bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Prognostic Value of Serum Albumin in Healthy Older Persons with Low and High Serum Interleukin‐6 (IL‐6) Levels
Authors: Reuben David B. , Ferrucc Luigi , Wallace Robert , Tracy Russell P. , Corti M. Chiara , Heimovitz Harley , Harris Tamara B. 
Published: April 2015

OBJECTIVE: We sought to determine the prognostic value of serum albumin for 4‐year mortality among high‐functioning persons who did or did not have evidence of inflammation as indicated by high interleukin‐6 (IL‐6) levels.DESIGN: We used a case‐cohort design of healthy, nondisabled older persons who had serum albumin and plasma IL‐6 measured at baseline. Crude and multiply adjusted (for sociodemographics and chronic diseases) proportional hazards models were used to identify the effect of baseline levels of serum albumin level on 4‐year mortality among those with higher and lower levels of IL‐6.RESULTS: Among subjects without evidence of IL‐6‐mediated inflammation (IL‐6 < 3.20 pg/mL), having a lower (≤4.4 g/dL) albumin level was associated with a multiply adjusted relative risk of 2.1 for 4‐year mortality compared with those with higher albumin. In the presence of inflammation (IL‐6 ≥ 3.20 pg/mL), higher and lower serum albumin levels had similar risks (adjusted relative risks 4.0 and 3.8, respectively) compared with the referent group (higher albumin and low IL‐6).CONCLUSIONS: High serum albumin has a protective effect in healthy older persons who do not have evidence of cytokine‐mediated inflammation. This protective effect is not conferred in presence of inflammation. The mechanisms by which inflammation eliminates the protective effect of high albumin remain to be determined.
Self‐Reported Walking Ability Predicts Functional Mobility Performance in Frail Older Adults
Authors: Alexander Neil B. , Guire Kenneth E. , Thelen Darryl G. , Ashton‐Miller James A. , Schultz Albert B. , Grunawalt Julie C. , Giordani Bruno 
Published: April 2015

OBJECTIVE: To determine how self‐reported physical function relates to performance in each of three mobility domains: walking, stance maintenance, and rising from chairs.DESIGN: Cross‐sectional analysis of older adults.SETTING: University‐based laboratory and community‐based congregate housing facilities.PARTICIPANTS: Two hundred twenty‐one older adults (mean age, 79.9 years; range, 60–102 years) without clinical evidence of dementia (mean Folstein Mini‐Mental State score, 28; range, 24–30).INTERVENTION AND MAIN OUTCOME MEASURES: We compared the responses of these older adults on a questionnaire battery used by the Established Populations for the Epidemiologic Study of the Elderly (EPESE) project, to performance on mobility tasks of graded difficulty. Responses to the EPESE battery included: (1) whether assistance was required to perform seven Katz activities of daily living (ADL) items, specifically with walking and transferring; (2) three Rosow‐Breslau items, including the ability to walk up stairs and walk a half mile; and (3) five Nagi items, including difficulty stooping, reaching, and lifting objects. The performance measures included the ability to perform, and time taken to perform, tasks in three summary score domains: (1) walking (“Walking,” seven tasks, including walking with an assistive device, turning, stair climbing, tandem walking); (2) stance maintenance (“Stance,” six tasks, including unipedal, bipedal, tandem, and maximum lean); and (3) chair rise (“Chair Rise,” six tasks, including rising from a variety of seat heights with and without the use of hands for assistance).A total score combines scores in each Walking, Stance, and Chair Rise domain. We also analyzed how cognitive/behavioral factors such as depression and self‐efficacy related to the residuals from the self‐report and performance‐based ANOVA models.RESULTS: Rosow‐Breslau items have the strongest relationship with the three performance domains, Walking, Stance, and Chair Rise (eta‐squared ranging from 0.21 to 0.44). These three performance domains are as strongly related to one Katz ADL item, walking (eta‐squared ranging from 0.15 to 0.33) as all of the Katz ADL items combined (eta‐squared ranging from 0.21 to 0.35). Tests of problem solving and psychomotor speed, the Trails A and Trails B tests, are significantly correlated with the residuals from the self‐report and performance‐based ANOVA models.CONCLUSIONS: Compared with the rest of the EPESE self‐report items, self‐report items related to walking (such as Katz walking and Rosow‐Breslau items) are better predictors of functional mobility performance on tasks involving walking, stance maintenance, and rising from chairs. Compared with other self‐report items, self‐reported walking ability may be the best predictor of overall functional mobility.
Assessment of Adherence to Renal Dosing Guidelines in Long‐Term Care Facilities
Authors: Papaioannou Alexandra , Clarke Jo‐Anne , Campbell Glenda , Bédard Michel 
Published: April 2015

OBJECTIVE: We determined whether dosing guidelines based on creatinine clearance (Ccr) for renally excreted drugs are being applied when prescribing to long‐term care residentsDESIGN: A cross sectional chart review for the month of May 1999.PARTICIPANTS: Long‐term care residents more than 65 years of age from four long‐term care facilities in Southern Ontario who were prescribed a medication from a list of renally excreted drugs commonly prescribed in long‐term care facilities.RESULTS: Approximately one in three prescriptions (34.1%) were considered inappropriate for the calculated Ccr of the residents. Overall, 42.3% of the residents who were prescribed a drug under review received at least one inappropriate prescription based on creatinine clearance. Logistic regression found that age (odds ratio (OR) = 1.06 per year; 95% confidence interval (CI) 1.03–1.09, P = .001), weight (OR = 0.96 per kg; 95% CI 0.94–0.98, P < .001), the total number of prescribed medications (OR = 1.10; 95% CI 1.04–1.17, P = .001), and the number of physicians prescribing in the facility (OR 1.02; 95% CI, 1.003–1.044, P = .03) were predictive for receiving an inappropriate prescription based on Ccr.CONCLUSIONS: Renal function is often overlooked when prescribing renally excreted drugs to older long‐term care residents. These findings emphasize the need for consideration of Ccr when prescribing such drugs in this population.
Relationship Between Low Blood Pressure and Depressive Symptomatology in Older People
Authors: Stroup‐Benham Christine A. , Markides Kyriakos S. , Black Sandra A. , Goodwin James S. 
Published: April 2015

OBJECTIVES: To determine if low blood pressure is associated with a definable constellation of somatic and psychological symptoms in older persons.DESIGN: A population‐based study.SETTING: In‐home interviews in five southwestern states.PARTICIPANTS: A total of 2723 Mexican Americans aged 65 or older not living in institutions.MEASURES: Blood pressure, Center for Epidemiologic Studies Depression Scale (CES‐D), global self‐rating of health, and self‐esteem.RESULTS: Bivariate analyses indicate a significant relationship between low blood pressure and increased depressive symptomatology; for example, systolic hypotensive subjects scored a CES‐D mean of 12.07 ± .67 compared to 8.99 ± .95 for normotensives (P < .01). Regression analyses supported these findings when controlling for confounders such as gender, age, and use of antihypertensive medications. Subjects with low blood pressure also scored lower on self‐esteem and global self‐reported health and reported more days waking up feeling tired.CONCLUSIONS: These data support the existence of a relationship between low blood pressure and higher levels of depressive symptomatology as well as a constellation of somatic and psychosocial symptoms. J Am Geriatr Soc 48: 250–255, 2000.
Coronary Artery Calcification in Older Adults with Minimal Clinical or Subclinical Cardiovascular Disease
Authors: MD Anne B. Newman , Naydeck Barbara , Sutton‐Tyrrell Kim , Edmundowicz Daniel , Gottdiener John , Kuller Lewis H. 
Published: April 2015

BACKGROUND: Coronary artery calcification (CAC) reflects the extent of coronary artery atherosclerosis. The extent of coronary artery calcification is not well described in older adults.OBJECTIVE: To determine the extent of CAC in older adults participating in a large population study of cardiovascular disease (CVD), especially those characterized as having minimal clinical or subclinical cardiovascular disease.DESIGN: An observational epidemiologic study.POPULATION: Participants in the Cardiovascular Health Study Cohort, mean age 78 years, who had electron beam computed tomography (EBT) scan of the heart (n = 133); included were 106 persons with no prior evidence of clinical or subclinical CVD.MEASUREMENTS: Total CAC score was measured using cardiac EBT. Cardiovascular disease and risk factors, as well as carotid ultrasound, electrocardiogram, echocardiogram, and ankle‐arm index, had been measured previously to define subclinical disease. Previous cerebral magnetic resonance imaging was also evaluated.RESULTS: Overall, the CAC scores were higher in those with clinical cardiovascular disease or evidence of subclinical cardiovascular disease than in those with no evidence of disease. For the 106 participants without evidence of clinical or subclinical disease, the median score was 176, compared with 367 in those with subclinical disease and 923 in those with clinical CVD. Seventeen persons had scores of zero. There was little difference in risk factors across quartiles of CAC in the subgroup of 106 with prior characterization of minimal CVD despite the broad range of CAC scores. There was a higher proportion of those with white matter grade ≥2 by magnetic resonance imaging among those with higher CAC scores (P = .025). Infarct‐like lesions prevalence ranged from 12.5% in the lowest group to 47.1% in the highest CAC group (P = .019).CONCLUSIONS: Older adults with evidence of clinical or subclinical CVD have higher total CAC scores. Though the extent of coronary artery calcification was lower in those with minimal evidence of CVD, the range was broad and not explained by CVD risk factors. J Am Geriatr Soc 48: 256–263, 2000.
Patterns of Care in the Early Stages of Alzheimer's Disease: Impediments to Timely Diagnosis
Authors: Knopman David , Donohue Jane A. , Gutterman Elane M. 
Published: April 2015

OBJECTIVE: Description of factors associated with delay in diagnosis of Alzheimer's disease (AD).DESIGN: A self‐administered mail questionnaire.SETTING: Households including someone with AD identified through a nationwide marketing database.PARTICIPANTS: A total of 1480 caregivers of patients diagnosed with ADMEASUREMENTS: There were two measures of delay examined through caregiver reports: (1) duration in years from first AD signs until determination of a definite problem, and (2) duration from problem recognition to first physician consultation. Also, caregivers were categorized by time since patient's diagnosis and relationship to patient. Within‐group analyses examined the impact of these characteristics on delay measures.RESULTS: Mean lag in years from observation of first symptoms to problem recognition for those diagnosed in the past 12 months, the past 13 to 48 months, and the past 49 months or more was, respectively, 1.20, 1.56, and 2.25 (P < .001). The timing of diagnosis also influenced lag from problem recognition to first physician consultation so that subgroups with recent, less recent, and distant diagnosis reported delays in years of .82, .84, and 1.31 (P < .001). Caregiver relationship was not significantly related to these lags. Correct diagnosis of AD was reported by caregivers in only 38% of cases at initial physician consultation.CONCLUSIONS: These results suggest that both caregivers and physicians lack ready understanding of the difference between memory processes in aging and AD. Ongoing public and professional education is needed to convey the basics of the diagnosis of AD. In addition, routine screening for dementia should be considered to surmount attitudinal and logistical barriers. J Am Geriatr Soc 48: 300–304, 2000.
Hodgkin's Disease Survival by Stage and Age
Authors: Kennedy B.J. , Fremgen Amy M. , Menck Herman R. 
Published: April 2015

OBJECTIVE: Prior reports on Hodgkin's disease have suggested a biologic behavior difference between young and old patients. A study of 35,033 patients could confirm that older patients do not do as well as young patients regardless of age.METHODS: The National Cancer Data Base provided data from U.S. tumor registries on 35,033 patients newly diagnosed with Hodgkin's disease from 1985 through 1994. For analysis the patients were divided into two time periods, 1985–1989 and 1990–1994. The earlier period provided survival data to assess the impact of age and stage.RESULTS: The overall disease‐specific, 5‐year survival rate for the 1985–1989 period was 84.9%. For stages I and II, it reached almost 90%. For both observed survival based on all deaths and disease‐specific survival, the duration of survival decreased with increasing age. This decrease with age occurred for all stages of the disease.CONCLUSIONS: The data reflect the actual status of management of Hodgkin's disease in the United States rather than the best attainable results. The decreasing survival with increasing age and in all stages further supports the concept of a difference in biologic behavior of Hodgkin's disease associated with age. J Am Geriatr Soc 48: 315–317, 2000.
Exercise and Older Patients: Guidelines for the Clinician
Authors: Christmas Colleen , Andersen Ross A. 
Published: April 2015

“If I'd known I was going to live this long, I'd have taken better care of myself.” Eubie BlakeSedentary persons who improve their physical fitness are less likely to die of all causes and of cardiovascular disease than are those who remain sedentary. There now exists a wealth of data demonstrating that physical activity and exercise may ameliorate disease and delay decline in function in the geriatric population. We review evidence that exercise can improve body composition, diminish falls, increase strength, reduce depression, reduce arthritis pain, reduce risks for diabetes and coronary artery disease, and improve longevity. However, many healthcare professionals do not feel adequately prepared to design and prescribe exercise programs for their patients. This review provides a basic overview of the benefits of exercise in the geriatric population and guidelines indicating how to prescribe and facilitate adherence to an exercise program. Healthcare providers are strongly encouraged to promote a less sedentary life style for their older patients, which may augment quality of life in these older individuals. J Am Geriatr Soc 48: 318–324, 2000.
Interdisciplinary Geriatric Primary Care Evaluation and Management: Two‐Year Outcomes
Authors: Burns Robert , Nichols Linda O. , Martindale‐Adams Jennifer , Graney Marshall J. 
Published: April 2015

BACKGROUND: The long‐term efficacy of interdisciplinary outpatient primary care Geriatric Evaluation and Management (GEM) has not been proven. This article focuses on results obtained during the 2 years of the study.METHODS: In this 2‐year randomized clinical trial, at the Veterans Affairs Medical Center, Memphis, TN, 128 veterans, age 65 years and older, were randomized to outpatient GEM or usual care (UC). Two‐year follow‐up analyses are based on the 98 surviving individuals. Study outcome measurements included health status, function, and quality of life including affect, cognition, and mortality.RESULTS: At 2 years, there were positive intervention effects for eight of 11 outcome measures, five of which had attained significance at 1 year. GEM subjects, compared with UC subjects, had significantly greater improvement in health perception (P = .001), smaller increases in numbers of clinic visits (P = .019) and instrumental activities of daily living (IADL) impairments (P = .006), improved social activity (P < .001), greater improvement in Center for Epidemiologic Studies‐Depression (CES‐D) scores (P = .003), general well‐being (P = .001), life satisfaction (P < .001), and Mini‐Mental State Exam (MMSE) scores (P = .025). There were no significant treatment effects in activities of daily living (ADL) scores (P = .386), number of hospitalizations (P = .377), or mortality (P = .155).CONCLUSIONS: These findings suggest that a primary care approach that combines an initial interdisciplinary comprehensive assessment with long‐term, interdisciplinary outpatient management may improve outcomes for targeted older adults significantly. Findings suggest further that outcomes may continue to improve over time and that the GEM care model provides an effective way to manage health care of older adults. J Am Geriatr Soc 48: 8–13, 2000.
The Influence of Patient Age on Primary Care Resident Physician‐Patient Interaction
Authors: Callahan Edward J. , Bertakis Klea D. , Azari Rahman , Robbins John A. , Helms L. Jay , Chang Dong W. 
Published: April 2015

OBJECTIVES: To explore resident physician‐patient interaction in primary care to address issues relevant to quality of care for older people.DESIGN: A sample of 509 new, adult, nonpregnant patients was assigned to the care of second‐ and third‐year residents in primary care clinics. Care was compared for three subgroups of patients: older patients (65 years or older; n = 45), those aged 18 to 44 years (n = 320), and those aged 45 to 64 years (n = 144).SETTING: Observations were made at the family medicine and general internal medicine clinics at the University of California, Davis.MEASUREMENTS: Self‐report by means of the Medical Outcomes Study Short Form‐36 (MOS SF‐36) was used to determine patient demographics and patient health status. Two measures of satisfaction were obtained gauging reaction to medical care in general and to the videotaped visit specifically. Videotapes were coded for content using the Davis Observation Code.RESULTS: Self‐reported health status of older persons was poorer than that of younger groups as measured by the MOS SF‐36. Differences in demographics were explored and then controlled, along with physical health status in subsequent analyses. Supporting prior studies, this study found that older patients had more return visits and reported higher levels of satisfaction than did younger comparison groups. Contrary to prior literature, older patients were found to have longer visits than did younger cohorts. The physician‐patient interaction was significantly different in many areas between these three groups. Whereas older patients experienced more chatting in their visits, they were given less counseling, asked fewer questions, had less discussion about their families and their use of substances, were asked to change their health behavior habits less often, and were given less health education. For older patients, more of each visit was spent checking on compliance with earlier treatment and developing treatment plans.CONCLUSIONS: These results provide a new and more detailed view of how resident physician‐patient interaction differs between older and younger groups and raise important issues on whether quality of care needs for this population are being adequately addressed, particularly regarding mental health issues. J Am Geriatr Soc 48: 30–35, 2000.
Measures of Postural Stability Are Not Predictors of Recovery from Large Postural Disturbances in Healthy Older Adults
Authors: Owings Tammy M. , Pavol Michael J. , Foley Kevin T. , Grabiner Mark D. 
Published: April 2015

OBJECTIVES: To determine, in healthy older adults, the relationship between postural steadiness, stability limits, and the ability to recover balance from three postural disturbances requiring anteriorly directed stepping responses.DESIGN: Analysis of multiple motor tasks in a cross‐sectional sample of healthy older adults.SETTING: A biomechanics research laboratory.PARTICIPANTS: Fifty women and 29 men aged 65 or older, all healthy, living in the community, participated in this study. Subjects were examined by a geriatrician to identify the presence of exclusionary factors.MEASUREMENTS: Anterior‐posterior and medial‐lateral excursion distances of the center of pressure during quiet standing (postural steadiness), static leaning (static stability limits), and dynamic swaying (dynamic stability limits) were determined from ground reaction forces measured by a strain gauge forceplate. Within the same group of subjects, the maximum angle of forward lean from which a subject could recover with a single step, the ability to recover balance in response to an accelerated support surface, and the ability to recover balance after being tripped were determined.RESULTS: Recovery from the three types of postural disturbances were found to be statistically independent. The postural steadiness and the stability limit variables were only weakly correlated. Postural steadiness and stability limits were not related to the maximum recoverable angle of lean. The average medial‐lateral center of pressure speed during the postural steadiness test was significantly slower for those who failed to recover after tripping than for the subjects who recovered successfully. However, a logistic regression model failed to achieve statistical significance, suggesting that the difference may not be functionally important. The anterior‐posterior static stability limits were significantly larger for subjects who recovered successfully than for those who failed to recover during the accelerated support surface test. Although logistic regression suggested that a reduced anterior‐posterior stability limit represents a risk factor for failure to recover during this task, only nine of 28 failures could be properly classified, thus diminishing the functional importance of this finding.CONCLUSIONS: Because recovery following postural disturbances could not generally be predicted from measures of postural stability, these findings suggest that these measures of postural stability are of limited utility in identifying potential anteriorly directed fallers in healthy older adults. J Am Geriatr Soc 48: 42–50, 2000.
Survey Methods for Seriously Ill Hospitalized Adults: Practical Lessons from SUPPORT
Authors: Kreling Barbara , Wu Albert W. , Lynn Joanne 
Published: April 2015

OBJECTIVE: To describe issues confronted in collecting questionnaire‐based data in a large study of seriously ill hospitalized adults, discuss methods used to achieve acceptable results, summarize the reliability of selected measures, and explore challenges for patient‐based research in this population.DESIGN: A prospective cohort study.SETTING: Five teaching hospitals in the US.PARTICIPANTS: 9105 patients, with a subset of 80 patients and 10 proxy respondents for reliability testing.MEASUREMENTS AND MAIN OUTCOMES: Response rates; percent agreement and Kappa statistics to assess test‐retest reliability.RESULTS: A pretest and pilot test were used to help develop the assessment strategy, establish study procedures, and identify staff characteristics likely to facilitate the project. Achieving adequate response rates required great perseverance and flexibility by interview staff as well as close monitoring and central supervision. Standardized quality assurance with timely feedback, and social support provided by peer and supervising staff were both important. Older women proved to be the best interviewers. Reliability was acceptable for existing and newly developed scales to measure subjective health status, preferences, and satisfaction.CONCLUSIONS: It was possible to collect reliable and useful data on preferences and subjective health outcomes from a cohort of seriously ill hospitalized patients and their proxies. Achieving acceptable data quality required a large interview team, mature staff, flexibility about modes of administration, and centralized, structured quality assurance. Successful outcomes research in this population is likely to require similar planning and efforts.