bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic and Prognostic Value of Stress Testing in Older Persons
Authors: Fleg Jerome L. 
Published: April 2015

OBJECTIVE: To review the diagnostic and prognostic utility of exercise and pharmacologic stress testing in older individuals.DATA SOURCE: A computer‐assisted search of the literature, followed by a manual reference review of pertinent articles.STUDY SELECTION: Studies addressing the use of exercise and pharmacologic stress testing for coronary artery disease (CAD) detection and prognosis were reviewed. Emphasis was placed on those studies applying these procedures to older populations.DATA EXTRACTION: Pertinent data were extracted regarding the diagnostic and prognostic accuracy and safety of exercise and nonexercise stress testing techniques in older patients.DATA SYNTHESIS: Available data from relevant articles were summarized and the merits and limitations of the available techniques discussed.CONCLUSIONS: Numerous studies over the past 2 decades support the usefulness of the exercise ECG and exercise thallium‐201 perfusion scan for detecting CAD in older populations. Although exercise echocardiography generally appears to have diagnostic and prognostic accuracy similar to thallium‐201 imaging, greater technical difficulty with this technique is frequently encountered in older patients. Non‐exercise forms of stress testing, particularly those employing pharmacologic agents such as dipyridamole, adenosine, or dobutamine, combined with either thallium‐201 scintigraphy or echocardiography, allow accurate CAD diagnostic and prognostic assessment in even very frail older patients. Additional studies are needed to compare the accuracy and cost‐benefit ratio of the many stress testing modalities now available for older patients.
Higher Respiratory Infection Rates on an Alzheimer's Special Care Unit and Successful Intervention
Authors: MD Thomas T. Perls , Herget Mary 
Published: April 2015

OBJECTIVE: To determine the rates of various types of infections on an Alzheimer's special care unit (ASCU) compared with the rates found on traditional nursing home units. Because patients on the ASCUs are allowed to wander throughout the unit and typically come into contact with each other more frequently, we hypothesized that the rate of communicable infections such as upper respiratory infections are significantly higher than on other units where patients are more easily isolated when sick.METHODS: A 4‐year retrospective case control study, 1990–1993.SETTING: A metropolitan long‐term care skilled nursing facility. Three floors are traditional nursing care units (123 beds), and one floor is the ASCU (41 beds).PRIMARY OUTCOME: Annual nosocomial infection rates per 10,000 patient days were measured for six types of infection during the 1990–1993 study period. Data were segregated by location of infection, either the traditional nursing units or the ASCU. In 1992, patients on the Alzheimer's unit were placed in smaller activity groups, and an education program for the control of infectious agents was provided to the unit's staff.RESULTS: The relative order of prevalence for the different infection types remained constant during the 4 years. The most common type of infection for all 4 years of the study period was urinary tract infection (UTI), followed by upper respiratory infection (URI), Lower respiratory tract infection (LRI), cutaneous infection, gastrointestinal (GI) infection, and eye infection. Of these various infections, only URI rates remained consistently higher on the ASCU versus the traditional nursing unit over the 4‐year study period (in years 1990, 1991, and 1993; these differences were statistically significant, P < .05). In 1992, the year in which nursing interventions to curb the relatively high rates of URI on the ASCU took place, the rates of URI on the two unit types were not statistically different.CONCLUSIONS: This study suggests that an inherent risk of ASCUs is an increased exposure to highly contagious infections such as upper respiratory infections. An intervention program effective in decreasing this risk to the level of traditional nursing units is proposed. A prospective study is needed to confirm these findings.
Physician‐Reported Determinants of Screening Mammography in Older Women: The Impact of Physician and Practice Characteristics
Authors: Roetzheim Richard G. , Fox Sarah A. , Leake Barbara 
Published: April 2015

OBJECTIVE: Despite having markedly higher breast cancer risk, compliance of older women with screening mammography has been poor. This study was undertaken to determine which physician and patient practice characteristics were associated with high self‐reported mammography referral rates for older women.METHODS: Primary care physicians (n = 129) from three socioeconomically diverse communities in Los Angeles were surveyed. Agreement with annual screening and self‐reported referral rates were assessed for two groups of women, those 65 to 74 years of age and those 75 years and older. Screening outcomes were compared with physician and patient practice characteristics using bivariate and multivariate techniques.RESULTS: Although 73% of physicians agreed with annual screening of women aged 65 to 74 years, only 24% of physicians reported actually screening most women seen in this age group. Similarly, 57% of physicians agreed that women age 75 years and older should be screened annually, but only 21% reported recommending mammograms for most women seen in this age group. In multivariate analysis, white physicians (adjusted OR = 9.1), younger physicians (adjusted OR = 3.85), and those who used the American Cancer Society's low cost mammography projects (adjusted OR = 5.01) were more likely to report screening the majority of women seen.DISCUSSION: This study suggests that although physicians' intentions to screen older women may be relatively high, a gap exists between intentions and what is reported to be accomplished in practice. Race/ethnicity and physician specialty were the two strongest predictors of high self‐reported referral rates, suggesting that targeted interventions may be useful.
Bone Density, Vitamin D Nutrition, and Parathyroid Hormone Levels in Women with Dementia
Authors: Kipen Eva , Helme Robert D. , Wark John D. , Flicker Leon 
Published: April 2015

OBJECTIVE: To determine whether patients with dementia have reduced bone mass, altered vitamin D, or parathyroid hormone status.DESIGN: Survey.SETTING: University hospital outpatient department.PARTICIPANTS: Twenty women with DSM‐III‐R mild dementia living in the community were compared with 40 cognitively normal community‐dwelling women, matched for age, who had been recruited as part of studies in elderly twins.MEASUREMENTS: Bone density at the lumbar spine and neck of femur by dual‐energy X‐ray absorptiometry, intact serum PTH, and 25‐hydroxyvitamin D levels.MAIN RESULTS: There was no significant difference in bone density between the subjects with mild dementia and the age‐ and sex‐matched controls. The intact PTH (mean ± SD) in the demented subjects was 4.9 ± 2.1 pmol/L compared with 2.9 ± 1.7 pmol/L in the twin controls (P < .01). The mean 25‐hydroxyvitamin D in the demented subjects was 61 ± 33 nmol/L, whereas it was 90 ± 38 nmol/L in the twin controls (P < .01).CONCLUSIONS: We conclude that there were no significant differences in the bone density of community‐dwelling women with mild dementia compared with normals. However, there were significant differences in parathyroid hormone and vitamin D levels between the two groups, suggesting that there is a high prevalence of subclinical hypovitaminosis D in demented women in the community.
Predictors of 2‐Year Mortality Among Older Male Veterans on a Geriatric Rehabilitation Unit
Authors: McMurtry Cynthia T. , Rosenthal Amy 
Published: April 2015

OBJECTIVE: To determine if nutritional parameters and discharge setting are associated with mortality in older male veterans on a Geriatric rehabilitation unit (GRU).DESIGN: Two‐year follow‐up of sequential admissions to the GRU who had laboratory studies completed on admission to the acute hospital and on transfer to and discharge from the GRU.SETTING: University‐affiliated VA medical center.PATIENTS: Eighty‐three consecutive older male veterans admitted to the GRU.MEASUREMENT: Mortality during a period of 2 years post‐discharge.MAIN RESULTS: In a univariate analysis, predictors of mortality were serum albumin level ≤ 3.5g/dL on admission to the GRU (P = .01), moderate or severe Nutritional Status Score (P = .03), discharge to a place other than home (P = .01), and use of antibiotics while on the GRU (P = .05). Discharge albumin remained the single significant predictor of mortality in a multivariate analysis (P = .005).CONCLUSIONS: Serum albumin is the strongest predictor of 2‐year post‐hospitalization mortality of older patients cared for on a GRU. Other predictors were presence of infection, Nutritional Status Score of moderate or severe compromise, and discharge to a place other than home.
Evaluation of Outpatient Geriatric Assessment: A Randomized Multi‐site Trial
Authors: Silverman Myrna , Musa Donald , Martin David C. , Lave Judith R. , Adams Janet , Ricci Edmund M. 
Published: April 2015

OBJECTIVE: To evaluate the process and outcome of outpatient consultative geriatric assessment compared with traditional community care.DESIGN: Randomized, controlled clinical trial, with 12‐month follow‐up.SETTING: Four hospital‐based ambulatory geriatric assessment clinics and community physicians' offices.PARTICIPANTS: 442 recruited older adults with a health problem or recent change in health status.INTERVENTION: Outpatient consultative geriatric assessment or usual physician assessment.MAIN OUTCOME MEASURES: Identification of health problems, mortality, nursing home admissions, health status, health services utilization, satisfaction with care, and caregiver well‐being.RESULTS: Geriatric assessment, in comparison with usual community care, resulted in the identification of a significantly greater number of patients with cognitive impairment (P < .0001), depression (P = .0004) and incontinence (P < .0001). The group receiving a geriatric assessment had greater improvement in anxiety levels at 1 year (P = .036). Caregivers of participants in the geriatric assessment group had less caregiver stress at 1 year (P = .002). No outcome differences in mortality, nursing home admissions, cognitive health, functional health, or health services utilization were observed. Some evidence of greater patient satisfaction with respect to qualities of the physician was found for the geriatric assessment group.CONCLUSIONS: Consultative outpatient geriatric assessment led to significantly improved diagnosis of the common health problems of cognitive impairment, depression, and incontinence, to psychological and emotional benefits for patients, and to reduced levels of caregiver stress. Even with limited follow‐up care and control of treatment, outpatient geriatric assessment has potential for significant positive effects
Predictors of Hospital Mortality in Older Patients with Subdural Hematoma
Authors: Rozzelle Curtis J. , Wofford James L. , Branch Charles L. 
Published: April 2015

Predictors of Hospital Mortality in Older Patients with Subdural HematomaOBJECTIVE: To identify presenting characteristics of older patients with subdural hematoma who are unlikely to survive hospitalization.DESIGN: A retrospective cohort.PATIENTS: All patients ≥ 65 years of age hospitalized at a tertiary care center from 1985–1990 with the primary diagnosis of subdural hematoma.MEASUREMENTS: Chart review was performed to characterize presenting clinical characteristics, hospital course, and outcome at the time of hospital discharge.MAIN RESULTS: Of the 157 eligible patients, 42% (66/157) were ≥80 years of age. Although 30% of patients had no recorded trauma, 54% experienced a fall before hospitalization. Twenty‐six percent (47/157) of patients had been on antithrombotic therapy (14 on coumadin, two on heparin, 31 on antiplatelet agents, one on both coumadin and an antiplatelet agent). Sixty percent of patients had no focal neurologic findings, and the mean Glasgow Coma Score was 12.3 (±3.6). The hematoma was considered chronic in 49% (77/157) of cases, based on time from antecedent trauma or on neuroimaging criteria. Midline shift by neuroimaging was present in 69%.Overall hospital mortality was 31% (48/157). Using logistic regression to control for other factors, level of consciousness (Glasgow Coma Score ≤7) (OR = 10.4), age ≥ 80 (OR = 3.7), duration of hematoma considered acute (OR = 2.7), and craniotomy (OR = 2.6) were significantly associated with hospital mortality. Presence of focal symptoms, previous antithrombotic medication use, nature of trauma, comorbidity score, and presence of midline shift were not associated with hospital mortality.CONCLUSIONS: Among older patients with subdural hematoma, level of consciousness, extreme old age, duration of the hematoma, and nature of the intervention were significantly associated with hospital mortality. These factors should help physicians in clinical decision making and formulation of advance directives for geriatric patients with subdural hematoma. J Am Geriatr Soc 43: 240–244, 1995.
Effect of Psyllium on Absorption of Co‐ingested Calcium
Authors: Heaney Robert P. , Weaver Connie M. 
Published: April 2015

Effect of Psyllium on Absorption of Co‐ingested CalciumOBJECTIVE: To determine whether psyllium fiber (in the form of Metamucil®) interferes with absorption of calcium ingested at the same meal.DESIGN: Three‐way, randomized, cross‐over study in 15 healthy postmenopausal women, with calcium‐fortified orange juice as the calcium source in all three meals. The test load of calcium was 219 mg (∼5.5 mmol). One test meal contained Metamucil, providing 3.4 g psyllium fiber; one had an equivalent amount of neutral cellulose; the third had no added fiber.METHODS: The calcium‐fortified orange juice was extrinsically labeled with 45Ca; calcium absorption fraction was calculated from the specific radioactivity of serum calcium at 5 hours after tracer ingestion.RESULTS: Fractional absorption of calcium from orange juice without added fiber averaged 0.341 ± 0.059; in the presence of psyllium fiber, 0.317 ± 0.067; and in the presence of neutral fiber, 0.354 ± 0.083. While the absorption with cellulose was slightly higher than in the absence of fiber, and the absorption with psyllium was slightly lower, neither difference was statistically significant. However, the difference between added psyllium and cellulose was statistically significant (P < .05).CONCLUSION: Psyllium in the form of Metamucil makes little practical difference to availability of co‐ingested calcium when ingested at typical therapeutic doses. J Am Geriatr Soc 43: 261–263, 1995.
A Randomized Comparison of Intravenous Amrinone Versus Dobutamine in Older Patients with Decompensated Congestive Heart Failure
Authors: Rich Michael W. , Woods William L. , Davila‐Roman Victor G. , Morello Patric J. , Kurz Howard , Barbarash Rick , Spinner Lisa , Sperry Jane , Beckham Valerie , Coulter Lynn , Brown Peggy 
Published: April 2015

A Randomized Comparison of Intravenous Amrinone Versus Dobutamine in Older Patients with Decompensated Congestive Heart FailureOBJECTIVE: To compare the hemodynamic effects of amrinone and dobutamine in patients 75 years of age or older who have severe congestive heart failure requiring invasive hemodynamic monitoring and inotropic support.DESIGN: Prospective, randomized, double‐blind clinical trial.SETTING: Coronary care unit of a university teaching hospital.PARTICIPANTS: Fourteen patients ≥75 years of age (mean 80.3 ± 5.7 years) with refractory New York Heart Association class IV congestive heart failure. All patients had a cardiac index <2.5 L/min/M2 (mean 1.8 ± 0.3 L/min/M2), pulmonary capillary wedge pressure ≥18 mm Hg (mean 26 ± 10 mm Hg), and left ventricular ejection fraction <40% (mean 26 ± 10%).INTERVENTION: Patients were randomly assigned to treatment with 2‐hour infusions of amrinone (n = 7) or dobutamine (n = 7) at fixed dosages of 5 and 10 μg/kg/min.MEASUREMENTS: Complete hemodynamic data were obtained at baseline and after each 2‐hour medication infusion. Transthoracic two‐dimensional echocardiography was performed at baseline and after the 10 μg/kg/min medication dose. The primary analysis compared the effects of the two drugs on cardiac index and stroke volume index at each of the two dosages.RESULTS: Both amrinone and dobutamine had salutary hemodynamic effects, as indicated by improvements in cardiac index, stroke volume index, pulmonary capillary wedge pressure, and systemic vascular resistance (all P < .05 except effect of amrinone on stroke index and wedge pressure). Although the overall hemodynamic effects of amrinone and dobutamine were similar, stroke volume index was higher with dobutamine at the 10 μg/kg/min dose (35 ± 7 ml/M2 vs 26 ± 6 mL/M2; P = .045). Two dobutamine patients were withdrawn from the study after the 5 μg/kg/min dose due to adverse effects (tachycardia, increased ventricular ectopy). One additional patient in each group was noted to have ventricular arrhythmias not requiring termination of the protocol.CONCLUSIONS: Both amrinone and dobutamine are efficacious in improving hemodynamics in older patients with severe congestive heart failure caused by left ventricular contractile dysfunction. Despite the effect of aging on β‐ad‐renergic responsiveness, dobutamine is at least as effective as amrinone but may be associated with a higher incidence of arrhythmic side effects. J Am Geriatr Soc 43: 271–274, 1995.
Urine Specimen Collection from Incontinent Female Nursing Home Residents
Authors: Ouslander Joseph G. , Schapira Moises , Schnelle John F. 
Published: April 2015

Urine Specimen Collection from Incontinent Female Nursing Home ResidentsOBJECTIVE: To determine if a clean catch technique can accurately diagnose bacteriuria among incontinent female nursing home residents.DESIGN: Cultures and dipstick screening test results from paired urine specimens, one collected by a clean catch technique and the other collected by sterile in‐and‐out catheterization, were compared.PARTICIPANTS: A total of 101 incontinent female nursing home residents who were being assessed for participation in a larger clinical intervention trial for incontinence.MEASUREMENTS: Each urine was tested by a dipstick method for leukocyte esterase and nitrite and sent to a bioclinical laboratory for quantitative culture.RESULTS: Positive and negative culture results matched in 92 of the 101 paired specimens. Using the catheter specimen as a gold standard, the clean catch had a sensitivity of 90%, specificity of 92%, positive predictive value of 81%, and a negative predictive value of 95%. In a population with symptoms suggestive of infection, among whom the prevalence of bacteriuria would likely be higher than in the asymptomatic residents we studied (e.g., 60% vs 30%), the positive predictive value would increase to 95%, but the negative predictive value would decrease to 86%. The concordance of the results of the urine screening tests was not as good, except for the detection of a positive leukocyte esterase test and a negative nitrite test.CONCLUSION: Incontinent female nursing home residents do not necessarily have to be catheterized in order to obtain an accurate quantitative urine culture. Our results using a careful clean catch technique are comparable to those previously reported using urine obtained from a urine‐soiled diaper as well as those using a condom catheter technique in men. J Am Geriatr Soc 43: 279–281, 1995.
Two‐Year Trends in Cardiorespiratory Function Among Older Tai Chi Chuan Practitioners and Sedentary Subjects
Authors: Lai Jin‐Shin , Lan Ching , Wong May‐Kuen , Teng Shi‐Hai 
Published: April 2015

OBJECTIVE: To evaluate the training effects of Chinese shadow boxing, Tai Chi Chuan (TCC), on the maintenance of cardiorespiratory function in older individuals.DESIGN: Prospective study of a cohort of TCC practitioners and a group of sedentary controls examined 2 years after initial examination.SETTING: Research project at a hospital‐based exercise physiology laboratory.PARTICIPANTS: Eighty‐four community‐dwelling older adults (mean age: 64 ± 9 years) with no significant cardiovascular, pulmonary, and musculoskeletal disease completed this study. The TCC group, 23 male and 22 female subjects, had been practicing TCC regularly for 6.7 ± 3.3 years. The control group included 21 male and 18 female sedentary subjects with age and body size matched to the TCC group.INTERVENTION: During the period of the study, the TCC practitioners practiced TCC 5.0 ± 1.1 times per week. Each session included 20 minutes of warm up, 24 minutes of TCC training, and 10 minutes of cool down. The baseline cardiorespiratory function was recorded in the initial exercise test. The same measurements were repeated 2 years later to determine the rate of decline of cardiorespiratory function. Furthermore, heart rates (HR) were monitored in 18 men and 16 women during the performance of TCC to determine the exercise intensity of TCC.MAIN OUTCOME MEASURE: The study measured 2‐year trends of cardiorespiratory function in both groups.RESULTS: In the TCC group, the males showed a 2.8% decrease in maximal oxygen uptake (O2max) from 31.6 ± 7.6 mL × kg.−1 × min−1 to 30.7±7.1 mL × kg.−1 × min−1; the females showed a 2.9% decrease in O2max from 20.7±2.3 mL × kg.−1 × min−1 to 20.1±2.5 mL × kg.−1 × min.−1 In contrast, the male control group showed a 6.6% decrease in O2max from 24.4±4.4 mL × kg1 × min1 to 22.8 ± 4.4 mL × kg1 × min1; the females showed a 7.4% decrease in O2max from 16.2±2.3 mL × kg.−1 × min−1 to 15.0 ±2.7 mL × kg.−1 × min.−1 At the ventilatory threshold (Vet), the sedentary group also showed a significant decrease in O2. During the steady‐state performance of TCC, subjects' mean HR was approximately the HR at the Vet (53–57% of HRmax reserve).CONCLUSION: The data substantiate that practicing Tai Chi Chuan regularly may delay the decline of cardiorespiratory function in older individuals. In addition, TCC may be prescribed as a suitable aerobic exercise for older adults.