bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Physical Exercise for Elderly Patients with Physical Impairments
Authors: Thompson Robert F. , Crist Douglas M. , Marsh Marjorie , Rosenthal Mark 
Published: April 2015

Exercise is known to preserve many physiological responses in the healthy elderly, yet those with physical impairments are often discouraged from exercising. The authors studied the effects of a closely supervised exercise program designed specifically for elders with health problems and functional limitations. Tests, selected for their relevance to clinical patient management, included the Self Evaluation of Life Function questionnaire, treadmill performance, and tests of autonomic nervous system and neuromotor functions. Ambulatory volunteers, aged 64 to 83 years, with noncardiac health problems, were randomly assigned to a control group (CG; n = 17) or a 16‐week exercise group (EG; 3 hr/wk, n = 18).Nine of the control and 13 of the exercise subjects completed the study. All EG dropouts were due to illness. EG attendance averaged 87%, and subjects trained at a heart rate (HR) of 103 $pL 5 beats/min (SD) (98% of prescription HR). Though EG test responses showed a tendency to improve, none reached statistical significance. This result was affected by the small number completing the study and the variability inherent in such a sample. Though these impaired elderly subjects enthusiastically and safely participated with high attendance and at an exercise intensity adequate to expect benefit, measurable training effects were not demonstrated.
Health and Function in the Old and Very Old
Authors: Ford Amasa B. , Folmar Steven J. , Salmon Richard B. , Medalie Jack H. , Roy Ann W. , Galazka Sim S. 
Published: April 2015

This report advocates conceptual separation and parallel assessment of medically diagnosed health conditions and functional disability in clinical and epidemiological studies of the aged. Data from a study of urban elderly are presented to demonstrate how this can be done and to reexamine the meaning of self‐reported illness and disability.One hundred thirteen subjects 74 to 95 years old, recruited from a longitudinal study of a representative sample of the elderly population of Cleveland, Ohio, participated in structured interviews and epidemiologically based medical examinations, conducted by a physician‐nurse team at the place of residence. The presence or absence of 11 common chronic conditions was determined according to preestablished criteria, by self‐report and, separately, by medical diagnostic evaluation. Functional disability was estimated by self‐report and by physician‐nurse assessment, using established measures of mobility and activities of daily living.Results indicate that interview self‐report can provide useful estimates of the prevalence of medical conditions and functional disabilities in elderly populations, although self‐report alone is not a sufficiently sensitive measure to be used for case‐finding or diagnosis.When functional disabilities are matched against the specific medical conditions that cause them and disease‐specific mortality is also taken into account, a three‐dimensional classification results that has implications for future clinical and survey work with the elderly.
Determinants of Total Serum Carotene Concentrations in Institutionalized Elderly
Authors: Kergoat Marie‐Jeanne , Leclerc Bernard S. , PetitClerc Claude , Imbach Andrée 
Published: April 2015

The current analysis was designed to examine further the association between total serum carotenoids and a series of preselected variables (dietary intakes, anthropometric parameters, serum cholesterol, vitamin A, transport proteins, and others) using 85 elderly patients.Simple correlation between serum carotene and carotene intake, as estimated by a three‐day weighed method, was 0.19 (P = 0.08), which was substantially increased (r = 0.29, P = 0.01) after adjustments for a selected set of variables. Standardized coefficients of multivariate regression indicated that the most important predictors of serum carotene were serum cholesterol (β = 0.38), total serum proteins (β = —0.35), and sex (β = 0.34), followed by carotene intake (β = 0.28) and midarm circumference (β= 0.20). These variables accounted for 46% of the variance. Results suggest that serum carotene may be related to protein‐energy status in hospitalized elderly, but further investigation should be directed to serum carotene in undernourished elderly. Nevertheless, total serum proteins could be an important factor in any attempt to correlate carotene intake and blood concentration.
Clinical Spectrum and Diagnostic Techniques of Coronary Heart Disease in the Elderly
Authors: Coodley Eugene L. 
Published: April 2015

Coronary heart disease is a major cause of morbidity and mortality in the older population. The recognition of such disease in the elderly varies in a number of parameters from that noted in younger patients. There are a number of physiologic changes in cardiac function as a result of aging, and they have an important bearing on the recognition of cardiac disease in the elderly.This review stresses the particular features of coronary disease in the aged and contrasts them with features more readily recognized in younger patients. Changes in the development of angina pectoris, heart failure, and the diagnosis of myocardial infarction vary significantly in the elderly population. The role of diagnostic modalities varies considerably in sensitivity and specificity when comparing younger and older patients. Potential areas for further research are stressed.
Clinical Determinants of Biomechanics Platform Measures of Balance in Aged Women
Authors: Lichtenstein Michael J. , Shields Sharon L. , Shiavi Richard G. , Burger M. Candice 
Published: April 2015

The cross‐sectional associations between clinical variables and biomechanics platform measures of balance (sway) were determined in a random sample of 50 aged single women living in high rise apartment buildings. A history of falling in the previous year was associated with increased areas of sway. Increased body mass was associated with decreased velocity of sway. Poor near, but not far, visual acuity was associated with increased areas of sway. A postural drop of 10 mmHg or more in diastolic pressure was associated with increased velocity of sway. The associations between these variables and the balance measures persisted after adjustment for age and each other to adjust for potential confounding.Slower hand reaction times and poor hearing were associated with increased areas of sway, but these associations were removed after adjustment for age and near visual acuity. There were no associations between any of the balance measures and postural changes in systolic pressure and heart rate. There were no associations between balance measures and base of support. The observed associations, if causal, can aid in development and testing of effective interventions to improve balance and prevent falls in the elderly.
What are the Psychiatric Manifestations of Vitamin B12 Deficiency?
Authors: Hector Melvin , Burton John R. 
Published: April 2015

Psychiatric symptoms attributable to vitamin B12 deficiency have been described for decades. The earlier reports are for the most part in accord with more recent ones, despite being diagnostically less specific in psychiatric and hematologic terms. These symptoms seem to fall into several clinically separate categories: slow cerebration; confusion; memory changes; delirium, with or without hallucinations and/or delusions; depression; acute psychotic states; and (more rarely) reversible manic and schizophreniform states.While there still remain abundant hematologic, psychiatric, neurologic, or nutritional reasons for obtaining a serum vitamin B12 level, its use in the investigation of the etiology of a patient's dementia seems unjustified. However, acute or subacute changes in a demented patient's mental status, specifically a clouding of their consciousness, may make such testing advisable as part of the complete workup of their delirium regardless of a normal hematologic picture.
BOOK REVIEWS
Authors: Barzel Uriel S. 
Published: April 2015

Love is Ageless. Stories about Alzheimer's Disease. Edited by Bryan J. Oakland, California, Serala Press (PO Box 3876, Oakland, CA 94609), 1987, 200 pages, $9.95.Journey with Grandpa: Our Family's Struggle with Alzheimer's Disease. By Honel RW. Baltimore, The Johns Hopkins University Press, 1988, 243 pages, $16.95.
A Sensitive Thyroid Stimulating Hormone Assay for Screening of Thyroid Functional Disorder in Elderly Japanese
Authors: Okamura Ken , Ueda Kazuo , Sone Hisao , Ikenoue Hiroshi , Hasuo Yutaka , Sato Kaori , Yoshinari Mototaka , Fujishima Masatoshi 
Published: April 2015

The use of a screening test for thyroid functional disorder by sensitive thyroid stimulating hormone assay in the elderly was investigated. The basal thyroid stimulating hormone levels predicted the response of thyroid stimulating hormone to thyrotropin releasing hormone; it was suppressed in 99 (99.0%) of 100 hyperthyroid patients. Therefore, not only primary hypothyroidism but also hyperthyroidism can be excluded when the serum thyroid stimulating hormone levels are normal.An epidemiological study was then performed on 2,421 (76.7%) of the Japanese general population aged 40 or over recruited from the residents in Hisayama town and also in 122 residents between 20 and 40 years of age. Additional free T4 measurement was necessary in about 10% of the residents with abnormal TSH levels to confirm the diagnosis of hyperthyroidism or distinguish latent from overt hypothyroidism. There was a significant correlation between age and serum thyroid stimulating hormone levels after logarithmic conversion (r = 0.1533, P < .001). The prevalence of thyroid dysfunction found in 1,026 males and in 1,395 females aged 40 or over was, respectively: hyperthyroidism, < 0.1% and 0.2%, latent (subclinical) hypothyroidism, 3.2% and 5.5%, and overt hypothyroidism, 0.4% and 0.7%.We conclude that the screening with this sensitive thyroid stimulating hormone assay and additional free T4 measurement is useful for detection of patients with thyroid functional disorder.
Utility of Fever, White Blood Cells, and Differential Count in Predicting Bacterial Infections in the Elderly
Authors: Wasserman Michael , Levinstein Mark , Keller Eugene , Lee Stephen , Yoshikawa Thomas T. 
Published: April 2015

A total of 221 elderly patients between the ages of 70 to 99 years who presented to a community‐based teaching hospital emergency room were prospectively evaluated by assessing for fever (≥ 37.5°C), leukocytosis (≥ 14,000/ mm3) and bandemia (> 6%) as a screening method for predicting the presence of bacterial infection. Thirty‐three patients had documented bacterial infections. Although with increasing body temperature the percent of patients who were infected increased, 48% of the infected elderly patients had no fever. In patients with fever, 39% had a bacterial infection compared to only 9% in the afebrile group. In patients with fever, leukocytosis, and bandemia, all patients were infected. Conversely, in the absence of fever, leukocytosis, and bandemia, only 6% had bacterial infection.All elderly patients who present with an acute or subacute change in health status or functional capabilities associated with fever, leukocytosis, or bandemia should be carefully assessed for the high probability of a bacterial infection.
Assessing Treatment Decision‐Making Capacity in Elderly Nursing Home Residents
Authors: Fitten L. Jaime , Lusky Richard , Hamann Claus 
Published: April 2015

Clinicians usually employ indirect measures of cognitive and physical function in order to assess medical decision‐making capacity. We tested a reference group of well elderly (Mini‐Mental State Exam [MMSE] score = 29.1 ± 0.8, mean ± SD), for their understanding of three increasingly complex, hypothetical treatment situations or “vignettes”—use of a hypnotic, need for thoracocentesis, and desire for CPR. From this, we have developed a more direct, Guttman‐like assessment of decision‐making capacity. Of 51 Veterans Affairs nursing home residents (MMSE score = 22.4 ± 6.9), only 33.3% demonstrated intact decision‐making capacity by this method, whereas 77% were felt by their primary physicians to be capable of giving consent for oral surgery; 37.3% had very impaired decision‐making capacity; and 29.4% were intermediate in this ability.Judged against our more direct assessment of decision‐making capacity, primary physicians' judgment of capacity for consent was 31% to 39% sensitive in identifying impaired decision‐making and the MMSE was 53% to 63% sensitive. These measures were 100% and 82% to 83% specific in identifying intact decision‐making capacity, respectively. We conclude that (1) more directly assessed decision‐making capacity varies noticeably among elderly nursing home residents and correlates in only limited fashion with frequently used cognitive screening methods; and (2) cognitive screening tests underestimate the prevalence of impaired decision‐making capacity in this population. For informed consent and advance directives, our study suggests that decision‐making capacity should be directly, rather than indirectly, assessed.
Effects of Three Liquid Diets on Nutrition‐Sensitive Plasma Proteins of Tube‐Fed Elderly Men
Authors: Feller Axel G. , Caindec Norma , Rudman Inge W. , Rudman Daniel 
Published: April 2015

The effects on three nutrition‐sensitive plasma proteins of isocaloric feedings with three enteral formulas were compared in 10 tube‐fed male nursing home residents. The enteral products were Isocal (based on whole protein), Peptamen (based on a mixture of oligopeptides), and Vivonex T.E.N. (based on free amino acids). The nutrition‐sensitive plasma proteins were albumin, transferrin, and retinol‐binding protein. After observation during four weeks of feeding with Isocal, each subject was then monitored during four weeks of Peptamen and four weeks of Vivonex T.E.N. The latter two products were alternated in a crossover design.The shift of Isocal to Peptamen did not significantly (P > .05) influence the serum level of albumin, transferrin, or retinol‐binding protein. In contrast, the shift of Isocal to Vivonex T.E.N. or of Peptamen to Vivonex caused a significant (P < .05) decline in all three plasma proteins, the kinetics of their reductions corresponding to their known half‐lives.The behavior of the three nutrition‐sensitive plasma proteins suggests that in elderly nursing home men without gastrointestinal disease the nutritional value of the protein component of the three formulas follows the order Isocal = Peptamen > Vivonex T.E.N. However, this conclusion will require confirmation by nitrogen balance studies.
Cognitive Impairment and Length of Hospital Stay in Older Persons
Authors: Binder Ellen F. , Robins Lee N. 
Published: April 2015

We looked at performance on the Folstein Mini‐Mental State Exam (MMSE) as a predictor of hospitalization and length of stay in the coming year in community‐dwelling older persons from the National Institute of Mental Health Epidemiologic Catchment Area program. They had been assessed with the MMSE at the outset and were reevaluated with the MMSE and a Health Services Questionnaire 1 year later. Subjects were more likely to be hospitalized in the subsequent year if they were older than 75 years or if they scored poorly on the MMSE. Severe cognitive impairment increased the risk more than mild impairment. Multivariate analyses that controlled for demographic variables demonstrate that MMSE performance is a significant predictor of any subsequent hospitalization (medical or psychiatric) among whites and among those at both high and low educational levels. This effect was not explained solely by the increased rate of psychiatric hospitalizations. We also determined that a decline in MMSE score over 1 year was associated with an increased risk of hospitalization, more hospital days, longer average length of stay, and a prolonged (> 20 days) hospital stay.We conclude that both initial poor performance on the MMSE and deterioration increase the risk of hospital use and lead to more extended hospital stays. However, even with poor MMSE performance, most older persons remain out of the hospital and most of those hospitalized do not have prolonged stays; thus, MMSE score alone is insufficient as a predictor of impending hospitalization. Further studies are needed to add other measures of risk for hospitalization and prolonged hospital stays.
Pygmalion in the Nursing Home The Effects of Caregiver Expectations on Patient Outcomes
Authors: Learman Lee A. , Avorn Jerry , Everitt Daniel E. , Rosenthal Robert 
Published: April 2015

Several characteristics of nursing home care can diminish rather than enhance the clinical status of older residents. In view of evidence from other settings that “interpersonal expectancy effects” can influence outcomes in a variety of relations, we conducted a randomized controlled trial to test the effects of caregiver expectations on the clinical status of nursing home residents. Within 2 weeks of admission, 63 older residents at six nursing homes were given a comprehensive assessment of cognitive, functional, and emotional status. Residents were then randomly assigned to a “high‐expectancy” or “average‐expectancy” condition. Nurses and aides were told that, in comparison with other residents having similar problems, residents in the high‐expectancy group were predicted to perform above average in their rehabilitation. The assessment was repeated 3 months later; information on the health and psychosocial status of residents was drawn from their medical records covering the same period.Aides reported having higher expectations for treatment group residents. When assessed by a blinded research assistant, residents in the high‐expectancy group experienced greater relief of depressive symptoms but showed greater decrements in functional independence in comparison with control residents. Treatment group residents were admitted significantly less frequently to hospitals despite a comparable number of emergency ward visits, suggesting a lower incidence of severe illness despite comparable medical surveillance. There was also a trend toward improved performance in mental status testing among the high‐expectancy residents compared with controls (P = .08). Additional research is needed to define further the magnitude and mechanisms of expectancy effects in relations between nursing home caregivers and residents.
Availability of Knowledgeable Informants for a Psychological Autopsy Study of Suicides Committed by Elderly People
Authors: Younger Susan C , Clark David C. , Oehmig‐Lindroth Ruth , Stein Robert J. 
Published: April 2015

Psychological autopsy methodology has not been applied in studies of elderly suicides, despite the fact that the elderly are associated with a higher rate of suicide than any other age group. One school of thought argues that older adults who die by suicide are socially isolated and/or estranged for a long period of time before death, so that knowledgeable informants are difficult or impossible to obtain. In the present retrospective study we examine the number and availability of knowledgeable informants for 145 older people who committed suicide. We believe that the ability to access several motivated informants per case is essential to any psychological autopsy study by modern standards.The stereotype of the “average expectable” elderly suicide victim as socially isolated and living alone or in an institutional setting was not supported by our findings; an unexpectedly high percentage of subjects were married at the time of their death. There was at least one knowledgeable informant in 90% of cases and two or more in almost 50%. In 46%, the subject had expressed despondency over illness. In a prospective study involving interviews with informants for eight subjects, all eight had at least two knowledgeable and willing informants. Two cases of the eight are presented to illustrate the role of delirium and an ominous diagnosis (cancer) as causes of suicide. We conclude that it is feasible to do a psychological autopsy study of elderly suicides.
What Practicing Physicians in North Carolina Rate as Their Most Challenging Geriatric Medicine Concerns
Authors: Williams Mark E. , Connolly Nancy K. 
Published: April 2015

We recently surveyed a random sample of 500 physicians in family practice, general practice, and internal medicine in North Carolina, to discover their most challenging geriatric concerns. Using a three‐stage survey technique, respondents were asked to answer two open‐ended questions about the most challenging geriatric problems they face and what specific geriatric content areas would attract their participation in an educational program. They were then asked to rank 34 topics on which they would like more information.A total of 242 responses were received for a 55% response rate (63 of the 500 were undeliverable). Responses indicated that physicians are more concerned with management than diagnosis and revealed considerable evidence of empathy and concern. The top three topics had to do with the management of dementia, multiple problems, and depression. Approximately 25% of physicians consider problems of financing health care as among the most challenging problems.
A Questionnaire Investigation of Anxiety and Depression in Early Dementia
Authors: Wands Kim , Merskey Harold , Hachinski Vladimir C. , Fisman Michael , Fox Hannah , Boniferro Mary 
Published: April 2015

We report findings on a study of anxiety and depression by questionnaire in 50 patients with mild dementia and 134 control subjects using the Hospital Anxiety and Depression Scale. Thirty‐eight percent of patients and 9% of controls had a possible or probable diagnosis of an anxiety disorder. Possible or probable depression was found in 28% of the patients and 3% of the controls. These rates for the patients were above those in normal populations.All patients and control subjects were tested with the Extended Scale for Dementia (ESD). Neither group showed a significant relationship between depression and ESD scores. In the control subjects there was a negative correlation (P < .006) between anxiety and cognitive scores, one that was not found in the patients.
The Case of Ms. Nancy Cruzan and the Care of the Elderly
Authors: Glover Jacqueline J. 
Published: April 2015

The case of Ms. Nancy Cruzan is the first so‐called “right to die” case to be heard by the US Supreme Court. The Missouri Supreme Court had ruled that Ms. Cruzan's parents, who are also her court‐appointed guardians, cannot authorize the withdrawal of artificial hydration and nutrition from their daughter. Ms. Cruzan has been in a persistent vegetative state since an auto accident more than six years ago. Even though Ms. Cruzan is only 32 years old, the decision in her case will have serious implications for care of the elderly.Key features of the Missouri Supreme Court decision include their claims that (1) the authority for surrogate decision‐making flows from the parens patriae power of the State rather than from the authority of the incompetent person, (2) the State has an unqualified interest in the preservation of life, and (3) the medical provision of nutrition and hydration ought to be considered differently than other forms of medical treatment. Such claims are at considerable variance from accepted standards of ethically defensible decision‐making that focus on the well‐being of the patient understood according to the patient's own values and life goals.If the US Supreme Court restricts decisions to forgo life‐sustaining treatment according to patient prognosis, capacity for decision‐making, type of treatment, or state of residence, then a patient‐centered standard of medical decision‐making will be impossible to sustain and the maximization of life extension will be required without regard to the suffering thereby imposed.