bluuebunny/crossref_metadata_2025_split huggingface dataset:
Referral of Patients from Long‐term to Acute‐care Facilities
Authors: GILLICK MURIEL , STEEL KNIGHT 
Published: April 2015

Medical care available to residents of nursing homes and chronic‐care hospitals was assessed by studying transfers of such persons to the emergency room of an acute‐care hospital. One hundred patients transferred from nursing homes and 16 patients transferred from chronic‐care hospitals were compared with 338 elderly patients from home (control group). Elevated temperature (≥102°F) was found in 17.3 per cent of nursing home patients and 30.0 per cent of chronic‐case hospital patients, compared with 1.8 per cent of controls (P < .05); mental status abnormalities were found in 66.1 per cent of patients from nursing homes and in 90.9 per cent of those from chronic‐care hospitals, compared with 36.2 per cent of controls (P < .025). In addition, patients from chronic‐care hospitals, but not those from nursing homes, often showed substantial abnormalities of blood pressure and pulse. Thus, the patients from nursing homes tended to be slightly sicker than controls, and those from chronic‐care hospitals considerably sicker. The probability of requiring admission to the hospital was the same for residents of nursing homes and persons living at home (44.0 per cent and 43.2 per cent, respectively), but was higher for persons from chronic‐care hospitals (81.3 per cent, P < .005).It was also determined whether a disproportionately large percentage of transfers from extended‐care facilities occurred at night or on weekends. Among nursing home patients, 12.6 per cent of emergency room visits occurred on weekends, compared with 20.0 per cent of chronic‐care hospital patients and 24.3 per cent of controls. Thus, no evidence for “dumping” of patients was found.It was concluded that utilization of a hospital emergency room by nursing home patients is very similar to that by home residents, suggesting an inadequacy of on‐site medical services, whereas that by chronic‐care hospital patients is restricted to major illness, which is entirely appropriate.
Multiple‐monitored Electroconvulsive Therapy: Safety and Efficacy in Elderly Depressed Patients
Authors: MIELKE DAVID H. , WINSTEAD DANIEL K. , GOETHE JOHN W. , SCHWARTZ BARRY D. 
Published: April 2015

ABSTRACT:Forty‐four patients with severe endogenous depression, all of whom had been administered multiple‐monitored electroconvulsive therapy (MMECT), were studied by retrospective chart review. The subjects were divided into two groups, the elderly and the nonelderly, and compared for number of anesthesia inductions (treatment sessions), total number of seizures, total seizure time, and therapeutic outcome. One myocardial infarction occurred in an elderly man, and a confusional state developed whenever MMECT was administered simultaneously with lithium. The conclusions from this project are that MMECT is as safe and efficacious for the elderly as for the nonelderly and that the elderly tolerate many seizures as well as do the nonelderly. While other variables were similar between groups, the overall number of anesthesia inductions in both groups was less than is expected with conventional electroconvulsive therapy.
The Clinical Use of Electroconvulsive Therapy in Old Age
Authors: KARLINSKY HARRY , SHULMAN KENNETH I. 
Published: April 2015

ABSTRACT:A retrospective review was conducted on the charts of 33 elderly inpatients (age range, 62–85 years) who received electroconvulsive therapy (ECT) in a geriatric psychiatry unit of a general hospital. Electroconvulsive therapy was found to be safe but not uniformly effective; only 42.4 per cent of patients obtained an immediate good outcome. The implications of these findings for further evaluations of the indications and efficacy of ECT in old age are discussed.
Nutrition by Hypodermoclysis
Authors: BERGER EUGENE Y. 
Published: April 2015

ABSTRACT:It is possible to administer fluid subcutaneously at a rate so slow that the forces of diffusion and perfusion are able to transfer that fluid to the circulation at a rate equal to the rate of its delivery. In clinical practice, fluid can be delivered subcutaneously in the presence of hyaluronidase at about 1 ml per minute without the accumulation of edema. Thus, 1500 ml can be delivered in 24 hours at a single site, and 3000 ml of fluid can be delivered at two sites in 24 hours. This procedure, called hypodermoclysis, is used for hydration. It is particularly useful for the aged patient in the long‐term care institution when it will save the patient from the dangers of hospitalization and save society from its costs.
The Relationship Between Dietary Intake of Choline, Choline Serum Levels, and Cognitive Function in Healthy Elderly Persons
Authors: SANCHEZ CLARE J. , HOOPER ELIZABETH , GARRY PHILIP J. , GOODWIN JEAN M. , GOODWIN JAMES S. 
Published: April 2015

ABSTRACT:This study was designed to obtain information on normal dietary intake and serum levels of choline in a healthy elderly population and to observe the relationship between blood levels of choline and cognitive function. Two hundred fifty‐eight healthy volunteers with a mean age of 72 years were recruited, and blood samples and dietary histories were obtained. All subjects were ambulatory, living at home, free of serious medical illnesses, and taking no prescription medications. Cognitive abilities were assessed by the Halstead Category Test, a nonverbal test measuring abstract thinking, and the Wechsler Memory Scale, using the multiple scoring method, which measures both long‐ and short‐term memory. The mean value for serum choline was 13.16 μm with a standard deviation of 3.31. Serum choline levels were found to increase with age, but no difference was found between serum choline levels for men and women. There was no association between dietary intake and serum choline levels, nor could a relationship be found between serum choline levels and cognitive function.
Adipocyte Hormone Responsiveness and Aging in the Rat: Problems in the Interpretation of Aging Research
Authors: KIRKLAND JAMES L. , DAX ELIZABETH M. 
Published: April 2015

ABSTRACT:Fat is a metabolically dynamic tissue. Its metabolism is under the control of several well‐characterized hormonal systems. There appear to be changes in the hormonal sensitivity of rat fat with age. No single mechanism has been proved to explain all the changes observed in adipocyte hormonal responsiveness with aging, although it does seem likely that age does have an independent effect on fat metabolism from studies to date.
Effects of a Physician‐led Home Care Team on Terminal Care
Authors: ZIMMER JAMES G. , GROTH‐JUNCKER ANNEMARIE , McCUSKER JANE 
Published: April 2015

ABSTRACT:Inconsistent results in studies of cost‐effectiveness of home health care have led to the need for identification of target populations for whom cost‐savings can be anticipated if expanded home care programs are introduced. This analysis of results of a randomized controlled study of efficacy of a physician/geriatric nurse practitioner/social worker home care team identifies such a potential target population. The team provides round‐the‐clock on‐call medical services in the home when needed, in addition to usual nursing and other home care services, to home‐bound chronically or terminally ill elderly patients. Overall health services utilization and estimated costs were not substantially different for the patients who did not die while in the study; however, for those who did die, team patients had considerably lower rates of hospitalization and overall cost than controls, and more frequently died at home. Of 21 team and 12 control patients who died but had at least two weeks of utilization experience in the study, team patients had about half the number of hospital days compared with controls during the terminal two weeks, and although they had more home care services, had only 69 per cent of the estimated total health care costs of the controls. Satisfaction with care received was significantly greater among the total group of team patients, and especially among their family caretakers, than among controls. This model is effective in providing appropriate medical care for seriously ill and terminal patients, and in enabling them to die at home if they so wish, while at the same time reducing costs of care during the terminal period.
Underdiagnosis of Cognitive Impairment in a Rehabilitation Setting
Authors: GARCIA CARLOS A. , TWEEDY JAMES R. , BLASS JOHN P. 
Published: April 2015

ABSTRACT:Of 100 patients consecutively admitted to a rehabilitation hospital, 25 were cognitively impaired. On two brief tests of intellectual function, they scored below the criteria selected by the originators of those tests for clinically significant mental impairment. Nineteen of the 25 had vascular disease of the heart, brain, or peripheral vessels; two had cardiac valvular disease; three had head trauma; and one was mentally retarded. Mental impairment appears to be relatively common among the hospitalized elderly who do not carry the primary diagnosis of “dementia” or “organic brain syndrome.” It appears to be particularly common among those with cardiovascular disease, even without frank stroke. Brief mental status examinations should be part of the routine evaluation of such patients.
Geriatric Psychiatry in the Emergency Department, II: Evaluation and Treatment of Geriatric and Nongeriatric Admissions
Authors: WAXMAN HOWARD M. , DUBIN WILLIAM , KLEIN MELISSA , WEISS KENNETH J. , CARNER ERWIN A. 
Published: April 2015

ABSTRACT:The records of a hospital psychiatric emergency department were reviewed for elderly and middle‐aged patients who were diagnosed with organic brain syndrome (OBS) or psychiatric disorder. These records were then compared with those of elderly patients from the medical emergency department. While elderly medical patients received routine physical evaluations and laboratory testing, elderly psychiatric patients with behavioral symptoms were often referred to psychiatry before they received tests necessary to differentiate physical disorders from functional psychiatric disorders. When tests were administered to psychiatric patients, many abnormal results were apparent, indicating the possible presence of physical disease. It is recommended that all elderly patients with psychiatric symptoms undergo adequate medical evaluations to screen for physical causes of the psychiatric symptoms.
Medications and Diagnoses in Relation to Falls in a Long‐Term Care Facility
Authors: Granek Elisabeth , Baker Susan P. , Abbey Helen , Robinson Elizabeth , Myers Ann H. , Samkoff Judith S. , Klein Lawrence E. 
Published: April 2015

The association between falls, drugs, and diagnoses in elderly residents of a long‐term care facility was explored using case‐control methodology. The odds of being a faller rather than a control were significant (P < .01) for those taking antidepressants, sedatives/hypnotics, or vasodilators, and for those with osteoarthritis or depression.When drug/diagnosis subgroups were examined, these same drug classes and diagnoses had high‐odds ratios in the largest numbers of subgroups. In general, risk of falling appeared to be more strongly associated with drugs than with diagnoses.
Correlates of Depression and Burden for Informal Caregivers of Patients in a Geriatrics Referral Clinic
Authors: Drinka Theresa J. K. , Smith Jane C. , Drinka Paul J. 
Published: April 2015

Caregiver burden has been associated with patient dementia. In this study we tested the hypothesis that caregiver burden and depression are related to patient cognitive impairment. We analyzed records of 127 elderly male patients from a Veterans hospital geriatrics referral clinic. The patients and their informal caregivers had been referred to the clinic because the complexity and multiplicity of their problems were beyond the treatment capability of other clinics. There was a high prevalence of dementia (73%) and depression (69%) in these patients according to Diagnostic and Statistical Manual (DSM‐III) criteria.Quantitative measures of patient dementia and dependency in activities of daily living were not statistically associated with measures of caregiver depression or burden. In contrast, measures of patient depression were significantly correlated with measures of caregiver depression and burden.We hypothesize that caregivers of chronically ill, elderly men cope better with physical and cognitive incapacity than with affective symptoms. Because caregiver support is the most important factor in maintaining a disabled elder in the community, we suggest evaluating patients and caregivers for depression as part of standard practice in geriatric clinical settings.
Gram‐Negative Bacillary Bacteremia in the Elderly: Incidence, Ecology, Etiology, and Mortality
Authors: McCue Jack D. 
Published: April 2015

The incidence, ecology, and mortality of gram‐negative bacillary bacteremia in elderly patients were studied in an analysis of 334 episodes over a four‐year‐period in a 489–bed North Carolina community teaching hospital, 135 (40.4%) of which occurred in patients 70 years of age or older. The bacteremia rate per 1000 hospital admissions increased sharply with increasing age. The ecology and in vitro antimicrobial susceptibilities of the bacterial isolates were strongly influenced by community v hospital acquisition, but not by age. Urosepsis was significantly more likely to be the underlying source of hospital‐acquired bacteremia in patients 70 years or older (P< 0.01).Total bacteremia‐related mortality did not increase with increasing age; in the group of patients aged 70 years or older with nonfatal/ultimately fatal underlying diseases (NF/UFUD), however, mortality was 9.1% compared to 2.9% in the younger age group (P< 0.001). Significantly increased bacteremia‐related mortality was also noted in the older patients with NF/UFUD admitted from nursing homes (P< 0.05) and those not treated with an appropriate antimicrobial agent within 24 hours (P< 0.01). Overall, the older patients with hospital‐acquired bacteremia, neutropenia‐associated infection, those bacteremic from a nonurinary source of infection, and those treated with multiple‐drug regimens had higher mortality (P< 0.05).Gram‐negative bacteremia is much more common in patients 70 years of age or older and compared with younger patients mortality appears to be significantly increased for the important subgroup of older patients with nonfatal or ultimately fatal underlying diseases.
Severe Disability Related to Cerebral Stroke: Incidence and Risk Factors Observed in a Japanese Community, Hisayama
Authors: Ueda Kazuo , Fujii Ichiro , Kawano Hideo , Hasuo Yutaka , Yanai Toshiro , Kiyohara Yutaka , Wada Junichi , Kato Isao , Omae Teruo , Fujishima Masatoshi 
Published: April 2015

To elucidate the incidence of severe disability due to cerebral stroke and its related factors, prospective data of 1,621 Hisayama residents aged 40 and over were examined. Severe disability resulting from stroke was defined as patients who were unable to dress, take care of their toilet needs, and feed themselves without assistance, or who required a wheel chair for ambulation three months after the most recent episode.During 20 years of follow‐up 255 stroke patients were observed among the sample population. The annual incidence of stroke per thousand was 9.8, and rate of severe disability was 2.8 for men and 6.4 and 2.0 for women, respectively. Of the 74 cases with severe disability, approximately 92% were attributed to cerebral infarction. Related factors to severe disability due to cerebral infarction were recurrent attacks, hypertension, changes in ocular fundi and diabetes mellitus among predispositions and quadriplegia or muscular contraction, and intelligent or mental disorders among inhibiting factors for functional recovery. Furthermore, in 59 autopsy cases with multiple cerebral infarctions, the frequency of disability increased as the number of infarcts increased. Hypertension and diabetes mellitus, as risk factors for cerebral infarction and factors inhibiting postictal functional recovery were discussed.
Binding the Elderly: A Prospective Study of the Use of Mechanical Restraints in an Acute Care Hospital
Authors: Robbins Laurence J. , Boyko Edward , Lane Judy , Cooper Darcy , Jahnigen Dennis W. 
Published: April 2015

Little information exists on the use of mechanical restraints among nonpsychiatric inpatients. This prospective study evaluates their use among consecutive medical and surgical admissions to an acute care hospital. Daily direct observation of patients and hospital record review provided data on potential predictors of restraint, reasons for their application, complications, and outcome. Cox regression analysis was used to calculate relative risk of restraint while adjusting for duration of hospitalization as well as other variables.Restraints were applied to 37 (17%) of the 222 study patients. Restrained patients were eight times more likely to die during hospitalization (24% v 3%; P < 0.01). Abnormal mental status exam, diagnosis of dementia, surgery, and presence of monitoring and support devices (eg, intravenous lines) were statistically significant independent predictors of restraint. Mechanical restraint is a common occurrence among nonpsychiatric inpatients particularly those with impaired mentation, requirement for surgery, or intensive medical intervention. Identification of medical and surgical patients at risk for restraint may reduce the use of these devices by concentrating surveillance and prevention on this group.
Old People in the Emergency Room: Age‐Related Differences in Emergency Department Use and Care
Authors: Baum Stephen A. , Rubenstein Laurence Z. 
Published: April 2015

Little is known about how the care received in emergency departments (ED) by the elderly population differs from that received by younger people. We prospectively abstracted ED records of 1620 consecutive patients visiting a large community hospital ED over a 22‐day period in 1984 for demographic and medical variables. Charts of patients presenting with five specific complaints (dyspnea, chest pain, abdominal pain, syncope, and motor vehicle accidents) were also analyzed for process of care variables and, for patients hospitalized, the accuracy of the ED diagnosis.Older people (ie, those ≥65 years of age) do not seem to be overutilizers of the ED for minor complaints, in fact, they tend to be more acutely ill on presentation than younger people. Older people were more likely to be hospitalized (46% v 10%, P < .001), to arrive by ambulance (35% v 10%, P < .001), and to have an identified source of primary care (95% v 64%, P < .01). Older people stayed longer in the ED than younger people if they were eventually released home but shorter if admitted to the hospital. Test ordering patterns for specific complaints varied by patient age (eg, older patients had more electrocardiograms performed for chest pain and fewer urinalyses for abdominal pain than younger patients). Therapy for specific complaints showed less age effect. Although generally more diagnostic tests were performed on older patients, the ED diagnosis tended to be more accurate for younger patients. Our data indicate that the process of ED care may be substantially different for the elderly population and have implications for future planning and financing of medical care.
The Examination of Physicians' Awareness of Dementing Disorders
Authors: Rubin Susan M. , Glasser Michael L. , Werckle Michael A. 
Published: April 2015

Despite a significant increase in the amount of research being conducted on the etiology, diagnosis, and treatment of Alzheimer's disease and other dementing disorders, there has been little assessment of the utilization of this new wealth of information by the primary care physician. It was hypothesized that there would be a wide variation in physicians' knowledge of dementing disorders and the procedures used to diagnose these disorders. To quantitate the present status of primary care physicians' knowledge of dementing disorders and to investigate possible relationships between this knowledge and different physician and practice characteristics, 50 general internists and family practitioners from Winnebago County, Illinois, were interviewed regarding their recall of causes of dementia, procedures used in diagnosing these diseases, treatment recommendations, and comfort in making a differential diagnosis.Results revealed a wide variation in both physicians' familiarity with the causes of dementia as well as the procedures used in making the diagnosis. Although a majority (80%) of the physicians reported some degree of confidence in making a differential diagnosis of dementing disorders, a significant trend was found between physician age and comfort in making the diagnosis, with age being directly correlated with comfort. This was in spite of a significant negative association between physician age and immediate recall of causes of dementia. These data imply that younger physicians are entering the work force with at least better immediate recall of information on dementing disorders, but they have had little opportunity to become comfortable with that knowledge due to a generally smaller geriatric population in their practice. Secondly, despite good recall of specific causes of dementia, younger physicians were no more likely to evaluate patients using mental status testing. In fact, only 42% of physicians mentioned mental status testing as a procedure with only 12% mentioning using any formal mental testing procedure. Although these data reflect favorably on the medical education system's incorporation of geriatric medicine classes in the curriculum, they also imply that dissemination of the information to the present physician population and subsequent use is still problematic.
Identifying the Older Person Likely to Require Long‐Term Care Services
Authors: Williams Mark E. 
Published: April 2015

The purpose of this study is to determine the accuracy of predictions in identifying older persons who subsequently require long‐term care such as home services or institutionalization. Eighty‐six individuals undergoing geriatric evaluation between May 1983 and April 1984 were evaluated using a series of commonplace tasks such as opening doors, stacking checkers, and copying a simple sentence. Predictions of an individual's use of long‐term care services were made during the initial evaluation and were based on whether the person could complete all the manual tasks and on the amount of time required to do so. Outcomes were determined by telephone interviews by a trained social worker in Dec 1984.A statistically significant association (P < 0.005) was observed between the predictions and actual outcomes. Analysis of variance confirmed that the mean times for each outcome were different (F = 2.6, P < 0.05).The results suggest that timing manual performance offers a useful way to prospectively identify older persons at risk of requiring additional long‐term care services.