric subjects were enrolled in the study; 34 (35%) had elevated urine antibody and 64 (65%) had not elevated urine antibody. The two groups did not differ in demographic features, co‐morbidities, functional status, medication use, or infecting organisms. Survival was significantly (P <.001) poorer in the group with elevated urine antibody. At 24 months, 35% of subjects with an elevated urine antibody were alive compared with 75% with a low urine antibody level. This survival difference was consistent when the two groups were stratified by sex, institution, and presence of a chronic indwelling catheter. Subjects with elevated urine antibody had no evidence for accelerated functional or nutritional decline during the study period compared with the group with low urine antibody. These subjects did, however, have an increased incidence of episodes of symptomatic urinary infection and infections at non‐urinary sites.CONCLUSIONS: Older, bacteriuric, institutionalized subjects with elevated urine antibody had decreased survival rates compared with subjects with lower urine antibody levels. There is no clinical evidence to support accelerated decline caused by chronic infection to explain this observation. Urine antibody may be a marker for immune dysregulation, which precedes death in older impaired subjects. J Am Geriatr Soc 46:947–953, 1998.