bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Utilization of Fecal Occult Blood Testing in the Institutionalized Elderly
Authors: Klos Steven E. , Drinka Paul , Goodwin James S. 
Published: April 2015

Objective: To examine physician use of stool guaiac testing in order to determine indications for testing, how the test was used, and the consequences of a particular test result.Design: Retrospective case series.Setting: Large midwestern inpatient nursing home facility.Patients: All patients with positive fecal occult blood tests (FOBT) and one‐third of patients with negative FOBT.Results: In an 18‐month period, 916 occult blood tests were performed on 339 patients (37% of the nursing home census). Patients over age 90 were as likely to receive FOBT as those under age 70. Fourteen percent of those tested had at least one positive test. Fifty‐eight percent of the patients with positive tests underwent no additional diagnostic testing. No cause for the positive FOBT was found for 68% of patients receiving the test for routine screening. Physician estimates of how frequently they employed FOBT for these patients correlated very poorly with their actual practices (r = .17).Conclusion: There is a high prevalence of positive results from FOBT among nursing home patients. In most cases, such results do not cause a change of therapy or result in additional workup. Lack of information on the role of FOBT in nursing home patients contributes to the great diversity in utilization of this test by nursing home physicians.
Survival in a Residential Home: An Eleven‐Year Longitudinal Study
Authors: Dontas Anastasius S. , Tzonou Anastasia , Kasviki‐Charvati Popi , Georgiades George L. , Christakis George , Trichopoulos Dimitrios 
Published: April 2015

The length of survival and various risk factors were studied utilizing 408 residents (141 men, 267 women) of a large residential home. The subjects, aged 68 years or more at entry, admitted between 1978 and 1983, were physically independent, continent, and non‐diabetic. They were followed until December 31, 1988, by which time 78% had died. The multivariate proportional hazard analysis showed the following entry variables to have the indicated effects on relative mortality rate ratios: 5‐years' higher age (+10%, NS), persistent bacteriuria (+13%, NS), abnormal ECG (+26%, NS), current smoking (+63%, P < 0.01), mildly impaired mobility (+96%, P < 0.001), higher levels of in‐study systolic pressure in 10‐mm Hg steps (‐4%, NS), higher entry serum cholesterol in 1‐mmol/L steps (‐7%, NS), and higher hematocrit in 5% steps (‐14%, P < 0.02). Female sex was associated with a +25% (NS) rate ratio; socioeconomic status and body weight were without effect.These data highlight the relative importance of specific factors associated with survival of persons within retirement homes and indicate that: (1) the presence of mild impairment of mobility at entry is by far the strongest predictor of early death; (2) smoking and lower hematocrit also exert important adverse effects; and (3) certain “risk factors”, ie elevated systolic blood pressure and serum cholesterol, have a minimal protective effect, if any, in this age group.
Daytime Sleepiness in the Healthy “Old Old”: A Comparison with Young Adults
Authors: III Charles F. Reynolds , Jennings J. Richard , Hoch Carolyn C. , Monk Timothy H. , Berman Susan R. , Hall Florence T. , Matzzie Jeanette V. , Buysse Daniel J. , Kupfer David J. 
Published: April 2015

Objective: To determine if excessive daytime sleepiness is an inevitable consequence of aging.Methods: Daytime sleepiness was measured using Multiple Sleep Latency Tests (MSLT's) before and after a night of total sleep deprivation in a sample of 22 healthy men and women in their eighties and 29 men and women in their twenties.Results: Young adults were somewhat sleepier than elders, as measured by rapidity of sleep onset during daytime nap recordings using the MSLT, and showed a higher incidence of REM sleep during naps. However, recovery from the effects of acute sleep loss was slower in the elderly, judging from the presence of more daytime sleepiness 2 days after a night of total sleep deprivation. Such persistent sleepiness was absent in the young adult control group.Conclusions: Healthy persons in late old age may have a level of daytime sleepiness no greater than, and perhaps even less than, that seen in healthy young adults.
Low Body Mass Index in Demented Outpatients
Authors: Berlinger William G. , Potter Jane F. 
Published: April 2015

In order to determine the association between dementia and low body weight in outpatients, Body Mass Index (BM1) was evaluated prospectively in 346 frail elderly outpatients presenting for comprehensive geriatric assessment. Patients were categorized into four groups (cognitively intact, dementia of the Alzheimer's type (DAT), other dementia, and patients with depressive symptoms). Patients were assessed for severity of dementia by the Clinical Dementia Rating scale. Differences between groups for various clinical parameters were evaluated using an analysis of variance and Duncan's Multiple Range Test. Patients with dementia, regardless of etiologic type or severity, and patients with depressive symptoms had BMI's ≥10% lower than the cognitively intact patients. BMI was positively correlated with Instrumental Activities of Daily Living (IADL) but not Activities of Daily Living (ADL) or Mini‐Mental State Exam (MMSE) score. Low BMI was not associated with increased physical illness. In fact, in the subset of patients with DAT, lower BMI correlated with significantly lesser amounts of comorbid physical illness. Finally, compared to cognitively intact outpatients, patients with DAT appeared to be physically healthier despite their having a lower BMI.These results suggest an association between dementia and low BMI. On the other hand, the presence of comorbid physical illness, a common focus of evaluation in these patients, was not more common in those patients with lower BMI's.
A Randomized Study of Ciprofloxacin versus Ceftriaxone in the Treatment of Nursing Home‐Acquired Lower Respiratory Tract Infections
Authors: Hirata‐Dulas Cheryl A. I. , Stein Daniel J. , Guay David R. P. , Gruninger Robert P. , Peterson Phillip K. 
Published: April 2015

Objective: To compare the efficacy and safety of ciprofloxacin and ceftriaxone in patients with nursing home‐acquired lower respiratory tract infections requiring initial hospitalization.Design: Prospective, randomized trial.Setting: Extended care nursing homes affiliated with a teaching hospital.Patients: Fifty patients aged 60 years or older with normal or mildly impaired renal function admitted to the hospital for treatment of lower respiratory tract infections.Interventions: Twenty‐four patients received initial therapy with intravenous ciprofloxacin, 200 mg every 12 hours (19 patients) or 400 mg every 12 hours (5 patients) during the acute phase followed by 750 mg orally every 12 hours during the convalescence phase. Twenty‐six patients received initial therapy with intravenous ceftriaxone, 2 g every 24 hours during the acute phase followed by 1 g administered intramuscularly every 24 hours during the convalescent phase. The total duration of therapy was 14 days.Main Outcome Measurements: Successful outcome was defined as resolution or marked improvement in clinical signs and symptoms of lower respiratory tract infection upon completion of the treatment course.Results: Twelve (50%) of the ciprofloxacin‐treated and 14 (54%) of ceftriaxone‐treated patients had successful outcomes. Recurrent oropharyngeal aspiration was the reason for treatment failure in most patients refractory to either antibiotic. Mortality during therapy was 8% in each group. From 21 satisfactory sputum specimens collected, S. pneumoniae was the most common isolate, followed by H. influenzae and other Gram‐negative bacteria. Ciprofloxacin therapy was well tolerated; ceftriaxone therapy was discontinued in two patients (8%) due to adverse reactions (intramuscular pain and drug fever).Conclusions: Sequential intravenous/oral ciprofloxacin appears to be as safe and effective as sequential intravenous/intramuscular ceftriaxone. The optimal dosage of intravenous ciprofloxacin in this patient population appears to be 400 mg every 12 hours; however, additional clinical and pharmacokinetic studies with this regimen are warranted.
Trends in Elderly Hospitalization and Readmission Rates for a Geographically Defined Population: Pre‐ and Post‐Prospective Payment
Authors: Leibson Cynthia L. , Naessens James M. , Campion Mary E. , Krishan Iqbal , Ballard David J. 
Published: April 2015

To address the paucity of patient‐level data regarding the effectiveness of Medicare's prospective payment system (PPS), we conducted a population‐based study of inpatient hospitalizations among individually identified elderly residents of Olmsted County, Minnesota, 1970–1987.A 4.3% increase in total days of care/1000 population from 2,652/1,000 in 1970 to 2,766/1,000 in 1980 was followed by a 9.8% decline from 1980 to 1987 (2,495/1,000). The decline was due primarily to a 13.4% decrease in mean length stay (9.7 days in 1980 to 8.4 days in 1987). The number of hospitalizations/1,000 Olmsted County elderly in 1980 was already below 1987 U.S. figures and did not exhibit the decline evidenced nationally between 1980 and 1987. A 4.6% decline in the proportion of county residents age 65–74 years who were hospitalized (174/1,000 in 1980 to 166/1,000 in 1987) was offset by an 8.3% increase for persons age ≥ 75 (252/1,000 to 273/1,000) and by a 5.7% increase in the number of hospitalizations per individual hospitalized for persons age 65–74 years (1.34 to 1.42).Using a time‐dependent Cox model, which adjusted for differences in patient characteristics between years, there was a significantly higher risk of readmission within 14 days in 1987 vs 1980 (hazard ratio (HR) = 1.33, 95% confidence interval (CI) = 1.05–1.70). The difference between years was no longer evident at 30 or 60 days (HR = 0.84, 95% CI = 0.63–1.11 between 15 and 30 days; HR = 1.12, 95% CI = 0.84–1.49 between 31 and 60 days).This study suggests that initial effects of PPS on utilization may be temporary and that more research is needed to appreciate the impact of cost‐containment on patient outcome.
Shoe Sole Thickness and Hardness Influence Balance in Older Men
Authors: Robbins Steven , Gouw Gerard J. , McClaran Jacqueline 
Published: April 2015

ObjectiveTo test the hypothesis that shoes with thick, soft midsoles, such as modern running shoes, provide better stability in older individuals than those with thin‐hard midsoles. In addition, we examined the relation between footwear comfort and stability and stability when barefoot.DesignRandomized‐order, cross‐over, controlled comparison.SettingSubjects were drawn from an internal medicine practice.ParticipantsA random sample of 25 healthy men, minimum age 60 years. Additional selection criteria were absence of disabilities influencing ability to walk and lack of history of frequent falls.MeasurementsBalance failure frequency, which was defined as falls from the beam per 100 meters of beam walking when 10 passes were made down a 9 M long balance beam. Comfort rating was based on an ordinal scale.ResultsContrary to the hypothesis: (1) midsole softness was associated with poor stability (F(2,48) = 17.9, P < 0.0001); (2) thick midsoles also provided poor stability (F(1,24) = 7.36, P < 0.01). When barefoot, subjects showed 19% higher balance failure frequency than with the poorest shoe and 171% greater than the best shoe (t = 5.33, P < 0.0001). Higher comfort was generally found in shoe types associated with higher balance failure frequency.ConclusionsFor optimal stability, shoes with thin, hard soles are preferable for older individuals. Health professionals should exercise caution when recommending shoes with thick, yielding midsoles, such as running shoes, to unstable elderly individuals. Older men and women with a history of falls or who are obviously unstable, should avoid barefoot locomotion.
Development of Scoring Criteria for the Clock Drawing Task in Alzheimer's Disease
Authors: Mendez Mario F. , Ala Thomas , Underwood Kara L. 
Published: April 2015

ObjectiveTo investigate the reliability and validity of freehand clock drawings, a frequently used measure of constructional apraxia, in patients with Alzheimer's disease.DesignSurvey for the purpose of testing reliability and validity of a new scale.SettingMemory Disorder Clinic at a university‐affiliated hospital in the Upper Midwest.PatientsForty‐six patients were diagnosed with clinically probable dementia of the Alzheimer type after a dementia evaluation, and 26 normal elderly controls were research volunteers without a history of cognitive dysfunction.MeasurementsNeuropsychological tests, dementia‐related scales, and clock drawings rated by a new 20‐item Clock Drawing Interpretation Scale. Reliability measures, correlations, and clustering of items in the CDIS.ResultsThe CDIS had inter‐rater reliability (r = .94), internal consistence (rtt = .95), and reproducibility over a 6‐month interval. CDIS scores were significantly correlated with two dementia‐related scales and all neuropsychological tests and had the highest correlations with other measures of constructional apraxia. All but four Alzheimer patients (91%) and none of the controls had CDIS scores of 18 or less.ConclusionClinicians may reliably screen patients with Alzheimer's disease with the clock‐drawing task, a measure sensitive to deficits in constructional apraxia.
Driving in Alzheimer's Disease
Authors: Dubinsky Richard M. , Williamson Annette , Gray Carolyn S. , Glatt Sander L. 
Published: April 2015

ObjectiveTo determine if the impaired mental skills in Alzheimer's Disease (AD) may adversely affect driving ability.DesignRetrospective survey.SettingThe Alzheimer's Clinic of the University of Kansas Medical Center.PatientsWe interviewed 67 AD patients and their families and compared them with 100 elderly, non‐spousal controls.MeasuresThe questionnaire was designed to obtain information on their driving habits, with emphasis placed on whether they were still driving, and the number of accidents per year for the past 10 years.ResultsForty‐six of the AD subjects had stopped driving because of safety concerns expressed by the subjects, their families, or health care providers, and two had stopped for other reasons. Only two of the normal controls had stopped driving (P < 0.0001, Chi‐square test). Over the past 3 years, the 19 AD subjects who were still driving had 263.2 motor vehicle accidents per million vehicle miles of travel compared with 14.3 for the controls (P < 0.002, Mann‐Whitney U test) and 5.7 for the general driving population age ≥ 55 years (P < 0.05, Students one group, two‐tailed t test).ConclusionThis study suggests that a significant traffic safety problem exists in subjects with AD who continue to drive. Efforts should be directed to detect patients with AD whose driving presents a traffic safety problem.
Instrumental Activities of Daily Living as a Screening Tool for Cognitive Impairment and Dementia in Elderly Community Dwellers
Authors: Barberger‐Gateau Pascale , Commenges Daniel , Gagnon Michèle , Letenneur Luc , Sauvel Claire , Dartigues Jean‐François 
Published: April 2015

ObjectiveTo identify which Instrumental Activities of Daily Living (IADL) are related to cognitive impairment, independent of age, sex, and education; to assess the performance of an IADL score using these items in screening for cognitive impairment and dementia in elderly community dwellers.DesignSurvey based on the baseline interview of the PAQUID study on functional and cerebral aging.SettingCommunity survey in 37 randomly selected parishes in Gironde, France.SubjectsRandom sample of 2,792 community dwellers aged 65 and over (participation rate: 69%).MeasurementsTwo‐phase screening: (1) functional assessment, Mini‐Mental State Examination (MMSE) and DSM‐III criteria for dementia; (2) in DSM‐III‐positive patients, NINCDS‐ADRDA criteria applied by a neurologist. Functional assessment: IADL scale of Lawton and Brody. Criterion standards: cognitive impairment: MMSE score lower than 24; dementia: DSM‐III and NINCDS‐ADRDA criteria.ResultsFour IADL items are correlated with cognitive impairment independent of age, sex, and education: telephone use, use of means of transportation, responsibility for medication intake, and handling finances. A score adding the number of IADL dependencies has a sensitivity of 0.62 and a specificity of 0.80 at the lowest cut‐off point (score > 0) for the diagnosis of cognitive impairment. The same score at the same cut‐off has a sensitivity of 0.94 and a specificity of 0.71 for the diagnosis of dementia. The prevalence of dementia (2.4%) is reduced by a factor of 12 in subjects independent for the four IADL.ConclusionThe four IADL score could be incorporated into the screening procedure for dementia in elderly community dwellers.
Treatment of Hypercholesterolemia: Comparison of Younger versus Older Patients Using Wax‐Matrix Sustained‐Release Niacin
Authors: Keenan Joseph M. , Bae Chul‐Young , Fontaine Patricia L. , Wenz Joyce B. , Myers Shepherd , Huang Zhiquan , Ripsin Cynthia 
Published: April 2015

ObjectiveCompare lipid response, side effect profile and toxicity of younger (<50 years) versus older (50 to 70 years) hypercholesterolemic subjects taking wax‐matrix sustained‐release niacin (Endur‐acin®).Study DesignAn 8‐week randomized double‐blind placebo controlled trial.SettingGeneral community.ParticipantsVolunteers from community cholesterol screening programs and chart review of patients at family practice clinics. Male and female subjects, age 20 to 70, with baseline low density lipoprotein cholesterol level within the 75th to 95th percentile, excluded if on medications that affect lipids or if a history of diabetes, gout, peptic disease, or liver disease is present.InterventionNicotinic acid dosage schedules were 1,000 mg/day, 1,250 mg/day, 1,500 mg/day, or 2,000 mg/day for 8 weeks.Main Outcome MeasuresChange in blood lipids and blood chemistries, side effects, and pill compliance.Results158 subjects (79%) completed the study. Higher dose groups (1,500 mg and 2,000 mg) demonstrated improvements in total cholesterol, LDL‐cholesterol, HDL cholesterol, and total‐to‐HDL‐cholesterol ratio (P < 0.05) compared to baseline and controls. Higher‐dose older subjects demonstrated significantly greater improvements than younger subjects on comparable doses for total cholesterol, HDL cholesterol, total‐to‐HDL‐cholesterol ratio, and triglycerides, P < 0.02). Adherence to medication schedules was better and incidence of side effects and toxicity no greater in older subjects compared to younger.ConclusionWax‐matrix niacin (Endur‐acin®) was shown to be effective and well tolerated for the pharmacological treatment of hypercholesterolemia. Older persons, ages 50 to 70, appear to experience greater benefits with no greater side effects when compared to younger subjects on similar doses.
Dementia and the Nursing Home: Association with Care Needs
Authors: Aronson Miriam K. , Cox Donna , Guastadisegni Paul , Frazier Cynthia , Sherlock Lila , Grower Ronnie , Barbera Arlene , Sternberg Marc , Breed Joseph , Koren Mary Jane 
Published: April 2015

ObjectiveTo determine whether RUG reimbursement categories accurately predict requirements for care in nursing homes.DesignProspective descriptive study of residents in lower reimbursement categories according to RUG.SettingThree nursing homes in New York City.ParticipantsConvenience sample of 173 residents who agreed to participate, not significantly different from 201 who did not agree to participate.Main MeasuresChart review; assessment of residents' cognitive and functional abilities; nursing assistants' ratings of residents' functional abilities, behavioral problems, the amount of effort required in care; and time‐motion studies of staff‐resident interactions.ResultsBoth the residents' RUG classification (P < 0.01) and the level of ADL independence (P < 0.001) had significant impacts on the staff effort required in their care, with more dependent residents requiring greater effort. The residents' level of cognitive impairment also had a significant impact on the staff effort, with the severely impaired requiring greater effort (P < 0.05). The time‐motion analysis indicated that residents within the same RUG category differed in the number of staff‐resident interactions based on their level of cognitive impairment.ConclusionsCognitive impairment is a significant morbidity (or co‐morbidity) in determining the quantity of staff effort required by the resident, and behavioral interventions are an important care component. There is marked heterogeneity within lower (RUG) reimbursement categories which translates into strikingly different care requirements.
A Simple Method of Recognizing Geriatric Patients at Risk for Death and Disability
Authors: Incalzi Antonelli R. , Capparella O. , Gemma A. , Porcedda P. , Raccis G. , Sommella L. , Carbonin P. U. 
Published: April 2015

ObjectiveTo identify prognostic indicators for geriatric patients discharged from an acute care hospital.DesignProspective observational study.SettingBase line assessment at discharge from an acute care hospital; reassessment after 1 year at home.PatientsOne hundred‐seventy‐eight consecutive patients over 70 years of age (mean age ± SD = 75.6 ± 13.1 years, range 70–95 years, 52% males); 56% were dependent in one or more Activities of Daily Living, 21% had abnormal Mini Mental State Scores.Main Outcome Measuresmortality, increasing physical dependence, health care utilization.ResultsMortality was directly related to a low ADL score at hospital discharge (Odds Ratio = 3.31, Confidence Limits = 1.91–5.75), neoplastic diseases (OR = 3.59, CL = 2.01–6.43), cardiovascular diseases (OR = 2.47, CL = 1.40–4.36), and drug use, expressed as the total number of individual preparations prescribed at discharge (OR = 1.72, CL = 1.05–2.83). Low ADL score, cardiovascular and neoplastic diseases were also predictive of increasing physical dependency. The use of health care services, quantified by an appropriately designed score, did not correlate with any of the baseline variables, with the implication that the use of the health care services was not proportional to the need for care. Conclusions: Elderly subjects at major risk of death and disability can be easily identified at discharge by a simple assessment of their medical and functional state.