bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subjective Memory Complaints and Personality Traits in Normal Elderly Subjects
Authors: Hänninen Tuomo , Reinikainen Kari J. , Helkala Eeva‐Liisa , Koivisto Keijo , Mykkänen Leena , Laakso Markku , Pyörälä Kalevi , Riekkinen Paavo J. 
Published: April 2015

Objective: To evaluate the relationship between objectively measured memory functions and subjective complaints of memory disturbance and whether subjective complaints are affected by some personality traits or affective states.Design: Cross‐sectional two‐group comparison.Setting: The city of Kuopio in Eastern Finland, considered representative of the urban elderly population of Finland.Participants: Originally 403 subjects aged 67–78 years from the random sample and then two matched study groups initially including eighteen subjects but only ten in the final analysis.Measurements: Screening and follow‐up examinations of subjects with and without subjective memory complaints: (1) Memory functions: Benton's visual retention test and the paired‐associated learning subtest of Wechsler Memory Scale. (2) Memory complaints: Memory Complaint Questionnaire. (3) Personality traits and affective state: Two subscales from Minnesota Multiphasic Personality Inventory and Geriatric Depression Scale.Results: Complaints of memory loss did not correlate with the actual memory performance in the tests. However, those subjects who most emphatically complained of memory disturbance had greater tendencies toward somatic complaining, higher feelings of anxiety about their physical health, and more negative feelings of their own competence and capabilities than those who did not complain of memory deterioration associated with aging.Conclusions: The study suggests that subjective feelings of memory impairment are more closely associated with personality traits than with actual memory performance in normal elderly people. J Am Geriatr Soc 42:1–4, 1994
The Relationship of Chronic Diseases and Health Status to the Health Services Utilization of Older Americans
Authors: Blaum Caroline S. , Liang Jersey , Liu Xian 
Published: April 2015

OBJECTIVE: To study simultaneously the relationships among chronic diseases and physical health status as they affect health services utilization of older adults.DESIGN: Secondary analysis of a large, cross‐sectional health interview survey, the Supplement on Aging of the 1984 National Health Interview Survey, using multiple equation methods to evaluate disease‐specific impacts on physical health status, the direct impact of specific diseases on utilization of physician services and hospital care, and the indirect impact of specific diseases on utilization, mediated through physical health status.PARTICIPANTS: A total of 11,497 people aged 65 and older, representing a complex, multistage sample of the noninstitutionalized, older adult population of the United States.MEASUREMENTS: Predictor variables included specific chronic diseases (hypertension, arthritis, diabetes, cancer, and atherosclerotic heart disease), self‐rated health status, and total number of disabilities. Control variables included age, gender, race, education, social integration. Outcome variables were physician visits and hospital stays.MAIN RESULTS: It was shown that different diseases have different relative impacts on physical health status, probability of utilization, and amount of utilization, if any, and different chronic diseases have a different mix of direct and indirect effects on utilization.CONCLUSION: The impact of chronic disease on health services utilization in a community‐dwelling population is not a simple or direct relationship. Diseases vary according to their impact on different types of utilization, their impact on the probability of any health services use versus the amount of use, and on how much their effect on utilization is mediated through health status.
Cognitive Screening of Nursing Home Residents: Factor Structures of the Mini‐Mental State Examination
Authors: Abraham Ivo L. , Manning Carol A. , Snustad Diane G. , Brashear H. Robert , Newman Maureen C. , Wofford Amy B. 
Published: April 2015

OBJECTIVE: To examine factor structures of the Mini‐Mental State Examination, attempting first to replicate any of previously proposed 2‐factor solutions; and to explore, secondly, the presence of clinically more differentiated and statistically stable factor structures representing common neurocognitive dimensions.DESIGN: Factor analytic investigation of descriptive dataset collected on nursing home residents. Two factor analyses were performed, one in which the number of factors was fixed at 2 in an effort to replicate previous studies, and one in which the number of factors to retain was determined by the scree test. Both factor analyses used established methods for judging the adequacy of the correlation matrix and the significance of factor loadings, and both applied principal components analysis for initial factor extraction and the equamax criterion for orthogonal rotation.SETTING: Seven nursing homes with a total of 894 beds.PARTICIPANTS: 922 assessments on nursing home residents were performed, of which 892 were complete and entered into the factor analyses. The observation‐to‐variable ratio exceeded 81:1, assuring the statistical stability of factor solutions derived.MEASUREMENT: The Mini‐Mental State Examination, with standardization of words to be recalled and the inverted spelling of “world” as the mental reversal task.MAIN RESULTS: Two factor structures were derived. A 2‐factor solution, explaining 36.5% of the variance and statistically and conceptually different from those obtained in previous studies, distinguished between Perceptual‐Organizational and Psychomotor skills. A 4‐factor solution, which explained 56.1% of the variance, included a factor named Executing Psychomotor Commands, while also further differentiating the perceptual‐organizational processes into the factors of Memory, Concentration, and Language.CONCLUSION: The 2‐factor solution shows that, notwithstanding previous claims to the contrary, the MMSE can make stable and independent distinctions between psychomotor and perceptual‐organizational processes. However, this solution is statistically and conceptually limited and, therefore, of limited clinical and scientific relevance. The 4‐factor solution of the MMSE maps well onto commonly recognized dimensions of neurocognitive ability. It offers a stable, intuitively sound, and statistically supported framework for clinical differentiation of cognitive screening data into independent clinical dimensions of neurocognitive functioning. Thus, it offers clinicians and researchers a 4‐dimensional framework for interpreting data obtained by means of the MMSE. Studies with other populations of cognitively impaired and intact elderly are recommended to validate and extend the present findings.
Body Weight Estimation of Elderly Patients by Nomogram
Authors: Atiea J.A. , Haboubi N.Y. , Hudson P.R , Sastry B.D. 
Published: April 2015

OBJECTIVE To determine a safe and easy way to estimate body weight (BW) accurately in nonambulant elderly patients.DESIGN An anthropometric study of ambulant patients.PARTICIPANTS Two hundred eleven ambulant inpatients, 108 males and 103 females.SETTING Inpatient departments of the University Department of Geriatric Medicine, Cardiff, Wales, UK.MEASUREMENTS Skinfold thickness of chin, triceps, forearm, wrist, subscapular, sternal angle, waist, suprailiac, knee, and calf; circumference of arm, forearm, thigh and calf; body weight, chest girth, abdominal girth, upper limb length, leg length, and body weight. Measurements were carried out by means of Harpenden Skin‐Fold Caliper, tape measure, and bathroom scale.RESULTS Measured body weight in males was highly correlated with both arm circumference and chest girth. In females, measured body weight was highly correlated with waist skinfold thickness and thigh circumference. Nomograms for weight estimation in males and females were constructed from the regression equations for these measurements.CONCLUSIONS Convenient estimation of body weight in nonambulant patients may be carried out using nomograms, which, themselves, may be used as progress sheets to assess the effect of dietary supplementation on body weight.
Does Age Play a Role in Clinical Presentation of Hypothyroidism?
Authors: Doucet J. , Trivalle Ch. , Chassagne Ph. , Perol M‐B. , Vuillermet P. , Manchon N‐D. , Menard J‐F. , Bercoff E. 
Published: April 2015

OBJECTIVE: To determine if aging modifies the clinical presentation of hypothyroidism.DESIGN: Comparison of 24 clinical signs of hypothyroidism between elderly patients (≥ 70 years of age) and younger patients (≤ 55 years of age).SETTING: Prospective study of patients with chemically confirmed overt hypothyroidism.PATIENTS: Sixty seven elderly patients (79.3 ± 6.7 years) and 54 younger patients (40.8 ± 9 years) were included in the study.RESULTS: Neither mean duration of evolution nor mean thyroid‐stimulating hormone (TSH) level were different between the 2 groups. Two signs were found in more than 50% of the elderly patients (fatigue and weakness). Four signs were significantly less frequent in elderly patients (chilliness, paresthesiae, weight gain, and cramps). Mean number of clinical signs in the elderly (6.6 ± 4) was significantly smaller than in young patients (9.3 ± 4.7) (P < 0.01).CONCLUSIONS: Our results suggest that the presentation of hypothyroidism is altered in the elderly in comparison with young patients in that there are (1) fewer signs or symptoms and (2) diminished frequency of some classical signs. Our results underline the importance of TSH measurement in the elderly.
Physicians' Knowledge of Drug Costs for the Elderly
Authors: Glickman Lillian , Bruce Ellen A. , Caro Francis G. , Avorn Jerry 
Published: April 2015

OBJECTIVE: To measure physicians' knowledge of the costs of commonly used medications in geriatric practice and how such awareness influences their prescribing decisions.DESIGN: A survey of pharmacies to determine the prices of 14 commonly used brand name and generic drugs and an in‐person survey of physicians asking them to price these drugs.SETTING: Eastern MassachusettsPARTICIPANTS: One hundred thirty‐two primary care practitioners were surveyed during hospital rounds and medical society meetings.MEASUREMENT: The study examined physician awareness of patients' ability to afford drugs, the use of generic drugs, clinical decision‐making practices, and the physicians' level of knowledge of drug costs. Actual drug prices were measured by surveying 22 pharmacies.RESULTS: Of the 132 respondents, 85% reported that inability to afford medications was a problem for some of their patients. One in five indicated that they did not believe generic drugs to be as safe or effective as brand name drugs, and 30% reported that they rarely or never had access to information about drug costs. Of the 99 physicians who estimated drug prices, there was a marked trend toward underestimation of the prices of more expensive drugs as well as overestimation of the prices of less costly drugs. Physician estimates of prices were highly variable; their estimates were much more variable than pharmacy prices. Younger physicians were more likely than older physicians to make correct estimates, and specialists in internal medicine were less likely to make correct estimates than physicians in other specialties.CONCLUSIONS: These data indicate that substantial knowledge deficits exist in physicians' understanding of the economic implications of the prescriptions they write. Considerable educational activity will be necessary in this area if clinicians are to function as cost‐effective prescribers under health care reform.
Blinking and the Release Reflexes: Are They Clinically Useful?
Authors: Thomas Robert Joseph 
Published: April 2015

Objective: To review the clinical utility of blinking and the release reflexes, palmomental, glabellar, grasp, and snout, as an important part of the bedside neurological examination.Design: Articles published from 1966 to 1993 that addressed blinking or the release reflexes were identified by searching the MEDLINE database. Thirty‐seven references provided clinically useful and applicable information.Results: There is controversy regarding the optimal method of clinical elicitation of these reflexes. The release reflexes are frequently seen as an incidental abnormality in the elderly. A positive grasp reflex, especially if asymmetrical, is sensitive but not specific for abnormal brain function. Lack of habituation is more important than the mere presence or absence of a reflex. The brainstem circuits involved in the regulation of blinking and the release reflexes are discussed, as are their abnormalities in a variety of clinical settings.Conclusion: Blinking and the release reflexes have clinical utility in the diagnosis and bedside clinical assessment of diseases as diverse as frontal lobe lesions, hydrocephalus, multiple sclerosis, Parkinson's disease, Alzheimer's disease and other dementias, falls in the elderly, ageing, HIV‐encephalopathy, schizophrenia, tumors in the region of the sylvian aqueduct and recovery from head trauma.
Guidelines, Practice Policies, and Parameters: The Case for Geriatrics
Authors: Rudberg Mark A. , Barr Gwendolyn , Cassel Christine K. , Hayward Robert S. A. , Sussman Elliot J. , Roizen Michael F. 
Published: April 2015

Objective: As the population ages, the care of older persons becomes more important. At the same time, practice guidelines that provide recommendations for appropriate care are being published in greater numbers. The purpose of this work is to determine the proportion of guidelines that contain specific information about older persons.Design: Through a random sample of published guidelines listed in the AMA Directory of Practice Parameters, 1992 Edition, we determined the proportion of guidelines that contain specific age‐related information. We also determined if, over time, there was a difference in the proportion of practice guidelines containing information about older persons.Results: 45.9% (95% CI, range 33.4–58.4) of guidelines that could conceivably pertain to older persons contain no age information; 24.6% (95% CI, range 13.8–35.4) of guidelines contain information only about persons less than 65 years of age; 29.5% (95% CI, range 18.1–41.0) of guidelines contain specific information about older persons. Moreover, there were no secular trends in the proportion of guidelines pertaining to older persons.Conclusions: Only a minority of practice guidelines contain information about older persons. Possible causes and solutions to this shortfall are discussed.
Improving Compliance with Immunization in the Older Adult: Results of a Randomized Cohort Study
Authors: Herman Carla J. , Speroff Theodore , Cebul Randall D. 
Published: April 2015

OBJECTIVE: To compare three approaches for improving compliance with influenza and pneumococcal vaccination of elderly patients.DESIGN: Randomized controlled trial using three parallel group practices at a public urban teaching hospital.SETTING: Public teaching hospital.SUBJECTS: All patients 65 years of age and older (n = 1202) seen by resident physicians (n = 66) attending three ambulatory medical practices from October 1, 1989 to March 31, 1990.INTERVENTIONS: All three provider groups received intensive education in immunization standards. The control group received no further intervention. Staff in the second group offered education to patients at their visits. In the third group, the prevention team, a flowsheet was used, patient education offered, and staff had their tasks redefined to facilitate compliance; for vaccinations, eg, nurses could vaccinate independent of MD initiative.MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for the 1202 patients seen, including 756 patients seen during both the 1988‐89 and 1989‐90 influenza seasons, to determine documented offering and receipt of vaccinations. During the intervention period (1989‐90), influenza vaccinations were offered significantly more frequently to prevention team patients (68.3%) than to patients in either the patient education (50.4%) or control (47.6%) groups (P = 0.006), even after adjusting for the patients' prior vaccination status, age, gender, race, and high‐risk co‐morbidity and for physicians' level of training. Likewise, pneumococcal vaccinations were offered more frequently to previously unvaccinated prevention team patients (28.3%) than to patient education (6.5%) or control (5.4%) group patients (P = 0.001), even after adjusting for the factors using multivariate analysis. Compliance rates did not differ between patient education and control subjects for either vaccine. Pre‐intervention physician surveys documented higher perceived than actual compliance for both vaccines, with 89.0% and 52.8% of physicians believing that they complied with influenza and pneumococcal vaccination guidelines, respectively.CONCLUSIONS: The results of this trial provide strong support for organizational changes that involve non‐physician personnel to enhance vaccination rates among older adults.
The MDS Cognition Scale: A Valid Instrument for Identifying and Staging Nursing Home Residents with Dementia Using the Minimum Data Set
Authors: Hartmaier Susan L. , Sloane Philip D. , Guess Harry A. , Koch Gary G. 
Published: April 2015

OBJECTIVE: We report the development and validation of an MDS‐based cognitive index, the MDS Cognition Scale (MDS‐COGS), by evaluating it against two popular dementia rating scales, the Global Deterioration Scale (GDS) and the Mini‐Mental State Examination (MMSE).DESIGN: A Cross‐sectional study.PARTICIPANTS: Two hundred nursing home residents.MEASUREMENTS: Each study participant was assessed on the GDS and the MMSE by trained medical students. At the same time, but independent of the medical students, a geriatric nurse completed the Minimum Data Set (MDS) instrument on each participant.MAIN RESULTS: The Cognitive Performance Scale (CPS), a categorical measure of cognition that uses MDS items, was compared with the GDS in 133 subjects, using a split‐sample technique. The GDS was found to be more appropriate as a 4‐stage than a 7‐stage scale, with GDS stages 1–4 acting as a single stage. The CPS showed very poor percent agreement with GDS stages 5 and 7 (50% or less) and, therefore, was revised by adding other MDS predictors. The new instrument, designated MDS‐COGS, is a 0–10 point scale generated from eight MDS cognitive items. The MDS‐COGS was then validated against the 4‐stage GDS and MMSE in the remaining 67 nursing home residents. Chance‐corrected agreement (kappa) between the MDS‐COGS and GDS in the 67 subjects was 0.80 (95% CI = 0.70, 0.88), and percent agreement with GDS stages 5 and 7 was 60% and 85%, respectively. The MDS‐COGS was also demonstrated to be a valid measure of cognitive impairment as defined by the MMSE, with sensitivity, specificity, chance‐corrected agreement (kappa), and area under the ROC curve, all above 0.80.CONCLUSIONS: The MDS Cognition Scale, the MDS‐COGS, provides a valid measure of the presence and severity of cognitive impairment in nursing home residents using items from the Minimum Data Set.
Is Geriatrics a Primary Care or Subspecialty Discipline?
Authors: Reuben David B. , Zwanziger Jack , Bradley Thomas B. , Beck John C. 
Published: April 2015

Objective: To determine how much of the clinical care provided to older persons by geriatricians is primary versus consultative.Design: National Survey.Participants: Candidates for the 1988 certifying examination in geriatrics, physicians who expressed interest in the examination but did not register for the examination, and physicians who expressed no interest in the examination (comparison group physicians).Results: Based on a 72% response rate, 78% of the care rendered by certified internal medicine geriatricians and 90% of the care rendered by certified family practice geriatricians to older persons was primary care. Internal medicine geriatricians spent a greater percentage of their care of older persons providing primary care compared with internists with no interest in geriatrics. Although internist geriatricians who were formally trained or had additional subspecialty certification provided less of their care as primary care compared with geriatricians who had no formal training, the majority of care (approximately 70%) provided by each of these two subgroups was primary care.Conclusions: The vast majority of care provided to older persons by geriatricians is primary care, and these physicians should be considered as generalists for health policy and educational purposes.
Incidence of Injury‐Causing Falls Among Older Adults by Place of Residence: A Population‐Based Study
Authors: Luukinen Heikki , Koski Keijo , Honkanen Risto , Kivelä Sirkka‐Liisa 
Published: April 2015

OBJECTIVE: To describe the incidence and associated factors of injury‐causing falls by place of residence.DESIGN: A prospective population‐based study.SETTING: Five municipalities in northern Finland.PARTICIPANTS: All persons in the five communities aged 70 years or older living at home (n = 1016) and in long‐term institutionalized care (n = 143).MEASUREMENTS: We recorded all fall incidents during a 2‐year period by occurrence and severity of injury, using diary reporting and regular calls and by examining the medical and nursing records of all participants. The times, places, circumstances, and medical treatment needed were recorded as well.RESULTS: Men living at home experienced 71 minor injuries/1000 person years (PY), 42 major soft tissue injuries/1000PY, and 12 fractures/1000PY; women at home experienced 175 minor injuries/1000PY, 65 major soft tissue injuries/1000PY, and 33 fractures/1000PY. Institutionalized older men had 272 minor injuries/1000PY, 122 major soft tissue injuries/1000PY, and 41 fractures/1000PY; institutionalized women had 292 minor injuries/1000PY, 131 major soft tissue injuries/1000PY, and 58 fractures/1000PY. Falls causing injury to older adults in long‐term institutionalized care were more evenly distributed by time of day than those that occurred at home. The majority of the injuries sustained in long‐term institutionalized care were injuries to the head. The incidence rate of fall injuries requiring medical attention in women, 113/1000PY, was twice that in men, 57/1000PY.CONCLUSIONS: Injury‐causing falls are more frequent in older people living in long‐term institutionalized care, and the time‐distribution and some circumstances differ from those of injury‐causing falls in home‐dwelling older people. J Am Geriatr Soc 43:871–876, 1995.