bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Descriptive Study of Physically Aggressive Behavior in Dementia by Direct Observation
Authors: Bridges‐Parlet Sarah , Knopman David , Thompson Travis 
Published: April 2015

Objective: To study, by direct observation, physically aggressive behavior (PAB) in a cohort of older persons with dementia.Design: Cross‐sectional survey.Setting: A locked special care unit for Alzheimer's Disease and an ordinary skilled unit of two suburban nursing homes.Participants: Twenty men and women with a history of PAB.Measurements and Main Results: Portable bar‐code‐readers and daily diaries were used to determine the frequency of PAB as well as to elucidate the antecedents and consequences of it. PAB was most often directed toward staff (23/28 episodes), usually in the context of personal care (15/23 episodes). In the majority of cases, verbal aggression or noncompliance preceded the PAB. Most often PAB was followed by a rapid return to non‐aggressive behavior.Conclusions: Very little PAB was truly spontaneous, nor was it usually the participant's normal behavior. Most PAB occurred in response to intrusion into the participant's personal space by staff or other residents. The PAB is better understood as a defensive response than an expression of anger.
Treatment Seeking for Urinary Incontinence in Older Adults
Authors: Burgio Kathryn L. , Ives Diane G. , Locher Julie L. , Arena Vincent C. , Kuller Lewis H. 
Published: April 2015

Objective: To examine treatment seeking for urinary incontinence among older adults and to identify characteristics associated with treatment‐seeking behavior.Design: Survey.Setting: Five rural counties in northwestern Pennsylvania.Participants: 1104 community‐dwelling ambulatory older adults aged 65 to 79 years with self‐reported urinary incontinence. Participants were a subgroup of a large sample (n = 3884) who volunteered for a study of health promotion services. Those who reported urinary incontinence within the past year, during an in‐person health risk appraisal, were included in this analysis.Measurements: Reporting incontinence to the participant's physician was the main dependent measure.Main Results: 37.6% of the participants had told their physician about loss of urine. Reporting incontinence to a physician was strongly associated with severity of incontinence as indicated by eight measures (P < 0.001). Treatment seeking was also related to type of incontinence (P < 0.001), physical disability (P < 0.01), and the pattern of health care utilization (P < 0.01). In multiple logistic regression analyses, younger age, physical disability, and frequency of physical and rectal examinations had significant predictive value independent of severity. Not associated with treatment seeking were gender, marital status, income, employment status, educational level, and distance from health care provider.Conclusions: The majority of older adults with urinary incontinence do not report the condition to their doctor. Severity of incontinence, physical disability, and a pattern of regular health care utilization appear to be the strongest predictors of treatment‐seeking behavior.
Rationale and Design of a Multi‐Center Randomized Trial of Comprehensive Geriatric Assessment Consultation for Hospitalized Patients in an HMO
Authors: Borok Gerald M. , Reuben David B. , Zendle Les J. , Ershoff Daniel H. , Wolde‐Tsadik Girma , Rubenstein Laurence Z. , Ambrosini Virginia L. , Fishman Linda K. , Beck John C. 
Published: April 2015

Objective: To describe the evaluation of an interdisciplinary comprehensive geriatric assessment (CGA) consultation program for targeted hospitalized patients.Design: Multi‐center randomized clinical trial (RCT) at four hospitals where patients were randomly assigned to CGA consultation or usual care by the attending physician, and a non‐equivalent control group (NCG) at two hospitals.Setting: Six hospitals in a multi‐specialty group practice model health maintenance organization (HMO).Participants: 3593 patients age 65 years or older meeting at least one of 13 inclusionary criteria at admission.Intervention: Screening by hospital staff and standardized CGA consultation conducted by a nurse practitioner, social worker, and geriatrician at the four RCT hospitals.Main Outcome Measures: Functional and health status, mortality, rehospitalization, and cost‐effectiveness of the CGA program at 1 year post‐randomization; validation of targeting (inclusionary) criteria that identify subgroups of patients deriving benefit from CGA; and physician contamination (learning from CGA and changing treatment provided to control patients).Conclusions: A number of methodological issues need to be considered when conducting effectiveness trials of CGA. The concurrent design of a multi‐center RCT, coupled with the NCG to determine physician contamination, is an innovative approach intended to determine more precisely the cost‐effectiveness of CGA for frail hospitalized elderly persons. The large and heterogeneous patient population and the broad array of inclusionary criteria will permit the evaluation of the benefit of CGA for subgroups. All these features are intended to enhance the generalizability of study results.
Differential Diagnosis of Dementia: A Prospective Evaluation of the DAT Inventory
Authors: Coen Robert F. , O'Mahoney Denis , Bruce Irene , Lawlor Brian A. , Walsh J. Bernard , Coakley Davis 
Published: April 2015

Objective: To compare prospectively the concordance between the diagnosis of dementia based on clinical criteria and using the DAT Inventory.Design, Setting, and Participants: A prospective study of 81 consecutive patients referred to a Memory Clinic. Only patients for whom a definitive diagnosis of dementia was established after 8 to 20 months follow‐up were retained in the study (n = 76).Measurements: The sensitivity, specificity, positive and negative predictive values, and overall diagnostic accuracy of the DAT Inventory were calculated. Kappa values were also computed.Results: Based on all patients (n = 76), sensitivity and specificity were 71% and 95%, respectively, with 98% positive prediction, 56% negative prediction, 78% overall accuracy, and kappa of 0.54. Of 21 cases not meeting NINCDS/ADRDA criteria for DAT, one patient with multi‐infarct dementia was misclassified as DAT on the DAT Inventory. Of 55 DAT cases (NINCDS/ADRDA criteria), 16 patients, predominantly very mild or mixed cases, were classified as non‐DAT on the DAT Inventory. When mixed, very mild, and borderline cases were excluded (remaining n = 54), DAT Inventory sensitivity increased to 94%, and specificity remained unchanged at 95%, with 97% positive and 91% negative prediction, 94% overall accuracy, and kappa of 0.88.Conclusions: In general, scores above the designated cutoff point (>14/20) on the DAT Inventory are consistent with a clinical diagnosis of DAT (NINCDS/ADRDA criteria). Concordance is best in cases of mild to moderate dementia (Clinical Dementia Rating 1–2). The Inventory is less discriminating as a differential diagnostic instrument in cases of very mild dementia, atypical presentations of DAT, or in cases of mixed pathology. J Am Geriatr Soc 42:16–20, 1994
The Appropriateness of Oral Fluoroquinolone‐Prescribing in the Long‐Term Care Setting
Authors: Pickering Terri‐Diann , Gurwitz Jerry H. , Zaleznik Dori , Noonan James P. , Avorn Jerry 
Published: April 2015

Objective: To evaluate the appropriateness of ciprofloxacin‐prescribing in the long‐term care setting.Design: Retrospective chart review.Setting: A large academically oriented long‐term care facility.Patients: Institutionalized elderly patients with a mean age of 88 years.Methods: One hundred orders were randomly selected for review from all ciprofloxacin orders initiated over a 3‐year period. Criteria for appropriateness of ciprofloxacin‐prescribing were developed based on a comprehensive review of the medical literature. Evaluation of appropriateness of prescribing was based on the indication for therapy and the availability of more effective and/or less expensive alternative antibiotic regimens. Only information available to the physician at the time of the order was used to judge appropriateness. Abstracted medical records were evaluated independently by a geriatrician and an infectious diseases specialist.Results: With respect to site of infection, the urinary tract accounted for 43% of all ciprofloxacin orders; the lower respiratory tract, 28%; and skin and soft‐tissue infections, 17%. Only 25% of orders were judged appropriate. Twenty‐three percent of orders were judged less than appropriate based on indication, and 49% due to the availability of a more effective and/or less expensive alternative antibiotic choice. There was insufficient information in the medical record to judge 3% of the orders.Conclusion: These results indicate less than optimal prescribing of oral fluoroquinolones in the long‐term care setting, with potential consequences including the development of resistant bacterial strains and increased health care costs. J Am Geriatr Soc 42:28–32, 1994
Stroke Inpatient Rehabilitation: A Comparison across Age Groups
Authors: Falconer Judith A. , Naughton Bruce J. , Strasser Dale C. , Sinacore James M. 
Published: April 2015

Objective: To examine and compare the inpatient stroke rehabilitation experience of older adults (≥75 years) with that of young adults (<65 years) and young‐old adults (65–74 years).Design: Cross‐sectional descriptive study.Setting: A large university‐affiliated free‐standing rehabilitation hospital.Participants: 260 adults who were admitted to inpatient stroke rehabilitation with a primary diagnosis of recent (<120 days) stroke (ICD9 430–436).Variables: Demographic data, diagnosis, time between stroke onset and rehabilitation admission, discharge disposition, and functional status on admission and discharge were obtained from the patient's medical record. Treatment intensity and type, length of stay, and primary payment source data were obtained from the patient's billing record. Three‐month mortality data were available from the hospital's routine follow‐up survey.Main Results: Compared with the younger adults (<65 yrs and 65–75 years), the older adults (≥75 years) were admitted to rehabilitation earlier and with comparable cognitive but poorer motor function. Rehabilitation treatment intensity (per day) and type were similar across age groups, but the older adults (≥75 years) had significantly shorter rehabilitation stays. Three‐month survival was comparable across age groups, but the older adults (≥75 years) had poorer motor function at discharge and were more often discharged to a nursing home or required a paid caregiver.Conclusions: Age‐associated factors may influence inpatient stroke rehabilitation referral, treatment, and outcome, particularly for patients over age 75. The cumulative effects of frailty and co‐morbid disease upon stroke disability and treatment are possible explanations for the findings. The study provides evidence of a need for further investigation of stroke rehabilitation strategies for adults over 75 years old. J Am Geriatr Soc 42:39–44, 1994
Use of Laxative Medication in Older Persons and Associations with Low Serum Albumin
Authors: Pahor Marco , Guralnik Jack M. , Chrischilles Elizabeth A. , Wallace Robert B. 
Published: April 2015

Objective: To study laxative use among older persons and the association of laxative intake with hypoalbuminemia.Design: Cross‐sectional study in a population‐based cohort.Setting: Community and institutions in the Iowa and Washington counties, Iowa site of the Established Populations for Epidemiologic Studies of the Elderly.Participants: Persons aged 71 years or older, who were interviewed at the 6th year of follow‐up and for whom drug intake information was obtained (n = 2,529).Main Outcome Measures: Laxative medication use and prevalence of hypoalbuminemia.Results: The prevalence rate of laxative use was 8.8% in the community and 74.6% in nursing homes. Increasing age was independently associated with laxative use (odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.33 to 2.07 for a 10‐year increase), after adjusting for gender, institutionalization, disability in activities of daily living, body mass index, and use of the following drugs: furosemide, benzodiazepines, antidepressants, codeine, and calcium antagonists. Laxative use was independently associated with hypoalbuminemia (OR = 3.17, 95% CI = 1.42 to 7.08) after adjusting for age, gender, anemia, number of comorbid conditions, disability in activities of daily living, body mass index, use of furosemide, and institutionalization status. Compared with those who never used laxatives, those who took laxatives only at the 6th year of follow‐up were at increased risk of hypoalbuminemia (OR = 2.65, 95% CI = 1.04 to 6.77), and those who used laxatives at both the 3rd and 6th years of follow‐up were at greatest risk (OR = 4.02, 95% CI = 1.53 to 10.06).Conclusion: Laxatives are used by large numbers of older persons, and the investigation on unknown adverse effects is important. Prospective studies are needed to confirm the association of laxative use with hypoalbuminemia found in this study and to assess the mechanisms of this association. J Am Geriatr Soc 42:50–56, 1994
Treatment of Small Cell Lung Cancer in the Elderly
Authors: Shepherd Frances A. , Amdemichael Esiahas , Evans William K. , Chalvardjian Peter , Hogg‐Johnson Sheila , Coates Randall , Paul Karen 
Published: April 2015

Objective: Since both the incidence of lung cancer and the proportion of the population over age 65 are increasing rapidly in North America, we undertook a retrospective review of elderly patients with small cell lung cancer (SCLC) in an attempt to assess the effect of age on treatment decisions, response, survival, and toxicity.Design: Retrospective chart view.Setting: Oncology Unit of a university‐affiliated teaching hospital.Patients: There were 123 patients age >70 years treated from 1976–88. Chemotherapy consisted of either cyclophosphamide, doxorubicin, and vincristine, or etoposide and cisplatin.Results: There were 74 patients aged 70–74, 35 aged 75–80, and 14 aged 80 years or older. No significant differences existed between the groups in sex, stage, performance status, or presence of co‐morbid disease. Median survivals for patients with limited and extensive disease were 11.9 and 5.2 months, respectively (P = <0.0001), with no significant difference for patients in any age group (P = 0.4). For both limited and extensive disease, survival correlated strongly with the treatment received. Twenty‐five patients received no treatment (median survival 1.1 months), 20 had radiation only (median 7.8 months), and 27 patients had <3 cycles of chemotherapy (median 3.9 months). Median survival for the 50 patients who had 4–6 cycles was 10.7 months (limited disease 15.0 months, extensive disease 8.61 months). In the Cox Model, survival correlated strongly with stage of disease and chemotherapy treatment (P < 0.0001), but only marginally with performance status (P < 0.077). Of the 77 patients who had chemotherapy, less than 50% in all age groups completed six cycles. Only two patients completed chemotherapy without a single dose reduction, and 76.7% required more than two reductions.Conclusions: Chemotherapy should not be withheld from elderly patients with SCLC on the basis of age. The survival of patients who receive chemotherapy is significantly longer than that of untreated patients even though frequent dose reductions for toxicity may be required. The survival benefit is due to treatment effect and is not due to a selection bias in the cohort of patients chosen for therapy. J Am Geriatr Soc 42:64–70, 1994
Reducing Hospital Costs for the Geriatric Patient Admitted from the Emergency Department: A Randomized Trial
Authors: Naughton Bruce J. , Moran Maureen B. , Feinglass Joe , Falconer Judith , Williams Mark E. 
Published: April 2015

OBJECTIVE: To test the impact of a geriatric evaluation and management model on the costs of acute hospital management of emergently admitted older adults.DESIGN: Randomized controlled trial. Patients were followed in the acute hospital from admission through discharge. Results based on both univariate and multiple regression analyses.SETTING: Private, nonprofit, academic medical center in a densely populated urban area.PATIENTS: Adults 70 years of age and older admitted from the Emergency Department to the medicine service (non‐ICU admission) who did not have an internist on staff at the admitting hospital. Of 141 randomized patients, 111 (78.7%) met eligibility criteria.INTERVENTION: Assignment of a geriatrician and a social worker as the primary managing team during the hospital stay.MAIN OUTCOME MEASURES: Length of stay, total cost of acute hospital care, cost of laboratory, pharmacy, and rehabilitation services.RESULTS: Patients in the intervention group had 2.1 fewer days of hospitalization, but this shorter length of stay was not statistically significant (P = 0.108). There were no differences in mortality or discharge disposition. In risk‐adjusted, multiple regression analysis the intervention group had a statistically significant lower predicted total cost per patient than the usual care group (‐$2,544, P = 0.029); assignment to the intervention group was associated with a lower predicted cost per patient for laboratory (including cardiology graphics) services (P = 0.007) and pharmacy costs (P = 0.047).CONCLUSIONS: When controlled for important predictors of expected resource use, care provided by a geriatric management team resulted in a significant reduction in the cost of hospitalization. A reduction in the cost of laboratory, cardiographic, and pharmacy services is consistent with the team's philosophy of defining the services needed based on goals related to functional outcomes.
Dietary Sodium and Bone Mineral Density: Results of a 16‐Year Follow‐up Study
Authors: Greendale Gail A. , Barrett‐Connor Elizabeth , Edelstein Sharon , Ingles Sue , Haile Robert 
Published: April 2015

BACKGROUND AND PURPOSE: It has been proposed that high dietary sodium intake, resulting in a sodium‐mediated increase in renal calcium excretion, is a risk factor for osteoporosis. To evaluate the relationship between dietary sodium intake and bone mineral density (BMD), a prospective study of the Rancho Bernardo cohort was performed.METHOD: A 24‐hour diet recall was done for the period 1973 through 1975; follow‐up bone mineral density of the ultradistal radius, midradius, total hip, and spine was measured between 1988 and 1991. Covariates were ascertained by self‐report and examination at baseline. Multivariable analysis of the sodium‐BMD association was performed using gender and menopause‐specific linear regressions.RESULTS: All subjects were white. At the bone evaluation, there were 258 women (average age 73.3 years) and 169 men (average age 72.4 years). In both men and women, higher levels of sodium intake were strongly associated with higher levels of calcium intake and total calories. Body mass index increased with sodium quartile in women, while a modest negative association was seen in men. In women, after age adjustment, positive associations between dietary sodium and bone density were found at the ultradistal radius (β = 0.01, P = 0.03) and the total hip (β = 0.019, P = 0.02). BMD increased by 0.01 to 0.02 g/cm2 per gram increase in sodium ingested. After adjustment for estrogen use, body mass, dietary calcium, alcohol, and total calories, these effects were no longer significant. Similar patterns were seen in pre‐ and postmenopausal women. In men, age and multivariate‐adjusted BMD increased with higher sodium intake at the ultradistal radius only (β = 0.013, P = 0.05). Stratification by gender‐specific median calcium level did not significantly effect the results.CONCLUSIONS: After control for confounders, a small, statistically significant protective effect of sodium was found at the ultradistal radius in men only. At other sites in women and men, no effect of sodium on BMD was apparent in the multivariable models. These results do not support a detrimental effect of dietary sodium on bone mineral density. Rather, the findings suggest that sodium intake, in the range measured, is not a major osteoporosis risk factor.
Colonization and Infection with Antibiotic‐Resistant Bacteria in a Long‐Term Care Facility
Authors: Terpenning Margaret S. , Bradley Suzanne F. , Wan Jim Y. , Chenoweth Carol E. , Jorgensen Karen A. , Kauffman Carol A. 
Published: April 2015

OBJECTIVE: To assess colonization and infection with methicillin‐resistant Staphylococcus aureus (MRSA), high‐level gentamicin‐resistant enterococci (R‐ENT) and gentamicin and/or ceftriaxone‐resistant Gram‐negative bacilli (R‐GNB) and the factors that are associated with colonization and infection with these organisms.DESIGN: Monthly surveillance for colonization and infection over a period of 2 years. In the second year, an intervention to decrease MRSA colonization by the use of mupirocin ointment was carried out.SETTING: Long‐term care facility attached to an acute care Veterans Affairs Medical Center.PATIENTS: A total of 551 patients in the facility were followed for a period of 2 years.MEASUREMENTS: Colonization and infection rates with MRSA, R‐ENT, and R‐GNB. Analysis of risk factors associated with colonization and infection with these three groups of organisms.MAIN RESULTS: In the first year, colonization rates were highest for MRSA (22.7 ± 1% patients colonized each month) and R‐ENT (20.2 ± 1%) and lower for R‐GNB (12.6±1%). After introduction of decolonization of nares and wounds with mupirocin, the rate of MRSA colonization fell significantly to 11.5 ± 1.8%, but rates remained unchanged for R‐ENT and R‐GNB. Risk factors for MRSA colonization included the presence of wounds and decubitus ulcers. For R‐ENT, the presence of wounds, renal failure, intermittent urethral catheterization, low serum albumin, and poor functional level were significant. For R‐GNB, intermittent urethral catheterization, chronic renal disease, inflammatory bowel disease, presence of wounds, and prior pneumonia were significantly associated with colonization. Overall, of infections caused by known organisms, 49.6% were due to MRSA, R‐ENT, or R‐GNB, and 50.4% were due to susceptible organisms. Infections were more commonly due to R‐GNB (21.1% of all infections) than to R‐ENT (8.3%) or MRSA (4.6%). The most common infections were urinary tract infections (42.9% of all infections) and skin and soft tissue infections (31.9% of all infections). Risk factors for MRSA infections were diabetes mellitus and peripheral vascular disease, for R‐GNB infections were intermittent urethral catheterization and indwelling urethral catheters, and no one factor was associated with R‐ENT infection.CONCLUSIONS: In our long‐term care facility, colonization with resistant MRSA and R‐ENT was more common than R‐GNB, but infections were more often due to R‐GNB than R‐ENT and MRSA. Several host factors, which potentially could be modified in order to prevent infections, emerged as important in colonization and infection with these antibiotic‐resistant organisms.