bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alcohol Use and Functional Disability Among Cognitively Impaired Adults
Authors: Reid M. Carrington , Concaio John , Towle Virginia R. , Williams Christianna S. , Tinetti Mary E. 
Published: April 2015

BACKGROUND: The extent to which alcohol exposure increases risk for functional disability among older adults with cognitive impairment has not previously been assessed.OBJECTIVE: To examine the potential relationship between alcohol use and functional disability among older cognitively impaired adults.DESIGN: Retrospective medical record review.SETTING: Hospital‐based geriatric assessment center. PARTICIPANTS: Two hundred forty‐two consecutive participants with Mini‐Mental Status Examination scores of < 24.MEASUREMENTS: Proxy‐reported alcohol intake was classified in categories of never, former, light (<1 drink/week), moderate (> 1 but <14 drinks/week), and heavy (> 14 drinks/ week) drinkers, and functional status was determined by proxy‐reported performance in seven basic (BADL) and seven instrumental (IADL) activities of daily living (0 = poorest function and 14 = best function).RESULTS: Compared with never drinkers, moderate drinkers demonstrated higher mean BADL (12.2 vs 11.4, P =. 033) and IADL scores (6.6 vs 5.6, P =. 067), whereas heavy drinkers had higher BADL (12.8 vs 11.4, P =. 019) but lower IADL scores (4.8 vs 5.6, P =. 425). Former drinkers demonstrated both lower BADL (10.8 vs 11.4, P =. 107) and IADL scores (3.9 vs 5.6, P =. 011) compared with never drinkers. Evaluation of a potential dose‐response effect was limited due to low numbers of light and heavy drinkers.CONCLUSIONS: Among cognitively impaired adults, moderate and heavy drinkers demonstrated better BADL function, whereas former drinkers had poorer IADL function, compared with never drinkers. Prospective studies that incorporate additional measures of exposure (e.g., cumulative lifetime consumption) and function (e.g., performance‐based tests) may provide a more comprehensive understanding of alcohol's effects among older cognitively impaired adults.
Development and Testing of a Five‐Item Version of the Geriatric Depression Scale
Authors: Hoyl M. Trinidad , Alessi Cathy A. , Harker Judith O. , Josephson Karen R. , Pietruszka Fern M. , Koelfgen Maryanne , Mervis J. Randy , Fitten L. Jaime , Rubenstein Laurence Z. 
Published: April 2015

OBJECTIVE: To develop and test the effectiveness of a 5‐item version of the Geriatric Depression Scale (GDS) in screening for depression in a frail community‐dwelling older population.DESIGN: A cross‐sectional study.SETTING: A geriatric outpatient clinic at the Sepulveda VA Medical Center, Sepulveda, California. PARTICIPANTS: A total of 74 frail outpatients (98.6% male, mean age 74.6) enrolled in an ongoing trial. MEASUREMENTS: Subjects had a comprehensive geriatric assessment that included a structured clinical evaluation for depression with geropsychiatric consultation. A 5‐item version of the GDS was created from the 15‐item GDS by selecting the items with the highest Pearson x1 correlation with clinical diagnosis of depression. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values were calculated for the 15‐item GDS and the new 5‐item scale.RESULTS: Subjects had a mean GDS score of 6.2 (range 0–15). Clinical evaluation found that 46% of subjects were depressed. The depressed and not depressed groups were similar with regard to demographics, mental status, educational level, and number of chronic medical conditions. Using clinical evaluation as the gold standard for depression, the 5‐item GDS (compared with the 15‐item GDS results shown in parentheses) had a sensitivity of. 97 (.94), specificity of. 85 (.83), positive predictive value of. 85 (.82), negative predictive value of. 97 (.94), and accuracy of. 90 (.88) for predicting depression. Significant agreement was found between depression diagnosis and the 5‐item GDS (kappa = 0.81). Multiple other short forms were tested, and are discussed. The mean administration times for the 5‐ and 15‐item GDS were. 9 and 2.7 minutes, respectively.CONCLUSIONS: The 5‐item GDS was as effective as the 15‐item GDS for depression screening in this population, with a marked reduction in administration time. If validated elsewhere, it may prove to be a preferred screening test for depression.
Pharmacologic Treatment of Hypersexuality and Paraphilias in Nursing Home Residents
Authors: Levitsky Andrew M. , Owens Norma J. 
Published: April 2015

PURPOSE: To discuss the pharmacologic options for treatment of hypersexuality or paraphilias in nursing home residents.DATA SOURCES: A MEDLINE search was conducted for English‐language articles published over the past 20 years and was supplemented by a search of bibliographies of relevant articles.STUDY SELECTION: Case reports of pharmacologic treatment of hypersexual or paraphilic behavior were selected only if the patient receiving treatment was an older person and/or cognitively impaired.DATA EXTRACTION: Case reports were grouped according to the class of the pharmacologic agent used (antiandrogens, estrogens, GnRH analogues, or serotonergic drugs). Each case report was evaluated for pharmacologic agent administered, route of administration, duration of therapy, therapeutic response, and incidence of side effects.CONCLUSIONS: Nursing home residents who display hypersexual or paraphilic behavior are extremely difficult to manage. Before initiating pharmacotherapy to control unwanted sexual behaviors, the current drug regimen should be evaluated carefully for drugs that may be causing or exacerbating the behavior. Case reports suggest that antiandrogens, estrogens, GnRH analogues, and serotonergic medications may be useful when other methods have failed. Controlled comparative trials of these agents are needed to establish their efficacy clearly. J Am Geriatr Soc 47:231–234, 1999.
Factors Contributing to Dehydration in Nursing Homes: Inadequate Staffing and Lack of Professional Supervision
Authors: Kayser‐Jones Jeanie , Schell Ellen S. , Porter Carol , Barbaccia Joseph C. , Shaw Heather 
Published: April 2015

OBJECTIVE: To investigate the factors that influenced fluid intake among nursing home residents who were not eating well.DESIGN: A prospective, descriptive, anthropological study.SETTING: Two proprietary nursing homes with 105 and 138 beds, respectively.PARTICIPANTS: Forty nursing home residents.MEASUREMENTS: Participant observation, event analysis, bedside dysphagia screening, mental and functional status evaluation, assessment of level of family/advocate involvement, and chart review were used to collect data. Data were gathered on the amount of liquid served and consumed over a 3‐ day period. Daily fluid intake was compared with three established standards: Standard 1 (30 mL/kg body weight), Standard 2 (1 mL/kcal/energy consumed), and Standard 3 (100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, 15 mL/kg for the remaining kg).RESULTS: The residents' mean fluid intake was inadequate; 39 of the 40 residents consumed less than 1500 mL/day. Using three established standards, we found that the fluid intake was inadequate for nearly all of the residents. The amount of fluid consumed with and between meals was low. Some residents took no fluids for extended periods of time, which resulted in their fluid intake being erratic and inadequate even when it was resumed. Clinical (undiagnosed dysphagia, cognitive and functional impairment, lack of pain management), sociocultural (lack of social support, inability to speak English, and lack of attention to individual beverage preferences), and institutional factors (an inadequate number of knowledgeable staff and lack of supervision of certified nursing assistants by professional staff) contributed to low fluid intake. During the data collection, 25 of the 40 residents had illnesses/conditions that may have been related to dehydration.CONCLUSIONS: When staffing is inadequate and supervision is poor, residents with moderate to severe dysphagia, severe cognitive and functional impairment, aphasia or inability to speak English, and a lack of family or friends to assist them at mealtime are at great risk for dehydration. Adequate fluid intake can be achieved by simple interventions such as offering residents preferred liquids systematically and by having an adequate number of supervised staff help them to drink while properly positioned.
Detection of Older People at Increased Risk of Adverse Health Outcomes After an Emergency Visit: The ISAR Screening Tool
Authors: McCusker Jane , Bellavance Francois , Cardin Sylvie , Trepanier Sylvain , Verdon Josee , Ardman Orly 
Published: April 2015

OBJECTIVES: To develop a self‐report screening tool to identify older people in the emergency department (ED) of a hospital at increased risk of adverse health outcomes, including: death, admission to a nursing home or long‐term hospitalization, or a clinically significant decrease in functional status.DESIGN: Prospective (6‐month) follow‐up study of a cohort of ED patients aged 65 and older.SETTING: The EDs of four acute‐care hospitals in Montreal, Quebec, Canada.PARTICIPANTS: Community‐dwelling patients aged 65 and older who came to the EDs during the weekday shift over a 3‐month recruitment period. Patients were excluded if they could not be interviewed either because of their medical condition or because of cognitive impairment and no other informant was available.MEASUREMENTS: Measures ascertained at the ED visit included: 27 self‐report screening questions on social, physical, and mental risk factors; medical history; use of hospital services, medications, and alcohol; and the Older American Resources and Services (OARS) activities of daily living (ADL) scale. At follow‐up, the OARS scale was readministered by telephone, and other adverse health outcomes were ascertained.RESULTS: Among 1673 patients who completed the follow‐up measures, 488 (29.2%) had an adverse health outcome. Scale development and selection methods included logistic regression, receiver operating characteristic curves, and expert judgment. The proposed screening tool (ISAR) comprises six self‐report questions on functional dependence (premorbid and acute change), recent hospitalization, impaired memory and vision, and polymedication. The tool performed well in the total cohort aged 65 and older, and in sub‐groups defined by disposition (admitted or released from ED), language of questionnaire administration (French or English), information source (patient or other), and other characteristics.CONCLUSIONS: The ISAR is a short self‐report questionnaire that can quickly identify older patients in the ED at increased risk of several adverse health outcomes and those with current disability.
Walking Speed and Stride Length Predicts 36 Months Dependency, Mortality, and Institutionalization in Chinese Aged 70 And Older
Authors: Woo Jeanne , Ho Suzanne C. , Yu Ashley L. M. 
Published: April 2015

BACKGROUND: Increasing emphasis is being placed on physical performance measures as an outcome predictor. It is uncertain whether one or two simple measurements will have predictive value compared with a battery of tests.OBJECTIVES: To assess whether simple performance measures such as walking speed and stride length will predict dependency, mortality, and institutionalization.DESIGN: A 3‐year longitudinal study of a random sample of subjects.SETTING: Older people living in the community in Hong Kong, Special Administrative Region, China.SUBJECTS: A total of 2032 Chinese subjects aged 70 years and older were recruited territory‐wide by proportional random sampling and followed for 3 years.MEASUREMENTS: Functional status was measured using the Barthel Index at baseline and follow‐up. The time taken to walk a distance of 16 feet and the number of steps taken were measured at baseline. Stride length is estimated by dividing 16 by the average number of steps needed to complete the walk. Outcomes regarding dependency, mortality, and institutionalization at 36 months were recorded.RESULTS: After excluding subjects lost to follow‐up and those who had died, data were available for 559 men and 612 women. Univariatc analysis showed that reduced walking speed and stride length were associated with increased risk of dependency, mortality, and institutionalization. In multivar‐iate analysis for dependency and mortality, stride length, walking speed, age, and sex were included in the best prediction model (ROC = 0.798 and 0.707, respectively), whereas only stride length was included in the prediction for institutionalization (ROC = 0.764).CONCLUSIONS: In terms of prevention or modifying outcomes, these two simple performance measures may be used as indicators for checking for occult disease and for interventional measures such as exercise prescription.
Cost of Alzheimer's Disease and Related Dementia in Managed‐Medicare
Authors: Gutterman Elane M. , Markowitz Jeffrey S. , Lewis Barbara , Fillit Howard 
Published: April 2015

BACKGROUND: Managed care organizations (MCOs) will have increased responsibility for the care of large numbers of persons with dementia. There are, however, few studies that inform about decisions of healthcare utilization and expenditures for individuals with dementia in managed care.OBJECTIVES: To examine in a large MCO whether people diagnosed with dementia have higher healthcare utilization and costs than enrollees without dementia.DESIGN: A retrospective study of medical and prescription claims.SETTING: An MCO covering more than 80,000 Medicare enrollees in four geographical locales between January 1, 1996, and March 31, 1998.SUBJECTS: There were 677 paired cases with and without dementia. Controls were selected randomly and matched to cases on age, gender, and region.MEASUREMENTS: Summed total costs and number of claims accrued during the study period, as well as a breakdown of costs and claims with respect to place of service, were annualized and adjusted for age, gender, and comorbid conditions. Costs and claims were broken down by place of service.RESULTS: Dementia prevalence was 0.83%. Mean total costs were 1.5 times higher for patients with dementia relative to controls ($13,487 vs $9,276, P < .001) when annualized and adjusted for level of comorbidity. Almost 75% of the higher costs among cases were linked to inpatient expenses.CONCLUSIONS: Higher costs for individuals with dementia and disproportionate inpatient costs in this MCO parallel patterns among Medicare enrollees in fee‐for‐service. The high prevalence of dementia among the oldest old coupled with the high costs of dementia care create very significant clinical and financial incentives for managed care plans to improve the care of members suffering from dementia. J Am Geriatr Soc 47:1065–1071,1999.
ADVANCING GERIATRIC NURSING PRACTICE: Randomized Controlled Trial of Nurse Case Management of Frail Older People
Authors: Mezey Mathy , Fulmer Terry , Gagnon Anita J. , Schein Constance , McVey Lynne , Bergman Howard 
Published: April 2015

OBJECTIVES: To compare the effects of nurse case management with usual care provided to community‐dwelling frail older people in regard to quality of life, satisfaction with care, functional status, admission to hospital, length of hospital stay, and readmission to emergency department.DESIGN: Randomized controlled trial.SETTING: University hospital and two proximal community health centers.PARTICIPANTS: 427 frail older people (>70 years of age and at risk for repeated hospital admissions) discharged home from the emergency department.INTERVENTIONS: Experimental: Nurse case management, which consisted of coordination and provision of healthcare services by nurses, both in and out of hospital, for a 10‐month period.Control: Usual care, which varied by healthcare provider and community health center.MEASUREMENTS: Outcomes were assessed 10 months post‐randomization by telephone and/or home interview and by medical record review. Questionnaires included the SF‐36®, CSQ‐8, and OARS.RESULTS: No significant differences were found in quality of life, satisfaction with care, functional status, admission to hospital, or length of hospital stay. Nurse‐case‐managed older adults were readmitted to the emergency department significantly more often than their usual care counterparts.CONCLUSIONS: Frail older people receiving nurse case management are more likely to use emergency health services without a concomitant increase in health benefits. J Am Geriatr Soc 47:1118–1124,1999.
Effectiveness of Preventive In‐Home Geriatric Assessment in Well Functioning, Community‐Dwelling Older People: Secondary Analysis of a Randomized Trial
Authors: Büla Christophe J. , Bérod Annick Clerc , Stuck Andreas E. , Alessi Cathy A. , Aronow Harriet U. , Santos‐Eggimann Brigitte , Rubenstein Laurence Z. , Beck John C. 
Published: April 2015

OBJECTIVES: To determine whether preventive in‐home comprehensive geriatric assessment (CGA) prevents functional decline in community‐dwelling older persons with different baseline functional status: (1) without any basic activities of daily living (BADL) dependency at baseline; and (2) without any instrumental ADL (IADL) and basic ADL dependency at baseline.DESIGN: Subgroup analyses of a 3‐year randomized controlled trial.SETTING: The city of Santa Monica, California.PARTICIPANTS: Participants came from the original population (n = 414) of community‐living older persons aged 75 years and older who participated in a trial testing the effectiveness of annual preventive in‐home CGA. For the first subgroup analysis, we excluded subjects (n = 27) who were dependent in one or more BADL before randomization (final sample size, n = 387); for the second subgroup analysis, we excluded 93 additional subjects who were dependent in one or more IADL before randomization (final sample size, n = 294).INTERVENTION: Annual preventive in‐home CGA, with quarterly home visits by gerontologic nurse practitioners, for 3 years.MEASUREMENTS: Functional status data were collected through yearly in‐home interviews by independent observers. Subjects were classified as (1) independent in both BADL and IADL, (2) dependent in IADL but independent in BADL, or (3) dependent in both IADL and BADL.RESULTS: In both subgroup analyses, there was no difference in survival between intervention and control subjects. In the subgroup with no BADL impairment at baseline, intervention subjects spent significantly fewer days dependent in both BADL and IADL during each year of the study (5 days vs 14 days, P = .022; 13 vs 33, P = .016; and 19 vs 44, P = .014 for years 1, 2, and 3, respectively) and over all 3 years combined (36 days vs 92 days, P = .016) in bivariate analyses. In multivariate analyses, the intervention reduced time spent in complete (BADL and IADL) dependency (P = .028). In the subgroup of subjects without any IADL or BADL impairment at baseline, no significant differences were apparent in the number of days spent in complete independence and days spent in complete dependency. Intervention group subjects spent more days in partial dependency during Year 1 (24 days vs 9 days, P = .021), but the difference was not significant during Year 2 (47 vs 29, P = .088), Year 3 (49 vs 41, P = .370), and over all 3 years combined (120 vs 79, P = .123) as well as in multivariate analysis (P = .062).CONCLUSION: These findings support the hypothesis that in‐home preventive visits delay the onset of disability in people without initial BADL impairment. Further studies in larger samples are needed to determine optimal intervention strategies and effectiveness among well functioning older people.
Severe Disruptive Vocalizers
Authors: Sloane Philip D. , Davidson Susan , Knight Nancy , Tangen Catherine , Mitchell C. Madeline 
Published: April 2015

OBJECTIVES: To describe the most severe disruptive vocalizers in nursing facilities, in regard to their clinical and behavioral characteristics, staff responses, and treatments used, and to report on their prognosis over 6 months.DESIGN: A longitudinal cohort study.SETTING: One hundred seven skilled nursing facilities.PARTICIPANTS: The 203 residents who were among the two most disruptive vocalizers in their respective facilities and who vocalized at least 2 hours a day.MEASUREMENTS: Telephone interviews of licensed nursing staff who cared for the subjects, conducted at baseline, 2, 4, and 6 months. Data gathered included subject demographics, physical function, diagnoses, medication and restraint use, behavioral problems, vocalization characteristics, treatments used, and status at follow‐up.RESULTS: Subjects tended to have dementia, to be dependent in most activities of daily living, to have multiple medical problems, to be physically restrained (48%), and to be taking psychotropic medication (76%). Nearly all (95%) were audible at least 50 feet away, with loudness associated with more severe cognitive impairment (OR 4.90, P = .001). When subjects who primarily made nonverbal noises (“screamers”) were compared with those whose predominant expressions were words (“talkers”), hearing impairment, severe cognitive impairment, and greater dependency in activities of daily living characterized the screamers. Staff reported trying a variety of treatments with all subjects, often with little success.Two months after enrollment, 66% of surviving subjects vocalized fewer hours than at baseline, and 45% were rated as improved. Independent predictors of improvement included greater ADL independence, hearing and vision problems, shorter length of stay, urinary incontinence, and use of a treatment other than one‐on‐one interventions. Nearly one‐quarter of subjects (23.4%) died within 6 months. Baseline factors associated independently with a higher probability of death included age, use of activity intervention, physical abusiveness, and absence of wandering.CONCLUSION: Severe disruptive vocalization is associated with severe cognitive and physical impairment and with a high probability of mortality within 6 months. Subcategorization of severe vocalizers by vocalization type or other associated factors may be useful for prognostic and treatment purposes.
Religious Activity Improves Life Satisfaction for Some Physicians and Older Patients
Authors: Ayele Hana , Mulligan Thomas , Gheorghiu Sylvia , Reyes‐Ortiz Carlos 
Published: April 2015

OBJECTIVE: To assess religious perceptions and activities of physicians and older patients and to determine whether religious activities are associated with life satisfaction.DESIGN AND SETTING: A cross‐sectional survey of practicing Virginia internists and psychiatrists and hospitalized or institutionalized (nursing home) older adults.PARTICIPANTS: One hundred randomly sampled practicing physicians and 55 hospitalized or institutionalized older patients.METHODS: A mailed survey was used for the physicians and a structured interview for the patients. All subjects provided information pertaining to demographics and life satisfaction using the Life Satisfaction Index (LSI‐B). For physicians or patients who engaged in any religious activity, the Intrinsic/Extrinsic Religiosity (I/E‐R) scale was used.RESULTS: Of the 100 physicians (49 internists and 51 psychiatrists) who answered the survey (50% response rate), 75% used religious activity as a coping resource (39% somewhat, 36% definitely). There was a positive correlation between intrinsic religious activity (e.g., prayer, Bible reading) and life satisfaction (r = .293, P =. 042). Of the 55 patients interviewed, 47 (86%) used religion as a coping resource, and intrinsic religious activity was positively associated with life satisfaction (r =. 843, P <. 001). Even after controlling for age, gender, health, and marital status, intrinsic religious activity remained a predictor of higher life satisfaction.CONCLUSIONS: Intrinsic religious activity is associated positively with life satisfaction in physicians and ill older adults.