bluuebunny/crossref_metadata_2025_split huggingface dataset:
Restraint Reduction Reduces Serious Injuries Among Nursing Home Residents
Authors: Neufeld Richard R. , Libow Leslie S. , Foley William J. , Dunbar Joan M. , Cohen Camille , Breuer Brenda 
Published: April 2015

OBJECTIVES: To describe how removing physical restraints affected injuries in nursing home settings.DESIGN: A 2‐year prospective study of an educational intervention for physical restraint reduction.SETTING: Sixteen diverse nursing homes with 2075 beds in California, Michigan, New York, and North Carolina.PARTICIPANTS: Study A: 859 residents who were physically restrained at the onset of the intervention on October 1, 1991. Study B: all residents who occupied the 2075 beds in the 16 facilities 3 months before the intervention and 3 months after its completion.INTERVENTION: Educational program for nursing home staff followed by quarterly site consultations to participating nursing homes.MAIN OUTCOME MEASURES: Rate of physical restraint use and injuries.RESULTS: Study A: Serious injuries declined significantly among the 859 residents restrained initially when restraint orders were discontinued (x2 = 6.2, P = .013). Study B: During the intervention period, physical restraint use among the 2075 residents decreased from 41% to 4%, a 90% reduction. The decrease in the percentage of injuries of moderate to serious severity was significant (i.e., 7.5% vs 4.4%, 2‐taii = .0004) as was the rate of moderate and serious injuries combined (Rate Ratio = 1.580, P2‐tail = −0033).CONCLUSIONS: A substantial decrease in restraint use occurred without an increase in serious injuries. Although minor injuries and falls increased, restraint‐free care is safe when a comprehensive assessment is done and restraint alternatives are used.
Delayed Thrombolytic Treatment of Older Patients with Acute Myocardial Infarction
Authors: McLaughlin Thomas J. , Gurwitz Jerry H. , Willison Donald J. , Gao Xiaoming , Soumerai Stephen B. 
Published: April 2015

OBJECTIVE: To determine demographic and clinical factors associated with delayed thrombolysis in patients with acute myocardial infarction.DESIGN: A retrospective cohort.SETTING: 37 Minnesota hospitals during the time periods October 1992‐July 1993 and July 1995‐April 1996.PATIENTS: We reviewed the medical records of 776 older patients aged 65 or older hospitalized with an admission diagnosis of acute myocardial infarction, suspected acute myocardial infarction, or rule‐out acute myocardial infarction, who were treated with a thrombolytic agent.MEASUREMENT: We used multivariate logistic regression models to examine the association between selected study characteristics and time between hospital presentation and administration of thrombolytic treatment. Early thrombolysis was defined as less than 60 minutes after hospital presentation and late thrombolysis as 60+ minutes.RESULTS: Of 776 study patients, 57.5% (n = 446) received early thrombolysis. Of the remaining 330 patients receiving late treatment, 12.1% (n = 94) were thrombolyzed more than 2 hours after hospital presentation. After controlling for other factors, the odds of delayed thrombolysis among patients aged 75 or older were 1.48 compared with younger individuals (95% CI, 1.17‐1.88). The odds of delayed thrombolysis among patients with severe comorbidity were 1.46 (95% CI, 1.10— 1.94) compared with individuals without severe comorbidity. Predictors of early thrombolytic treatment included hospital arrival via emergency transport (ORdelay = 0.46; 95% CI, 0.34–0.63) and chest discomfort at admission (ORdelay = 0.40; 95% CI, 0.18–0.86).CONCLUSIONS: The present study indicates that patients of advanced age and with severe comorbidity are more likely to experience delayed thrombolytic treatment after hospital presentation. These are the patients who suffer the highest morbidity from acute myocardial infarction and for whom expeditious treatment may enhance therapeutic benefit.
An In‐Home Nurse‐Administered Geriatric Assessment for Hypoalbuminemic Older Persons: Development and Preliminary Experience
Authors: Reuben David B. , Effros Rita B. , Hirsch Susan H. , Zhu Xiaoming , Greendale Gail A. 
Published: April 2015

BACKGROUND: Although malnutrition in older persons is a common, potentially treatable condition, few data indicate that treatments for this disorder can be effective.OBJECTIVE: To develop and preliminarily evaluate a two‐component intervention that includes a nurse‐administered, in‐home assessment to identify potentially remediable causes of hypoalbuminemia and protocols to treat these problems.DESIGN: A pre‐test post‐test case‐series.SETTING: An academic geriatrics practice.PARTICIPANTS: Seventeen persons aged 65 and older with serum albumin levels ± 3.8 g/dL; eight of the participants received pre‐and post‐test outcome measures.INTERVENTION: Nurse‐administered standardized assessment and intervention protocols.MEASUREMENTS: Serum albumin, Medical Outcome Study (MOS) SF‐36, serum IL‐la and b, TNF a, IL‐6, and lymphocyte markers of immune function.RESULTS: The assessment took 87 minutes, on average, and generated a mean 4.2 recommendations. Among the eight subjects with pre‐ and post‐test measures, serum albumin increased by 0.2 g/dL (P = .035). Compared with baseline, two T cell markers of immune function demonstrated changes consistent with better function.CONCLUSIONS: These preliminary data support the potential benefit of a nurse‐administered assessment coupled with protocols to address remediable contributors to hypoalbuminemia.
Predictors of Five‐Year Mortality in Older Canadians: The Canadian Study of Health and Aging
Authors: Østbye Truls , Steenhuis Runa , Wolfson Christina , Walton Ruth , Hill Gerry 
Published: April 2015

OBJECTIVE: Based on the Canadian Study of Health and Aging (CSHA), to determine the importance of cognitive status, sociodemographic factors, functional status, and other health related factors as predictors of 5‐year overall mortality in older Canadians.DESIGN, SETTING AND PARTICIPANTS: Two partially overlapping groups from the Canadian Study of Health and Aging (1991) were identified: (1) older people living in the community (n = 8949) who had a screening interview (larger sample, fewer variables) and (2) older people who underwent an extensive clinical examination (smaller sample, more objective variables; n = 2914). Deaths in the subsequent 5 years were determined from death certificates and interviews with the caregivers. Multivariate logistic regression models, with death within 5 years as the outcome, were developed separately for men and women. Predictor variables were introduced in the following groups: sociodemographic factors, physical and cognitive status, and physical illnesses and life style factors. Parallel models were developed for the screening sample and for the clinical sample.RESULTS AND DISCUSSION: Five‐year mortality ranged from 10.0% (women aged 65–74 living in the community) to 88.1% (men aged 85 and older living in institutions). Multi–variate models showed that the odds of death within 5 years increased with age. This effect remained after adjustment for all other variables. Odds of death increased with institution‐alization and with increasing cognitive and physical impairment. Although vision and hearing problems and the presence of heart disease, stroke, and diabetes were all strongly related to 5‐year mortality in univariate, unadjusted analyses, their contributions were minimal in the multivariate analyses. Increased Body Mass Index was associated with lower mortality in both univariate and multivariate analyses.CONCLUSIONS: This population‐based study supported the importance of gender, age, functional status, cognition, and health status in predicting 5‐year mortality, and after accounting for cognitive status, physical status, and specific disease variables, the difference in mortality between older people in the community and in institutions was reduced. Knowledge about survival and prognosis is important not only for the planning of long‐term facilities and home care, but it can also be helpful for clinical decision‐making and for family and caregivers.
Prevalence of Coexistence of Coronary Artery Disease, Ischemic Stroke, and Peripheral Arterial Disease in Older Persons, Mean Age 80 Years, in an Academic Hospital‐Based Geriatrics Practice
Authors: Ness Jose , Aronow Wilbert S. 
Published: April 2015

OBJECTIVE: To investigate the prevalence of coronary artery disease (CAD), ischemic stroke, and peripheral arterial disease (PAD), alone and in combination, in older persons.DESIGN: A retrospective analysis of charts from all older persons seen from April 1, 1998, through December 31, 1998, at an academic hospital‐based geriatrics practice.SETTING: An academic hospital‐based geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.PATIENTS: A total of 474 men and 1328 women, mean age 80 ± 9 years (range 60 to 102 years) were included in the study.MEASUREMENTS AND MAIN RESULTS: Of 1802 persons studied, 612 (34%) had CAD, 351 (19%) had ischemic stroke, 236 (13%) had PAD, and 816 (45%) had either CAD, stroke, or PAD. Three hundred twenty‐eight (18%) of the 1802 persons had CAD alone, 128 (7%) had stroke alone, 50 (3%) had PAD alone, 123 (7%) had CAD + stroke and no PAD, 86 (5%) had CAD + PAD and no stroke, 25 (1%) had PAD + stroke and no CAD, 75 (4%) had CAD + stroke + PAD, and 986 (55%) had no CAD, PAD, or stroke. If CAD was present, coexistent PAD was present in 26% and coexistent stroke in 32% of persons studied. If stroke was present, coexistent CAD was present in 56% and coexistent PAD in 28%. If PAD was present, coexistent CAD was present in 68% and coexistent stroke in 42% of persons studied.CONCLUSIONS: These data showed that if CAD was present, ischemic stroke was also present in 32% and PAD in 26% of the population. If ischemic stroke was present, CAD was also present in 56% and PAD in 28% of the population. If PAD was present, CAD was also present in 68% and ischemic stroke in 42% of the population.
Improving Morning Care Routines of Nursing Home Residents with Dementia
Authors: Rogers Joan C. , Holm Margo B. , Burgio Louis D. , Granieri Evelyn , Hsu Chuanchieh , Hardin Michael , McDowell B. Joan 
Published: April 2015

OBJECTIVES: This study examined the effectiveness of a behavioral rehabilitation intervention for improving the performance of morning care activities of daily living (ADL) of nursing home residents with dementia.DESIGN: Participants and their caregivers were observed for 5 days each under conditions of Usual Care (naturalistic) and Skill Elicitation (intervention), and for 15 days under Habit Training (intervention follow‐up). Observations involved the ADL categories of DRESSING, OTHER ADL, and NO ADL. A 3 × 3 design (condition X ADL category) was used.SETTING: Observations occurred in five proprietary nursing homes in Pittsburgh, Pennsylvania.PARTICIPANTS: The participants were 58 women and 26 men, mean age 82 years (range = 64–97, SD = 6.3), with Probable Alzheimer's disease (AD) (n = 19) and Possible AD (n = 65), with a mean MMSE score of 6.07.INTERVENTION: Condition 1, Usual Care, was the naturalistic caregiving condition. Condition 2, Skill Elicitation, consisted of an individualized behavioral rehabilitation intervention designed to identify and elicit retained ADL skills. Under Condition 3, Habit Training, the behavioral rehabilitation intervention was continued to reinforce and solidify retained skills and to facilitate further functional gains.MEASUREMENTS: A computer‐assisted data collection system was used to document in real‐time the assists used by caregivers, the participants' ADL performance, and the participants' responses to caregiving, including disruptive behavior.RESULTS: Compared with Usual Care, during Skill Elicitation participants increased the proportion of time engaged in nonassisted and assisted dressing significantly and increased their overall participation in ADL, with a concomitant significant decrease in disruptive behavior. These functional gains were demonstrated within 5 days of initiating the behavioral rehabilitation intervention and were maintained for 3 weeks during Habit Training. Physical assists were provided for significantly smaller proportions of a morning care session during Skill Elicitation and Habit Training compared with Usual Care.CONCLUSIONS: Even very severely cognitively impaired and functionally disabled nursing home residents can respond to a systematically implemented behavioral rehabilitation intervention. Their rapid response to this intervention suggests that it is alleviating excess disabilities brought on by care patterns rather than retraining ADL task performance. Residents with dementia benefit from behavioral rehabilitation by becoming more appropriately involved in their care and being less disruptive. However, behavioral rehabilitative care takes considerably more time than usual care. J Am Geriatr Soc 47:1049–1057, 1999.
Lateral Stability, Sensorimotor Function and Falls in Older People
Authors: Lord Stephen R. , Rogers Mark W. , Howland Amelia , Fitzpatrick Richard 
Published: April 2015

AIMS: To design simple tests of lateral stability for assessing balance in older people and to determine whether poor performances in these tests are associated with impaired vision, lower limb sensation, quadriceps strength, simple reaction time, and falling in this group.DESIGN: A cross‐sectional and retrospective study.SETTING: Falls and Balance Laboratory, Prince of Wales Medical Research Institute.PARTICIPANTS: One hundred fifty‐six community‐dwelling men and women aged 63–90 years (mean age 76.5, SD = 5.1).OUTCOME MEASURES: The maximal lateral sway in a near‐tandem stability test with eyes open and closed and the necessity of taking a protective step in the near‐tandem stability test with eyes closed.RESULTS: All 156 subjects could complete the near‐tandem stability test with eyes open, but only 99 subjects (63.5%) could undertake the test with eyes closed without taking a protective step. Subjects with a history of falls had increased lateral sway both with eyes open and eyes closed as well as poorer visual acuity, proprioception, and quadriceps strength. Fallers were also significantly more likely to take a protective step when undertaking the near‐tandem stability test with eyes closed. Multiple regression analysis revealed that impaired lower limb proprioception, quadriceps strength, and reaction time were the best predictors of increased maximal sway in the near‐tandem stability test with eyes open. Reduced proprioception and quadriceps strength, in addition to age, were also found to be the best determinants of the necessity of taking a protective step in the near‐tandem stability test with eyes closed.CONCLUSIONS: The study findings identify simple new tests that are associated with falling in older people and elucidate the relative importance of specific physiological systems in the maintenance of lateral stability. J Am Geriatr Soc 47:1077–1081, 1999.
Non‐Influenza Respiratory Viruses May Overlap and Obscure Influenza Activity
Authors: Drinka Paul J. , Gravenstein Stefan , Krause Peggy , Hanger Elizabeth H. , Barthels Lori , Dissing Margaret , Shult Peter , Schilling Margo 
Published: April 2015

OBJECTIVE: To report the number and timing of influenza A isolates, as well as overlapping respiratory viruses. Co‐circulating respiratory viruses may obscure the determination of influenza activity.DESIGN: Prospective clinical surveillance for the new onset of respiratory illness followed by viral cultures during seven separate influenza seasons.SETTING: The Wisconsin Veterans Home, a skilled nursing facility for veterans and their spouses.RESULTS: Influenza A isolates were encountered in greater numbers than non‐influenza A isolates during three seasons. Seasonal variability is striking. In December 1992, we identified a large outbreak of respiratory illness. Influenza type B was cultured from 102 residents. In December 1995, influenza A was cultured from 285 people in Wisconsin. At that time, we identified outbreaks of respiratory illness in two of our four buildings. Based on statewide data, we suspected an influenza outbreak; however, 26 isolates of parainfluenza virus type 1 were cultured with no influenza. The potential importance of culturing at the end of the season was demonstrated in 1991–1992 when an outbreak of respiratory syn‐cytial virus (RSV) overlapped and extended beyond influenza A activity.CONCLUSIONS: When interpreting new clinical respiratory illnesses as a basis for declaring an outbreak of influenza A, clinicians should realize that co‐circulating respiratory viruses can account for clinical illnesses. Clinicians might utilize healthcare dollars efficiently by performing cultures to focus the timing of influenza A chemoprophylaxis. Cultures could be performed when clinical outbreak criteria are approached to confirm an outbreak. Culturing of new respiratory illness could begin again before the anticipated discontinuation of prophylaxis (approximately 2 weeks). J Am Geriatr Soc 47:1087–1093,1999.
Decision‐Making for Percutaneous Endoscopic Gastrostomy Among Older Adults in a Community Setting
Authors: Callahan Christopher M. , Haag Kathy M. , Buchanan Nancy Nienaber , Nisi Rod 
Published: April 2015

OBJECTIVE: To describe clinical decision‐making for percutaneous endoscopic gastrostomy from the perspective of patients, caregivers, and physicians.DESIGN: A prospective cohort study.SETTING AND PATIENTS: All patients aged 60 and older receiving percutaneous endoscopic gastrostomies in a defined community over a 16‐month period.MAIN OUTCOMES MEASURES: Either patients or their surrogate decision‐makers completed a semistructured face‐to‐face interview to map out the information gathering process, expectations, and discussants involved in the decision to proceed with gastrostomy feeding. Physicians completed a written questionnaire to determine their likelihood of recommending percutaneous endoscopic gastrostomy, their involvement in the decision‐making and recommendation process, and sources of perceived pressure in the decision‐making.RESULTS: We identified 100 patients who received percutaneous endoscopic gastrostomy during the study window and 82 primary care physicians who provided care in the defined community. The most common reasons for the procedure were stroke, neurologic disease, and cancer. Patients or their surrogate decision‐makers reported multiple discussants, incomplete information, and considerable distress in arriving at the decision to proceed with artificial feeding. This distress was usually in the context of an acute and debilitating illness that often overshadowed the decision about artificial feeding. The decision for gastrostomy often appeared to be a “non‐decision” in the sense that decision‐makers perceived few alternatives. Physicians also reported considerable distress in arriving at recommendations to proceed with percutaneous endoscopic gastrostomy, including perceived pressures from families or other healthcare professionals. Physicians have clear patterns of triage for percutaneous endoscopic gastrostomy, but the assumptions underlying these patterns are not well supported by the medical literature.CONCLUSIONS: Patients, caregivers, and physicians are often compelled to make decisions about long‐term enteral feeding under tragic circumstances and with incomplete information. Decision‐makers typically do not perceive any acceptable alternatives. Because data on these patients' long‐term functional outcomes are lacking, decision‐makers appear to focus primarily on the short‐term safety of the procedure and the potential for improved nutrition. J Am Geriatr Soc 47:1105–1109,1999.
Alcohol Consumption Is Negatively Associated with the Prevalence of Coronary Heart Disease in the New Mexico Elder Health Survey
Authors: Lindeman Robert D. , Romero Linda J. , Allen Andrew S. , Liang Hwa Chi , Baumgartner Richard N. , Koehler Kathleen M. , Garry Philip J. 
Published: April 2015

OBJECTIVE: To compare the prevalence of coronary heart disease (CHD) and the effects of various risk factors, including alcohol consumption, on prevalence rates in a randomly selected sample of older Hispanic and non‐Hispanic white (NHW) men and women.DESIGN AND SETTING: A cross‐sectional study of equal numbers of Hispanic and NHW men and women, selected randomly from Health Care Financing Authority (Medicare) rolls, recruited for a home interview followed by a 4‐hour interview/examination in a senior health clinic.PARTICIPANTS: A total of 883 volunteers, mean age 74.1, years were interviewed/examined.MEASUREMENTS: CHD was identified by interview and electrocardiogram. Risk factors were identified by interview (hypertension, diabetes, medications, smoking, alcohol consumption) and by direct measurements (glucose tolerance, serum lipids, blood pressure, anthropometry).RESULTS: The age‐adjusted prevalences of CHD were not significantly different when Hispanic men and women were compared with their NHW counterparts. Age‐, ethnicity‐, and gender‐adjusted relative risk of CHD was inversely associated with alcohol consumption (OR. 46; 95% CI,. 28‐.73; P <. 001). Hypertension, diabetes mellitus, and male gender were also significant risk factors; age, anthropometric measurements, smoking, serum lipid concentrations, and level of education were not. HDL cholesterol levels were significantly lower in nondrinkers; other lipid levels were not associated with alcohol consumption. The type of alcoholic beverage was not associated with the prevalence of CHD.CONCLUSIONS: No significant differences in CHD prevalence existed between Hispanic and NHW participants despite a higher prevalence of diabetes and central obesity in Hispanics. Alcohol consumption was strongly negatively associated with the prevalence of CHD identified in this older, biethnic population.
Measures of Disease Control in Medicare Beneficiaries with Diabetes Mellitus
Authors: Kell Sherron H. , Drass Jan , Bausell R. Barker , Thomas Katherine A. , Osborn Morris A. , Gohdes Dorothy 
Published: April 2015

OBJECTIVE: To investigate measures of disease control for Medicare beneficiaries with diabetes and their outpatient care in the fee‐for‐service setting.DESIGN: Retrospective cohort study.SETTINGS: Office practices in Alabama, Iowa, and Maryland of 293 primary care physicians (PCPs) who volunteered to participate in the Ambulatory Care Quality Improvement Project.PARTICIPANTS: A total of 5980 patients with an average age of 75.2 years.MEASUREMENTS: For an 18‐month period (1/1/94–6/30/ 95), medical records were abstracted for clinical parameters, including up to four blood glucose values; two blood pressure measurements; one total cholesterol value; two serum creatinine values; medication use, including antihypertensives, angiotensin‐ converting enzyme (ACE) inhibitors, and lipid‐lowering agents; and frequency of glycosylated hemoglobin (GHb) determinations.RESULTS: During the study, 44% of patients received at least one GHb determination, 94% received at least one blood glucose, 68% at least one total serum cholesterol, 74% at least one serum creatinine test, and 97% at least one blood pressure measurement. Ten percent of patients had mean blood glucose levels ≥ 250 mg/dL. Eighty‐five percent had evidence of hypertension. Of this group of hypertensive patients with blood pressure readings available, 70% had blood pressure readings ≥ 140/90 mm Hg, even though there were on medication that could have been prescribed for hypertension. Thirty‐six percent of those who had evidence of hypertension were taking an ACE inhibitor. Thirty‐two percent of those taking lipid‐lowering medication had a total serum cholesterol value ≥ 240 mg/dL. Statistically significant differences were noted for age and gender, with men and patients more than 85 years old generally having better measures of disease control.CONCLUSIONS: Many older Medicare patients with diabetes did not achieve recommended target levels of blood glucose, blood pressure, and lipids. GHb and serum cholesterol are not being monitored at recommended intervals. Significant opportunities exist to improve diabetes care for this population.