bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for Depression in Hospitalized Elderly Medical Patients: Taking a Closer Look
Authors: Koenig Harold G. , Meador Keith G. , Cohen Harvey J. , Blazer Dan G. 
Published: April 2015

Objective: To re‐examine the test characteristics of the Geriatric Depression Scale (GDS) and the Brief Carroll Depression Rating Scale (BCDRS) in elderly medical inpatients, simulating the procedure followed by clinicians when using screening instruments.Design: Masked comparison of GDS and BCDRS with psychiatric interview.Setting: Durham VA Medical Center.Participants: 109 consecutively admitted persons aged 70 or over.Measurements: Screening by a social worker using GDS and BCDRS on day one, followed the next day by an investigator's structured psychiatric interview to determine the presence of major depressive disorder (MDD).Results: By this method, the sensitivity and specificity of the GDS (cutoff 11) were 82% and 76%, respectively; for the BCDRS (cutoff 6), they were 73% and 79%. Among those with a negative test, the likelihood of MDD dropped from an a priori probability of 10% to an a posteriori probability of 3% with the GDS and 4% with the BCDRS. Among those with a positive test, the likelihood of MDD was 27% for the GDS and 28% for the BCDRS. Excluding patients with cognitive impairment (MMSE ≤ 25) only slightly improved test characteristics.Conclusion: These estimates are considerably below those reported in earlier studies where concordant screening, two‐stage screening, or other methods have been utilized and may impact the decision whether or not to screen for depression using these instruments. J Am Geriatr Soc 40:1013–1017, 1992
The Relationship between Low Vision and Performance of Activities of Daily Living in Nursing Home Residents
Authors: Marx Marcia S. , Werner Perla , Cohen‐Mansfield Jiska , Feldman Robert 
Published: April 2015

Objective: To explore the link between low vision and Activities of Daily Living (ADL) performance in cognitively intact nursing home residents.Design: Survey.Setting: A non‐profit geriatric long‐term care facility.Subjects: 21 males, 82 females, aged 66–98.Measures: Survey of 103 nursing home residents. ADL functioning assessed via Maryland Appraisal of Patient Progress (MAPP); medical data collected through chart review; ophthalmological data obtained through dilated eye examination by an ophthalmologist.Results: In comparison with residents having good vision (n = 52), a significantly greater proportion of residents with low vision (n = 51) were dependent on caregivers for performing ADLs (eg, toileting, transferring, washing). Residents with low vision had significantly more eye pathology (eg, cataracts, age‐related macular degeneration) than did residents with good vision. There were no significant differences between groups with regard to presence of musculoskeletal problems (eg, arthritis) or number of medical conditions (eg, cardiovascular disorder, cerebrovascular accident).Conclusions: There is a strong link between low vision and ADL disability in nursing home residents. Moreover, ADL dependency is significantly related to the presence of eye disorders. J Am Geriatr Soc 40:1018–1020, 1992
Mid‐Career Faculty Development Awards in Geriatrics: Does Retraining Work?
Authors: Robbins Laurence J. 
Published: April 2015

ObjectiveTo evaluate the success of a mid‐career physicians faculty retraining in geriatric medicine.DesignWritten survey of participants in the John Hartford Foundation's Mid‐Career Faculty Development Program (1984–1988).SettingFour well established geriatric fellowship training programs.ParticipantsThe 29 physicians who received John Hartford Foundation awards.ResultsTwenty‐one (87%) of 24 respondents felt that the fellowship year had either a “major” or “significant” impact on their careers, and 87% also spend a significant portion of their time training others in geriatrics.ConclusionThis 4‐year experiment in mid‐career faculty retraining in geriatrics suggests that this approach is a viable alternative to traditional 2‐year fellowships for helping to reduce the shortage of faculty in geriatric medicine.
Inpatient Community‐Based Geriatric Assessment Reduces Subsequent Mortality
Authors: Thomas David R. , Brahan Robert , Haywood Barry P. 
Published: April 2015

ObjectiveTo evaluate the effect of an Inpatient Geriatric Consultation Team on patient outcome.DesignRandomized controlled clinical trial.SettingA non‐academic‐affiliated 503‐bed community hospital.PatientsAll inpatients over the age of 70 years. Sixty‐two patients received multidimensional geriatric assessment and 58 patients received no intervention.InterventionTeam assessment, leading to formal recommendations to the attending physician.MeasurementsData were collected on hospital length of stay, referrals to community service, discharge destination, hospital readmissions in 6 months, number of post‐discharge physician visits, and change in functional status. Mortality at 6 months and at 1 year was determined for each patient.Main ResultsAt 6 months, 12/58 patients (21%) had died in the control group versus 3/62 (6%) patients in the experimental group (P = 0.01). During hospitalization, the length‐of‐stay was 10.1 days for the control group versus 9.0 days for the experimental group (P = 0.20). The control group had significantly more readmissions (0.6 per patient vs 0.3 per patient, P = 0.02). A higher number of experimental patients, 22% (13/59), showed improvement in ADL scores compared with 7% (4/46) of control patients, P = 0.07. At one year for all randomized patients, 7/68 (10%) of experimental patients and 13/64 (20%) of control patients had died.ConclusionsShort‐term mortality can be reduced in community inpatient acute hospital settings by comprehensive geriatric consultation teams. Important differences in mortality remain at 1 year of followup. Trends towards improved functional status and fewer hospital readmissions favor the intervention group.
Clinical Features Distinguishing Large Cohorts with Possible AD, Probable AD, and Mixed Dementia
Authors: Corey‐Bloom Jody , Galasko Douglas , Hofstetter C. Richard , Jackson J. Edward , Thal Leon J. 
Published: April 2015

Objective: To determine whether clinical features and rate of cognitive and functional decline differed in cohorts of possible AD (poAD), probable AD (prAD), and mixed dementia (MIX) patients.Design: Cohort study with 1‐year follow‐up examination, comparing three groups of subjects.Setting: Outpatient evaluation at nine California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC).Patients: There were 1701 elderly patients who presented for evaluation of memory complaints.Measurements: Historical, physical, and neurological variables for cross‐sectional comparisons and 1‐year rate of change on the Mini‐Mental State Examination (MMSE), Blessed Information‐Memory‐Concentration test (BIMC), and Blessed Dementia Scale (BDS).Results: Mean initial MMSE scores for poAD (n = 279), prAD (n = 928) and MIX (n = 430) were 17.9 (±7.4), 13.9 (±7.5), and 15.4 (±7.1). Delusions and psychosis occurred in about one‐third of each group, most often in those with moderate dementia (MMSE 11–20). PoAD were distinguished from prAD by significantly more alcohol abuse, physical health problems, and focal motor or sensory findings. MIX differed from AD alone by increased prevalence of cardiovascular disease, hypertension, stroke, TIA, and exposure to general anesthesia, and by a greater frequency on exam of depressed mood, focal motor or sensory findings, and gait disorder. All groups declined by about 2.8 points on the BIMC, 2.9 points on the MMSE, and 1.8 points on the BDS, a functional scale, over 1 year. Neither extrapyramidal signs nor psychosis predicted a more rapid rate of decline.Conclusions: Various features help to distinguish poAD, prAD, and MIX in a large cohort of patients, but do not predict the rate of progression.
Validation of a Measure of Physical Illness Burden at Autopsy: The Cumulative Illness Rating Scale
Authors: Conwell Yeates , Forbes Nicholas T. , Cox Christopher , Caine Eric D. 
Published: April 2015

Objective: To further validate an objective measure of physical illness burden, the Cumulative Illness Rating Scale (CIRS).Design: Survey with correlation of CIRS ratings made from physician interviews and review of medical records with postmortem ratings made independently at tissue autopsy.Subjects: Victims of completed suicide investigated by both psychological and tissue autopsy (n = 72).Results: CIRS ratings made by examination of tissue at autopsy were highly predictive of analogous ratings based on historical data, accounting for 75% of the variance in CIRS scores. Taking autopsy findings as the gold standard of objective health assessment, historical ratings tend to underestimate physical illness at high levels of tissue pathology and to overestimate burden at lower levels.Conclusions: The CIRS score, when derived from all available sources of medical information, is a valid objective measure of physical illness burden and has broad applicability to research in geriatrics.
Projecting the Need for Physicians to Care for Older Persons: Effects of Changes in Demography, Utilization Patterns, and Physician Productivity
Authors: Reuben David B. , Bradley Thomas B. , Zwanziger Jack , Beck John C. 
Published: April 2015

Objective: To determine the influence of differing assumptions of population growth, visit rates, prevalence of functional impairment, physician productivity, and hospitalization rates on projected need for physicians to provide medical care for older persons.Design: Sensitivity analysis of a manpower model.Main Results: The factors that appear to have the most impact on projections of physician need are related to physician productivity, especially delegation to mid‐level providers, and case‐mix. Other factors, such as the variability of census projections and per capita visit rates, are likely to have less effect on overall physician supply needs.Conclusions: Although case mix and delegation to mid‐level providers may both substantially affect the need for physician supply to care for older persons, only the latter can be directly affected by health policy decisions. Consideration should be given to increasing the supply of mid‐level providers and providing incentives for patients and physicians to receive and provide care in delivery systems that utilize mid‐level providers extensively.
HMO Medical Directors' Perceptions of Geriatric Practice in Medicare HMOs
Authors: Friedman Bruce , Kane Robert L. 
Published: April 2015

Objective: To determine the extent to which health maintenance organizations (HMOs) with Medicare risk contracts utilize geriatricians and selected aspects of “organized” geriatric practice.Design: A telephone interview survey.Participants: Eighty‐two percent (64 of 78) of the HMOs with Medicare risk contracts as of June 1991.Measurements: Questions to medical directors of the Medicare HMOs on (1) the presence of geriatricians, (2) the roles of geriatricians, and (3) “organized” geriatric practice.Main Results: Fifty‐three percent of the Medicare HMOs have one or more geriatricians, but only 19% have attempted to recruit geriatricians. Geriatricians provide primary care in 76% of the HMOs with geriatricians and serve as specialist consultants in 61%. Geriatricians are reported to be used actively in 32% of the HMOs that have them. The proportion of HMOs utilizing “organized” geriatric activities ranges from a high of 58% for a general health information questionnaire to a low of 12% for a special form(s) for comprehensive geriatric assessment. While the percentage of HMOs using each of the “organized” strategies is higher for the HMOs with geriatricians than for those without, this is statistically significant for only one strategy—the use of special approaches or formal protocols for problems frequently found in the elderly (P = 0.04).Conclusions: The perception of Medicare HMO medical directors is that about half of the HMOs utilize geriatricians and that there is evidence of “organized” geriatric practice. However, it appears that geriatricians and many of the elements of organized geriatric practice are used to a much lesser extent than experts recommend. Medicare HMOs must themselves test the various components of organized geriatric practice in order to determine their utility.
Sex Differences in the Psychiatric Manifestations of Alzheimer's Disease
Authors: Cohen Donna , Eisdorfer Carl , Gorelick Philip , Luchins Daniel , Freeh Sally , Semla Todd , Paveza Gregory , Shaw Helen , Ashford J. Wesson 
Published: April 2015

Objective: To test the null hypothesis, ie, that there are no gender differences in psychiatric problems manifest in patients with Alzheimer's disease.Design: Survey.Setting: Patients living in the community and evaluated at Alzheimer's disease and geriatric outpatient programs.Patients: Three hundred twenty‐eight women and 186 men clinically diagnosed with Alzheimer's disease using NINCDS/ADRDA or DSM‐III‐R criteria.Measurements: Psychiatric signs and symptoms recorded following a psychiatric interview, including the Hamilton Depression Rating Scale.Results: Approximately two‐thirds of both men and women had psychiatric problems, but women had significantly more multiple symptoms. When pairs of symptoms were analyzed for independence, agitation was only significantly associated with paranoia in men, whereas in women agitation was significantly associated with most other psychiatric problems.Conclusion: The higher prevalence of multiple psychiatric problems in women may be due to many factors, including sociodemographic influences, physician bias, and/or other differences between men and women. The finding of a different pattern of association of symptoms with agitation in men and women deserves replication.
Predictors of Formal Home Health Care Use in Elderly Patients after Hospitalization
Authors: Solomon Daniel H. , Wagner D. Raye , Marenberg Marjorie E. , Acampora Denise , Cooney Leo M. , Inouye Sharon K. 
Published: April 2015

Objective: To prospectively study the incidence of and risk factors for home health care (HHC) use in a cohort of elderly medical and surgical patients discharged from acute care. Although HHC is commonly received by patients in this group, its predictors have not been well studied.Design: Prospective cohort study.Setting: Medical and surgical wards at a university teaching hospital, followed by 23 Medicare‐certified HHC agencies in the study catchment area.Patients: 226 medical and surgical patients aged 70 years and older immediately after discharge from acute care.Measurements: HHC initiated within 14 days after hospital discharge, measured by direct review of HHC agency records.Results: The incidence of HHC initiated within 2 weeks post‐discharge was 75/226 (34%). The median duration of service was 30 days (range 3–483) with a median of 3 visits per week. Four independent predictors of HHC were identified through multivariate analysis: educational level ≤12 years (relative risk (RR) 3.3; 95% confidence interval (CI) 1.6 to 6.6); less accessible social support (RR, 1.7; CI 0.9 to 3.1); impairment in at least one instrumental activity of daily living (RR, 1.9; CI, 1.0, 3.4); and prior HHC use (RR, 2.1; CI, 1.2 to 3.6). Risk strata were created by adding one point for each risk factor present: with 0–1 risk factors, 8% used HHC; with two risk factors, 28%; with three risk factors, 45%, with four risk factors, 76%. This trend was statistically significant (P< 0.001).Conclusions: HHC use is common among elderly patients after discharge from acute care. A simple predictive model based on four risk factors can be used on admission to predict HHC use. This model may be useful for discharge planning and health care utilization planning for the elderly population.
Early Experience with Dobutamine Stress Testing and Cardiac Cine‐tomographic Imaging in the Elderly: Antianginal Effects of Nifedipine‐GITS
Authors: Schwartz Janice B. , Caputo Gary , Abbott Joseph 
Published: April 2015

Objective: To determine the effects of nifedipine‐GITS (GITS = gastrointestinal transport system) on angina and cardiovascular responses to stress‐dobutamine infusion, we used ultrafast cine‐computed tomography (CT) to assess regional wall motion, myocardial perfusion, and indices of ventricular filling and emptying.Design: Randomized, double‐blind placebo‐controlled efficacy study after an open‐label dose titration phase.Setting: University of California, San Francisco.Patients: Elderly patients (>60 years; n = 9:8 male, 1 female) with coronary artery disease by history and diagnostic treadmill or coronary angiography.Intervention: After a 3‐week open‐label dose‐titration phase, eight subjects were randomized to receive either placebo or nifedipine‐GITS at the highest tolerated dose for 2 weeks, followed by a crossover to the alternate therapy for 2 weeks. One declined because of singulus in the open‐label period.Main Outcome Measures: Symptomatic angina relief (frequency and nitroglycerin consumption), dobutamine stress responses (time to ischemia during dobutamine infusions, cardiac output, cardiac ejection fraction, ventricular segmental wall motion, and perfusion as measured by ultrafast cine‐CT), and reported adverse effects.Results: When compared with placebo, nifedipine‐GITS administration was associated with less frequent angina and nitroglycerin consumption (NS) and significantly decreased systolic blood pressure. Nifedipine‐GITS administration also increased resting supine heart rates. Dobutamine infusions increased heart rate, cardiac output, cardiac ejection fraction, and stroke volume and induced angina symptoms. Neither double product at angina nor systolic indices of cardiac function in response to dobutamine differed between nifedipine‐GITS and placebo, although heart rate responses were greater during nifedipine. A trend toward increased peak filling rates was seen during dobutamine stress in the nifedipine‐administration period. In most subjects (6/8), perfusion and regional wall motion abnormalities were not visualized on either rest or stress cine‐CT studies. Edema without congestive heart failure occurred frequently during nifedipine‐GITS administration.Conclusions: These data suggest that (1) dobutamine stress can be used to induce cardiac ischemia in elderly patients with coronary artery disease, (2) nifedipine‐GITS provides symptomatic angina relief in elderly patients, (3) peripheral edema is frequent in elderly patients on nifedipine‐GITS, and (4) ultrafast computed cine‐tomography testing can be used to assess ventricular performance, but current methodology may not detect perfusion or wall motion abnormalities during angina.
Sensory Impairment and Quality of Life in a Community Elderly Population
Authors: Carabellese Corrado , Appollonio Ildebrando , Rozzini Renzo , Bianchetti Angela , Frisoni Giovanni B. , Frattola Lodovico , Trabucchi Marco 
Published: April 2015

Objective: To determine the association between quality of life measures and sensory impairment in aged individuals living at home.Design: SurveySetting: A community survey, carried out in the historical center of a town in Northern Italy.Patients: 1191 non‐institutionalized elders (age 70–75 years).Measurements: Comprehensive QOL questionnaire, free‐field voice testing, and Snellen eye chart.Results: Single sensory impairments (either visual or auditory) were significantly and independently associated with increased risk for depression (odds ratio: 2.3, 95% confidence interval: 1.5–3.4; OR:1.8, CI:1.1–2.7, respectively) and decreased self‐sufficiency in daily living activities (OR: 1.7, CI:1.1–2.6; OR:2.1, CI:1.4–3.2, respectively). Visual dysfunction, but not hearing dysfunction, was independently associated with lower social relationships (OR:2.0, CI:1.3–3.1).Conclusion: The quality of life of community‐dwelling elderly people is significantly linked to sensory impairment, which can be detected through simple physical examination. Mood level and social relationships are particularly affected by visual impairment, whereas self‐sufficiency in daily living is more strongly related to hearing impairment.
Profile of Depressive Symptoms in Younger and Older Medical Inpatients with Major Depression
Authors: Koenig Harold G. , Cohen Harvey J. , Blazer Dan G. , Krishnan K. Ranga Rama , Sibert Thomas E. 
Published: April 2015

Objective: To examine and compare the profile of cognitive symptoms, somatic symptoms, and somatic complaints in younger and older medical inpatients diagnosed with major depressive disorder (MDD)Design: Cross‐sectional cohort.Patients and Setting: Male patients aged 20–39 years (n = 116) and aged 70–102 years (n = 332), consecutively admitted to the medical and neurological services of a VA medical center, underwent psychiatric evaluations for depression.Measurements: Depressive symptoms were measured using the observer‐rated Hamilton Depression Scale and the self‐rated Geriatric Depression Scale using an “inclusive” approach (symptoms rated regardless of etiology). Data on 12 common somatic complaints were also collected. Clinical diagnoses of MDD were made by a psychiatrist based on the Diagnostic Interview Schedule and other psychiatric and physical health data.Results: After controlling for severity of medical illness, functional status, and alcohol use, symptoms that discriminated MDD best among younger men were loss of interest, feelings of guilt or of being a burden, suicidal thoughts, and depressed mood (primarily cognitive and affective symptoms). Among older men, loss of interest, insomnia, suicidal thoughts, and hypochondriasis most strongly differentiated depressed from non‐depressed patients (mixture of cognitive and somatic symptoms); fatigue, weight loss, genital symptoms, and somatic anxiety were weakly related or unrelated to MDD. Number of somatic complaints (headache, dizziness, palpitations, etc.) helped differentiate patients with MDD; although equally common among depressed young and older patients, a distinct pattern of complaints emerged in each age group.Conclusions: Cognitive symptoms of depression can help to distinguish medical inpatients with and without MDD. In older adults, however, somatic symptoms cannot be ignored and may be more important for diagnosing MDD than previously realized. These findings will help clinicians identify patients with MDD and differentiate them from non‐depressed patients with medical illness.
Total Quality Management: Administrative and Clinical Applications in Nursing Homes
Authors: Schnelle John F. , Ouslander Joseph G. , Osterweil Dan , Blumenihal Sheldon 
Published: April 2015

Objective: Describe the application of the Total Quality Management (TQM) model to the unique work force, resident population, and regulatory issues that characterize long term care settings.Design: The key differences between TQM and current management and training practices in nursing homes are described. A specific data‐based example is provided of a successful TQM application to health care involving clinical work processes related to incontinence care.Conclusion: Significant organizational and clinical obstacles must be overcome if TQM is to improve the quality of life and satisfaction of nursing home residents and their families as it has improved the efficiency and product quality in hospital and non‐health‐care settings.