bluuebunny/crossref_metadata_2025_split huggingface dataset:
Corticotropin‐Dependent Cushing's Syndrome in Older People: Presentation of Five Cases and Therapeutical Use of Ketoconazole
Authors: Berwaerts Joris J. , Verhelst Johan A. , Verhaert Griet C. , Verhaegen Ann A. , Abs Roger E. 
Published: April 2015

BACKGROUND: Cushing's syndrome is a rare disorder. The corticotropin (ACTH)‐dependent form of this syndrome generally results either from excessive ACTH secretion by a pituitary adenoma or ectopic secretion by a malignant tumor. Theoretically, the latter type can be assumed to occur more frequently in old age as the incidence of malignancy increases.METHODS: Diagnostic procedures for these five cases of Cushing's syndrome consisted of 24‐hour urinary cortisol excretion, plasma ACTH and serum cortisol levels, oCRH stimulatory test, low‐dose and high‐dose dexamethasone suppression tests, CT scan or MR imaging of the pituitary region, and bilateral inferior petrosal sinus sampling. Patients were treated with ketoconazole, if possible, and evaluated according to clinical response and 24‐hour urinary cortisol excretion.PATIENTS: The five cases presented were selected on the basis of age—75 years or older – from a total of about 100 patients presenting with Cushing's syndrome. In only three cases were signs of hypercorticism found on clinical examination. The other two patients were evaluated for adrenocortical excess because of severe hypokalemia and the fortuitous finding of enlarged adrenal glands on CT scan, respectively.RESULTS: As a result of endocrine testing, pituitary‐dependent Cushing's disease was suspected in three patients and ectopic Cushing's syndrome in two patients. Imaging techniques demonstrated only one pituitary adenoma in the first three patients and a lung tumor in one of the latter two patients. Inferior petrosal sinus sampling confirmed the suspected origin of the Cushing's syndrome in the three patients in which this procedure was performed. All three patients with pituitary‐dependent Cushing's disease underwent successful clinical and biochemical treatment with ketoconazole.CONCLUSION: Pituitary‐dependent Cushing's disease may occur more frequently in patients older than 75 years of age than has previously been assumed. Because surgical treatment is not always easily tolerated by older patients, the steroidogenesis inhibitor, ketoconazole, can be a valuable alternative for the control of hypercorticism.
Effect of Tamoxifen on Bone Fractures in Older Nursing Home Residents
Authors: Breuer Brenda , Wallenstein Sylvan , Anderson Richard 
Published: April 2015

OBJECTIVES: To evaluate the association between tamoxifen (TAM) treatment and rate of bone fractures in older, nursing home residents.PARTICIPANTS: A total of 93,031 women, aged 65 years and older, whose data were part of the 1993 New York State MDS and for whom there was documentation of treatment with at least one medication.SETTING: New York State long‐term care facilities.DESIGN: Cross‐sectional study via secondary analysis of 1385 matched sets of residents. Each set included one resident who was receiving TAM treatment and up to four residents who were not.MEASUREMENTS: Measurements included age, ethnicity, TAM treatment, hormone replacement therapy, vision impairment, any bone fractures, and, specifically, hip fractures.RESULTS: During the 1.5‐year period for which bone fractures are documented in the 1993 MDS, the fracture rates were: 7.62% in women not treated with TAM, 3.20% in women receiving 10 mg TAM daily, and 6.73% in women receiving 20 mg TAM daily. The odds ratio (OR) for bone fractures among women receiving 20 mg TAM daily compared with nontreated women was 0.916 (95% confidence interval (CI): 0.720–1.164; P =.472), and was 0.312 (95% CI: 0.112–0.865; P =.025) for those receiving 10 mg daily. The rates of hip fracture were 4.98%, 2.40%, and 4.57% for controls and women receiving 10 mg and 20 mg TAM daily, respectively. Whereas the hip fracture rate for women receiving 20 mg daily was statistically similar to that of the controls (OR =.963; 95% CI: 0.718–1.291; P =.800), the difference between the controls and those receiving 10 mg daily approached significance (OR: 0.313; 95% CI: 0.096–1.018; P =.054).CONCLUSION: Although standard treatment of 20 mg TAM daily offers no apparent protection against bone fracture in older nursing home residents, a daily 10 mg dose seems to be protective. J Am Geriatr Soc 46:968–972, 1998.
Hearing Loss in Community‐Dwelling Older Persons: National Prevalence Data and Identification Using Simple Questions
Authors: Reuben David B. , Walsh Kathleen , Moore Alison A. , Damesyn Mark , Greendale Gail A. 
Published: April 2015

OBJECTIVE: To estimate the prevalence of hearing loss among community‐dwelling older persons according to clinical criteria and to develop a brief self‐report screening instrument to detect hearing lossDESIGN: SurveySETTING: National probability sample of noninstitutionalized older personsPARTICIPANTS: A total of 2506 persons aged 55 to 74 who participated in the National Health and Nutrition Examination SurveyMAIN OUTCOME MEASURES: Hearing loss as defined by Ventry and Weinstein (VW) criteria and by the High Frequency Pure‐Tone Average (HFPTA) scaleRESULTS: Hearing loss by VW criteria was present in 14.2% and by HFPTA criteria in 35.1% of those surveyed. The prevalence increased with advancing age and was higher among men and those with less education. A logistic regression model identified six independent factors for hearing loss by VW criteria: age ≥ 70 years (adjusted odds‐ratio (AOR) 2.7, 95% confidence interval (95% CI) 1.6, 4.4), male gender (AOR 3.0, 95% CI 1.9, 4,8), ≤ 12th grade education (AOR 3.8, 95% CI 1.8, 7.7), having seen a doctor for deafness or hearing loss (AOR 8.9, 95% CI 5.3, 14.9), unable to hear a whisper across a room (AOR 3.2, 95% CI 2.0, 5.1), and unable to hear a normal voice across a room (AOR 6.2, 95% CI 2.6, 14.9). A clinical scale based on the logistic model had 80% sensitivity and 80% specificity in predicting hearing loss using VW criteria and 59% sensitivity and 88% specificity in predicting hearing loss using HFPTA criteria.CONCLUSIONS: Hearing loss, as defined by two clinical criteria, is common and can be screened for accurately using simple questions that assess sociodemographic and hearing‐related characteristics. J Am Geriatr Soc 46:1008–1011, 1998.
A Practical Approach to Identifying Mortality‐Related Factors in Established Long‐Term Care Residents
Authors: Flacker Jonathan M. , Kiely Dan K. 
Published: April 2015

OBJECTIVE: Determining prognosis is an important part of medical planning for long‐term care residents. Clarifying the resident characteristics associated with increased mortality has received little attention from investigators, and many approaches that have been suggested are unsuitable for widespread use. Using a readily available database, we sought to determine factors associated with 1‐year mortality in established long‐term care residents.DESIGN: A retrospective cohort study.SETTING: A 725‐bed long‐term care facility.MEASUREMENTS: We examined Minimum Data Set (MDS) information on 780 residents from April 1994 through August 1997. The association between death and 65 resident factors, covering a broad array of physical, functional, medical, and psychosocial measures, was examined initially in bivariate proportional hazards models. Putative factors with P values <.10 in bivariate analysis were considered in the multivariate analysis. Using these factors, we employed a forward step‐wise multivariate proportional hazards regression method to select the set of factors associated independently with mortality at a P value <.05. A mortality score was developed by assigning points to each factor based on the risk ratio in the multivariate proportional hazards model. The performance characteristics of the model were examined using logistic regression.RESULTS: Forty‐four of the 65 factors examined were associated with 1‐year mortality in bivariate proportional hazards analysis. Eight of these 44 factors were associated with 1‐year mortality in the multivariate proportional hazards regression. These factors were functional impairment, weight loss, shortness of breath, male gender, low body mass index, swallowing problems, congestive heart failure, and advanced age. A higher mortality score was associated with a higher death rate in the subsequent year. The model demonstrated good performance with an area under the ROC curve of 0.77.CONCLUSIONS: Using a widely available database that requires no additional medical testing or staff training, a useful model for identifying factors associated with 1‐year mortality in established long‐term care residents can be developed. Widespread use of such a practical approach to assess mortality risk could be of benefit to patients, their families, and physicians for informing care plan decisions. J Am Geriatr Soc 46:1012–1015, 1998.
The Epidemiology of Cardiac Pacemakers in the Older US Population
Authors: Daley W. Randolph , Kaczmarek Ronald G. 
Published: April 2015

OBJECTIVES: This study estimates the age distribution of older patients (>64 years) receiving implantable cardiac pacemakers in non‐federal US hospitals and determines major characteristics of this group using a massive, nationally representative sample of inpatient discharge records.DESIGN: Discharge records were obtained from the 1992 Nationwide Inpatient Sample. Correlation with census data from 1992 was used to determine age and gender specific rates.SETTING: The Nationwide Inpatient Sample is a 20% stratified probability sample of non‐federal US hospitals.PATIENTS: Records of all recipients (26,425) of an initial or replacement pacemaker were selected.RESULTS: Individuals 65 years of age and older received an estimated 131,361 initial and replacement pacemaker pulse generators (87% of the total) in non‐federal US hospitals in 1992. Pacemaker implantation was performed in urban teaching hospitals (28.9%), non‐teaching urban hospitals (57.8%), and rural hospitals (13.3%). The age specific implantation rates per 100,000 population were 226.5 (age 65–74 years), 585.9 (age 75–84 years), 874.9 (age 85–94 years), and 540.4 (more than 94 years). The age‐adjusted rate for men was 70% greater than the corresponding rate for women. Major diagnoses of implant recipients included atrioventricular block (37.8%) and atrial fibrillation (28.5%). Two percent of pacemaker recipients died before discharge.CONCLUSIONS: The rate of pacemaker implantation increases sharply up to age 95. As the number of older people in the US population grows, particularly those in the age ranges greater than 75 and 85 years, a sharply increased number of pacemakers will be implanted unless other factors decrease the need for these devices. The data also demonstrate diffusion of this technology from academic centers. J Am Geriatr Soc 46:1016–1019, 1998.
Iatrogenic Benzodiazepine Withdrawal Delirium in Hospitalized Older Patients
Authors: Moss Jay H. , Lanctôt Krista L. 
Published: April 2015

OBJECTIVE: The purpose of this review was to identify cases of benzodiazepine withdrawal delirium in a population of older hospitalized patients and to determine whether the withdrawal was caused by iatrogenic factors.DESIGN: Retrospective chart review of selected cases from a referred sample. A Bayesian Adverse Reactions Diagnosis Instrument (BARDI) was applied to cases of benzodiazepine withdrawal delirium to quantify the probability that drug withdrawal was the causative mechanism.SETTING: A university‐affiliated health sciences center.PATIENTS: A review of the psychiatric consultation liaison service database for a consecutive 4‐month period yielded 21 cases of delirium in a referred sample of 119 patients more than 65 years of age. Four cases of benzodiazepine withdrawal were identified within the group of patients with delirium, and retrospective chart review identified potential iatrogenic causes for withdrawal in three patients.RESULTS: The posterior possibilities calculated by the BARDI for the three cases of delirium were 0.98, 0.95, and 0.75, indicating a high probability that the delirium was caused by benzodiazepine withdrawal.CONCLUSIONS: Benzodiazepine withdrawal delirium in older hospitalized patients may be associated with iatrogenic factors. J Am Geriatr Soc 43:1020–1022, 1995.
That Was the Year That Was: An Evidence‐Based Clinical Geriatrics Update
Authors: Leipzig Rosanne M. 
Published: April 2015

BACKGROUND: Physicians are faced with an ever‐growing information base in medical practice. Studies regularly show a disparity between science and patient care, with scientifically validated practices often taking 20 years and more to enter mainstream clinical practice.OBJECTIVES: To review the recent medical literature for high quality studies that practicing geriatricians should be aware of, either because they provide evidence that might lead to a change in clinical practice or because they provide insight into common geriatric syndromes.DESIGN: OverviewDATA SOURCES: All articles abstracted or noted in ACP Journal Club, Evidence‐Based Medicine, or The New York Times from July 1996 to June 1997.STUDY SELECTION: Studies that met the standards for inclusion in ACP Journal ClubSTUDY DESIGN: Sampling plan (including eligibility criteria), sample size, response rate, data analysis plan, proportion available for follow‐up, main outcomes and measures, main results.RESULTS: Review of the 98 articles that met criteria resulted in the identification of several themes of importance to geriatricians, including the hazards of hospitalization, the prevention of NSAID‐induced peptic ulcers, and the treatment and prevention of Alzheimer's disease. The results of these studies expand the therapeutic armamentarium of practicing geriatricians, provide new insights into geriatric syndromes, and raise cautions about the use of certain therapies in older adults.CONCLUSIONS: Many methodologically rigorous studies relevant to the medical care of older people have recently been published. Evidence‐based medicine and the use of journals of secondary publication are useful tools to enhance the efficiency of journal reading for geriatric practitioners whose interests span the journals of several disciplines and subspecialties. J Am Geriatr Soc 46:1040–1049,1998.
Home Environmental Hazards and the Risk of Fall Injury Events Among Community‐Dwelling Older Persons
Authors: Sattin Richard W. , Rodriguez Juan G. , DeVito Carolee A. , Wingo Phyllis A. ,   Study to Assess Falls Among the Elderly (SAFE) Group
Published: April 2015

OBJECTIVE: To determine if home environmental hazards increase the risk of fall injury events among community‐dwelling older persons.DESIGN: Population‐based case‐control study.SETTING: South Miami Beach, Florida.PARTICIPANTS: 270 persons aged 65 years and older who sought treatment at six area hospitals for injuries resulting from falls within the dwelling unit and 691 controls, frequency matched for sex and age, selected randomly from Health Care Financing Administration (Medicare) files.MAIN INDEPENDENT VARIABLES: The home environment of each person, assessed directly by interviewers using a standardized instrument.RESULTS: Environmental hazards were present in nearly all dwelling units. After adjusting for important confounding factors, most of these hazards were not associated with an increased risk of fall injury events among most older persons. Increasing numbers of tripping hazards, or total hazards in the dwelling unit, did not increase the risk of fall injury events, nor was there an increasing trend in risk.CONCLUSIONS: Current fall‐prevention strategies of finding and changing all environmental hazards in all community‐dwelling older persons' homes may have less potential effect than previously thought. The usefulness of grab bars, however, appears to warrant further evaluation.
The Association Between Chronic Illness and Functional Change Among Participants in a Comprehensive Geriatric Assessment Program
Authors: Cho Choo‐Yon , Alessi Cathy A. , Cho Meehyung , Aronow Harriet U. , Stuck Andreas E. , Rubenstein Laurence Z. , Beck John C. 
Published: April 2015

OBJECTIVE: To examine the association between chronic illness and functional status change during a 3‐year period in older people enrolled in an in‐home comprehensive geriatric assessment (CGA) and preventive care program.DESIGN: Secondary analysis of data from a longitudinal cohort study.SETTING: Santa Monica, California.PARTICIPANTS: Two hundred two community‐dwelling older persons (mean age at baseline was 81 years, 70% were women, and 72% reported good health) randomized to the intervention group in a trial of in‐home comprehensive geriatric assessment and preventive care.MEASUREMENTS: We studied 13 common chronic illnesses/conditions determined clinically from an annual comprehensive evaluation by gerontologic nurse practitioners (GNPs) in consultation with study geriatricians. These target conditions included hypertension, osteoarthritis, coronary artery disease, obesity, undernutrition, urinary incontinence, sleep disorders, falls, gait/balance disorders, hearing and vision deficits, depression, and unsafe home environment. The dependent variable was functional change as measured by instrumental activities of daily living (IADL) and basic activities of daily living (BADL) assessed at baseline and annually for 3 years by independent research personnel. Potential confounding variables, including comorbid conditions and other subject characteristics, were controlled for in the analyses.RESULTS: Although functional status was similar at baseline, the presence of certain target conditions in this sample was associated significantly with functional decline in IADL and BADL during the 3‐year period. Four conditions (gait/balance disorders, depression, unsafe home environment, and coronary artery disease) were associated with significant declines in IADL, and four conditions (gait/balance disorders, depression, hypertension, and urinary incontinence) were associated with significant declines in BADL. Conversely, subjects with obesity had no significant change in IADL or BADL throughout the study period and had less decline in IADL compared with nonobese subjects.CONCLUSIONS: Certain chronic conditions, particularly gait/balance disorders and depression, are associated with significant decline in functional status in older persons who receive CGA. These findings may help identify older persons at risk for greatest functional decline despite participation in CGA and may also suggest the need for more effective intervention strategies in these individuals.
Psychometric Characteristics of the Minimum Data Set I: Confirmatory Factor Analysis
Authors: Casten Robin , Lawton M. Powell , Parmelee Patricia A. , Kleban Morton H. 
Published: April 2015

OBJECTIVE: To determine the structure and statistical reliability of the federally mandated Minimum Data Set (MDS).DESIGN: Confirmatory, hypothesis‐testing factor analysis was performed on MDS protocols of 733 nursing home residents.SETTING: All participants were residents of the Philadelphia Geriatric Center.PARTICIPANTS: Participants represented consecutively admitted skilled and intermediate care residents and another pool of residents with probable dementia.MEASUREMENTS: MDS protocols were completed by nurse care coordinators. Item composites hypothesized represented the domains of cognition, activities of daily living, time use, social quality, depression, and problem behaviors.RESULTS: For higher functioning residents (n = 336) and for all residents together, all domain clusters except social quality were confirmed. None of the domain clusters were confirmed within the more impaired (n = 391) group.CONCLUSIONS: The MDS does provide usable indicators of five areas of basic competence of nursing home residents. Lack of reliability in rating many aspects of the behavior and states of cognitively impaired residents is evident, however. Improvement of such measures and rating procedures constitutes a major research priority.
Psychometric Characteristics of the Minimum Data Set II: Validity
Authors: Lawton M. Powell , Casten Robin , Parmelee Patricia A. , Van Haitsma Kimberly , Corn Julie , Kleban Morton H. 
Published: April 2015

OBJECTIVE: To determine the validity of the Minimum Data Set (MDS).DESIGN: MDS domain scores were correlated with a variety of independently obtained measures of basic behavioral and mental health functions of 513 nursing home residents.SETTING: All participants were residents of the Philadelphia Geriatric Center.PARTICIPANTS: One group of residents (n = 260) represented consecutive admissions who were able to respond to formal testing. The other group of residents (n = 253) represented presumably cognitively impaired residents whose data did not depend on self‐report.MEASUREMENTS: MDS item‐composite scores based on a confirmatory factor analysis were derived for the domains of cognition, activities of daily living (ADL), time use, depression, and problem behaviors. Hypotheses stating how these MDS domains should be related to standard measures of cognitive function, ADL, depression, agitation, social behavior, and irritability were tested.CONCLUSIONS: The majority of the hypotheses were upheld, thus suggesting that the MDS is usable as a source of research data. The sizes of the validity coefficients were modest, however. Depression and problem behavior were less well affirmed than cognition, ADL, and Time Use. There is a clear need for improvement in training and probably in the form of MDS measurement in some areas.
Accuracy of Medical Records in Hip Fracture
Authors: Fox Kathleen M. , Reuland Melissa , Hawkes William G. , Hebel J. Richard , Hudson James , Zimmerman Sheryl Itkin , Kenzora John , Magaziner Jay 
Published: April 2015

OBJECTIVE: To determine the accuracy of diagnoses and procedure codes in medical records for hip fracture patients.DESIGN: A validation sample of hip fracture medical records was used to compare the facesheet data with progress notes, operative reports, and discharge summaries for patients in a prospective study of functional recovery.SETTING: Eight Baltimore hospitals with the highest volume of older hip fracture patients.PATIENTS: Study subjects were 343 community‐dwelling patients, 65 years of age and older, admitted to one of eight Baltimore hospitals between January 1990 and June 1991 with a diagnosis of hip fracture.MAIN OUTCOME MEASURES: Facesheet diagnosis codes were compared with admitting notes, discharge summary, and/or progress notes. The abstracted surgical procedure was compared with postoperative radiographs.RESULTS: Excess coding of diagnoses on the hospital facesheet was evident in 12% of charts. In 17% of charts, a complication identified in the chart was not coded on the facesheet. More complications with low severity were omitted. Agreement between the abstractor's procedure review and radiograph readings for arthroplasty was 84%. In 15% of patients, the abstractor coded total arthroplasty when hemiarthroplasty was done.CONCLUSIONS: Discrepancy between the hospital facesheet and the medical record and between the abstracted surgical procedure and radiographs was found for hip fracture patients. This may make findings from health outcomes research relying on administrative databases uncertain and reimbursement inaccurate.