bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional Reach: A Marker of Physical Frailty
Authors: Weiner Debra K. , Duncan Pamela W. , Chandler Julie , Studenski Stephanie A. 
Published: April 2015

ObjectiveTo establish the concurrent validity of our new balance instrument, functional reach (FR = maximal safe standing forward reach), as a marker of physical frailty compared with other clinical measures of physical performance.Design, Setting, and Participants45 community‐dwelling persons age 66–104 were evaluated at one point in time using (1) FR (yardstick method), (2) Physical and Instrumental Activities of Daily Living (PADL, IADL), (3) Life Space, a 3‐point measure of social mobility, (4) 10‐item hierarchical mobility skills protocol, (5) 10‐foot walking speed, (6) one‐footed standing, and (7) tandem walking. Data analysis employed Spearman correlations. Partial r's were also calculated after controlling for age.ResultsThe FR performance range was broad (4.3–16.5 inches, mean 10.9, SD 3.1). Except for PADL, the association of FR with the other physical performance measures was strong, with r‘s ranging from 0.64–0.71; the association of FR with PADL was 0.48. After controlling for age in the regression analysis, partial r‘s ranged from 0.52–0.63. The association of FR with age was—0.50.ConclusionsBased on cross‐sectional data, FR is a practical instrument that correlates with physical frailty even more than with age.
Methicillin‐Resistant Staphylococcus aureus Colonization in a Long‐Term‐Care Facility
Authors: Murphy Sean , Denman Susan , Bennett Richard G. , Greenough William B. , Lindsay Jennifer , Zelesnick Lorrie B. 
Published: April 2015

ObjectiveTo study the prevalence and risk factors for colonization with MRSA at a long‐term‐care facility.DesignCross‐sectional surveillance culture survey.SettingA 233‐bed university‐affiliated long‐term‐care facility.MeasurementsSurveillance cultures for MRSA were performed on patients of two adjacent nursing units and on new admissions to the entire facility over a 4‐month period.ResultsOn the chronic medical unit, where patients known to be colonized had been cohorted, 20 of 38 (52.6%) were colonized vs 3 of 67 (4.5%) on the skilled/intermediate unit (P < 0.001), suggesting that little intra‐facility spread of MRSA occurs. Twenty‐four of 55 (43.6%) chronic medical admissions were colonized vs 6 of 63 (9.5%) admitted to the other units (P < 0.001). Thirteen of 30 (43.3%) admissions were not previously known to be colonized. By univariate analysis, colonized admissions were younger and more often male; had more listed diagnoses, including pressure sores, a previous positive MRSA culture, and urinary incontinence; were more often fed by feeding tube; and had longer durations of hospital stay prior to admission. Logistic regression analysis showed that the most powerful independent predictors of colonization at admission were: a prior positive culture for MRSA (OR 8.8, 95% CI 2.4, 32.4), male sex (OR 8.2, 95% CI 2.3, 29.7), urinary incontinence (OR 3.8, 95% CI 1.4, 10.4), and presence of pressure sores (OR 2.9, 95% CI 0.9, 9.2).ConclusionsUnrecognized colonization of nursing home residents with MRSA is common, and nursing homes are unwittingly repositories for patients colonized with MRSA following acute hospitalization. Gloving and careful attention to handwashing may limit spread of MRSA within nursing homes, and identification of colonized patients may be facilitated by targeted surveillance cultures of the most debilitated patients at admission.
The Significance of Age‐Related Enlargement of the Cerebral Ventricles in Healthy Men and Women Measured by Quantitative Computed X‐Ray Tomography
Authors: Kaye Jeffrey A. , DeCarli Charles , Luxenberg Jay S. , Rapoport Stanley I. 
Published: April 2015

Objective(1) To establish the range of cerebral atrophy across the adult age spectrum in optimally healthy, rigorously evaluated individuals. (2) To determine, across the age spectrum, the relation of gender and cerebral atrophy (as measured by ventricular enlargement) to cognitive function.DesignCross‐sectional comparison by age and gender.SettingAmbulatory research unit.ParticipantsSixty‐four healthy men (mean age ± SD = 49 ± 18 yr) and 43 healthy women (51 ± 18 yr) volunteers enrolled in a longitudinal study of healthy aging. The population was selected for optimal health; all were rigorously screened to exclude medical and psychiatric illness.Main Outcome MeasuresBrain atrophy by CT scan and cognitive function by standardized neuropsychological testing.ResultsAfter correction for inter‐subject variability in cranial volume, women had smaller lateral, but not third, ventricles. For both genders, there were significant differences with age in ventricular volume. After an approximately constant 20% increase in ventricular volume per decade in both genders, a precipitous increase in volume was found beginning in the fifth decade in men and in the sixth decade in women. In men and women, there was a significant negative correlation between ventricular volume and the sum of performance scale scores on the Wechsler Adult Intelligence Scale (WPSS) but not in the sum of the verbal scale scores (WVSS). However, after controlling for age, ventricular volume no longer significantly contributed to the relation between age and WPSS.ConclusionsIn unequivocally healthy individuals, gender plays an important role in age‐associated central cerebral atrophy as measured by progressive ventricular enlargement. Increase in ventricle volume independent of age, does not explain normal age‐related declines seen in WPSS scores.
Outcomes of Skilled Cardiopulmonary Resuscitation in a Long‐Term‐Care Facility: Futile Therapy?
Authors: Awoke Sissay , Mouton Charles P. , Parrott Marian 
Published: April 2015

ObjectiveTo assess whether cardiopulmonary resuscitation performed by in‐house physicians is effective for long‐term‐care residents.DesignRetrospective chart review.SettingLong‐term‐care facility with an intermediate care unit, “skilled” care unit, and a convalescent and assessment unit at a retirement community for veterans.ParticipantsAll residents resuscitated from April 1987 to August 1990. All participants were male. The mean age was 75 years ± 7.3 (range 42–93 years).Main Outcome MeasurementsCharts were abstracted for demographics, advanced directives information, information about the arrest, and post‐resuscitation course.ResultsForty‐five elderly residents underwent resuscitation during this period. Nine residents (20%) were successfully resuscitated, with seven dying within 24 hours of hospitalization. No residents survived to return to long‐term care (95% CI, 0–7%). The diagnoses were consistent with age‐related chronic disease. Seventeen (38%) arrests were witnessed. The predominant rhythm at onset of resuscitation was asystole.ConclusionWe conclude that cardiopulmonary resuscitation, even when performed by a trained and experienced physician and team, has limited benefit for elderly long‐term‐care populations.
A Population‐Based Study of Assessed Applicants to Long‐Term Nursing Home Care
Authors: Gray Leonard C. , Farish Stephen J. , Dorevitch Michael 
Published: April 2015

ObjectiveTo examine the characteristics of all individuals assessed as requiring nursing home care arising from a population living within a defined geographical region and to study the manner in which they presented for assessment.DesignClinical assessment by a physician in geriatric medicine with the assistance of other disciplines.SettingRegional Geriatric Assessment Service.SubjectsAll persons recommended for nursing home care within the study period.ResultsThe major diseases contributing to the need for nursing home care were organic brain disorders (60%) and stroke (32%). Dementia was present in 64% of cases; significant behavioral disturbance in 18%; severe communication disorders were frequent. The majority (86%) had been ill for greater than 1 year.The mode of presentation was acute in 9%, acute‐on‐chronic in 46%, and chronic in 45%. It was associated with significant differences in case characteristics including the location at the time of assessment, diagnoses, duration of illness, physical dependency, communication disorders, behavioral disturbance, and skilled nursing care requirements.ConclusionsThese observations suggest that progression to nursing home care varies considerably. Strategies directed toward the prevention of institutionalization should be organized in recognition of these variations.
Prognosis after Hospital Discharge of Older Medical Patients with Delirium
Authors: Francis Joseph , Kapoor Wishwa N. 
Published: April 2015

ObjectiveTo determine survival, functional independence, and cognitive performance of older patients 2 years after an episode of delirium.DesignDescriptive cohort study.SettingGeneral medical wards of a teaching hospital.PatientsTwo hundred twenty‐nine consecutive patients aged 70 years or older who had been community‐dwelling prior to admission. Fifty patients met criteria for delirium (cases); these were compared to patients without delirium (controls). Two‐hundred twenty‐three patients survived hospitalization (46 cases, 177 controls) Of these, 92% were followed ≥2 years.Main Outcome MeasuresVital status, place of residence, activities of daily living (ADL), and cognitive performance were determined by telephone interview of patients or caregivers 2 years after discharge. Independent community living was defined as survivorship outside of an institution and without dependence in any of four basic ADL (bathing, dressing, transfers, eating).ResultsTwo‐year mortality in the entire population was 39% for cases and 23% for controls (relative risk 1.82, 95% confidence interval 1.04–3.19). Delirium identified those patients at risk for loss of independent community living, even after adjustment for potential confounding variables (adjusted odds ratio 2.56, 95% confidence interval 1.10–5.91). Follow‐up cognitive testing in a subset of patients with high baseline performance revealed a greater decline in performance among cases of delirium than controls (P= 0.023).ConclusionsDelirium identifies older patients at risk for mortality or loss of independence. Delirium may also identify patients at risk for future cognitive decline.
Patient‐Related Predictors of Rehabilitation Use for Community‐Dwelling Older Americans
Authors: Mayer‐Oakes S. Allison , Hoenig Helen , Atchison Kathryn A. , Lubben James E. , De Jong Fred , Schweitzer Stuart O. 
Published: April 2015

ObjectiveTo determine patient factors that predict use of physical or occupational therapy (PT/OT) services by elderly people.DesignTime‐series study of the relationship of PT/OT use to a variety of characteristics present at baseline.ParticipantsEight‐hundred nine community‐dwelling men and women aged 65 and older.SettingThe Medicare Screening and Health Promotion Trial at UCLA.Main Outcome MeasuresUse of PT/OT services, as reported in a telephone survey 1 year after initial information was obtained on the same subjects by the baseline telephonic survey.ResultsFifteen percent of the sample used PT/OT within 12 months of baseline. In multiple logistic regression analysis, PT/OT use was significantly less frequent among racial minorities, less well educated groups, and the oldest age group. PT/OT use was higher among those who had both functional disability and the presence of arthritis, heart or lung disease, or a prior history of stroke. However, neither functional disability alone nor the presence of arthritis, cardiovascular or lung disease, in the absence of limited functioning, was associated with PT/OT use. Patients who had obtained a pneumococcal vaccination or used transportation services were also more likely to receive PT/OT.ConclusionsOur findings suggest that there may be important sociodemographic inequalities in the use of rehabilitation services and raise the possibility of inappropriate underuse in certain subgroups. Additional studies are needed to determine whether similar inequalities of PT/OT use are found in other populations and whether rehabilitation is effective in various subgroups.
Leukb‐Araiosis and Cerebral Hypoperfusion Compared in Elderly Normals and Alzheimer's Dementia
Authors: Kawamura Jun , Meyer John Stirling , Terayama Yasuo , Weathers Susan 
Published: April 2015

ObjectiveTo elucidate the pathogenesis of leuko‐araiosis in patients with Alzheimer's disease by utilizing CT densitometry of the brain and measurements of local perfusion in order to quantify the extent of leuko‐araiosis and local hypoperfusion compared with similar measurements made among age‐matched normal volunteers.DesignCross‐sectional case‐control study.SettingOut‐patient visits to a specialized laboratory located in a large hospital facility.PatientsEighteen elderly patients with probable dementia of Alzheimer type (DAT, aged 71.8 ± 5.1 years) and 17 neurologically and cognitively normal, age‐matched volunteers (aged 68.2 ± 9.6 years) were admitted to the study according to established criteria.InterventionNoneMain Outcome MeasuresCerebral blood flow (mL/100 g brain/min) estimated by the xenon inhalation CT‐CBF method correlated with volume percentage ratio (%) measured by CT densitometry for leuko‐araiosis, compared to normal white and gray matter.ResultsPerfusion values for frontal and occipital white matter as well as frontal, parietal, temporal, and occipital cortex were all decreased in DAT patients. Ratios for leuko‐araiosis to total brain tissue volumes were greater among patients with DAT compared with age‐matched normal volunteers. White matter perfusion in zones of leuko‐araiosis was decreased to a similar degree in both DAT and elderly normal volunteers.ConclusionsPerfusion is reduced to the same degree in regions of leuko‐araiosis in elderly normals as in DAT patients, but the extent of leuko‐araiosis is greater among DAT patients and presumably contributes to cognitive impairments.
Nocturia: A Risk Factor for Falls in the Elderly
Authors: Stewart Ronald B. , Moore Mary T. , May Franklin E. , Marks Ronald G. , Hale William E. 
Published: April 2015

Objective: To determine if nocturia is a risk factor for reported falls and bone fractures in older persons.Objective: Cross‐sectional study comparing falls in men and women with and without nocturia.Setting: Longitudinal health screening program of ambulatory elderly participants.Participants: Participants included 988 (65.5%) women and 520 (34.5%) men who had completed their tenth annual visit to the program.Main Outcome Measures: Reported falls in the past year and reported bone fractures in the past 5 years.Results: Participants who reported nocturia at least twice during the night were at significantly greater risk to report falls (Odds Ratio = 1.84; 95% CI = 1.05–3.22), and the risk increased in subjects reporting more than three nocturia events (Odds Ratio = 2.15; 95% CI = 1.04–4.44). The significant increase in falls reported by nocturia participants did not result in an increase in reported bone fractures in the past 5 years (P < 0.4360).Conclusions: Nocturia is an important risk factor for falls in ambulatory elderly persons. Preventive measures should be taken to decrease nocturia events and to decrease the risk of falling during these nocturia events. J Am Geriatr Soc 40:1217–1220, 1992
Predictors of Two‐Year Post‐Hospitalization Mortality among Elderly Veterans in a Study Evaluating a Geriatric Consultation Team
Authors: Cohen Harvey Jay , Saltz Constance C. , Samsa Greg , McVey Laura , Davis Donald , Feussner John R. 
Published: April 2015

Objective: To determine predictors of 2‐year post‐hospitalization mortality in a cohort of elderly hospitalized patients originally assembled to assess the impact of a Geriatric Consultation Team (GCT).Objective: Two‐year follow‐up of an inception cohort.Setting: University‐affiliated tertiary care VA Medical Center.Patients: One hundred sixty‐seven veterans age 75 or older discharged following hospitalization on medical, surgical, or psychiatry services but not intensive care units.Intervention: None specifically studied here though cohort was previously part of randomized control trial of a Geriatric Consultation Team.Measurement: Mortality during 2 years of post‐hospitalization follow‐up.Results: Two‐year post‐hospitalization mortality was 28 percent with no difference between the original GCT and control groups. For the entire sample, age, mental status, admission or discharge ADLs (but not change in ADL status), number of admission problems, number of discharge diagnoses, and discharge site were significant predictors of mortality in univariate analysis. Only discharge ADLs and discharge site remained significant in multivariate analysis.Conclusion: Measures of ADLs during hospitalization are stronger predictors of mortality following hospitalization than disease diagnoses. Impaired ADLs and placement other than at home are significant predictors of mortality, suggesting that the decision for nursing home placement contains other independently predictive information within it and/or that the subsequent nursing home period produces excess mortality. As had been indicated in short‐term follow‐up, there was no survival advantage for the Geriatric Consultation Group. J Am Geriatr Soc 40:1231–1235, 1992
Alcohol Abuse in Elderly Emergency Department Patients
Authors: Adams Wendy L. , Magruder‐Habib Kathryn , Trued Sally , Broome Harry L. 
Published: April 2015

Objectives: To determine the prevalence of alcohol abuse in elderly emergency department (ED) patients; to determine the prevalence of alcohol abuse for various categories of illness and injury among these patients; and to determine the frequency of detection of elderly alcohol abusers by ED physicians.Objective: Cross‐sectional prevalence study.Setting: The emergency department of a 625‐bed university hospital that serves a mixed urban and rural population.Patients: 205 patients aged 65 and over who came to the ED during an 8‐week period.Measures: A structured interview, which included the CAGE questionnaire and other questions regarding alcohol use, was administered. Emergency department records and past medical records were reviewed.Results: The prevalence of lifetime alcohol abuse (CAGE positive or self‐reported drinking problem) was 24%. The prevalence of current alcohol abuse (CAGE positive or self‐reported drinking problem and alcohol use within the last year) was 14%. There was a particularly high prevalence (22%) among those presenting with gastrointestinal problems and a surprisingly low prevalence (7%) among those who presented with falls or other trauma. Physicians detected only 21% of the current alcohol abusers.Conclusions: Alcohol abuse is a prevalent and important problem among elderly ED patients. It is not well detected by physicians in this setting. Alcohol abuse appears to be less common among elderly trauma patients than their younger counterparts, but is very common among patients with gastrointestinal problems. J Am Geriatr Soc 40:1236–1240, 1992
Reported Home Health Agency Referrals by Internists and Family Physicians
Authors: Boling Peter A. , Keenan Joseph M. , Schwartzberg Joanne , Retchin Sheldon M. , Olson Lorayn , Schneiderman Mindy 
Published: April 2015

Objective: To evaluate the frequency of home health agency referrals (HHRs) by internists and family physicians.Objective: Telephone survey of a randomly selected, nationally representative, stratified physician sample.Participants and Setting: One thousand one hundred sixty‐one interviews with 576 family physicians and 585 internists selected from the American Medical Association Physician Masterfile.Main Results: Most respondents (88%) reported making HHRs (mean for those making HHRs = 43/year). Physicians with ≥ 48 annual HHRs (n = 315) reported a mean of 2.6 hours/week in home care telephone management and 2.1 hours/week on related paperwork. Rural internists and family physicians (n = 230) reported less availability of several types of non‐physician home health services than non‐rural respondents (n = 931), yet rural physicians were more likely to refer patients to home health agencies. Using multivariate linear regression, the reported frequency of HHRs was significantly related to rural practice location, number of home‐bound patients, proportion of geriatric patients, number of house calls, graduation from a U.S. or Canadian medical school, physician knowledge of community resources, and physician experience either as a medical director, a member of the board of directors, or a consultant for a home health agency.Conclusions: Internists and family physicians who work at least 10 hours per week in ambulatory care report making approximately three home health agency referrals per month and spending substantial amounts of time coordinating home health agency care. Despite reporting less availability of many home health agency services, rural physicians report greater involvement than non‐rural physicians in the delivery of home care. J Am Geriatr Soc 40:1241–1249, 1992
A Comparison of Patient Risk for Pressure Ulcer Development with Nursing Use of Preventive Interventions
Authors: Xakellis George C. , Frantz Rita A. , Arteaga Manuel , Nguyen Man , Lewis Anne 
Published: April 2015

Objective: (1) Determine if the Braden scale or Norton scale predicted the same patients to be at risk for pressure ulcer development as were receiving preventive nursing interventions. (2) Identify the items on the Braden and Norton risk assessment scales that the nurses used intuitively to determine a patient's need for a preventive intervention.Objective: Cross‐sectional study.Setting: Six hundred‐bed, state‐supported, long‐term care facility.Patients: War veterans who were 82% male and 97% Caucasian, mean age 73.Measurements: (1) Patients were categorized as at‐risk or not‐at‐risk by the Norton and Braden scales. (2) The presence of a preventive nursing intervention was noted. Agreement in assignment of at‐risk status among the two assessments and presence of a preventive intervention was analyzed using Cohen's Kappa. (3) The staff nurses' use of preventive interventions was modeled using stepwise logistic regression. The items from the Braden and Norton risk assessment scales were used as independent variables with staff nurse implementation of a preventive intervention as the dependant variable.Results: Nurse preventive interventions were found on 45% of patients. The Norton scale identified 38% and the Braden scale identified 27% of patients as at‐risk. Agreement among the three methods was 0.53. Agreement between the Braden and Norton scales was 0.73. Agreement between use of a preventive intervention and a classification as at‐risk by the Braden or Norton scale was 0.41 and 0.43, respectively. Stepwise logistic regression revealed that low Braden mobility scores (Odds Ratio: 2.74) and low Braden friction/shear scores (Odds Ratio: 3.29) were associated with an increased likelihood of a patient receiving a preventive nursing intervention.Conclusions: The overall level of agreement among the two scales predicting risk and the presence of a preventive intervention was not high. Agreement, however, between the two risk assessment scales was close. The staff nurses apparently relied on a patients' mobility, their exposure to friction/shear, and additional unidentified factors to guide implementation of a preventive intervention. Further study is needed to define the cost, efficacy, and related cost effectiveness of routine pressure ulcer risk assessment. J Am Geriatr Soc 40:1250–1254, 1992