bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ability of Surrogates To Represent Satisfaction of Nursing Home Residents with Quality of Care
Authors: Lavizzo‐Mourey Risa J. , Zinn Jacqueline , Taylor Lynne 
Published: April 2015

ObjectiveTo measure the ability of surrogates to accurately represent nursing home residents' satisfaction with the nursing home care.DesignComparison by correlation analysis of questionnaire answers by nursing‐home residents and their designated surrogates.SettingFour non‐profit community nursing homes.ParticipantsOne‐hundred fifty‐two resident‐surrogate pairs were included, based on the following criteria: (1) the resident was able to respond to questions verbally and in English, had cognitive abilities sufficient to understand the questions, and had a responsible party who had a telephone number in the medical record; (2) both the resident and the surrogate agreed to be interviewed.Outcome MeasuresA 26‐item instrument (21 specific and 5 global items) was developed to measure surrogates' perceptions of residents' satisfaction with the quality of the physician services, nursing care, and the nursing home environment. The instrument was scored on a 4‐point Likert scale in which higher scores indicated greater satisfaction and paralleled a similar instrument designed for nursing home residents. Correlation of residents' with surrogates' scores on the satisfaction instrument was examined.ResultsThe mean score for most items was greater than 3.0, indicating overall satisfaction with the care. Correlations between surrogates and residents on specific items ranged from 0.1 to 0.55. Correlations were highest for global items and items addressing satisfaction with the environment.ConclusionWe conclude that nursing home residents' surrogates cannot accurately express the residents' satisfaction with all areas of nursing home care and that their evaluations should not be taken in lieu of the residents' opinions.
Left Ventricular Hypertrophy
Authors: Aronow Wilbert S. 
Published: April 2015

ObjectiveTo review the pathophysiology, epidemiology, patterns, diagnosis, and treatment of left ventricular hypertrophy with emphasis on the elderly.Data SourcesA computer‐assisted search of the English‐language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.Study SelectionStudies on the pathophysiology, epidemiology, patterns, diagnosis, and treatment of left ventricular hypertrophy were screened for review. Studies on left ventricular hypertrophy in the elderly and recent studies were emphasized.Data ExtractionPertinent data were extracted from the reviewed articles. Emphasis was on studies involving the elderly. Relevant articles were reviewed in depth.Data SynthesisAvailable data about the pathophysiology, epidemiology, patterns, diagnosis, and treatment of left ventricular hypertrophy with emphasis on studies involving the elderly were summarized.ConclusionsLeft ventricular hypertrophy caused by hypertension or other cardiovascular disease is not only a marker for but also a contributor to cardiovascular morbidity and mortality in elderly and young patients. The question of whether regression of left ventricular mass in patients with hypertension will decrease cardiovascular morbidity and mortality needs to be answered by prospective studies using different types of antihypertensive drugs. Future studies on the efficacy of antihypertensive drugs and on stratification of therapy should include echocardiographic estimates of left ventricular mass index.
Physical Restraint Use and Cognitive Decline among Nursing Home Residents
Authors: Burton Lynda C. , German Pearl S. , Rovner Barry W. , Brant Larry J. 
Published: April 2015

ObjectiveThis study investigated the association between physical restraint use and decline in cognition.DesignCohort analytic study describing changes in resident characteristics.SettingEight nursing homes, both urban and suburban, operated by a proprietary corporation in a large metropolitan area.Participants437 nursing home admissions, with 201 remaining at 1 year.Main Outcome MeasuresCognitive status was measured by geropsychiatrists, using the Folstein Mini‐Mental State Exam, during a psychiatric evaluation of the resident. Daily restraint use was documented from nursing orders. Observations were made at 2 weeks, 10 weeks, and 1 year.ResultsRestraint use alone and in combination with neuroleptic use was associated with poor cognition. Other variables associated with poor cognitive scores were: ADL impairment, poor adaptive behavior, and longer time in the nursing home. The use of neuroleptics alone was not significant. Variables which were associated with good cognitive status were: being non‐ambulatory but without dementia and having strong social support.ConclusionsThese findings raise the possibility that restraint use may contribute to cognitive impairment, specifically among residents who have moderate to no cognitive impairment at admission; however, the findings do not exclude an alternative explanation that residents undergoing cognitive decline are more likely to be put in restraints. Further research is needed to understand whether factors which can be manipulated contribute to cognitive decline.
Positron Emission Tomography and Familial Alzheimer's Disease: A Pilot Study
Authors: Guze Barry H. , Hoffman John M. , Mazziotta John C. , Baxter Lewis R. , Phelps Michael E. 
Published: April 2015

ObjectiveLocal cerebral metabolic rates for glucose were compared between patients with familial Alzheimer's disease (FAD), sporadic Alzheimer's Disease (SAD), and normal controls (NC) to determine if FAD is associated with a unique pattern of brain metabolism.DesignCase‐control study matched to convenience sample of FAD.MethodsSubjects in the three diagnostic groups were scanned using fluorodeoxyglucose and the Positron Emission Tomographic (PET) technique. The criterion standard of a detailed clinical history and examination were compared to scan results.SettingPatients in a university hospital.SubjectsAmbulatory controls and Alzheimer's patients, both sporadic (n = 8) and familial (n = 7). The two groups were similar in severity of cognitive dysfunction.ResultsFAD and SAD patients did not significantly differ in terms of local cerebral metabolic rates for glucose.
The Effects of Patterned Urge‐Response Toileting (PURT) on Urinary Incontinence among Nursing Home Residents
Authors: Colling Joyce , Ouslander Joseph , Hadley Betty Jo , Eisch Joan , Campbell Emily 
Published: April 2015

ObjectiveTo test an individualized form of habit training for urinary incontinence (UI) among long‐stay cognitively and/or physically impaired elderly nursing home residents over time.DesignRandomization of subjects occurred by nursing home unit. Baseline wet checks were done hourly for one 24‐hour period at 3‐week intervals over 12 weeks followed by 72 hours of continuous electronic monitoring to establish precise voiding patterns for each subject. The 12‐week intervention period was administered by indigenous staff after they attended a 4‐hour UI educational program. Subjects were followed an additional 12 weeks to determine the extent of maintenance of the intervention among staff and subjects.SettingFour non‐profit nursing homes; west, mid‐west, east coast.PatientsConsent was obtained from 154 (71%) who met primary inclusion criteria. Forty‐one failed the secondary inclusion criteria leaving 113 who entered the 37‐week study. Eighty‐eight completed the study (experimental = 51, control = 37); all were physically and/or mentally impaired, averaged age 85, and had either urge or urge/stress UI.ResultsUI was significantly decreased during the 3‐month period (P < 0.001). Eighty‐six per cent showed improvement over baseline while one‐third improved 25% or more over their baseline UI rate. The control group's UI increased during the same period of time. The volume of UI among the experimental group also decreased (P < 0.005) while the control group's UI volume increased.ConclusionsThe training program was effective in reducing UI though compliance among nursing staff averaged only 70% of the prescribed toileting times. The success of this approach is similar to other recently described behavioral programs but achieved the reduction using only regular nursing staff. This individualized approach supports the recent regulatory thrust to individualize care to promote and maintain functional abilities and autonomy.
Recombinant Hemopoietic Growth Factors: Comparative Hemopoietic Response in Younger and Older Subjects
Authors: Shank Walter A. , Balducci Lodovico 
Published: April 2015

ObjectiveTo study the effectiveness of hemopoietic growth factors in older patients.DesignLiterature review. All articles published in English language between 1987 and 1990 were reviewed. Those reporting studies without age limits as entry criteria and describing the effects of growth factors in individual patients were suitable for analysis. Bone marrow transplantation related articles were excluded.Main Outcome MeasuresThe meanfold increase of granulocytes for Granulocyte‐Colony Stimulating Factor, Granulocyte Macrophage‐Colony Stimulating Factor, and Interleukin 3 and of hemoglobin for erythropoietin were compared in subjects younger and older than 65, by Mann‐Whitney U test.ResultsOf 68 studies, 23 were suitable for analysis. These included patients with myelodysplastic syndromes, aplastic anemia, chemotherapy‐induced myelosuppression, chronic granulocytopenia, anemia, and myelosuppression of malignancies and of chronic disease. Of 204 patients, 67 were 65 years of age or older and 42 were over 70. No difference was seen in meanfold increase of granulocyte and hemoglobin in time of response to growth factors or in response in presence of an absolute neutrophil count lower than 1000/μL between younger and older patients.ConclusionEarly response to hemopoietic growth factors appears well maintained with advanced age. Prospective studies of the prolonged effects of these factors in older and younger patients are needed.
Body Composition in Elderly Men: Effect of Dietary Modification during Strength Training
Authors: Meredith Carol N. , Frontera Walter R. , O'Reilly Kevin P. , Evans William J. 
Published: April 2015

ObjectiveTo assess how dietary change affects gain in strength and muscle mass during heavy resistance training of elderly men.DesignRandomized controlled trial.InterventionDuring 12 weeks of resistance training of knee extensors and flexors, a daily supplement of 560 ° 16 kcal/day (17% energy from protein, 43% from carbohydrate, 40% from fat) was randomly assigned to six men (S) while five men (U) received no supplement. Food intake, strength, whole body composition, and midthigh composition by CT scan were assessed before training and at 6 and 12 weeks.SettingThe men were outpatients but lived in a Metabolic Research Unit during the three assessments.ParticipantsEleven healthy men aged 61 to 72 years.ResultsDensitometry showed no change over time in fat or fat‐free mass. However, the S men increased (P < 0.05) weight, skinfold thickness at six sites, subcutaneous midthigh fat, and creatinine excretion; in all men, changes in these values and in midthigh muscle were proportional to changes in reported energy intake (P < 0.05). There was midthigh muscle hypertrophy in both groups, but it was greater in S than U (P < 0.01). Both groups gained strength (P < 0.001) with no effect of diet.ConclusionsDuring physical rehabilitation of the elderly, dietary intake may influence the increase in lean as well as adipose tissue without altering strength gain. These preliminary findings should be confirmed by a larger study with sedentary controls.
The Diagnosis of Small Bowel Bacterial Overgrowth in Elderly Patients
Authors: Donald I. P. , Kitchingmam G. , Donald F. , Kupfer R. M. 
Published: April 2015

ObjectiveTo examine the frequency of small bowel bacterial overgrowth in elderly subjects.DesignProspective observational study.SettingDepartment of Health Care of the Elderly in a university teaching hospital.PatientsThirteen elderly control subjects having undergone normal gastroscopy with normal hematology and anthropometry; 39 consecutive referrals of elderly patients with clinical or biochemical evidence of malnutrition.Main Outcome MeasuresDuodenal bacterial counts and the 14C‐glycocholate, hydrogen, and 14C‐xylose breath tests.ResultsFive of the 13 control subjects and 21 of 39 patients with malnutrition had high duodenal bacterial counts (>105 organisms/mL), whereas only seven patients were judged to have clinically significant bacterial overgrowth. The 14C‐xylose breath test showed a high specificity (89%) but a low sensitivity (30%) when compared with the results of duodenal culture. The hydrogen breath tests and the 14C‐glycocholate test showed a similar picture of moderately high specificity and low sensitivity (77% and 20%, respectively, for the hydrogen breath test, 76% and 33%, respectively, for the 14C‐glycocholate test).ConclusionsA positive xylose breath test was the best predictor of high duodenal bacterial counts. However, since many elderly subjects have high duodenal bacterial counts, the overdiagnosis of bacterial overgrowth syndrome will result if duodenal culture is relied upon exclusively.
Behavioral Disturbance in Severe Alzheimer's Disease: A Comparison of Family Member and Nursing Staff Reporting
Authors: Lukovits Timothy G. , McDaniel Keith D. 
Published: April 2015

ObjectiveThe purpose of this study is to describe the behavioral disturbances in a group of patients with severe Alzheimer's disease and to compare family members' and nursing staff members' perceptions regarding these behaviors.DesignCross‐sectional survey.SubjectsThe 33 subjects resided in nine different long‐term care facilities in the Rochester, NY area and were selected from a group of patients enrolled in a longitudinal research study of Alzheimer's disease, based on having severe disease.Outcome MeasuresCaregivers were surveyed with a self‐administered questionnaire. The primary outcome measures were the prevalences of 13 behaviors and the magnitude of caregiver concern reported by each group of caregivers.ResultsCompared with family members, nurses reported more concern with vegetative behaviors (incontinence, dietary change, and sleep disturbance; P = 0.055). There was statistical evidence that the number of behaviors reported by the nurses decreased with increasing disease severity (P = 0.002). Although not statistically significant, the magnitude of concern reported by the nurses also decreased with increasing disease severity (P = 0.063). Family members and nurses frequently disagreed about the presence of many behaviors exhibited by individual patients, and the responses of caregivers within the same group were highly variable.ConclusionInstitutionalized patients with severe Alzheimer's disease continue to exhibit troublesome behaviors although overall behavioral disturbance and concern appear to decrease with increasing disease severity. The assessment of these behaviors and their impact on caregivers can be very subjective, depending in part on the role of the caregiver.
Marital Coital Activity in Men at the Age of 75: Relation to Somatic, Psychiatric, and Social Factors at the Age of 70
Authors: Persson Göran , Svanborg Alvar 
Published: April 2015

ObjectiveTo find somatic, psychiatric, and social variables that predicted cessation of coital activity in elderly married men.DesignProspective, longitudinal, observational studySettingGeneral survey of a representative sample of 70‐year‐old urban men (born in 1901–02) in Göteborg, Sweden.ParticipantsForty‐one men who were married and had coital activity at age 70 and who, at the age of 75, were still married when the sample was reinterviewed.Main Outcome MeasuresPresence (c) or absence (nc) of coital activity at age 75.ResultsCessation of coital activity was associated with vasculogenic factors. At least one of the following disorders—systemic hypertension, ischemic heart disease, congestive heart failure, diabetes mellitus, or hypertriglyceridemia—was found in three of the C men and 14 of the NC men,P< 0.005. Systemic hypertension was the most common disorder and was found in one C man and 10 NC men,P< 0.01. Cessation of coital activity was associated with specified types of stress between 65 and 70 years of age in the subgroup of men who had stopped due to inability; six out of eight reported stress against five out of 20 in the C group,P< 0.05. There was no association with any of the psychiatric or social factors studied.ConclusionsCessation of coital activity is predicted by somatic disorders which are associated with vascular damage and especially by hypertension. This observation does not allow the conclusion that antihypertensive treatment would be effective in postponing the cessation of coital activity.
Occult Elevation of CK as a Manifestation of Rhabdomyolysis in the Elderly
Authors: Marcus E. L. , Rudensky B. , Sonnenblick M. 
Published: April 2015

ObjectiveTo evaluate the incidence, etiology and clinical course of rhabdomyolysis in hospitalized elderly patients.DesignRetrospective case series.SettingAcute geriatric department of a university‐affiliated teaching hospital.PatientsTwenty‐three patients who fulfilled our criteria of rhabdomyolysis. Criteria for inclusion were the finding of elevated serum creatine kinase of five‐fold or greater above the upper reference limit and greater than 97% MM isoenzyme.ResultsIn a 3‐year period 23 patients out of 2,870 admissions fulfilled the criteria for rhabdomyolysis, an incidence rate of 0.8%. Diseases or insults associated with rhabdomyolysis were, in order of frequency, acute immobilization, infectious disease, cerebrovascular accident, hyperosmolar state, hyponatremia, hypernatremia, hypothermia, and a fall. Twenty‐two patients recovered from the acute illness; one patient died from respiratory failure. Seventeen patients had renal failure (serum creatinine >180 μmol/L), none necessitating dialysis. Serum creatinine always declined following recovery.ConclusionElevation of CK with few other clinical features of rhabdomyolysis is common in admissions to a geriatric service. It is due to complete immobilization resulting from acute illness. Renal failure is mild and reversible, and the prognosis for recovery is excellent.
The Physician's Decision To Use Tube Feedings: The Role of the Family, the Living Will, and the Cruzan Decision
Authors: Ely John W. , Peters Philip G. , Zweig Steven , Elder Nancy , Schneider F. David 
Published: April 2015

ObjectiveTo determine the relative importance of factors influencing physicians to use tube feedings in patients lacking decision‐making capacity.DesignSurvey.Setting and ParticipantsFour hundred thirty‐nine members of the Missouri Academy of Family Physicians.MeasurementsUsing a mailed questionnaire, physicians were asked for a decision about feeding tube placement in an 89‐year‐old man who was unable to swallow or communicate after a stroke. Changing the conditions of the scenario, we then evaluated the influence of patient age, duration of disability, a living will, the Cruzan decision, and family preferences on the physician's decision.ResultsAfter reading the initial case history, 47% of physicians opposed tube feedings. Physicians who were told that the patient signed a living will specifically excluding tube feedings were more likely to oppose tube feedings than those who were told that he signed only a standard living will (53% vs 42%; P = 0.02). Forty‐two percent of physicians who initially suggested a feeding tube changed their recommendation if the family opposed it. Sixty‐six percent of physicians who initially opposed a feeding tube changed their recommendation if the family “pushed” for it. Thirty‐three percent of physicians who initially opposed tube feedings under the living will scenario would favor tube feedings if the patient had not signed a living will. Twenty‐two percent of physicians who initially opposed tube feedings would change to favor them if the issue had arisen before the Cruzan decision.ConclusionsAmong this group of physicians, there was no consensus on whether tube feedings should be initiated. However, it was found that the family's opinion was the most influential factor affecting the physician's recommendation about tube feedings. Most physicians endorsed family preferences for tube feedings even when this intervention was specifically opposed in the patient's living will.
A Clinicopathological Study of CT Scans in Alzheimer's Disease
Authors: Mendez Mario F. , Mastri Angeline R. , Zander Beth A. , Frey William H. 
Published: April 2015

ObjectiveTo investigate the accuracy of cranial computerized tomography (CT) scans in distinguishing patients with Alzheimer's disease from those with other dementing conditions.DesignRetrospective clinicopathological correlation with pre‐mortem CT scans.SettingUrban and rural hospitals and nursing homes in the Upper Midwest.PatientsAll 507 patients had clinical dementia diagnosed as Alzheimer's disease during life and the subsequent referral of their brains to a dementia brain bank. Of these, 375 patients had had CT scans as part of the diagnostic work‐up for dementia.Main Outcome MeasuresThe presence of neuropathological evidence of Alzheimer's disease and the specific findings on CT scans.ResultsOf the 375 patients evaluated with a CT, 28% were misdiagnosed (lacked neuropathological evidence of Alzheimer's disease); of the 132 patients evaluated without a CT scan, only 18% were misdiagnosed (P < 0.05). The degree of atrophy and other CT findings were similar in the correctly diagnosed and misdiagnosed groups except for increased ventricular size in the correctly diagnosed patients (P < 0.05).ConclusionAlthough CT scans do not usually contribute to the recognition of Alzheimer's disease, the presence of ventricular enlargement may help distinguish Alzheimer's disease from other dementias.
Glucose Tolerance in Women: The Effects of Age, Body Composition, and Sex Hormones
Authors: Busby M. Janette , Bellantoni Michele F. , Tobin Jordan D. , Muller Denis C. , Kafonek Stephanie D. , Blackman Marc R. , Andres Reubin 
Published: April 2015

ObjectiveTo determine the separate and interactive effects of age, phase of the menstrual cycle, menopausal hormone status, body fat mass, and regional fat distribution on glucose tolerance in healthy women.DesignRetrospective study.SettingThe Baltimore Longitudinal Study of Aging.PatientsTwo hundred sixty healthy women aged 22–89 years.MeasurementsPlasma levels of estradiol and progesterone, body mass index (BMI), waist‐to‐hip ratio (WHR), and plasma glucose values in the fasting state (FPG) as well as 120 minutes after 40 gm/m2 of oral glucose (G120) were measured for each participant.ResultsWe found a progressive decline in oral glucose tolerance of 0.4 mm (6.7 mg/dL)/decade at G120) in women from early to late adult years, with no relationship to phase of the menstrual cycle and no abrupt change associated with the menopause. Multiple regression analysis revealed significant, independent effects of BMI and WHR on FPG and G120. The influence of age (P < 0.01) on G120 was stronger than that of the BMI or WHR (P < 0.05). There was no significant relationship between the levels of endogenous sex hormones and glucose tolerance after adjustments for age, BMI, and WHR. However, women taking oral contraceptives, but not those receiving postmenopausal replacement therapy, did exhibit mildly elevated G120 values.ConclusionsAge per se, and to a lesser extent BMI and WHR, but not levels of endogenous sex steroids, contribute to the physiological decline in glucose tolerance in older women.