bluuebunny/crossref_metadata_2025_split huggingface dataset:
When Older Adults Face the Chair‐Rise Challenge: A Study of Chair Height Availability and Height‐Modified Chair‐Rise Performance in the Elderly
Authors: Weiner Debra K. , Long Rebecca , Hughes Michael A. , Chandler Julie , Studenski Stephanie 
Published: April 2015

Objective: Define the range of community seating heights available for use by older adults; test whether raising chair height by small increments facilitates chair‐rise performance; and heighten physician and furniture industry awareness of discrepancies that may exist between actual and acceptable chair heights for older adults.Design: Phase 1: Survey of commercially available chair heights. Phase 2: Cross‐sectional descriptive study of chair‐rise ability.Setting: Phase 1: Local furniture stores, physician offices, hospital waiting areas, and nursing homes. Phase 2: Postural Control Lab.Participants: Twenty‐two volunteers (nursing home residents and community dwellers). Exclusion criteria: inability to stand independently and inability to bear full weight on the lower extremities in the standing position.Measurements: Chair rise success at six heights (17–22 inches), self‐reported difficulty (visual analogue scale), change in minimum hip angle and maximum shoulder angle during rise, using motion analysis.Results: Phase 1: Community chair heights ranged from 12 to 18 inches, with a mean of 16.3 in physician offices, 16.6 in nursing homes, 16.4 in hospitals, 17.3 in “kitchens” and 15 in “living rooms.” Phase 2: As chair height increased from 17 to 22 inches, chair rise effort decreased, as shown by near doubling of percent successful rises, decline in mean self‐reported difficulty score, increase in mean minimum hip angle, and decrease in mean maximum shoulder angle.Conclusions: Seating height may need to be more closely scrutinized in areas frequented by frail elders. Augmentation of seat height by small increments facilitates chair rise performance.
Transcranial Doppler Assessment of the Cerebral Circulation during Postprandial Hypotension in the Elderly
Authors: Krajewski Adam , Freeman Roy , Ruthazer Robin , Kelley Margaret , Lipsitz Lewis A. 
Published: April 2015

Objective: The aim of the present study was to evaluate whether alterations in postprandial hemodynamics in the elderly were associated with changes in cerebral perfusion assessed by transcranial Doppler ultrasonography.Design: Time series, ie, post‐intervention compared to pre‐intervention with no‐intervention controls.Participants: Ten elderly institutionalized subjects (4 women, 6 men, mean age 84.9 years). Three subjects had a history of syncope.Setting: A 725‐bed academic long‐term care facility.Intervention: A 400‐kcal mixed meal.Measurements: Heart rate, blood pressure, and blood flow velocity in the middle cerebral artery by transcranial Doppler recording, before the test meal and at 5‐minute intervals for 60 minutes afterwards.Results: Systolic, diastolic, and mean arterial blood pressure declined significantly from baseline between 30 and 55 minutes after the meal (P < 0.05, ANOVA); however, maximum and mean blood flow velocity did not change. The pulsatility index (end diastolic to peak systolic amplitude divided by mean velocity) increased significantly (P < 0.05, ANOVA) between 30 and 55 minutes after the meal, suggesting increased arteriolar resistance. There were no significant changes in blood pressure, blood flow velocity, and pulsatility index during a control study conducted with four subjects under identical conditions but without a meal.Conclusions: The results of this study suggest a small, unexpected increase in resistance of the intracranial circulation following a meal in elderly people with postprandial hypotension. Although the clinical significance of this finding is not known, the occurrence of postprandial arteriolar vasoconstriction may lead to cerebral ischemia during periods of marked blood pressure decline.
Correction of Massive Vaginal Prolapse in an Older Population: A Four‐Year Experience at a Rural Tertiary Care Center
Authors: Kaminski Paul F. , Sorosky Joel I. , Pees Richard C. , Podczaski Edward S. 
Published: April 2015

Objective: To ascertain the success of complex reconstructive vaginal surgery in older women.Design: Retrospective review of hospital and outpatient records.Setting: Rural tertiary care referral center, Pennsylvania State University Hospital, Hershey, PennsylvaniaPatients: Twenty‐four patients referred for massive eversion of the vagina and/or complete procidentia.Measurements: Symptoms and anatomic correction of patients' complaints.Results: After surgery, 83 percent were asymptomatic without pelvic relaxation, 4 percent were asymptomatic with pelvic relaxation, 4 percent were symptomatic without pelvic relaxation, and 9 percent were symptomatic with relaxation.Conclusions: Older women can undergo major vaginal reconstructive surgery with relief of symptoms and restoration of vaginal depth and axis.
A Comparison of Hand‐Held Isometric Strength Measurement with Isokinetic Muscle Strength Measurement in the Elderly
Authors: Reed Richard L. , Den Hartog Robert , Yochum Kathleen , Pearlmutter Lori , Ruttinger A. Clark , Mooradian Arshag D. 
Published: April 2015

Objective: To compare hand‐held isometric muscle strength measurement to an isokinetic muscle strength measurement in a healthy elderly population.Design: Cross‐sectional survey.Setting: Retirement community in Southeastern Arizona.Participants: Thirty‐two volunteers (16 men and 16 women) age 60 and over (mean age 70.3 years) who were free of musculoskeletal problems and did not have significant health problems.Interventions: None.Measurements: Isometric muscle strength was determined using a hand‐held isometric strength device (Penny and Giles) for elbow flexion and extension and knee flexion and extension. Isokinetic muscle strength (average peak torque and average work per repetition) was measured on the same individuals using a Lido® isokinetic dynamometer.Results: Correlations between the strength measurement techniques were generally favorable with the lowest correlation being .72, (95 percent confidence interval .50–.86) and the highest being .85, (95 percent confidence interval .72–.93). However, there was substantial variability of hand‐held strength reading at some levels of isokinetic strength.Conclusions: Hand‐held dynamometry for strength measurement correlates strongly with measurement of strength using isokinetic dynamometry. Despite these high correlations, there is remaining variability of hand‐held muscle strength readings when compared with isokinetic strength measurement at some levels of isokinetic muscle strength. Modification of the testing methodology or instrumentation used in this study is needed to improve the consistency of these measurements.
Hospital Resources Used To Treat the Injured Elderly at North Carolina Trauma Centers
Authors: Covington Deborah L. , Maxwell J. Gary , Clancy Thomas V. 
Published: April 2015

Objective: The purpose of this paper is to compare the hospital resources used by elderly, adult, and pediatric patients treated in hospitals reporting to the North Carolina Trauma Registry (NCTR).Design: We analyzed data on all patients entered into the NCTR from 1 January 1988 to 31 December 1990.Setting: The NCTR is a statewide registry of all trauma patients admitted for at least 24 hours or dead on arrival at the eight Level I and II trauma center hospitals in North Carolina.Patients: The total number of patients included in the study was 21,214; elderly adults included those age 65 and older (n = 2808), adults included those 15 to 64 years old (n = 15,776), and pediatric patients included those 0 to 14 years old (n = 2630).Main Outcome Measures: We examined hospital resources using three measures: overall length of hospital stay in days, intensive care unit (ICU) length of stay in days for those admitted to the ICU, and total hospital charges billed during the hospitalization.Results: Controlling for injury severity, we found that elderly adults had longer mean hospital and ICU lengths of stay and higher mean hospital charges than adults or children. Whereas only 22% of injuries to elderly adults were transportation‐related, transportation injuries generated 38% of their hospital charges. Sixty‐eight percent of their injuries were caused by falls, generating total hospital charges of $17.6 million, an average of 15 days in hospital stay and 9 days in ICU stay.Conclusion: A 10% reduction in both transportation injuries and falls among the elderly could save $3.5 million in this population over 3 years.
The Use of Recombinant Interferon Alfa‐2b in Elderly Patients with Anti‐HCV‐Positive Chronic Active Hepatitis
Authors: Bresci Giampaolo , Del Corso Laura , Romanelli Anna Maria , Giuliano Gabriella , Pentimone Ferdinando 
Published: April 2015

Objective: To compare efficacy and tolerance of recombinant interferon alfa‐2b in the treatment of anti‐HCV‐positive chronic active hepatitis (CAH) in subjects aged 65 years and above with those less than 65.Design: A randomized controlled trial.Setting: Outpatients in two hospitals.Patients: 65 consecutive outpatients with anti‐HCV‐positive CAH for 1 to 30 years, having basal aminotransferase levels at least twice the normal value. Those 65 and over were randomized to an interferon group (A, n = 22) or a no‐treatment group (B, n = 22). All those under 65 received interferon (group C, n = 21).Intervention: Interferon at a dose of 3 mU 3 times a week for a 6‐month period. A normalization of serum aminotransferase levels was considered a positive response to therapy.Results: Response to therapy was positive in 62% of the treated elderly compared to 57% of the adults (P = 0.85). The two groups of responders showed a common highly significant reduction of aminostransferase (P < 0.001). Side effects were similar in elderly and young. Two untreated elderly showed spontaneous normalization of aminotransferase.Conclusion: Interferon in anti‐HCV‐positive CAH is useful in the elderly, allowing normalization of aminotransferase, improvement of the histology and remission of the disease in 62% of the cases. Side effects seem to be independent of age. Further studies are required to assess both duration of remission and usefulness of cyclic therapy in previous responders.
Calcium Homeostasis of an Elderly Population upon Admission to a Nursing Home
Authors: Komar Lindsay. , Nieves J. , Cosman F. , Rubin A. , Shen V. , Lindsay R. 
Published: April 2015

Objective: To evaluate the skeletal health, calcium, and vitamin D homeostasis of patients upon their entry to a long‐term‐care facility. Factors that could contribute to the risk of future osteoporotic fractures were also evaluated.Design: Cross‐sectional study.Patients: Two hundred eighty‐seven consecutive admissions were invited to participate; 109 patients were recruited into the study.Measurements: A high prevalence of low to low‐normal circulating levels of 25(OH)D was found in nursing home residents upon their admission to the nursing home, with 86% of the patients having circulating 25(OH)D levels of less than 50 nmol/L and 41% having levels below 25 nmol/L. Frankly elevated parathyroid hormone levels were found in 16% of the patients. Additionally, alkaline phosphatase and osteocalcin levels were elevated in 23% and 13% of the patients, respectively. Bone mineral measurements were in the osteoporotic range for 85% of the nursing home residents. Bone density results for females with a history of any classic osteoporotic fracture were significantly lower than for those with no fracture history (68.5 arbitrary units (AU) for those with no fracture history, 58.8 AU in those with history of hip fracture; P < 0.05). The bone mineral measurements were higher in women with adequate 25(OH)D compared with women with deficient or borderline 25(OH)D with and without fracture history. Levels of 25(OH)D were positively correlated with urine calcium/creatinine (r = .24; P = 0.03) and 1,25(OH)2D (r = .28; P = 0.01) and were negatively correlated with 1–84 PTH (r = ‐.24; P = 0.02).Conclusion: Hypovitaminosis D is prevalent among elderly patients entering a nursing home with secondary hyperparathyroidism and apparently increased bone turnover present in patients with circulating 25(OH)D levels below 50 nmol/L. Bone density measurements showed that a majority of the individuals entering a nursing home are osteoporotic. There is a positive association between 25(OH)D levels and bone mass and a negative association between 25(OH)D levels and a history of fracture.
Serum Fructosamine as a Screening Test for Diabetes in the Elderly: A Pilot Study
Authors: Cefalu William T. , Ettinger Walter H. , Bell‐Farrow Audrey D. , Rushing Julia T. 
Published: April 2015

Objective: To determine the value of serum glycated protein, measured as serum fructosamine, as a screening test for diabetes in the elderly.Design: Cross‐sectional pilot study.Setting: Ambulatory research clinic in university setting.Patients: One hundred fifty‐seven consecutive community‐dwelling participants in the Cardiovascular Health Study, average age 71.8 + 5 (mean ± SD, range 65–88 years).Measurements: Serum fructosamine levels (first and second generation assay) were obtained. All subjects who did not have a diagnosis of diabetes were given a 75‐g glucose tolerance test (GTT).Results: Twenty‐six subjects (17%) (10 previously diagnosed, 16 undiagnosed and asymptomatic) had diabetes mellitus, and 38 subjects (24%) had impaired glucose tolerance by history or by the GTT (WHO criteria). Only the 16 asymptomatic diabetics were included in the analysis for the pilot study. There was a significant difference in the fasting fructosamine level between non‐diabetics and asymptomatic diabetics for the first generation (2.06 ± .21 vs 2.53 ± .49 mMol/L, P < 0.0015) and second generation assay (221 ± 27 vs 269 ± 48 μMol/L, P < 0.0012). Receiver operator curves were constructed to evaluate the test characteristics of serum fructosamine. Using a point of ≥2.3 mMol/L for the first‐generation assay, the sensitivity to detect asymptomatic diabetes was 75%, specificity 83%, and positive predictive value 35%. To detect both diabetes and impaired glucose tolerance using a cutpoint of ≥2.3 mMol/L, the sensitivity was 24%, specificity 95%, and positive predictive value 68%. Employing a cut point of 250 μMol/L for the second generation assay, the sensitivity to detect diabetes was 81%, specificity 87%, and positive predictive value 43%. However, to detect diabetes and glucose intolerance using the second generation assay, the sensitivity was 39% and specificity was 86%.Conclusion: This study demonstrated that a single measurement of either first or second generation fructosamine showed promise as a screening test for diabetes, but not impaired glucose tolerance, in older people.
Serum Erythropoietin Levels in Elderly Inpatients with Anemia of Chronic Disorders and Iron Deficiency Anemia
Authors: Joosten E. , Van Hove L. , Lesaffre E. , Goossens W. , Dereymaeker L. , Van Goethem G. , Pelemans W. 
Published: April 2015

Objective: To analyze the relationship between serum erythropoietin levels and hemoglobin levels in elderly patients with anemia of chronic disorders related to cancer or acute infection when compared with anemic patients with iron deficiency.Design: Prospective survey with comparison groups.Setting: Tertiary care center.Patients: An elderly group aged 70 and above (mean 84, range 70–96) was divided into subgroups of 45 with anemia of chronic disorders (23 with cancer and 22 with acute infection), 24 with iron‐deficiency anemia, and 27 with no anemia. Thirty non‐anemic younger adults were also studied.Measurements: Serum erythropoietin (radioimmunoassay), complete blood count, serum iron, B12, folate and ferritin, liver and kidney function tests, blood gas analyses, and bacteriological and radiological tests.Results: The serum erythropoietin levels were significantly lower in the elderly non‐anemic hospitalized group than in the healthy younger group. A significant negative relationship between the log serum erythropoietin and hemoglobin levels was found in patients with iron deficiency, but not in the other groups. For any given hemoglobin level, the response of erythropoietin was significantly higher in anemic patients with iron deficiency when compared with the neoplastic and infectious group.Conclusion: Erythropoietin response to anemia is blunted in elderly patients with anemia of chronic disorders related to cancer or acute infection. Erythropoietin level is lower in non‐anemic elderly inpatients than in healthy younger persons.
Depression and Smoking Cessation in Older Adults: A Longitudinal Study
Authors: Salive Marcel E. , Blazer Dan G. 
Published: April 2015

Objective: To explore the relationship of smoking cessation and depression.Design: Cohort study with 3 years of follow‐up.Setting: North Carolina community of the Established Populations for the Epidemiologic Studies of the Elderly.Participants: Stratified cluster sample of adults age 65 years and older, with an oversampling of African Americans.Main Measures: Depressive symptoms using a modified Center for Epidemiologic Studies Depression (CES‐D) scale; smoking cessation using change in self‐reported smoking.Results: Current smokers had the highest prevalence of clinically significant CES‐D scores (11.2%), followed by never smokers (9.6%) and former smokers (7.1%). After 3 years, 128 (25%) of 511 baseline current smokers had quit. Among women with a clinically significant CES‐D score, 55% quit smoking, compared with only 25% among those with a normal score (P < 0.05). Depressive symptoms were significantly associated with nearly fourfold increased odds of smoking cessation among women (relative odds [RO] 3.7, 95% confidence interval [CI] 1.2, 11.0; P < 0.05), but not among men (RO 0.6, 95% CI 0.2, 2.0, not significant), after adjusting for potential confounding.Conclusions: Depressive symptoms may directly increase the likelihood of smoking cessation among older women. When predicting smoking cessation, depression and gender should be considered in combination since to consider them separately may be misleading. This challenges prior reports that depressed smokers are less likely to quit smoking than non‐depressed smokers.
Adverse Events Related to Drugs and Drug Withdrawal in Nursing Home Residents
Authors: Cerety Meghan B. , Cornell John E. , Plichta Denise T. , Eimer Michelle 
Published: April 2015

Objective: To (1) develop and standardize explicit criteria to link clinical adverse events to drug withdrawal, (2) determine the incidence and severity of Adverse Drug Events (ADEs) and Adverse Drug Withdrawal Events (ADWEs) in a nursing home population, and (3) establish the contribution of demographic, clinical, and functional characteristics to ADEs and ADWEs.Design: Retrospective record review of an admission cohort.Setting and Subjects: Consecutive admissions of residents of an academic Veterans Affairs nursing home with available records and lengths of stay >30 days (n = 175). Subjects were 96% men, aged 70 ± 12 years, and took 7.0 ± 3.4 medications.Methods: We applied standardized algorithms to determine incidence, probability, and severity of ADEs and ADWEs. Multiple regression techniques were used to identify factors associated with frequency and risk of events.Results: Ninety five residents experienced 201 ADEs. Twelve required hospitalization or prolonged hospitalization, and one resident died. Sixty two persons had 94 ADWEs. None were associated with death and one with hospitalization. The four most commonly prescribed drug classes accounted for 72% of ADEs and 80% of ADWEs. Results of multivariate analyses showed common risk factors for both ADEs and ADWEs: number of diagnoses, number of medications, and hospitalization during the nursing home stay.Conclusions: ADEs and ADWEs were common in nursing home residents in this Veteran's Affairs setting. Explicit criteria developed and applied in this study should be applied prospectively in other settings, both to further define risk of drug discontinuation and to assist in development of specific drug discontinuation guidelines.
Why Men Are Interested in an Evaluation for a Sexual Problem
Authors: Perez E. David , Mulligan Thomas , Wan Tom 
Published: April 2015

Objective: To understand why men were interested in an evaluation of a perceived sexual problem.Design: Survey.Setting: Tertiary‐referral VA Medical Center in Southeast Atlantic Region.Participants: Respondents from a 3% random sample of male veterans age 30–99 registered at a VA medical center with completed survey data (n = 427).Measurements: A cross‐sectional mailed survey. Independent variables included survey data related to emotional state, physical state, and/or demographic characteristics (marital status, race, and age). The dependent variable was interest in evaluation of a sexual problem.Main Results: Measures of erectile function, libido, and orgasm, when entered sequentially as separate functional sets in a logistic regression analysis, have a statistically significant (P < 0.05) influence on interest in an evaluation of a sexual problem. After controlling for sexual function and emotional state, physical state did not add to predicting interest in an evaluation for a sexual problem. After controlling for all other covariates, those who were never married, non‐white, and elderly were less interested in an evaluation for a sexual problem (P < 0.05).Conclusion: Age, race, and marital status, in addition to sexual function, influence male veterans' interest in seeking clinical assessment for a sexual problem.
Characteristic Features of Long‐Living Patients with Familial Hypercholesterolemia in Japan
Authors: Murano Shunichi , Shinomiya Masaki , Shirai Kohji , Saito Yasushi , Yoshida Sho 
Published: April 2015

Objective: To assess characteristics of long‐living familial hypercholesterolemics (FHs) in comparison with younger patients.Design: Cross‐sectional study.Setting: Lipid clinics of a university hospital and 14 related medical institutions.Patients: A total of 335 heterozygous FHs including 17 patients over 70 years old. The average ages of the aged (≥70 years old) and the younger groups were 73.5 ± 3.7 and 46.5 ± 15.0 years, respectively.Measurements: Medical history, serum lipids and apolipoproteins, and radiographic measurement of Achilles tendon xanthomas.Main Results: Age distribution of FHs suggests shorter life of FHs compared with the general population. The age distribution of FH females was shifted to older age compared with that of FH males (P < 0.01). No significant differences were found between the levels of serum lipids and apolipoproteins in the aged and the younger groups. The thickness of the Achilles tendon was positively correlated with the product of excess total serum cholesterol and age in the patients (P < 0.01). Progression of Achilles tendon thickening was less in females than in males. A few cases of longevity could not be explained by any of the anti‐atherogenic factors including female gender, a relatively low concentration of serum total cholesterol, a high concentration of HDL‐cholesterol, a non‐smoking habit, and a familial predisposition for longevity.Conclusion: The female gender was found to be one of the most important factors for long survival of FHs. The different progression of Achilles tendon thickening in females and males may be related to the slower development of atherosclerosis and higher survival rate of the female patients.