bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neuropsychological Deficits, Caregivers' Perception of Deficits and Caregiver Burden
Authors: Hadjistavropoulos Thomas , Taylor Steven , Tuokko Holly , Beattie B. Lynn 
Published: April 2015

ObjectiveWe tested three hypotheses about the effects of perceived and actual patient deficits on caregiver burden: (1) objective patient deficits directly influence caregiver burden; (2) caregiver burden is the result of caregiver perceptions of patient deficits; (3) objective patient deficits influence caregiver burden indirectly by determining perceived deficits.DesignCausal modeling.SettingA hospital‐based out‐patient diagnostic clinic.ParticipantsAn elderly sample (n = 136) referred to a diagnostic dementia clinic and their caregivers.MeasurementsNeuropsychological tests of patient functioning, a measure of patient mood (the Geriatric Depression Scale), caregiver perceptions of patient functioning, and a measure of caregiver burden (the Burden Interview).ResultsThe Geriatric Depression Scale and neuropsychological battery‐based indices of functioning were not predictive of caregiver burden. Caregiver perceptions of patient dysphoria, and of everyday functioning skills were related to burden. Caregiver perceptions of patient memory, self‐care, and language skills were unrelated to caregiver burden.ConclusionsThe results are consistent with the Lazarus and Folkman model of stress and coping; the caregiver's perceptions of the patient's functioning were the most important determinants of caregiver burden. Objective patient deficits influenced caregiver burden indirectly by influencing caregiver perceptions of patient deficits. These findings suggest that practitioners attempting to assess and manage caregiver burden should attend to the caregivers' perceptions of patient mood and everyday functioning. The relationship of caregiver appraisals with actual patient deficits also sheds light on the nature of caregiver stress.
Permanent Cardiac Pacemakers in the Elderly
Authors: Bush David E. , Finucane Thomas E. 
Published: April 2015

ObjectiveTo review (1) Changes in cardiac impulse generation, conduction, and ventricular filling in normal aging and disease; (2) Pacemaker technology and nomenclature; (3) Expert guidelines about pacemaker use; (4) Studies of pacemaker effectiveness and utilization.DesignArticles were identified through a Medline search, review of articles' bibliographies, and contact with pacemaker manufacturer representatives for information on device features and costs. These articles were reviewed, and the relevant data are presented.ResultsAbnormalities in impulse generation and conduction are common in the elderly. Pacemaker use is higher in the elderly than in other population groups. Hemodynamic changes associated with aging include an increased contribution of atrial contraction to ventricular filling. Pacemakers, which maintain the synchrony between the atria and ventricles, may be particularly advantageous in the elderly for this reason. Rate‐responsive ventricular pacemakers improve the quality of life compared with fixed rate devices in some patients over the age of 75. Dual‐chamber, sequential pacemakers are more likely to reduce symptoms of pacemaker syndrome than ventricular pacemakers and probably also prolong survival and reduce risk of atrial fibrillation in certain groups of patients. However, dual chamber devices are more expensive and require more frequent follow‐up. Pacemaker utilization can vary widely by region. Decisions about pacemakers require explicit tradeoffs between risk and quality of life on one hand and cost on the other. In many clinical situations, there is controversy as to whether pacemakers should be used.ConclusionsPacemakers provide definite benefits to some patients, whereas in others, the likelihood of benefit is uncertain. More sophisticated devices may provide some additional benefit, but they are more costly. Further data is still required to define precisely which groups of patients substantially benefit from complex and expensive pacing modalities compared with simpler ones.
The Predictive Power of Self‐Rated Health, Activities of Daily Living, and Ambulatory Activity for Cause‐Specific Mortality among the Elderly: A Three‐year Follow‐up in Urban Japan
Authors: Tsuji Ichiro , Minami Yuko , Keyl Penelope M. , Hisamichi Shigeru , Asano Hirotake , Sato Makito , Shinoda Kazuo 
Published: April 2015

Objective:To examine the predictive power of self‐rated health, activities of daily living (ADL), and ambulatory activity for different causes of death in a representative sample of older persons.Design:Three‐year prospective cohort study.Setting:Sendai City, Japan.Participants:2,552 persons 65 years and older at baseline in 1988.Measurements:Independent variables (measured by self‐report of participants) were age, sex, self‐rated health, ADL, ambulatory activity level, and use of medical care. Dependent variables were mortalities from cancer, stroke, and heart disease.Main Results:Self‐rated health significantly predicted cancer mortality but not the other two causes of mortality. ADL disability was a significant predictor for stroke mortality, and limitation in ambulatory activity significantly increased the risk of heart disease mortality. The associations between ADL and stroke mortality as well as between ambulatory activity and heart disease mortality remained significant even after excluding those who reported having the index disease in 1988.Conclusion:The predictive powers of self‐rated health, ADL function, and ambulatory activity varied significantly with the underlying causes of death among the elderly.
Patterns and Predictors of Institutionalization in Community‐Based Dementia Patients
Authors: MA Mary A. Severson , Smith Glenn E. , Tangalos Eric G. , Petersen Ronald C. , Kokmen Emre , Ivnik Robert J. , Atkinson Elizabeth J. , Kurland Leonard T. 
Published: April 2015

Objective:To investigate patterns and predictors of institutionalization in a community‐based sample of dementia patients.Setting:The Mayo Clinic Alzheimer's Disease Patient Registry (ADPR), a community‐based prospective registry.Patients:Two hundred seventy‐five participants, including 145 dementia patients and 130 controls on whom longitudinal follow‐up data was available. The mean ages were 79.9 and 78.8 years, and the mean Mini‐Mental State Examination (MMSE) scores at enrollment were 22.1 and 28.1 points for the demented cases and controls, respectively.Measures:Place of residence, marital status, number of direct support providers, global cognitive status, activities of daily living and instrumental activities of daily living were used in hazards modeling of institutionalization.Results:The results from our community‐based sample suggest a high rate of institutionalization for dementia patients. One‐half of the sample of dementia patients were institutionalized within 2.5 years of enrollment in our patient registry. Identified assistance providers were absent in a significant proportion (36%) of our dementia sample. Marital status, global cognitive function, and functional status were significant terms in hazards models of institutionalization. Age, gender, number of direct caregivers, and dementia etiology were not associated with significant risk. Seventy‐two percent of the dementia patients who died over the course of this study had been placed in nursing home care prior to death (with a mean length of stay of 2.8 years).Conclusions:Social (marital status) and disease‐related variables (cognitive and functional status) are related to risk for institutionalization. These variables may be useful in estimating time to institutionalization in various clinical and research populations.
Short‐Term Variability of Self Report of Incontinence in Older Persons
Authors: Resnick Neil M. , Beckett Laurel A. , Branch Laurence G. , Scherr Paul A , Wetle Terrie 
Published: April 2015

Objective: Virtually all estimates of the prevalence and incidence of incontinence in the community rely on self‐reported continence status. The goal of this study was to assess the reliability of this measure in older adults.Design: Telephone interviews administered approximately 2 weeks apart.Setting: Community‐based congregate living facility.Participants: A convenience sample of approximately 100 residents was contacted by letter; 48 of 51 (94%) who indicated their willingness to participate were interviewed. They included eight men and 40 women >70 years old (79% >80 years old), virtually all of whom were independent in basic ADLs and 83% of whom reported their health as good or excellent.Measurement: Responses to a structured questionnaire.Main Results: The prevalence of urinary incontinence was 40% at baseline and 44% on re‐interview; the prevalence of fecal incontinence was 17% on both occasions. All Spearman correlations for items related to urinary incontinence characteristics were between .80 and .86, except for a question related to stress incontinence (r = .62); correlations for fecal incontinence were .67–.69.Conclusion: Prevalence estimates of incontinence are stable over a 2‐week period. However, the variability of individual responses, while relatively low, was within the range previously reported for estimates of incidence and remission rates of incontinence in community‐dwelling elderly. This, variability should be taken into consideration when interpreting previous studies and designing future ones.
Stepping Responses of Young and Old Adults to Postural Disturbances: Kinematics
Authors: Luchies Carl W. , Alexander Neil B. , Schultz Albert B. , Ashton‐Miller James 
Published: April 2015

Objectives: When large disturbances of upright stance occur, balance must usually be restored by taking a step. We undertook this study to examine the biomechanics of stepping responses to sudden backward pulls at the waist. Primarily, response differences between young and old healthy adults were sought.Design: A controlled laboratory study.Subjects: Two groups of healthy and physically‐fit adult females, 12 of mean age 22 (Young) and 12 of mean age 73 years (Old).Measurements: Response kinematics were measured. From them, the stepping strategies of the subjects were derived, including the timing, length, and height of the first step taken and the rotations of major body segments and at major body joints that occurred.Results: In response to sufficiently large backward pull forces, all subjects responded by taking one or more steps backwards. No significant age group difference appeared in the smallest disturbance for which subjects sometimes used a step response. A significant age group difference appeared in the smallest disturbance at which subjects began consistently to use step responses, and that disturbance was larger for the Old than for the Young. Distinct age group differences were found in stepping strategy. At large disturbance levels, the Young mostly responded by taking a single step, whereas the Old mostly responded by taking multiple steps. The steps taken by the Old, compared with those of the Young, were significantly shorter, had significantly smaller heights, and were taken significantly earlier in the responses. Body segment and joint rotations were generally modest, and few significant age group differences were found in these kinematics.Conclusions: In restoration of perturbed balance by step‐taking, the responses of the healthy, physically‐fit young and old adults studied here were similar in many respects, but they differed in some important features. Joint range of motion (ROM) limitations are unlikely to explain age group differences in stepping responses to postural disturbances among healthy subjects because the ROM actually used in any of the responses observed were substantially smaller than the ROM available.
Symptom Patterns and Comorbidity in the Early Stages of Alzheimer's Disease
Authors: McCormick Wayne C. , Kukull Walter A. , van Belle Gerald , Bowen James D. , Teri Linda , Larson Eric B. 
Published: April 2015

Objective: To learn whether patients with early Alzheimer's disease tend to under‐report or over‐report symptoms and to compare their comorbidity with non‐demented patients.Design: Case Control Study in a population‐based dementia registry.Setting and Patients: Three groups of subjects (mean age 76) were enrolled from an HMO base population: 154 cases had clinically diagnosed probable Alzheimer's disease, 92 subjects were found to be not demented although they had complaints of cognitive impairment, and another 129 cognitively intact controls were enrolled after frequency‐matching for age and sex.Measurements and Results: Medical records were examined for the 2 years prior to enrollment. Symptoms suggestive of cognitive impairment were evident 7.8 months prior to enrollment (median 6 months) in 95% of cases, in 77% of the not demented subjects, and in 6% of controls. After corrections for multiple comparisons, only symptoms of cognitive impairment were more frequent in cases, whereas several common symptoms not suggestive of cognitive impairment (eg, gastrointestinal discomfort, joint pain, vision problems) occurred more often in controls and the not demented group, even though comorbidity was similar among all three groups (Charlson Index mean scores: case = 0.7, not demented = 0.7, control = 0.5).Conclusions: Persons with Alzheimer's disease do complain of symptoms clearly related to cognitive impairment early in the course of illness, but may under‐report common symptoms not suggestive of cognitive impairment, even though their comorbidity is similar to patients without dementia.
The Timed Manual Performance Test as a Predictor of Hospitalization and Death in a Community‐Based Elderly Population
Authors: Williams Mark E. , Gaylord Susan A. , Gerrity Martha S. 
Published: April 2015

Objective: To determine the usefulness of timed manual performance measurements (TMP) as predictors of health outcomes, hospitalization, and mortality in a large, heterogeneous sample of elderly people living in the community.Design: Prospective cohort study.Setting: Central North Carolina.Participants: 1,286 community‐dwelling older people.Measurements: Demographic background, health problems, number of prescribed medications, perceived health, quality of life, and the TMP, a 27‐item test that has been shown to predict functional dependency and need of health‐care services in older people.Results: During the 2‐year follow‐up period, 127 people died and 200 were hospitalized. Scores for those who were able to complete the original TMP, as well as scores for two shorter versions of the TMP, predicted mortality and, to a lesser extent, hospitalization within 2 years. For both original and shorter versions of the TMP, relative risk of death was approximately 2.5 times greater for those in the poorest performance quartile, as compared with the best performing quartile, when adjusted for age, gender, race, and number of prescribed medications. TMP tests and an index of IADL were independent predictors of death.Conclusions: TMP scores may be useful in the clinical setting as a vital sign of functioning, providing a means of targeting those individuals at increased risk of mortality. J Am Geriatr Soc 42:21–27, 1994
A Retrospective Review of Nosocomial Infections in an Acute Rehabilitative and Chronic Population at a Large Skilled Nursing Facility
Authors: Smith Miriam A. , Duke William M. 
Published: April 2015

Objective: This study was undertaken to analyze infection rate, risk for acquisition of infection, and spectrum of infectious disease in two distinct sub‐populations within a large, metropolitan, long‐term care skilled nursing facility (LTCSNF).Design: A retrospective chart review over an 18‐month period.Setting: A large, metropolitan LTCSNF.Patients: 786 acute rehabilitative patients and 554 chronic patients.Measurements: The study compared infection rate, risk for acquisition of infection, and the microbiology of the most common infections in the two sub‐populations. Analyses comparing the infection rate in the rehabilitative population with the infection rate in the chronic population were performed by multiple regression. The dependent variable in these analyses was the number of infections. The length of time that the patient was at risk for infection was included as a covariate.Main Results: Approximately 75% of patients in both groups were women. The median age was 80 years in the rehabilitative group, 85 years in the chronic group. Urinary tract infection, pneumonia, skin/soft tissue infection were the most common infections in both groups. Five hundred forty‐seven patients in the rehabilitative group and 479 patients in the chronic group had three or more underlying diseases. Enterobacteriaceae organisms were the most common isolates in urinary tract infectious episodes in both groups; mixed flora were the most common isolates for pneumonia and skin/soft tissue episodes in both groups. The calculated rate of infection for the rehabilitative and chronic groups was not significantly different (P = >0.05).Conclusions: In concordance with other studies, urinary tract infection, respiratory infections, and skin and soft tissue infections were the most common in the long‐term care facility. Analyses of two distinct populations within a single, large, teaching nursing facility revealed, however, that the rate of infection was not significantly different between the groups and that length of stay or presence of underlying disease was not predictive of infection. J Am Geriatr Soc 42:45–49, 1994
Serum Insulin‐Like Growth Factor I in Healthy Older Men in Relation to Physical Activity
Authors: Rudman Daniel , Mattson Dale E. 
Published: April 2015

Objective: The serum level of insulin‐like growth factor‐I (IGF‐I) is lower in old men than in young men. It has been theorized that this change may result in part from the lower level of physical activity in the elderly. The objective of the present study was to test this theory.Design: Cross‐sectional study.Setting: Community‐dwelling healthy men.Participants: Twenty‐nine young men aged 21–29 and 120 older men aged 58–98. A wide range of habitual physical activity was assured in the older men by recruiting them both in senior centers and in fitness centers.Measurements: Serum IGF‐I level was measured by radioimmunoassay. Physical activity was estimated as the sum of moderate, hard, and very hard activities in leisure and occupation during the previous week as determined by the interviewer‐administered Seven Day Physical Activity Recall questionnaire.Results: IGF‐I was significantly higher (363.7 + 16 ng/mL, avg + SEM) in the young men than in the senior center older men (219.6 + 5 ng/mL) or in the fitness center older men (168.3 + 11 ng/mL) (P < 0.01). The level of IGF‐I in the senior center older men was higher than that in the fitness center older men (P = 0.05). The physical activity of the fitness center older men (128.5 + 15 Kcal/kg/wk, avg + SE) was statistically similar to that of the young men (101.3 + 19 Kcal/kg/wk). The physical activity levels of both of these groups were significantly higher than that of the senior center older men (33.6 + 3 Kcal/kg/wk) (P < 0.010). Within none of the three groups was there a significant correlation between IGF‐I and physical activity. When the two groups of older men were combined, there was, in fact, an inverse correlation of IGF‐I and physical activity (P = 0.001).Conclusion: The data do not support the hypothesis that lack of physical activity is responsible for the decline in serum IGF‐I with advancing age. J Am Geriatr Soc 42:71–76, 1994
Aging and Marrow Neutrophil Reserves
Authors: Chatta Gurkamal S. , Price Thomas H. , Stratton John R. , Dale David C. 
Published: April 2015

Objectives: Measurement of blood neutrophil (PMN) counts after the administration of hydrocortisone, granulocyte colony‐stimulating factor (G‐CSF) and epinephrine.Design: Prospective study, with subjects serving as their own controls before and after administration of hydrocortisone, G‐CSF, and epinephrine.Setting: The G‐CSF and hydrocortisone studies were conducted at the Clinical Research Center, University of Washington, and the epinephrine study was conducted at the Seattle VA Medical Center.Participants: Healthy volunteers of both sexes (ages 20 to 30 years and 70 to 80 years) were recruited from the community. The subjects had no acute or chronic medical problems and were on no prescription medications.Main Outcome Measures: Change in the blood PMN count after administration of hydrocortisone (25 and 200 mg intravenously), G‐CSF (30 and 300 μg subcutaneously), or epinephrine (10, 25, and 50 ng/kg/min intravenously).Results: Baseline PMN counts were similar for all comparison groups. The peak PMN response (maximum count‐baseline count) to hydrocortisone was significantly less in the older subjects (P < 0.01) at both doses. The peak PMN responses were 4588 + 418/mm3 (25 mg) and 6906 + 1121/mm3 (200 mg) in the young and 1886 + 399/mm3 (25 mg) and 2387 + 372/mm3 (200 mg) in the elderly subjects. The peak PMN response following G‐CSF was not different (P > 0.05) in the two groups at both the dosages: 6696 + 736/mm3 (30 μg) and 9801 + 893/mm3 (300 μg) in the young and 6340 + 833/mm3 (30 μg) and 9733 + 956/mm3 (300 μg) in the elderly. There was no age‐related change in the response to epinephrine.Conclusions: Aging has no effect on baseline PMN counts, bone marrow PMN reserves as measured with G‐CSF, and blood PMN pools as measured with epinephrine. However the ability to mobilize these PMNs from the marrow into blood, as measured by the hydrocortisone response, is significantly reduced in the elderly. J Am Geriatr Soc 42:77–81, 1994
Increased Walking Variability in Elderly Persons with Congestive Heart Failure
Authors: Hausdorff Jeffrey M. , Forman Daniel E. , Ladin Zvi , Goldberger Ary L. , Rigney David R. , Wei Jeanne Y. 
Published: April 2015

OBJECTIVES: To determine the effects of congestive heart failure on a person's ability to walk at a steady pace while ambulating at a self‐determined rate.SETTING: Beth Israel Hospital, Boston, a primary and tertiary teaching hospital, and a social activity center for elderly adults living in the community.PARTICIPANTS: Eleven elderly subjects (aged 70–93 years) with well compensated congestive heart failure (NY Heart Association class I or II), seven elderly subjects (aged 70–79 years) without congestive heart failure, and 10 healthy young adult subjects (aged 20–30 years).MEASUREMENTS: Subjects walked for 8 minutes on level ground at their own selected walking rate. Footswitches were used to measure the time between steps. Step rate (steps/minute) and step rate variability were calculated for the entire walking period, for 30 seconds during the first minute of the walk, for 30 seconds during the last minute of the walk, and for the 30‐second period when each subject's step rate variability was minimal. Group means and 5% and 95% confidence intervals were computed.MAIN RESULTS: All measures of walking variability were significantly increased in the elderly subjects with congestive heart failure, intermediate in the elderly controls, and lowest in the young subjects. There was no overlap between the three groups using the minimal 30‐second variability (elderly CHF vs elderly controls: P < 0.001, elderly controls vs young: P < 0.001), and no overlap between elderly subjects with and without congestive heart failure when using the overall variability. For all four measures, there was no overlap in any of the confidence intervals, and all group means were significantly different (P < 0.05).CONCLUSIONS: Step rate variability is increased in elderly subjects with well compensated congestive heart failure compared with elderly subjects without congestive heart failure and healthy young adults.