bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Regular Multidisciplinary Team Interventions on Psychotropic Prescribing in Swedish Nursing Homes
Authors: Schmidt Ingrid , B. Claesson Cecilia , Westerholm Barbro , Nilsson Lars G. , Svarstad Bonnie L. 
Published: April 2015

OBJECTIVE: To evaluate the impact of regular multidisciplinary team interventions on the quantity and quality of psychotropic drug prescribing in Swedish nursing homes.DESIGN: A randomized controlled trial.SETTING: A sample of 33 nursing homes: 15 experimental homes and 18 control homes representing 5% of all Swedish nursing homes.PARTICIPANTS: The sample consisted of 1854 long‐term care residents with an average age of 83 years. Seventy percent of the residents were women, and 42% had a documented diagnosis of dementia. An additional 5% had a psychotic disorder, and 7% had a diagnosis of depression.INTERVENTION: Experimental homes participated in an outreach program that was designed to influence drug use through improved teamwork among physicians, pharmacists, nurses, and nurses' assistants. Multidisciplinary team meetings were held on a regular basis throughout the 12‐month study period.MEASUREMENTS: Lists of each resident's prescriptions were collected 1 month before and 1 month after the 12‐month intervention. Measures included the proportion of residents with any psychotropic drug, polymedicine, and therapeutic duplication and proportion of residents with nonrecommended and acceptable drugs in each psychotropic drug class, as defined by current Swedish guidelines.RESULTS: Baseline results show extensive psychotropic drug prescribing, with the most commonly prescribed drugs being hypnotics (40%), anxiolytics(40%), and antipsychotics (38%). After 12 months of team meetings in the experimental homes, there was a significant decrease in the prescribing of psychotics (‐19%), benzodiazepine hypnotics (‐37%), and antidepressants (‐59%). Orders for more acceptable antidepressants also increased in the experimental homes. In the control homes there was increased use of acceptable antidepressants, but there were no significant reductions in other drug classes.CONCLUSIONS: There is excessive prescription of psychotropic drugs in Swedish nursing homes. Improved teamwork among caregivers can improve prescribing as defined by clinical guidelines.
Relation of Colonic Transit to Functional Bowel Disease in Older People: A Population‐Based Study
Authors: Evans Jonathan M. , Fleming Kevin C. , Talley Nicholas J. , Schleck Cathy D. , Zinsmeister Alan R. , Melton L Joseph 
Published: April 2015

OBJECTIVE: The pathophysiology underlying chronic constipation in older people is poorly understood. Our objective was to determine if functional bowel disease (particularly constipation) in this population is associated with risk factors (age, immobility, low dietary fiber intake, and medication use) or directly with slow colonic transit.METHODS: A previously validated questionnaire was administered to a random sample of older residents (age range 65–104 years, n = 1609) of Olmsted County, MN. A random subset who met standard diagnostic criteria for functional constipation (n = 52) or irritable bowel syndrome (IBS) (n = 55) and a group without gastrointestinal symptoms (n = 93) were selected for further study. Each subject underwent structured interview and physical examination. Total caloric and fiber intake were assessed by dietitian interview, a food frequency questionnaire, and a food diary. Physical activity was assessed using a previously validated instrument. Medication use was determined by self‐report, physician interview, and review of medical records. Total and segmental colonic transit was assessed radiographically using radio‐opaque markers.RESULTS: Total colonic transit times were prolonged in subjects with functional constipation (median 50.4 hours) but not in subjects with IBS (median 34.2 hours) or in healthy controls (median 28.8 hours); however, only rectosigmoid transit was delayed significantly. Age, gender, physical activity, and dietary fiber intake were not associated with total transit times, nor could they discriminate among the three patient groups. Laxative use was associated with prolonged total transit times independent of patient group.CONCLUSIONS: Older subjects can be classified by abdominal pain and bowel symptoms, which reflect colonic transit times. Older subjects with constipation symptoms generally have prolonged rectosigmoid transit. Other potential risk factors do not distinguish symptom subgroups, nor are they associated with altered colonic transit although older people who use laxatives regularly have prolonged colonic transit.
Assessment of Insulin Sensitivity in Older Adults Using the Hyperglycemic Clamp Technique
Authors: Meneilly Graydon S. , Elliott Thomas 
Published: April 2015

OBJECTIVE: The euglycemic glucose clamp technique is the gold standard for the measurement of insulin sensitivity in older adults, whereas the hyperglycemic glucose clamp technique is used to assess insulin release. The objective of this study was to evaluate the ability of the hyperglycemic glucose clamp technique to assess insulin sensitivity and insulin release in older people.RESEARCH DESIGN AND METHODS: Healthy older controls (n = 26, age 72 ± 1) and older non‐insulin‐dependent diabetes mellitus (NIDDM) patients (n = 35, age 75 ± 1) underwent a 2‐hour hyperglycemic glucose clamp study (glucose 5.4 mM above basal) and a 3‐hour euglycemic clamp study (insulin infusion rate 40 mU/m2/min). The average glucose infusion rate (last 30 minutes) of each clamp was divided by the average insulin value (last 30 minutes). This value was then divided by the average plasma glucose value to give glucose clearance per plasma insulin concentration.RESULTS: In control subjects (Eug: 0.80 ± .05 mL/kg/min/pM; Hyper: 0.88 ± .07 mL/kg/min/pM, P = .357) and NIDDM patients (Eug: 0.48 ± .03 mL/kg/min/pM; Hyper: 0.42 ± .03 mL/kg/min/pM, P = .162), glucose clearance values were similar whether calculated from the euglycemic or the hyperglycemic clamp. The correlation between glucose clearance values derived from the euglycemic and hyperglycemic clamp was excellent in normal controls (r = .76, P < .001) and patients with NIDDM (r = .71, P < .001).CONCLUSIONS: We conclude that the hyperglycemic glucose clamp technique can reliably assess both insulin release and insulin sensitivity in older people.
Pharmacologic Treatment of Geriatric Depression: Key Issues in Interpreting the Evidence
Authors: Rigler Sally K. , Studenski Stephanie , Duncan Pamela W. 
Published: April 2015

OBJECTIVE: A framework for critical appraisal of antidepressant trial literature involving geriatric subjects is presented. Among older adults, treatment decisions are complicated by comorbid medical and cognitive illness, the variable course of recovery, and the overlap of depressive symptoms with other disease symptoms. Consumers of the literature on competing antidepressant therapies for older adults must consider disease and population‐specific outcome assessment issues.DESIGN: An appraisal guide, adapted for geriatric depression, is developed from literature on methodological challenges of outcome assessment and published clinical trials comparing competing antidepressant therapies in older subjects.CONCLUSIONS: The clinical utility of pharmacologic treatment of depression can be difficult to assess because depression scales in current use provide an important but limited perspective on treatment outcome and because the scales vary in actual content and ability to detect change. The use of indicators of function, independence, and self‐perceived well‐being as outcomes offers additional patient relevance and should be included. Key considerations involve (1) general characteristics: whether the depression outcome measure is valid and reproducible for the aged population under study, whether the outcome measure is sensitive to treatment‐related change, and whether the time‐frame of outcome assessment is appropriate for the treatment goal; (2) cognitive impairment: how subjects with dementia are assessed, and whether the impact of the intervention on caregivers and healthcare systems is considered as a relevant outcome; (3) pharmacologic issues: whether the comparator agent is a reasonable usual‐care standard in the older adult and whether ascertainment for adverse effects is similar for all agents under study; and (4) broader general health status issues: whether functional or quality of life measures are used as outcome indicators.
Association of Dehydroepiandrosterone Sulfate, Body Composition, and Physical Fitness in Independent Community‐Dwelling Older Men and Women
Authors: Abbasi Adil , Duthie Edmund H. , Sheldahl Lois , Wilson Charles , Sasse Edward , Rudman Inge , Mattson Dale E. 
Published: April 2015

OBJECTIVES: To determine the association of dehydroepiandrosterone sulfate (DHEAS), body composition, and physical fitness in independent community‐dwelling men and women aged 60 to 80 years.DESIGN: Cross sectional analysis.PARTICIPANTS: Independent men and women, 60 years of age and older, living in urban and suburban communities of Southeastern Wisconsin.MEASUREMENTS: History, physical examination, physical activity level, and anthropometrics were measured for every subject. Total adipose mass (TAM) and lean body mass were measured using dual energy X‐ray absorptiometry. Dehydroepiandrosterone sulfate, insulin‐like growth factor‐1 (IGF‐1), total testosterone (TT), and free testosterone (FT) were measured using radioimmunoassay. Physical fitness was measured as V̇O2max using exercise stress tests. Blood for lipids was analyzed using standard assays.RESULTS: In men, the DHEAS was significantly correlated to age (r = ‐.32), TAM (r = ‐.27), percent fat (r = ‐.30), HDL cholesterol (r = .34), TT (r = .30), V̇O2max (r = .23), and percent lean body mass (% LBM) (r = .33). In women, the DHEAS was not significantly correlated to any of the variables examined except body mass index (BMI) (r = .23). In men, after partialling out age, DHEAS was significantly correlated to HDL, % fat, TAM, % LBM, and TT. Multivariate analysis for men revealed that high density lipoprotein cholesterol (HDL) was the strongest predictor of serum DHEAS level, followed by % LBM, BMI, and age. The men in the highest quartile of serum DHEAS levels were different from those in the lowest quartile in terms of age, TT, FT, % fat, TAM, % LBM, HDL, and low density lipoprotein (LDL) cholesterol level. No such differences were found in the two groups of women.CONCLUSION: In this group of independent community‐dwelling older men, several factors were found to be associated with the serum DHEAS concentration, whereas in a group of older women, no such associations were identified with the exception of BMI. Men in the highest quartile of serum DHEAS level, compared with those with a serum DHEAS level in the lowest quartile, were younger, leaner, more fit, had higher TT and FT levels, and had a favorable lipid profile. No such differences were identified between the women in the highest and the lowest quartiles of serum DHEAS level.
Barriers to Obtaining Consent in Dementia Research: Implications for Surrogate Decision‐Making
Authors: Baskin Shari A. , Morris Jane , Ahronheim Judith C. , Meier Diane E. , Morrison R. Sean 
Published: April 2015

OBJECTIVE: To identify barriers to informed consent in research involving subjects with advanced dementia.DESIGN: A randomized controlled clinical trial of palliative care approaches, compared with usual care, in subjects with advanced dementia who are hospitalized.SETTING: A large metropolitan teaching hospital.PARTICIPANTS: All patients older than 65 years of age who have advanced dementia and a Functional Assessment Staging score of 6d to 7f and have been admitted to the hospital.MEASUREMENTS: Surrogates for all eligible subjects were approached for consent to enroll their family members in the trial. Reasons for refusal to enroll in the study were recorded and categorized as either informed refusal (i.e., the surrogate understood the research protocol but declined to give consent for participation) or as a barrier to informed consent (i.e., the surrogates could not participate in the informed consent process or there was no functional surrogate).RESULTS: Forty‐nine percent of 146 eligible subjects could not be enrolled in the study. Only four surrogates refused consent for their family members. Of the remaining 68 patients, 41 eligible subjects' surrogates could not be engaged in the informed consent process, and 22 subjects did not have a functional surrogate to consent for research.CONCLUSIONS: Absence of functional surrogate decision‐makers is a major barrier to research and clinical decision‐making for hospitalized patients with advanced dementia.
A Preliminary Assessment of the Medical and Functional Factors Associated with Vehicle Crashes by Older Adults
Authors: Sims Richard V. , Owsley Cynthia , Allman Richard M. , Ball Karlene , Smoot Tonya M. 
Published: April 2015

OBJECTIVES: To examine associations between medical and functional variables and at‐fault car crashes in a cohort of older drivers.DESIGN: A case‐control study.SETTING: A tertiary care medical center.PARTICIPANTS: Older drivers (ages 55–90 years) residing in Jefferson County, Alabama (n = 174). Cases were drivers who had at least one at‐fault crash in the previous 6 years; controls were crash‐free during the same period.MEASUREMENTS: Self‐reported medical conditions, reported and observed functional measures, and urinary drug screens. The occurrence of one or more at‐fault car crashes in the 6 years preceding the 1991 assessment date represented the outcome measure.RESULTS: Ninety‐nine older drivers experienced between one and seven at‐fault vehicle crashes during the period 1985 through 1991, whereas 75 drivers did not. Logistic regression models indicated that the following variables were independently associated with crash involvement: A 40% or greater reduction in the useful field of view (OR = 6.1; 95% CI, 2.9 to 12.7; P < 0.001), black race (OR = 6.6; 95% CI, 1.7 to 26.2; P = .007), a history of falling in the previous 2 years (OR = 2.6; CI, 1.1 to 6.1; P = .025), and not taking a beta‐blocking drug (OR = 4.3; CI, 1.2 to 15.0; P = .023).CONCLUSIONS: Functional assessments, such as a comprehensive test of visual processing, a falls history, and a review of current medications may be of greater relevance than specific medical conditions in the identification of older at‐risk drivers. If prospective studies determine that falling and crashing share risk factors, a unified approach to the prevention of these mobility disorders could result. The finding of an independent association of black race with at‐fault crashing is in need of further clarification because of the low representation of black drivers in this sample. J Am Geriatr Soc 46:556–561, 1998.
Development of a Test Battery to Identify Older Drivers at Risk for Self‐Reported Adverse Driving Events
Authors: Marottoli Richard A. , Richardson Emily D. , Stowe Meredith H. , Miller Eydie G. , Brass Lawrence M. , Cooney Leo M. , Tinetti Mary E. 
Published: April 2015

OBJECTIVES: The purposes of this study were (1) to develop a battery of tests that assessed a wide range of functional abilities relevant to driving yet could be performed in a clinician's office and (2) to determine which of these tests were most closely associated with self‐reported adverse driving events.DESIGN: A cohort study.SETTING: An urban community.PARTICIPANTS: Participants were drawn from the Project Safety cohort, a probability sample of noninstitutionalized older persons in New Haven, Connecticut, initiated in 1989. The current study included surviving, active drivers in the cohort (N= 125).MEASURES: The test battery assessed visual, cognitive, and physical abilities potentially relevant to driving, and was administered in participants' homes by trained interviewers between October 1994 and July 1995. Outcome measures included the self‐report of a crash, moving violation, or being stopped by police in any Project Safety interview since the inception of the cohort. Analyses compared performance on the elements of the test battery with participants' histories of adverse driving events.RESULTS: Of the 125 drivers, 50 (40%) had reported an adverse event in a mean period of 5.76 (±.25) years before the current interview. The elements of the test battery independently associated with a history of events, adjusting for driving frequency, included near visual acuity worse than 20/40 (adjusted odds ratio 11.90), limited neck rotation (OR 6.10), and poor performance on a test of visual attention, the number cancellation task (OR 3.00). The resulting regression equation yielded a sensitivity of 80%, a specificity of 55%, and an area under the curve of .75 by receiver operating characteristic analysis.CONCLUSION: These findings suggest it may be possible to identify individuals potentially at risk for self‐reported adverse driving events using simple tests of functional ability. If validated, such an approach could be used to identify individuals who need a more detailed assessment of functional abilities to determine the severity and etiology of impairments, and their effect on driving performance, as well as possible interventions to correct or compensate for the impairments. J Am Geriatr Soc 46:562–568, 1998.
Relation Between Intellectual Dysfunctioning and Mortality in Community‐Residing Older People
Authors: Nakanishi Noriyuki , Tatara Kozo , Ikeda Kazunori , Hino Youichi , Yamada Atsuhiro , Nishioka Chisato 
Published: April 2015

OBJECTIVE: To examine the relationship between intellectual dysfunctioning and mortality in a community‐residing older population.DESIGN: Of the 1473 randomly selected people aged 65 years and older living in Settsu, Osaka Prefecture, in October 1992, 1405 were contacted. Data for assessment of intellectual dysfunctioning were obtained from 1383 people (98.4%), who constituted the study cohort. Follow‐up for 42 months was completed for 1300 subjects (94.0%; 1117 living, 183 deceased).MEASURES: Data on general health status, history of health management, psychosocial conditions, and intellectual dysfunctioning were collected by means of interviews during home visits at the time of enrollment. Intellectual dysfunctioning was determined with the assessment instrument developed by the Social Survey Division of the Office of Population Censuses (OPCS) in Great Britain.RESULTS: The Kaplan‐Meier analysis indicated that the estimated survival rates for men and women decreased with a decline in intellectual function in two age groups: 65 to 74 and 75 years and older. For both sexes, the log rank test showed that the curves among the four groups based on intellectual dysfunctioning (intact, mild, moderate, and severe) achieved statistical significance for the age group of 75 years and older. For both age groups and each of the levels of intellectual dysfunctioning, the estimated survival rate for men was lower than that for women.Application of the Cox proportional hazards model resulted in unadjusted hazard ratios of mild, moderate, and severe intellectual dysfunctioning for mortality of 1.68, 2.44, and 5.37, respectively. Multivariate analysis on the other hand, yielded adjusted hazard ratios of mild, moderate, and severe intellectual dysfunctioning of 1.19, 1.12, and 1.74, respectively, leaving severe dysfunctioning as the only statistically significant factor associated with mortality. Other factors such as sex, age, general health status, history of management, and psychosocial conditions were controlled.CONCLUSION: Intellectual dysfunctioning, as measured by an assessment instrument developed by OPCS, represents an increased risk factor for mortality among community‐residing older people. J Am Geriatr Soc 46:583–589, 1998.
Executive Cognitive Abilities and Functional Status Among Community‐Dwelling Older Persons in the San Luis Valley Health and Aging Study
Authors: Grigsby Jim , Kaye Kathryn , Baxter Judith , Shetterly Susan M. , Hamman Richard F. 
Published: April 2015

OBJECTIVES: The purpose of this study was to evaluate the contribution of the executive cognitive functions to self‐reported and observed performance of activities of daily living and instrumental activities of daily living.DESIGN: These data were collected as part of a cross‐sectional survey of community‐dwelling older persons, using statistical sampling, in a two‐county area of southern Colorado.SETTING: Participants were interviewed and administered measures of general cognition, depression, executive functioning, and performance of self‐care and instrumental activities, either in their homes or at the study clinic.PARTICIPANTS: A total of 1158 community‐dwelling persons between the ages of 60 and 99 participated. Of these, 657 were female, 501 were male, 637 were Hispanic, and 521 were non‐Hispanic whites.MEASUREMENTS: Subjects were administered the Mini‐Mental State Exam (MMSE), a measure of executive functioning (the Behavioral Dyscontrol Scale), the Center for Epidemiologic Studies Depression scale (CES‐D), and the Structured Assessment of Independent Living Skills (SAILS, a measure of observed performance of daily tasks). They also were interviewed regarding their reported ADL and IADL status using measures from the Longitudinal Study on Aging.RESULTS: Both general mental status and executive functioning demonstrated statistically significant univariate associations with all seven functional status measures (both self‐report and observed performance). In a series of ordinary least squares regression models, executive functioning was a predictor for self‐reported ADLs and observed performance of complex IADL tasks such as managing money and medications. Mental status did not predict self‐reported functioning but was a predictor of observed performance. Depression was a significant variable for self‐report measures but not for observed performance. Executive functioning and general mental status demonstrated some degree of independence from one another.CONCLUSION: Executive functioning is an important determinant of functional status for both self‐reported and observed ADLs and IADLs and should be assessed routinely when evaluating the mental status and functional abilities of older people. These results replicate and extend previous research on executive functioning among older persons by examining these factors in a large bi‐ethnic community sample. J Am Geriatr Soc 46:590–596, 1998.