bluuebunny/crossref_metadata_2025_split huggingface dataset:
Underutilization of Controller and Rescue Medications Among Older Adults with Asthma Requiring Hospital Care
Authors: Hartert T.V. , Togias A. , Mellen B.G. , Mitchel E.F. , Snowden M.S. , Griffin M.R. 
Published: April 2015

BACKGROUND: Asthma causes serious morbidity in older people, but pharmacologic therapy in older people with asthma has never been studied, at least in part because of the difficulty of defining asthma in this population.OBJECTIVE: To determine if older persons enrolled in Medicaid and hospitalized with an exacerbation of asthma receive appropriate outpatient asthma care.DESIGN: Descriptive pharmacoepidemiology of a group of older adults with asthma.SETTING: The Tennessee Medicaid Program.PARTICIPANTS: Persons aged 65 and older, enrolled in the Tennessee Medicaid program, identified through Medicaid's computerized database as having a hospital care visit for asthma in 1992 and who had their diagnosis confirmed by chart review.MEASUREMENT: Medication utilization.RESULTS: The source population included 93,686 persons aged 65 or older enrolled in the Tennessee Medicaid program. The group meeting study criteria included 512 patients with chronic asthma who had a hospital care visit for an asthma exacerbation. Eighty‐one percent of these 512 persons with an asthma hospitalization confirmed by chart review were classified as having moderate to severe or potentially fatal asthma. These patients had had a median of 15 outpatient visits in the previous year, and more than half of them had an outpatient visit in the 14 days before their hospitalization. However, among those with moderate to severe or near fatal asthma only 25% filled prescriptions for inhaled corticosteroids, whereas 52% were taking theophylline, the most commonly prescribed asthma medication in this group. There was also high use of antibiotics (29%) and low use of rescue corticosteroids (5%) before the hospital care visit, despite frequent medical encounters.CONCLUSIONS: Despite widespread promulgation of the National Asthma Education Prevention Program guidelines, our study suggests that providers caring for indigent older subjects with moderate to severe or potentially fatal asthma were not following these guidelines. There was significant underutilization of inhaled anti‐inflammatory agents, beta‐agonists, and rescue corticosteroids in this population despite frequent outpatient medical care visits. J Am Geriatr Soc 48:651–657, 2000.
The C677T Mutation in the Methylenetetrahydrofolate Reductase (MTHFR) Gene and Vascular Dementia
Authors: Pollak Rivka Dresner , Pollak Arthur , Idelson Maria , Bejarano‐Achache Idit , Doron Dafna , Blumenfeld Anat 
Published: April 2015

OBJECTIVE: To determine the association between the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene and vascular dementia in Ashkenazi and non‐Ashkenazi Jews.DESIGN: A case‐control study.SETTING: Nursing homes in Jerusalem, Israel.PARTICIPANTS: Two hundred fifty nine Jewish people of Ashkenazi and non‐Ashkenazi origin, older than age 70, who have vascular dementia (VD) (n = 85), Alzheimer's disease (AD) (n = 92), and who are cognitively intact (n = 82) with no clinical evidence of atherosclerotic vascular disease.MEASUREMENTS: The frequencies of the mutant allele (T allele) and homozygotes for the C677T MTHFR mutation (T/T genotype). The total plasma homocysteine (tHCT) level in 75 subjects.RESULTS: There were no significant differences in the frequencies of the T/T genotype or T allele among VD, AD, and cognitively intact older people of the same ethnic origin (0.15, 0.19, 0.25 T/T genotype and 0.42, 0.46, 0.47 T allele in Ashkenazi; 0.08, 0.06, 0.10 T/T genotype and 0.28, 0.32, 0.33 T allele in non‐Ashkenazi with VD and AD, and in cognitively intact older people, respectively). The relative risk of VD associated with the T/T genotype versus the C/C genotype was 0.62 (95% CI, 0.19‐1.19) in Ashkenazi and 0.65 (95% CI, 0.11‐3.7) in non‐Ashkenazi, respectively. The relative risk of AD associated with the T/T genotype was 0.85 (95% CI, 0.29‐2.45) in Ashkenazi and 0.62 (95% CI, 0.1–4.3) in non‐Ashkenazi, respectively. The frequencies of mutant homozygotes and allele were significantly higher in Ashkenazi than in non‐Ashkenazi Jews (19.9% vs 7.5% T/T genotype, X2 = 6.2, P = .01, 0.45 vs 0.31 T allele, X2 = 9.77, P = .002 in Ashkenazi vs non‐Ashkenazi, respectively). There were no differences in mean tHCT concentration among VD, AD, and cognitively intact older people.CONCLUSIONS: The MTHFR C677T is not associated with an increased risk of vascular dementia or Alzheimer's disease. The frequency of the mutation is significantly higher in Ashkenazi compared with non‐Ashkenazi Jews. J Am. Geriatr Soc 48:664–668, 2000.
Dually Incontinent Nursing Home Residents: Clinical Characteristics and Treatment Differences
Authors: Chiang Lillian , Ouslander Joseph , Schnelle Jack , Reuben David B. 
Published: April 2015

OBJECTIVE: Previous studies have described urinary and fecal incontinence in nursing homes and their separate effects on healthcare utilization. However, little is known about those who are incontinent of both.DESIGN: Retrospective chart review.SETTINGS: Twenty sites in three statesPARTICIPANTS: A total of 413 nursing home residents were categorized as having neither fecal nor urinary incontinence (C, n = 114), urinary incontinence only (UI, n = 53), fecal incontinence only (FI, n = 9), or were dually incontinent (DI, n = 237).MEASUREMENTS: Charts were abstracted for sociodemographic information and health status information as well as utilization for the year before the date of abstraction. We then compared these characteristics across groups using ANOVA with pairwise comparisons and multiply adjusted regression.RESULTS: Almost all patients with DI were cognitively and mobility impaired. However, there were no significant differences between the groups with respect to age and number of diagnoses. A diagnosis of stroke was also more common among those with DI compared with C. When examining healthcare utilization in multiply adjusted regression, dually incontinent residents received significantly fewer days of hospital care than those with UI.CONCLUSIONS: Dual incontinence in NH residents is likely to have an important functional component. These residents seem to be treated less aggressively with respect to hospitalization compared with those with UI alone. The reasons for these differences need to be explored further. J Am Geriatr Soc 48:673–676, 2000.
Gender Differences in the Treatment of Cerebrovascular Disease
Authors: Ramani Subha , Byrne‐Logan Susan , Freund Karen M. , Ash Arlene , Yu Wei , Moskowitz Mark A. 
Published: April 2015

OBJECTIVE: Previous studies have shown that women receive fewer invasive procedures for the treatment of coronary artery disease than men, but gender differences in cerebrovascular disease have not been well studied. Our objective was to explore differences in the treatment of stroke between men and women.DESIGN: Secondary database analyses.STUDY PARTICIPANTS: We examined the use of carotid endarterectomy in a nationally representative sample of Medicare enrollees aged 65 to 84, hospitalized for a principal diagnosis of stroke in 1992, the “all strokes group”. We also studied a subgroup of patients, the “carotid disease subgroup”, admitted with a principal diagnosis of precerebral arterial occlusion and stenosis or transient cerebral ischemia.MEASUREMENTS: We determined rates of carotid endarterectomy for the all strokes group within gender and age groups and calculated corresponding female‐to‐male relative risks (RR) and 95% confidence intervals (CI). We also performed similar analyses for the carotid disease subgroup. We then used logistic regression to estimate the relative risk of use of carotid endarterectomy for women, controlling for age and comorbidity.RESULTS: The all‐strokes group consisted of 3356 women and 2927 men, of whom 1009 women and 990 men were in the carotid disease subgroup. The overall age‐adjusted female‐to‐male relative risk of undergoing carotid endarterectomy for those aged 65 to 84 was 0.69 (95% CI, 0.64‐0.74) in the all strokes group and 0.77 (95% CI, 0.72‐0.82) in the carotid disease subgroup. In both analyses, the RR became more pronounced with increasing age. In the all strokes group, for example, the RR was 0.80 (0.70‐0.92) for those aged 65 to 69 and 0.39 (0.32‐0.48) for those aged 80 to 84. The RR for the all strokes group remained similar in magnitude even after controlling for comorbidity (RR, 0.63 and 95% CI, 0.59‐0.70).CONCLUSION: We conclude that women hospitalized for strokes undergo fewer carotid endarterectomies than men. Further studies are needed to examine the reasons for and implications of this gender difference. J Am Geriatr Soc 48:741–745, 2000.
Effect of Aging on the Relationship Between Multiple Risk Factors and Waist Circumference
Authors: Iwao Satoshi , Iwao Nobuko , Muller Denis C. , Elahi Dariush , Shimokata Hiroshi , Andres Reubin 
Published: April 2015

OBJECTIVE: To examine the relationship between various coronary risk factors and the different levels of fat distribution in younger (<65 years) and older (<65 years) men and women, using the classifications proposed by the National Heart, Lung and Blood Institute (NHLBI) and the World Health Organization (WHO).DESIGN: Cross‐sectional study of subjects enrolled in the Baltimore Longitudinal Study of Aging.MEASUREMENTS: Systolic blood pressure, diastolic blood pressure, fasting glucose, 2‐hour glucose, fasting insulin, homeostasis model assessment insulin resistance (HOMAIR), triglyceride, total cholesterol, high‐density lipoprotein (HDL)‐cholesterol, and low‐density lipoprotein (LDL)‐cholesterol were measured as risk factors. The proportion of subjects with abnormal risk factor levels by waist circumference classifications was determined in the age and gender subgroups.RESULTS: There were significant adverse effects of age per se on all risk factors with the exception of fasting insulin and HOMAIR in both men and women, total cholesterol in men, and diastolic blood pressure in women. HDL‐cholesterol was higher in older subjects. There were significant correlations between waist circumference and all of the risk factors in the younger group. Waist circumference did not have a significant correlation with total cholesterol in older men, or with total cholesterol and LDL‐cholesterol in older women. The proportion of subjects with an abnormal risk factor level increased with increasing waist circumference for most risk factors in both younger and older subjects, but proportions of subjects in each individual waist group were higher in older than in younger groups for systolic blood pressure, diastolic blood pressure, fasting glucose, and 2‐hour glucose in men, and for systolic blood pressure, fasting glucose, 2‐hour glucose, total and LDL‐cholesterol, and triglyceride in women.CONCLUSIONS: Our data indicate that the waist circumference cutpoints proposed by NHLBI and WHO standards are useful for the prediction of cardiovascular disease risk factors in older as well as in younger men and women. J Am Geriatr Soc 48:788–794, 2000.
Subcutaneous Fluid Infusion in a Long‐Term Care Setting
Authors: Dasgupta Monidipa , Binns Malcolm A. , Rochon Paula A. 
Published: April 2015

OBJECTIVE: To study the use of hypodermoclysis in a long‐term care setting for chronic fluid supplementation and to compare it to intravenous (IV) fluid in the treatment of acute mild to moderate dehydration.DESIGN: A prospective observational study.PARTICIPANTS: Fifty‐five residents of a long‐term care facility treated with fluid therapy during a 5‐week period.MAIN OUTCOME MEASURES: Efficacy of hydration and adverse effects were obtained from detailed chart review, interviews with healthcare providers, and investigators' observations.RESULTS: The study subjects were frail older people. Hypodermoclysis was used for maintenance fluid needs in 24 residents; none of these residents required any additional fluid therapy for dehydration. In addition, 37 residents received fluids for acute dehydration. In these residents, hypodermoclysis was associated with clinical improvement in 57% and no clinical change in 25%. Recipients of IV fluids improved 81% of the time and the remainder were unchanged. Hypodermoclysis was associated with fewer fluid therapy‐related complications relative to IV therapy (P = .04).CONCLUSIONS: Hypodermoclysis is an effective procedure for providing fluids for both chronic maintenance needs and acute situations associated with mild to moderate dehydration in a long‐term care setting. Hypodermoclysis appears safer and can avoid transfers to hospital for rehydration. J Am Geriatr Soc 48:795–799, 2000.
Inclusion of Older Women in Randomized Clinical Trials: Factors Associated with Taking Study Medication in the Fracture Intervention Trial
Authors: Buist Diana S.M. , LaCroix Andrea Z. , Black Dennis M. , Harris Fran , Blank Jan , Ensrud Kristine , Edgerton Donna , Rubin Susan , Fox Kathleen M. 
Published: April 2015

OBJECTIVES: The purpose of this study is to describe the early study medication discontinuation (SMD) experience during the first year of follow‐up in a randomized clinical trial in older women and to determine the associations between various baseline characteristics and risk of SMD.DESIGH, SETTING, AND PARTICIPANTS: The authors studied 6459 postmenopausal women aged 55 to 80 from 11 clinical settings during their first year of participation in the Fracture Intervention Trial (FIT). This trial was designed to test the efficacy of alendronate (Fosamax) on fracture prevention among women with low bone mass.RESULTS: Study medication discontinuation was greatest in the first month post‐randomization (2.2%) and declined thereafter. Cumulative rates of study medication discontinuation were 4.8% (n = 311) at 3 months and 11.1% (n = 717) at 12 months. SMD was not associated with age, marital status, alcohol consumption, regular exercise, past estrogen replacement therapy use, bone mineral density, or personal or maternal fracture history. After adjusting for covariates and markers of comorbidity, the strongest predictor of SMD was fair‐to‐poor self‐rated health (relative risk (RR) 2.10; 95% confidence interval (CI) 1.47, 2.99). Having four or more depressive symptoms was also a significant predictor and had a risk associated with SMD (RR vs none 1.34; 95% CI 1.05, 1.71) similar to that seen for individuals with good self‐rated health (RR 1.49; 95% CI 1.16, 1.91).CONCLUSIONS: Results from this cohort emphasize that clinical trials in older women with multiple concomitant conditions can achieve high levels of adherence. Thought should be given to measuring self‐rated health and depressive symptoms before randomization to help identify individuals to be targeted for special assistance programs that focus on encouraging adherence.
Insights into the Pathophysiology and Mechanisms of Constipation, Irritable Bowel Syndrome, and Diverticulosis in Older People
Authors: Camilleri Michael , Lee Joon Seong , Viramontes Blanca , Bharucha Adil E. , Tangalos Eric G. 
Published: April 2015

OBJECTIVES: To review the epidemiology, pathophysiology and mechanisms of irritable bowel syndrome (IBS), constipation, and diverticulosis, for the purpose of addressing these three common conditions in older adults (>65 years of age).DESIGN: Using a MEDLINE search, we identified original English language journal articles and reviews from 1965 to December 1998. We also selected articles published before 1965 or after 1998 that were cross‐referenced or pertinent to the topics researched.RESULTS: The prevalence of constipation and diverticulosis is higher in older than in younger adults. Significant risk factors for constipation in older women are failure of the anorectal angle to open or excessive perineal descent, which represent disturbances of pelvic floor function and rectal evacuation. In contrast, the prevalence of IBS is no greater than in younger adults. Nevertheless, these syndromes impact on the patient's functional status and quality of life. The mechanisms resulting in these gastrointestinal syndromes are unclear. Uncoordinated colonic activity and colonic segmentation may lead to IBS and diverticulosis, respectively, and these pathophysiological findings suggest disorders of inhibitory control of neuromuscular function. The total number of neurons in the myenteric plexus is decreased, and collagen deposited in the distal colon is increased with aging in humans. Animal studies suggest that senescent colonic muscle responds less to excitatory factors in vitro, and neural injury in older animals may result from apoptosis, defects of mitochondrial metabolism, and inadequate levels or response to neurotrophins. Future investigations will reveal whether similar mechanisms underlie human disease. Currently, treatment is aimed at relief of symptoms of IBS or constipation or dealing with the complications of diverticulosis.CONCLUSIONS: Constipation, IBS, and diverticulosis are common problems of aging. There is a need for further systematic research of the basic mechanisms in neuromuscular dysfunction with aging, including the studies of physical characteristics of the colonic wall, pelvic floor function (particularly in women with excessive perineal descent), and neurohormonal control of motility and sensation. Insights on the pathophysiology and mechanisms of neural injury may lead to more specific treatments in the future, e.g., serotonergic agents and neurotrophins. Meanwhile, collaborations between primary care physicians, geriatricians, and gastroenterologists can optimize management of these three common conditions that significantly impact the quality of life of older adults.
GERIATRICS IN MANAGED CARE
Authors: Brummel‐Smith Kenneth , Morgenstern Nora E. , Gonzales Ralph , Anderson Robert J. 
Published: April 2015

OBJECTIVES: Little is known about the impact of mandatory (involuntary) disenrollment of patients from Medicare managed care organization (MCO) plans. We hypothesized that involuntary disenrollment raises significant concerns for patients, that younger enrollees (aged less than 65, “Medicare disabled”) have different concerns than older patients, and that younger patients respond to termination of their plan within the MCO differently from older patients. We also examined other factors associated independently with enrollee decisions to stay in the MCO or return to Medicare fee‐for‐service.DESIGN: A cross‐sectional telephone questionnaire.SETTING: A Medicare managed care plan at two outpatient clinics at an academic medical center in Denver, Colorado.PARTICIPANTS: Four hundred fifty enrollees recently notified of termination of their clinic's contract with a Medicare managed care plan were surveyed.MEASUREMENTS: Survey questions on demographics, patient concerns about disenrollment, and factors associated with staying at the academic medical center or switching to another clinic or plan associated with the MCO.RESULTS: Of 371 respondents, 57% switched to another plan within the MCO, including 65% of the Medicare disabled enrollees and 57% of the Medicare nondisabled enrollees. More than 60% of both Medicare disabled and older patients who switched felt that it was a significant problem for them. By multivariate analysis, age was not associated with switching, but a distant relationship with one's physician was associated with switching (odds ratio (OR) = 10.2; confidence interval (CI), 1.13–91.09) and having received care at the academic medical center for 1 year or longer (OR = 0.35, 95% CI, 0.17–0.69), postcollege education (OR = 0.34; CI, 0.16–0.69), and black race (OR = 0.29; CI, 0.13–0.68) were independently associated with not switching. Older and younger patients cited similar concerns raised by switching, but financial issues were identified as a major concern by more younger patients than older patients (P = .001).CONCLUSIONS: Involuntary disenrollment raised significant concerns for patients in a Medicare managed care plan.
Estrogen Replacement Therapy and MRI‐Demonstrated Cerebral Infarcts, White Matter Changes, and Brain Atrophy in Older Women: The Cardiovascular Health Study
Authors: Luoto R. , Manolio T. , Meilahn E. , Bhadelia R. , Furberg C. , Cooper L. , Kraut M. 
Published: April 2015

OBJECTIVE: We studied the relationship between the use of estrogen replacement therapy (ERT) and cerebral magnetic resonance imaging (MRI) abnormalities among older women.DESIGN: A population‐based prospective study (Cardiovascular Health Study).SETTING: Four regions in the United States.PARTICIPANTS: A total of 2133 (62.9% of the eligible) women aged 65 to 95 years (mean age 74.8), on whom MRI was performed in 1992–1994.MEASUREMENTS: Presence of global brain atrophy, white matter changes, small infarct‐like lesion (ILL) (<3 mm), MRI infarcts (≥3 mm, mostly small and asymptomatic), and cognitive function as measured by Mini‐Mental State Exam (MMSE), and by ERT use (current/past/never), adjusted for a number of socioeconomic, lifestyle, and reproductive covariates.RESULTS: Current use of ERT was reported by 15% and past use by another 23% of participants; 35% of all women had MRI infarcts. The prevalence of MRI infarcts did not differ in current or past users from those who had never used ERT (nonusers). Bifrontal distance, the largest distance between frontal horns, and the size of ventricles were larger among current ERT users compared to past users or nonusers (P (trend) = .01), adjusted for all other covariates, but no dose‐response relationship to current or past ERT use was found. Duration of estrogen use was not associated with any atrophy measure. Cortical atrophy measure, sulcal widening, or white matter disease did not differ significantly by ERT use or duration of use. Central measures of atrophy, bifrontal distance, and ventricular size were significantly associated with cognition as measured by MMSE.CONCLUSIONS: Current ERT users had much more clinically significant central atrophy than nonusers, but the implications remained unclear. J Am Geriatr Soc 48: 467–472, 2000.