bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indices of Dehydration Among Frail Nursing Home Patients: Highly Variable but Stable over Time
Authors: Weinberg Andrew D. , Pals Jean K. , McGlinchey‐Berroth Regina , Minaker Kenneth L. 
Published: April 2015

OBJECTIVE: To determine changes in standard laboratory measures of dehydration among residents of a nursing home care unit (NHCU) over a 6‐month period.DESIGN: A prospective cohort analytic study.SETTING: A 130‐bed NHCU in a Department of Veterans Affairs Hospital.PATIENTS: Fifteen infirm but stable male residents (mean age 77 years; range (R) 62–93) on one ward of the NHCU.MAIN OUTCOME MEASURES: We studied prospectively for 6 months the serum osmolality (osm), serum sodium (Na), blood urea nitrogen/creatinine (BUN/Cr) ratios and weight (wt) for 15 patients of the NHCU. None of the patients was acutely ill during the study period or exhibited clinical signs of dehydration.RESULTS: Mean serum osm at baseline: 291.6 mOsm/kg (R 278 to 300); 3 months: 291.5 mOsm/kg (R 276 to 301); 6 months: 291.3 mOsm/kg (R 283–300) were all similar. Forty percent (6/15) of patients had at least one high normal/elevated reading (≥ 295 mOsm/kg) during the study. Three patients (20%) had readings of ≥ 300 mOsm/kg, but none of these patients had either concurrent increased serum Na (≥ 146 mmole/L) or BUN/Cr ratios (≥ 25). Mean serum Na at baseline: 143.0 mmole/L (R 139–148); 3 months: 142.1 mmole/L (R 138–149); 6 months: 142.9 mmole/L (R 137–150) were all similar. Sixty percent (9/15) of the patients maintained normal (nl) serum Na levels throughout the study. The relationship between the change in serum Na and serum osm levels from baseline to 6 months was not significant (r = 0.242). BUN/Cr ratios ranged from 12–34 over the study period with 3 of 15 patients (20%) demonstrating elevated ratios consistently throughout the study without clinical evidence of dehydration. Only two patients had both high nl/elevated serum osm and elevated serum Na, although both had nl BUN/Cr ratios. Neither of these patients was thought by staff to be clinically dehydrated. Analysis of variance (ANOVA) indicated none of the laboratory measures changed significantly over time (serum osm: F(2,28) < 1; Na: F(2,28) < 1; BUN/Cr: F(2,228) < 1). There was no significant change in weight between the baseline and six month readings.CONCLUSIONS: These data suggest that in the presence of clinical stability, long‐term care residents may have a serum osm in the high normal/elevated range without overt clinical evidence of dehydration, an accompanying elevated Na, or BUN/Cr ratio. This may indicate a different central osm setting for these residents as the serum osm appeared to be stable for each resident over time. These data also suggest that measures of serum osm, Na, and BUN/Cr in the long‐term care setting may accurately predict future laboratory values in an individual patient if baseline values are drawn when the patient is not acutely ill.
Physician Assessment of Patient Competence
Authors: Markson Lawrence J. , Kern Donald C. , Annas George J. , Glantz Leonard H. 
Published: April 2015

OBJECTIVE: To determine if physicians know and can apply the legal standard for determining competence; to determine if physician assessment of competence varies by physician age or specialty.DESIGN: Mail survey with specific questions about a patient scenario and general questions about the law.PARTICIPANTS: 2100 randomly selected Massachusetts internists, surgeons, and psychiatrists.MEASUREMENTS: In Part I, the survey presented a scenario adapted from a court case that involved an elderly woman's refusing lifesaving surgery. The scenario was divided into three sections: the medical history, the patient's rationale, and a psychiatrist's opinion that the patient was incompetent. Respondents were not told that an appellate court later decided the psychiatrist applied the wrong standard of competence and the patient was indeed competent. Respondents were asked whether the patient was competent, whom they would consult, and how they would respond. Part II posed a series of theoretical questions about competence. Group differences were tested by chi‐square.MAIN RESULTS: Surveys were returned by 823 (41%) of the sample. In Part I, before the psychiatrist's opinion, 58% thought the patient was competent, 92% would consult a psychiatrist to help assess competence, and only 17% would to go to court. After the psychiatrist's opinion, only 30% thought she was competent and 55% would go to court. In Part II, 89% knew the correct standard for competence; however, most incorrectly responded that conditions such as dementia and psychosis establish incompetence. Psychiatrists performed significantly better on theoretical, but frequently worse on scenario, questions.CONCLUSIONS: Physicians in general, and psychiatrists in particular, know the standard for competence but may apply it incorrectly. This suggests that the common clinical practice of relying on expert medical opinion may introduce bias and produce inaccurate results that undermine patient autonomy.
Dexterity Testing as a Predictor of Oral Care Ability
Authors: Felder Robert , James Kenneth , Brown Claudia , Lemon Sherry , Reveal Marge 
Published: April 2015

OBJECTIVE: To examine a spectrum of elderly people to determine if hand function/dexterity measures can predict oral care ability.DESIGN: A series of dental, hand function, and dexterity measures were assessed by blinded examiners. Plaque scores were used as the criterion standard to assess plaque removal ability.PATIENTS: A convenience sample of 52, predominately male, elderly patients were recruited from the patient population of the Portland Veteran Affairs Medical Center and a community nursing home. Entry into the study required that the patient be able to give consent, be age 65 or older, have a minimum of six contiguous teeth or a minimum of 12 teeth total, be medically stable, have grossly adequate vision, and be able to hear and understand spoken instructions.OUTCOME MEASURES: The primary outcome measure was plaque score, as defined by the Turesky modification of the Quigley‐Hein index. This was related to four dexterity tests (Jebsen‐Taylor Hand Function test, Nine‐hole Peg test, Box and Block test, Toothbrushing Ability test), a grip strength measure, and a cognitive measure (Allen Cognitive Level Test).RESULTS: Oral hygiene was significantly impaired among institutionalized elderly compared with outpatient elderly (P < 0.001), as was dexterity (P < 0.001). All dexterity tests correlated significantly with plaque score (Spearman rho: 0.49–0.77; P < 0.000). Forward stepwise regression analysis identified the Toothbrushing Ability Test (P < 0.0001) and the time spent brushing (P = 0.007) as the most significant predictors of plaque score.CONCLUSIONS: Results suggest oral hygiene ability is decreased among long term care residents, that dexterity tests can help identify patients unable to perform adequate oral self‐care, and that these tests could be used to estimate brushing ability among elderly compromised patients.
Comprehensive Geriatric Assessment in a Day Hospital
Authors: Siu Albert L. , Morishita Lynne , Blaustein Jenna 
Published: April 2015

OBJECTIVE: To assess the effectiveness of comprehensive geriatric assessment conducted in day hospitals.DESIGN: Retrospective cohort comparison study with restricted inclusionary criteria and adjustment for baseline characteristics.SETTING: A hospital‐based geriatric day hospital and geriatric clinic sites (both in the university and in the community).PATIENTS: Four hundred sixty‐eight patients referred for comprehensive geriatric assessment during a 12‐month period.INTERVENTION: Comprehensive geriatric assessment in a geriatric day hospital compared with assessment received in clinic sites without a day hospital.MAIN OUTCOME MEASURES: Services received in the first 2 weeks; hospitalization, emergency room visits, placement, death, and change in selected health status measures. Follow‐up data was obtained from medical records, a telephone survey, and death certificates.RESULTS: Except in the case of rehabilitative services, day hospital patients were more likely to receive interdisciplinary services. The population seen in the day hospital was more functionally impaired and had significantly more dementia and depression. After adjusting for subjects' baseline characteristics and limiting the analyses to subjects meeting specific inclusionary criteria, the day hospital had no significant effect on mortality, use of emergency or hospital services, placement, or change on selected measures of health status. For example, compared with the clinic patients, receiving care in the day hospital was associated with an adjusted odds ratio of 1.01 (95% confidence interval: 0.53, 1.91) of being at a higher level of care at 6 months. The results were not sensitive to the choice of inclusionary criteria.CONCLUSION: Given their cost and uncertain effectiveness, day hospitals need additional evaluation before their further diffusion occurs.
The Use of Dietary Restrictions in Malnourished Nursing Home Patients
Authors: Buckler Debra A. , Kelber Sheryl T. , Goodwin James S. 
Published: April 2015

OBJECTIVE: To evaluate the dietary prescriptions of nursing home patients who show evidence of malnutrition.DESIGN: A descriptive chart review.SETTING: Four chronic care facilities in Milwaukee, Wisconsin.PATIENTS: A total of 336 charts were randomly selected from the four facilities. Analysis was done on the 217 charts that included a recorded serum albumin.MAIN OUTCOME MEASURES: Serum albumin, height, most recent weight, weight recorded 6 months previously, major diagnoses, and current diets were recorded. Average weight change per month and body mass index were calculated.RESULTS: In 109 of the 217 patients, the serum albumin was less than 3.5 g/dL. 75.2 percent of the hypoalbuminic patients were on some sort of dietary restriction, including caloric restriction in 18% and sodium restriction in 35%. Sixty‐six of the 217 patients had an average weight loss of greater than 1 pound per month, and 59% of this group were on dietary restrictions, with 21% on sodium restriction and 20% on limited calories.CONCLUSIONS: Malnutrition is a common problem in the nursing home population. A restricted diet is one possible factor that might contribute to this. While this study does not prove a causal relationship between a restricted diet and malnutrition, it would seem inappropriate that most patients with evidence of malnutrition are on diets that might discourage nutrient intake.
Geriatric Home Assessment After Hospital Discharge
Authors: Kravitz Richard L. , Reuben David B. , Davis James W. , Mitchell Anne , Hemmerling Karen , Kington Raynard S. , Siu Albert L. 
Published: April 2015

OBJECTIVES: To evaluate the feasibility of an intervention involving post‐discharge geriatric home assessment and follow‐up and to describe the spectrum of significant clinical problems identified during the home assessment.DESIGN: Prospective observational study nested within a randomized controlled trial.SETTING: Inpatient service of a large academic medical center in Southern California.PATIENTS: There were 152 adults aged 65 or greater who had one or more specific risk factors for functional decline or increased mortality, who were awaiting discharge from the hospital, and who were assigned to the intervention arm of a randomized controlled trial of post‐discharge comprehensive geriatric home assessment.MAIN RESULTS: During the home assessment, the gerontologic nurse practitioner (GNP) identified new or worsening problems in 150 patients (99%); 61 problems (eg, serum sodium 125 mg/dL; severe orthostatic hypotension) were considered by a reviewing physician to require urgent medical attention. Older age, non‐white race, and new incontinence were associated independently with a greater number of findings (P < 0.05). Based on the findings, an interdisciplinary team made an average of 3.4 recommendations per patient; only two of 111 requests for written approval of recommendations were rejected.CONCLUSIONS: Post‐discharge visitation by a GNP to patients at high risk is capable of detecting a high yield of important and potentially reversible clinical problems. This multidisciplinary approach is acceptable to physicians. Research is needed to identify additional links between short hospital stays, impairment or instability at discharge, and adverse outcomes.
Idpathic CD4+ T Lymphopenia in Older Persons
Authors: Kaiser Fran E. , Morley John E. 
Published: April 2015

OBJECTIVE: Survey of the association of idiopathic CD4+T cell lymphocytopenia in older persons with protein energy undernutrition and unusual infections/colonizations.METHOD: Retrospective chart analysis.RESULTS: Five subjects aged 61 to 87 years, with unusual organisms and/or either marasmus or kwashiorkor, were noted to have absolute CD4+and CD8+T cell lymphocytopenia. All were HIV negative.CONCLUSION: T cell lymphocytopenia may not be a uncommon finding in malnourished older persons, but additional studies to determine its prevalence need to be undertaken. Its role in disease and impact on therapeutic response needs to be further explored.
Assessing Health‐Related Quality of Life in Elderly Outpatients: Telephone Versus Face‐to‐Face Administration
Authors: Weinberger Morris , Nagle Becky , Hanlon Joseph T. , Samsa Gregory P. , Schmader Kenneth , Landsman Pamela B. , Uttech Kay M. , Cowper Patricia A. , Cohen Harvey J. , Feussner John R. 
Published: April 2015

OBJECTIVE: While health‐related quality of life (HRQOL) is increasingly being used as an outcome in clinical trials, it is unknown whether HRQOL assessments are influenced by the method of administration. Within the context of a randomized, controlled trial evaluating a pharmacist intervention for elderly outpatients prescribed at least five medications, we compared telephone and face‐to‐face administration of the SF‐36, a widely used HRQOL measure.DESIGN: SurveySETTING: General Medicine Clinic, Veterans Affairs Medical CenterPATIENTS: At entry, participants in the randomized trial received continuous care from a general medicine clinic physician, were>65 years of age, and were prescribed>5 regularly scheduled medications. Patients were excluded if they were cognitively impaired and had no caregiver available to participate in the study as a proxy or if they resided in a nursing home.MEASUREMENTS: Subjects completed the SF‐36 by telephone at doseout and face‐to‐face at clinic visits within 1 month (mean = 16.7 days).MAIN RESULTS: Telephone administration required significantly less time than face‐to‐face interviews (10.2 vs 14.0 minutes, P < 0.001). Although systematic differences between modes of administration were generally small, there were substantial nonsystematic discrepancies for all eight SF‐36 scales (mean absolute difference scores ranged from 10.8 to 30.1). Discrepancies were greatest for emotional role functioning, physical role functioning, social functioning, and bodily pain; these four scales also demonstrated low to moderate correlations (.33 to .58).CONCLUSIONS: The two modes of administration may not produce interchangeable results. Researchers should be cautious when mixing modes of administration to elderly patients. J Am Geriatr Soc 42: 1295–1299, 1994.
Constipation in the Elderly: Influence of Dietary, Psychological, and Physiological Factors
Authors: Towers Adele L. , Burgio Kathryn L. , Locher Julie L. , Merkel Ira S. , Safaeian Mehry , Wald Arnold 
Published: April 2015

OBJECTIVE: To identify dietary, psychological, and physiological characteristics of older individuals with chronic constipation, compared with a control group of individuals without constipation, and identify correlates of colonic transit time.DESIGN: Cohort study.SETTING: University hospital and affiliated clinics.PARTICIPANTS: Eighteen constipated and 18 control subjects who were nondemented, ambulatory, community‐dwelling outpatients over the age of 60 years.MEASURES: Measures included a 1‐week food diary, diet questionnaire, bowel diary, the Hopkins Symptom Checklist (SCL‐90R), colonic transit study, and medical history, including queries about activity, medications, medical illnesses, and bowel symptoms.MAIN RESULTS: Constipated subjects reported consuming fewer meals per day compared with control subjects (P < 0.01) and a tendency to consume fewer calories (P = 0.07). There were no differences between groups on fiber or fluid intake or any of the other dietary parameters. However, slow colonic transit was significantly related to low caloric intake (P < 0.0001), higher percent of protein in the diet (P < 0.05), low fluid intake (P < 0.05), and to psychological symptoms of somatization, obsessive‐compulsiveness, depression, anxiety, and the global severity index (P < 0.05). Transit times were unrelated to crude or dietary fiber intake, activity level, or age.CONCLUSIONS: The data suggest that constipation in this older population is related to caloric intake rather than fiber consumption or other dietary qualities. Psychological distress is associated with slowed colonic transit and should be investigated further as a possible etiologic factor in constipation.
Past Personal History of Dysphoria, Social Support, and Psychological Distress Following Conjugal Bereavement
Authors: Hays Judith C. , Kasl Stanislav , Jacobs Selby 
Published: April 2015

OBJECTIVE: This study describes the course and risk factors of psychological distress following bereavement, controlling for factors often omitted from studies of grief: psychiatric history, social support, and coping choices of the bereaved.PARTICIPANTS: Spouses of patients hospitalized for serious illness or elective surgery were systematically screened and followed longitudinally through the recovery or death of the hospitalized patient. Of 440 respondents, 154 were bereaved within 2 months.DESIGN AND SETTING: Spouses were interviewed in their homes by trained interviewers at intake and 2, 6, 13, and 25 months postintake.MEASUREMENTS: Dependent variables were measured with the CES‐D (depressive symptoms) and the PERI (general anxiety and hopelessness/helplessness) scales. Independent variables were measured with the SADS‐L (past personal history of dysphoria) and the Lazarus' Ways of Coping scale as well as sociodemographic measures.MAIN RESULTS: Lifetime prevalence of a brief period of dysphoric mood among spouses before the patient's illness was 22%; past personal history of dysphoric mood was related to female sex, smaller networks, and more depression and anxiety during the hospitalization of their spouses. Newly widowed persons with a past history of dysphoria perceived their networks to be relatively nonsupportive, but devoted similar amounts of coping effort to seeking social support and reported similar amounts of social interaction compared with persons with no history of dysphoria. Persons with a past history of dysphoria reported elevated levels of depressive symptoms, general anxiety, and hopelessness/helplessness through 25 months postbereavement, yet their recovery trajectory was similar to those without a past history of dysphoria.CONCLUSIONS: It was concluded that a past history of subsyndromal symptomatology in conjunction with a stressful life event such as bereavement increases one's vulnerability to excess psychological distress.
Causes of Death Associated with Alzheimer Disease: Variation by Level of Cognitive Impairment Before Death
Authors: Kukull W. A. , Brenner D. E. , Speck C. E. , Nochlin D. , Bowen J. , McCormick W. , Teri L. , Pfanschmidt M. L. , Larson E. B. 
Published: April 2015

OBJECTIVE: To describe causes of death for patients with Alzheimer disease (AD) and other dementing illnesses enrolled in a population‐based Alzheimer disease patient registry (ADPR) and to describe the variation in causes by the level of cognitive impairment before death in probable AD cases.SETTING: The ADPR enrolls and diagnoses newly recognized potential dementia cases occurring in a large, stable health maintenance organization. To date, 654 cases have been enrolled and followed annually to monitor cognitive decline and verify initial diagnosis.DESIGN: Longitudinal descriptive study.PATIENTS: ADPR enrollees who have died.MEASUREMENTS: Death certificates were obtained for all who died (total n = 104, probable AD = 55); reported causes of death were reviewed by a physician to determine the underlying cause. AD patients were categorized according to their Mini‐Mental State Exam score (cognitive impairment) within 12 months of death as (a) mildly (21+), (b) moderately (15–20), or (c) severely (0–14) impaired, and underlying cause and all reported causes of death for each group were tabulated.MAIN RESULTS: Among probable AD patients, pneumonia and AD were most often recorded on death certificates when cognitive impairment within the year prior to death had reached the severe level; heart disease, stroke, and other common causes of death predominated in AD patients who were less cognitively impaired.CONCLUSIONS: When AD cases were followed from first diagnosis to death, the causes of death varied by level of cognitive impairment. Illnesses potentially amenable to treatment caused death at all levels of disease, but more so early in the course of AD. Cognitive impairment may make patients less able to recognize and report symptoms of medical problems, thereby complicating efforts to intervene.
Older Adults' Perceptions of their Health and Functioning in Relation to Sleep Disturbance, Falling, and Urinary Incontinence
Authors: Kutner Nancy G. , Schechtman Kenneth B. , Ory Marcia G. , Baker Dorothy I. ,   FICSIT Group
Published: April 2015

OBJECTIVE: To investigate variation in older adults' perceived health and functioning that is associated with self‐reported sleep disturbance, falling, and urinary incontinence, controlling for self‐reported depression, ambulation difficulty, number of chronic conditions, and subjects' sociode‐mographic characteristics.DESIGN: Multicenter prospective study (FICSIT).SETTING: Persons age 70 and older living in the community evaluated at baseline.PARTICIPANTS: 239 women, 113 men; mean age = 77.MEASUREMENTS: Sleep disturbance score based on EPESE questions, recent falls history (Y/N), incontinent episodes (Y/N), CES‐D score, SIP Ambulation score, and 4 MOS SF‐36 scale scores.RESULTS: Women were significantly more likely than men to report multiple conditions (sleep disturbance, falling, incontinence) and to report lower levels of functioning as measured by 3 of 4 SF‐36 scales. In regression analyses, sleep disturbance and urinary incontinence were significant predictors of perceived limitation in usual role activities because of physical health problems. Depression and ambulation measures significantly predicted scores on all 4 SF‐36 scales.CONCLUSIONS: Our analysis suggests that it is important to address depressive symptomatology and ambulation difficulty—which in turn are related to sleep disturbance, falling, and urinary incontinence —in efforts to enhance older adults' perceived health and functioning.