bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exogenous Calciferol (Vitamin D) and Vitamin D Endocrine Status among Elderly Nursing Home Residents in the New York City Area
Authors: O'Dowd Kenneth J. , Clemens Thomas L. , Kelsey Jennifer L. , Lindsay Robert 
Published: April 2015

Objective: To determine the role and relative importance of sources of exogenous calciferol (vitamin D) in maintaining vitamin D endocrine status in the mid‐winter and early spring in a representative sample of institutionalized elderly persons in the New York City area.Design: Cross‐sectional survey.Setting: A privately‐run urban nursing home and the long‐term care unit of a suburban public hospital.Participants: Residents aged 60 years and older scheduled for a routine annual physical examination and an additional group of individuals ascertained by random sampling. Those with a history of anti‐convulsant or glucocorticoid use, liver disease, chronic renal disease (or serum creatinine > 1.5 mg/dL), parathyroid disease, Paget's disease, gastric surgery, or pharmacological vitamin D use were excluded. Of 301 sampled individuals, 221 were found eligible to participate, and 109 were successfully enrolled.Results: The average vitamin D intake was 379 IU/day (range 55–1006 IU/day) and total vitamin D intake was below the Recommended Dietary Allowance in 16% of subjects. Fifty percent of total vitamin D intake came from fortified milk, and 26% came from vitamin supplements. Vitamin supplement use was not associated with low dietary intake. Among subjects taking a supplement containing 400 IU/day, none had serum calcidiol levels below 15 ng/mL, while among subjects with vitamin D intake between 200 and 400 IU/day, 46% had serum calcidiol levels below 15 ng/mL and 14% had calcidiol levels below 10 ng/mL. Vitamin D intake from non‐supplement sources (but not from supplements) appeared to have a negative association with serum calcitriol levels.Conclusions: Many nursing home residents may require vitamin supplements in order to achieve optimal levels of calciferol replacement. The choice of a vehicle for calciferol replacement may affect calcitriol levels.
The Effects of Age and Diabetes Mellitus on Nerve Function
Authors: Maser Raelene E. , Laudadio Charles , DeCherney G. Stephen 
Published: April 2015

Objective: This project evaluated the association of age and vibratory thresholds (assessment modality of large sensory nerve fibers) in subjects with and without diabetes mellitus.Design: Cross‐sectional study.Setting: Medical Research Institute of Delaware.Participants: Individuals with non‐insulin‐dependent diabetes mellitus and non‐diabetic control subjects.Measurements: Vibratory thresholds were examined in four age groups (ie, <45 yrs, 45–54 yrs, 55–64 yrs, ≥65 yrs). The independent association of age, duration of diabetes, height, gender, glycemic control, and smoking history were analyzed in terms of their relationship to vibratory thresholds.Main Results: Vibratory thresholds increased with age for both control and diabetic subjects. Comparing controls with diabetic subjects in the same age categorizes revealed significant differences for vibratory thresholds only in the ≥65 year old age group. Modeling with vibratory thresholds as the dependent variable showed that age and male gender were independently associated with vibratory thresholds for the controls and explained the majority of the variability (R2 = 0.79). Age, duration of diabetes, and height were independently associated with vibratory thresholds for the diabetic subjects but explained much less of the variability (R2 = 0.39).Conclusion: The results suggest an acceleration of the natural aging process for large sensory nerve fiber function in diabetic subjects. Thus, young diabetic subjects may be at a risk of lower extremity complications as a result of injuries similar to that of older non‐diabetic individuals.
Clock Completion: An Objective Screening Test for Dementia
Authors: Watson Yasmira I. , Arfken Cynthia L. , Birge Stanley J. 
Published: April 2015

Objective To develop a simple, readily administered and scored screening test for dementia utilizing the clock‐drawing task.Design Retrospective analysis of clock‐drawing errors and prospective validations.Setting Hospital‐based outpatient geriatric assessment clinic, rehabilitation service, apartment building for older adults, and long‐term care facility.Participants Convenience sample of patients attending the geriatric assessment clinic, patients on the rehabilitation service, or residents of the above sites.Measurements Sensitivity and specificity of a clock‐scoring system in identifying patients with dementia and the comparison of this system with the Short Blessed Test (SBT) in the diagnosis of dementia and in the prospective validation of the test.Results Of the 10 clock‐drawing errors evaluated, placement of digits in a pre‐drawn circle had the greatest sensitivity and specificity in distinguishing patients with irreversible dementia from patients with other disorders who did not meet NINCDS‐ADRDA criteria for probable dementia. The derived scoring system had a sensitivity of 87% and a specificity of 82%, compared with a sensitivity of 82% and a specificity of 88% for the SBT in identifying dementia. Test‐retest reliability for the distinction between demented and non‐demented was 82%, with a Kappa of 0.63 for the clock completion, and 82%, with a Kappa of 0.62 for the SBT. Inter‐rater reliability for clock completion was 0.90 to 0.93.Conclusion A simple, completely objective scoring system for a clock completion test has been developed which involves only the number of digits placed in the fourth quadrant of a pre‐drawn circle. This readily administered test is as effective in screening for dementia as the longer six‐item SBT.
Comparison of Cyclic Guanosine Monophosphate Response to Infusion of Atrial Natriuretic Peptide in Young and Elderly Subjects
Authors: Tan Adriaan C.I.T.L. , Jansen Tim L. Th. A. , Thien Theo , Kloppenborg Peter W.C. , Benraad Theo J. 
Published: April 2015

Objective: To compare the sensitivity to atrial natriuretic peptide (ANP) in young and elderly subjects.Design: Double‐blind, random‐order, placebo‐controlled study using two different rates of ANP infusion.Subjects: Eight healthy young (23 ± 3 years, mean ± SD) and eight healthy elderly (76 ± 4 years) subjects recruited from the general population.Measurement: Plasma cyclic guanosine monophosphate (cGMP, the second messenger of ANP) levels reflecting the sensitivity of biologically active ANP receptors.Results: Baseline ANP levels were higher and rose to a greater extent in the elderly both during low‐ (0.25 μg/min) and high‐dose (2.0 μg/min) infusion of ANP. Plasma levels of cGMP rose in proportion to the increase in ANP. When the rise in cGMP levels was related to the increase in ANP levels (expressed as nmol/L per 100 pg/mL ANP increase), no difference was found between young and elderly subjects.Conclusion: The ability of elderly subjects to increase cGMP in response to exogenous ANP is similar to that of young subjects. This may reflect a similar sensitivity of the target organs towards ANP. However, because of lower clearance in the elderly, a similar dose of ANP results in a greater elevation of ANP and cGMP levels and hence induces a greater effect.
Repetitive Nocturnal Arterial Oxygen Desaturation and Silent Myocardial Ischemia in Patients Presenting for Vascular Surgery
Authors: Goldman M. D. , Reeder M. K. , Muir A. D. , Loh L. , Young J. D. , Gitlin D. A. , Casey K. R. , Smart D. , Fry J. M. 
Published: April 2015

Objective: To determine whether nocturnal respiratory abnormality (cyclic oxygen desaturation and tachycardia) is associated with nocturnal myocardial ischemia in older individuals with ischemic heart disease.Design: Non‐invasive monitoring on a single occasion.Setting: Tertiary care referral hospital.Patients: Thirty four consecutive older (68.5 ± 6 yrs) patients referred for elective abdominal or carotid reconstructive vascular surgery.Results: Seven patients (21%) had moderately severe nocturnal respiratory abnormality, defined by more than 50 dips in arterial oxygen saturation and increases in heart rate during the night. Two of these seven had clinical risk factors for ischemic heart disease and had nocturnal myocardial ischemia. Ten patients (29%) developed ischemia at some time during the study, of whom seven hand known ischemic heart disease, hypertension, and/or angina. Those with increased nocturnal ischemia showed very low frequency (1–2 cycles per minute) cyclic heart rate oscillations and repetitive nocturnal episodes of arterial oxygen desaturation, similar to patients with sleep apnea.Conclusion: Repetitive nocturnal cyclic arterial desaturation and cyclic increases in heart rate are associated with nocturnal myocardial ischemia in individuals with clinical risk factors for ischemic heart disease. Further investigation in a large patient sample utilizing non‐invasive monitoring of saturation, heart rate, and blood pressure may provide definitive evidence regarding causation of some of the nocturnal myocardial ischemia occurring in older individuals with vascular disease.
Attitudes of Physicians toward Elderly Drivers and Driving Policy
Authors: Miller Denver J. , Morley John E. 
Published: April 2015

Objective: To examine physicians' attitudes toward and knowledge concerning driving in older persons.Design: Questionnaire survey.Measurements: A questionnaire was sent to physician members of the American Geriatrics Society (n = 5009). The questionnaire explored physicians' practice characteristics, general approach to record keeping, frequency of behavior toward educating, counseling, and reporting patients to authorities when deemed appropriate, and their personal understanding of driving issues and physician responsibilities within the state in which they practice.Results: A response rate of 48% was obtained. There was a lack of consensus among physicians, with a broad range of attitudes and practices dealing with this growing public health concern. Physicians generally believed that they had a legal responsibility to assess driving ability but were uncertain about how to assess driving competence and their responsibility toward their senior patients who drive.Conclusions: Physician practices concerning the appropriate management of older drivers vary widely. Physicians should be aware that medical literature is available to aid in the evaluation of the elderly driver with medical impairments. In addition, physicians should consider referring their elderly patients to driver refresher courses to improve or maintain their driving skills. More research is needed to help guide health professionals in assessing the frail elder with multiple medical impairments and decreasing the crash risk for the older driver.
Identification of Alcoholism and Depression in a Geriatric Medicine Outpatient Clinic
Authors: Fulop George , Reinhardt Jayne , Strain James J. , Paris Barbara , Miller Myron , Fillit Howard 
Published: April 2015

Objective: To examine the utility of brief screening instruments for alcoholism and depression in the frail elderly medical outpatient.Design: Cross‐sectional examination.Setting: Coffey Geriatric Outpatient Clinic, The Mount Sinai School of Medicine, New York City.Subjects: Convenience sample of 84 consenting male and female outpatients over 62 years of age.Measurements: The Michigan Alcohol Screening Test (MAST), CAGE questionnaire, and the Geriatric Depression Scale (GDS).Results: Four subjects (5%) scored positive for alcoholism on the MAST, all of whom had been previously identified by the geriatric clinic staff. In contrast, the CAGE only identified 1 (1.4%) alcoholic subject. Thirty‐two percent of subjects scored positive for depression on the GDS, yet only one‐third of these depressed patients had been previously identified by the geriatric team as depressed. Among the depressed outpatients, 19% were labeled anxious and received anxiolytics from the geriatric medical staff.Conclusions: Whereas brief alcohol screening instruments to detect alcoholism did not augment the geriatrician's clinical assessment, screening for depression with the GDS may be an important adjunct to the identification of depression in geriatric medical patients.
Factors Affecting the Serum Free Thyroxine Levels in Hospitalized Chronic Geriatric Patients
Authors: Szabolcs Istvan , Ploenes Christoph , Beyer Mathias , Bernard Wolfdieter , Herrmann Jorg 
Published: April 2015

Objective: Determination of whether nonthyroidal factors affect the diagnostic value of free thyroxine estimation in geriatric patients.Design: Survey.Participants: A convenience sample of 381 non‐selected, chronic, hospitalized geriatric patients over 60 years of age (I = relatively good health; II = relatively poor health; III = bad health; subgroups “sine therapia,” ie, patients receiving no drugs that affect FT4) and 180 20–40 year old healthy persons.Measurements: Thyrotropin‐releasing hormone test; thyrotropin (TSH); free thyroxine (FT4, measured in part by two parallel methods) estimation in a screening study; and thy‐roxine‐binding globulin and thyroxine‐binding‐inhibitor activity measurements.Results: The normal FT4 ranges of the euthyroid geriatric (n = 210) and healthy young groups were similar. In the “sine therapia” euthyroid patients, FT4 decreased with age but increase with the severity of illness. High FT4 levels with non‐suppressed TSH were more frequent in patients in poor and bad health. (I = 6/112; II = 14/140; III = 13/74; P < 0.01). The serum thyroxine‐binding‐inhibitor activity of euthyroid geriatric patients correlated with the severity of their clinical state (I = 6.22 ± 5.65 (13); II = 7.40 ± 4.33 (23); III = 10.04 ± 5.50 (16) μg merthiolate equivalent/μL; ANOVA with log‐transformed values: F(2.51) = 3.50, P < 0.05). The mean FT4 was higher in 36 heparin‐treated patients (22.81 ± 4.67 pmol/L) than in the 193 “sine therapia” patients (19.03 ± 4.23 pmol/L; ‐ P < 0.001). In a convenience subsample of 240 patients, a weak inverse correlation was found between FT4 and the thyroxine‐binding globulin (r = −0.14, P < 0.02). Only 5/11 patients with low free thyroxine had hypothyroidism, while 11/46 patients with elevated free thyroxine had hyperthyroidism.Conclusions: There is no need to modify the normal free thyroxine range for hospitalized geriatric patients. Clinical condition, drug treatment, and, to a lesser extent, age are factors that significantly affect the diagnostic value of FT4 in hospitalized chronic geriatric patients, decreasing the specificity of the test in diagnosing clinical hyper‐ and hypothyroidism.
Driving Performance in Persons with Mild Senile Dementia of the Alzheimer Type
Authors: Hunt Linda , Morris John C. , Edwards Dorothy , Wilson Bradley S. 
Published: April 2015

Objective: To assess the effect of mild senile dementia of the Alzheimer type (SDAT) on driving ability.Design: Cross‐sectional study with correlation analysis.Setting: A university‐based Alzheimer's Disease Research Center, which evaluates community‐living older adult volunteers, and the university's Program in Occupational Therapy.Participants: Healthy elderly controls (n = 13) and subjects with very mild (n = 12) and mild (n = 13) SDAT. Dementia severity was staged by the Washington University Clinical Dementia Rating.Measurements: The driving ability of participants on the in‐car road test was scored independently by a driving instructor, blinded to the study design and to the dementia status of the subjects, and an unblinded occupational therapist. Interview‐based perceptions of driving ability were obtained independently from the subjects and their collateral sources. Attentional and visuospatial performances of the subjects were assessed prior to the road test.Results: All control and very mild SDAT subjects were judged to be “safe” drivers (ie, passed the in‐car road test), but five (40%) of the mild SDAT subjects had driving impairment sufficient to “fail” the road test. Neither subject self‐assessment nor caregiver perceptions of driving ability consistently predicted driving performance. Attentional task performance correlated well with road test results.Conclusions: Some SDAT subjects retain “safe” driving skills. The greater the dementia severity, the greater the likelihood of poor driving ability. Performance‐based (road test) evaluations are necessary to properly determine driving skills at present, but attention and other cognitive screening measures should be developed.
Does Radiographic Osteoarthritis Correlate with Flexibility of the Lumbar Spine?
Authors: Weiner Debra K. , Distell Bruce , Studenski Stephanie , Martinez Salutario , Lomasney Laurie , Bongiorni Dennis 
Published: April 2015

ObjectivesTo examine the association between radiographic lumbosacral (LS) osteoarthritis (OA) and lumbar flexibility in elders without back pain or known spinal pathology and to develop a reliable grading system for osteoarthritis of the lumbosacral spine.DesignCross‐sectional study.SettingDurham VA and Duke University Medical Center Department of Radiology.Participants35 volunteers aged 64–90 (nursing home residents and community dwellers). Exclusion criteria were known spinal pathology, back pain, inability to stand independently for 1 minute, and >150% of ideal body weight.InterventionsAll subjects underwent LS spine radiographs and flexibility measures (forward flexion, extension, lateral flexion, and axial rotation).Main Outcome MeasuresReliability of ordinal OA X‐ray grading system, tested using intraclass correlations (ICCs); stability of flexibility measures, using ICCs; and association of disc or facet summary scores (sum of all levels, T12 thru SI) with flexibility measures, using Pearson correlations.ResultsICCs for interest flexibility measures ranged from 0.72 to 0.94. ICCs for interobserver X‐ray scores were 0.85 for facet disease and 0.93 for disc disease. The correlation of facet disease with forward lumbar flexion was 0.29. The correlation of disc disease with flexibility showed modest correlation for forward (r = 0.34), right lateral (r = 0.36), and left lateral (r = 0.35) flexion. None of the correlations was influenced by age.ConclusionsWe have developed a reliable radiographic scoring instrument for assessing radiographic OA of the LS spine. It appears that painless LS disc OA is one factor that influences spinal motion.
Urinary Incontinence as a Risk Factor for Mortality
Authors: Herzog A. Regula , Diokno Ananias C. , Brown Morton B. , Fultz Nancy H. , Goldstein Nancy E. 
Published: April 2015

ObjectiveTo determine whether mortality is independently associated with urinary incontinence.Design6‐year prospective study that started in 1983/84.SettingA Midwestern County.ParticipantsProbability sample of 1956 community‐residing persons 60 years of age and older in 1983/84.MeasurementsThe independent variables of urinary incontinence, its types and severity, were measured by survey self‐report, which was validated with clinical exams. The control variables of age, education, and health status were also self‐reported. The dependent variable of death was established during follow‐up interviews from reports of previously designated contact persons.ResultsNeither incontinence status nor its severity level or types were found to be positively associated with 6‐year mortality in logistic regression analyses that adjusted for age, education, and health status.ConclusionWhereas urinary incontinence can be an embarrassing and socially debilitating condition, it does not itself predict or contribute to mortality.
Risk of Falls after Hospital Discharge
Authors: Mahoney Jane , Sager Mark , Dunham Nancy Cross , Johnson Jill 
Published: April 2015

ObjectivesTo determine the incidence of falls within the first month after hospitalization and risk factors associated with falling during this period.DesignCohort study with 1‐month follow‐up after hospital discharge.Setting370‐bed community hospital.PatientsConsecutive sample of 214 patients, aged 70 years and over, hospitalized for medical illness more than 48 hours and discharged to the community. Exclusion criteria: terminal illness, neurologic diagnosis, discharge to skilled nursing facility.MeasurementsInformation was obtained at hospital admission, discharge, and 1 month after discharge. Initial assessment included demographic data, vision, mood, pre‐admission function, and use of assistive device. Discharge assessment included length of hospital stay, use of assistive device, need for professional help after discharge, medications, cognition, and functional status. Patients were assessed 1 month after discharge for history of confusion and falls. Main outcome measure was falls in the first month after discharge.Main ResultsTwenty‐nine patients (13.6%) fell during the month after discharge. Major risk factors for falls included, at discharge, decline in mobility (P = 0.005), use of assistive device (P = 0.002), and cognitive impairment (P = 0.05), and after hospital discharge, self‐report of confusion (P = 0.002). Patients who were functionally dependent and needed professional help after discharge had the highest rate of falls (20.2%). In contrast, only 8.4% of independent patients not requiring professional help fell (P = 0.01).ConclusionsThere is a high incidence of falls after hospital discharge, particularly among patients who are functionally dependent. Further study is needed to determine to what extent acute illness and hospitalization may influence falls risk.
Association of Visual Impairment with Mobility and Physical Function
Authors: Salive Marcel E. , Guralnik Jack , Glynn Robert J. , Christen William , Wallace Robert B. , Ostfeld Adrian M. 
Published: April 2015

ObjectiveTo examine the association of distant vision and physical function in the population of older adults.DesignCross‐sectional and cohort study.Participants5143 older residents of three communities (Established Populations for the Epidemiologic Studies of the Elderly) who were interviewed in 1988–89, including residents of two communities who were re‐interviewed 15 months later (n = 3133, 97% of those eligible).MeasuresVisual acuity screening, self‐reported activities of daily living and mobility, and objective physical performance measures of balance, walking, and rising from a chair.ResultsLimitations in mobility, activities of daily living, and physical performance were associated with worse visual function. In prospective analyses controlling for potential confounders, participants with severe visual impairment had 3‐fold higher odds of incident mobility and activity of daily living limitations than those with acuity of 20/40 or better (P < 0.001). In prospective analyses investigating the relationship of vision with improvement in function, those with poor vision were about half as likely to improve as those with better acuity, but this relationship was only statistically significant for improvement in mobility limitations.ConclusionsDistant visual function appears to play an important role in physical function, particularly for mobility. An intervention to improve vision in at‐risk elders might preserve function and prevent disability; this warrants further investigation.