bluuebunny/crossref_metadata_2025_split huggingface dataset:
Home Visits by an Occupational Therapist for Assessment and Modification of Environmental Hazards: A Randomized Trial of Falls Prevention
Authors: Cumming Robert G. , Thomas Margaret , Szonyi George , Salkeld Glenn , O'Neill Elizabeth , Westbury Christine , Frampton Gina 
Published: April 2015

OBJECTIVE: To determine whether occupational therapist home visits targeted at environmental hazards reduce the risk of falls.DESIGN: A randomized controlled trial.SETTING: Private dwellings in the community in Sydney, Australia.PARTICIPANTS: A total of 530 subjects (mean age 77 years), recruited primarily before discharge from selected hospital wards.INTERVENTION: A home visit by an experienced occupational therapist, who assessed the home for environmental hazards and facilitated any necessary home modifications.MEASUREMENTS: The primary study outcome was falls, ascertained over a 12‐month follow‐up period using a monthly falls calendar.RESULTS: Thirty six percent of subjects in the intervention group had at least one fall during follow‐up, compared with 45% of controls (P = .050). The intervention was effective only among subjects (n = 206) who reported having had one or more falls during the year before recruitment into the study; in this group, the relative risk of at least one fall during follow‐up was 0.64 (95% confidence interval, 0.50‐0.83). Similar results were obtained when falls data were analyzed using survival analysis techniques (proportional and multiplicative hazards models) and fall rates (mean number of falls per person per year). About 50% of the recommended home modifications were in place at a 12‐month follow‐up visit.CONCLUSIONS: Home visits by occupational therapists can prevent falls among older people who are at increased risk of falling. However, the effect may not be caused by home modifications alone. Home visits by occupational therapists may also lead to changes in behavior that enable older people to live more safely in both the home and the external environment. J Am Geriatr Soc 47:1397–1402, 1999.
A U‐Shaped Association Between Home Systolic Blood Pressure and Four‐Year Mortality in Community‐Dwelling Older Men
Authors: Okumiya Kiyohito , Matsubayashi Kozo , Wada Tomoko , Fujisawa Michiko , Osaki Yasushi , Doi Yoshinori , Yasuda Nobufumi , Ozawa Toshio 
Published: April 2015

BACKGROUND: Several studies in older people have found a U‐shaped or J‐shaped association of blood pressure with mortality. The increased mortality associated with the lowest levels of blood pressure in older people have been explained by concurrent illnesses and frailty, but previous studies used blood pressure measured on a single occasion. Such a casual value is different from the long‐term average of blood pressure. We investigated the relation between the average level of 5‐day consecutive home blood pressure and mortality in older people while adjusting for potential confounding factors including morbidity and frailty at baseline.METHODS: In 1992, 1186 community residents of a rural Japanese town, Kahoku, aged 65 or older, measured their blood pressure in their homes 20 times (four times per day, 5 consecutive days). The mean value of the 20 measurements was used to examine the association between home BP and subsequent 4‐year mortality. A proportional hazards model was fitted while adjusting for activities of daily living impairment, medical history, antihypertensive medication, smoking, use of alcohol, and depression.RESULTS: A total of 134 persons died during the four‐year follow‐up period. There was no significant evidence that frailty is more prevalent in the lowest or highest systolic BP group than in intermediate groups. A U‐shaped association between the average level of home systolic blood pressure and mortality was found in men while adjusting for potential confounding factors, including morbidity and frailty. We also showed the U‐shaped curve of the association of systolic BP with all cause and noncardiovascular mortality in the whole population and the linear association of systolic BP with cardiovascular mortality.CONCLUSIONS: We showed a U‐shaped association between the average level of systolic blood pressure measured at home and mortality in older men while adjusting for potential confounding factors including morbidity and frailty. Not only high home systolic BP, but also low home systolic BP, is an independent risk factor for mortality in older men. The mechanisms underlying the association between BP and mortality differ by levels of systolic BP. Cardiovascular deaths tended to be higher in the highest SBP group, and only noncardiovascular deaths were increased in the lowest SBP group. The latter finding suggests that low SBP may be not only an independent risk of mortality but also an indicator of a subclinical noncardiovascular comorbid condition. J Am Geriatr Soc 47:1415–1421, 1999.
Synthetic Somatostatin Analog (Octreotide) Suppresses Daytime Growth Hormone Secretion Equivalently in Young and Older Men: Preserved Pituitary Responsiveness to Somatostatin's Inhibition in Aging
Authors: Mulligan Thomas , Jaen‐Vinuales Alejandro , Godschalk Michael , Iranmanesh Ali , Veldhuis Johannes D. 
Published: April 2015

OBJECTIVE: To gain greater insight into the mechanisms controlling the low daytime rate of growth hormone (GH) secretion in older men.DESIGN: We conducted a randomized, controlled study of GH secretion during inhibition by octreotide, a somatostatin analog.PARTICIPANTS: Nine young (35–44 years) and ten older (62–79 years) healthy men participated.INTERVENTION: Octreotide versus nothing, while subjects were on a standardized diet.MEASUREMENTS: All subjects were assessed on two separate occasions: baseline and at time of the intervention of octreotide (100 μg subcutaneously); the order of the intervention was randomly assigned. Octreotide was administered at 8:00 a.m. Venous sampling was performed every 10 minutes for 8 hours (8:30 a.m. to 4:30 p.m.). To estimate the joint parameters of pulsatile and basal (between secretory pulses) GH secretion, we used an ultrasensitive chemiluminescence‐based GH assay and multiparameter deconvolution analysis.RESULTS: Compared with baseline, octreotide markedly reduced mean (8‐hour) serum GH concentrations in both young (0.585 ± 0.255 μg/L vs 0.070 ± 0.029 μg/L; P = .008) and older (0.397 ± 0.107 μg/L vs 0.087 ± 0.027 μg/L; P = 0.005) men. In younger men, octreotide decreased the serum GH concentration primarily by suppressing the mass of GH released per secretory pulse (2.4 ± 0.9 μg/L vs 1.0 ± .7 μg/L; P = .015) and the interpulse (basal) rate of GH release (0.0014 ± 0.0003 μg/L/min vs 0.0006 ± 0.0002 μg/L/min; P = .051). In older men, octreotide also restrained the mass of GH per secretory pulse (1.5 ± 0.4 μg/L vs 0.4 ± 0.1 μg/L; P = .028) and lowered basal GH release (0.0014 ± 0.0003 μg/L/min vs 0.0004 ± 0.0001 μg/L/min; P = .007). There were no significant differences when the older men were compared with the young controls.CONCLUSIONS: Our data suggest that the daytime relative GH deficiency seen in older men is not a result of excessive pituitary susceptibility to the inhibitory capabilities of somatostatin, but more likely reflects impoverished endogenous GHRH drive and/or heightened release of brain somatostatin. J Am Geriatr Soc 47:1422–1424, 1999.
Use of Prescribed Drugs Among Older People in Japan: Association with Not Having a Regular Physician
Authors: Tsuji‐Hayashi Yoko , Fukuhara Shunichi , Green Joseph , Kurokawa Kiyoshi 
Published: April 2015

OBJECTIVES: Minimizing the overuse of prescribed drugs among older people is a goal of geriatricians and healthcare policy makers. Indirect evidence indicates that use of prescribed drugs is more common in Japan than in some Western countries, but the actual situation in Japan is unknown. The first aim of this study was to clarify the use of prescribed drugs among older people in Japan. We also tested the hypothesis that using five or more prescribed drugs is associated with a situation that is modifiable and is relatively common in Japan: not having a regular physician.DESIGN: A cross‐sectional survey.PARTICIPANTS: Subjects representing the Japanese general population aged 65 years and older were selected by two‐stage stratified sampling; 617 persons were eligible for the study.MEASUREMENTS: Each subject was given a self‐report questionnaire about current medications, sociodemographic characteristics, current state of health, health‐related quality of life, and whether they had a regular physician. Among users of prescribed drugs, the association between using five or more prescribed drugs and not having a regular physician was assessed by univariate analysis and by stepwise logistic regression.RESULTS: The questionnaire was returned by 491 (80%) of the eligible subjects, 299 (61%) of whom were taking at least one prescribed drug. Nearly 30% of those subjects were taking at least five prescribed drugs. The distribution of the number of prescribed drugs being taken was positively skewed; the minimum was one and the maximum was 17, the middle 50% of the values ranged from two to five, and the median was three. About half of those who were taking at least five prescribed drugs did not have a regular physician. Compared with those who had a regular physician, those who did not were 2.5 times more likely to be taking at least five prescribed drugs (95% confidence interval, 1.4 − 4.6).CONCLUSIONS: Older people in Japan are less likely to be taking many prescribed drugs if they have the continuity of care provided by a regular physician. J Am Geriatr Soc 47:1425–1429, 1999.
Prevalence of Significant Knee Pain Among Older Americans: Results From the Third National Health and Nutrition Examination Survey
Authors: Andersen Ross E. , Crespo Carlos J. , Ling Shari M. , Bathon Joan M. , Bartlett Susan J. 
Published: April 2015

OBJECTIVE: To assess the prevalence of persistent knee pain among older adults in the US.DESIGN: A nationally representative cross‐sectional survey with an in‐person interview and medical examinationSETTING AND PARTICIPANTS: Between 1988 and 1994, 6596 adults aged 60 to 90+ years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans and non‐Hispanic blacks were over‐sampled to produce reliable estimates for these groups.MAIN OUTCOME MEASUREMENTS: Participants were asked to report whether they had experienced knee pain on most days for the 6 weeks preceding their medical exam.RESULTS: Overall, 18.1% of US men and 23.5% of US women aged 60 years and older reported knee pain. Sixty‐ to ninety‐year‐old men reported knee pain less frequently than their age‐matched female counterparts. There was a trend for reports of knee pain to increase steadily as these adults aged from 60 to 85 years. The highest prevalence of knee pain was reported among 85‐ to 90‐year‐old men (23.7%) and women (30.0%). Among non‐Hispanic white adults older than age 60, 18.4% of men and 22.0% of women reported knee pain. Reports of knee pain among non‐Hispanic black men and Mexican American men were similar to those of their non‐Hispanic white counterparts. In contrast, 26.4% of Mexican American women and 32.8% of non‐Hispanic black women reported knee pain. We also found that difficulty in performing physical functioning activities was associated with a higher prevalence of knee pain.CONCLUSIONS: Many US adults older than age 60 years report knee pain, and the prevalence is higher in older adults. Reports of knee pain are highest among non‐Hispanic black women and the oldest Americans. Intervention strategies are needed to prevent and better manage knee pain among older US adults to stem the adverse health consequences and diminished quality of life associated with this common problem. J Am Geriatr Soc 47:1435–1438, 1999.
Managing Dyslipidemia in Older Adults1
Authors: Carlsson Cynthia M. , Carnes Molly , McBride Patrick E. , Stein James H. 
Published: April 2015

OBJECTIVES: To summarize and critically review clinical trial data regarding dyslipidemia as a risk factor for coronary heart disease (CHD) and the efficacy and safety of lipid‐lowering interventions in older adults. Based on these data, clinical recommendations for diagnosing and managing dyslipidemia in older adults are provided.METHODS: Peer‐reviewed journal articles were identified by a MEDLINE search and a review of journal article references. Studies that were performed exclusively in subjects older than 65 years or that included a large subgroup of older adults were included.CONCLUSIONS: Elevated low density lipoprotein and total cholesterol levels are independent risk factors for CHD events in patients aged older than 65 years. Older adults have a higher risk of mortality attributable to hypercholesterolemia. Diet and lipid‐lowering medications safely and effectively lower cholesterol levels in this age group. Exercise increases high‐density lipoprotein cholesterol levels and decreases triglyceride levels. If accompanied by weight loss, exercise may reduce low‐density lipoprotein and total cholesterol levels. Improving lipid levels in older adults with CHD decreases the risk of future coronary events by up to 45%, and significant effects on outcome measures may be observed within 2 years of the initiation of therapy. J Am Geriatr Soc 47:1458–1465, 1999.
Heart Failure in Community‐Dwelling Older Persons: Aims, Design and Adherence Rate of the ICARe Dicomano Project: An Epidemiologic Study
Authors: Di Bari Mauro , Marchionni Niccolò , Ferrucci Luigi , Pini Riccardo , Antonini Enrico , Chiarlone Melisenda , Marsilii Alberto , De Alfieri Walter , Fumagalli Stefano , MD Giulio Masotti 
Published: April 2015

BACKGROUND: The prevalence of heart failure (HF) increases with age, and HF is a major cause of disability and mortality in older persons. Detection of HF in epidemiological studies has relied on criteria validated only in young and middle‐age adults, and, therefore, may prove inadequate in older subjects, because they do not take into account the pathophysiologic and clinical peculiarities of HF in old age. Thus, the true prevalence of HF in the older general population remains uncertain and has probably been underestimated in previous studies. Moreover, the mechanism and the extent by which HF hinders physical functioning in older people has not been fully elucidated.OBJECTIVES: This paper describes the design of the ICARe study, carried out in an older home‐dwelling population to collect data about: (1) the sensitivity and specificity of diagnostic criteria used previously in epidemiological studies of HF; (2) the prevalence of the different pathophysiologic forms of HF; and (3) the impact of HF on overall health status, and on physical functioning, in the absence or presence of chronic comorbidity.DESIGN AND SETTING: This was a cross‐sectional survey. Eligible were all community‐dwelling persons aged 65 years or older recorded in the Registry Office of Dicomano, a small town nearby Florence (Italy). All the domains of multidimensional geriatric assessment were explored through different phases of the study (home interview, laboratory testing, geriatric visit) that comprised an extensive cardiopulmonary instrumental assessment including: color Doppler echocardiography, echotomography of the carotid arteries used in an original method to determine arterial compliance, and bell spirometry. Presence of major chronic conditions was ascertained by predefined, standard algorithms that were based largely on clinical examination.RESULTS: There were 864 older persons eligible for the ICARe study. Even with a substantial decline from home interview (91.2%) to the cardiopulmonary study (71.1%), the adherence rate remained high throughout the study, and the population examined was fairly representative of the original eligible population. Thus, we believe that the data collected in this study offer a unique opportunity to assess the validity of the diagnostic clinical criteria for HF in the general older population, to identify the pathophysiology underlying the syndrome, and to investigate the relationship between HF, comorbidity, and disability. J Am Geriatr Soc 47:664–671, 1999.
Subclinical Hypothyroidism in a Biethnic, Urban Community
Authors: Lindeman Robert D. , Schade David S. , LaRue Asenath , Romero Linda J. , Liang Hwa Chi , Baumgartner Richard N. , Koehler Kathleen M. , Garry Philip J. 
Published: April 2015

OBJECTIVES: To evaluate the association between hypothyroidism, and the health status of older Hispanic and non‐Hispanic white (NHW) men and women. To accomplish this, we determined the prevalences of the treated and untreated conditions and examined the associations between an elevated serum thyroid stimulating hormone (TSH) and cognitive and affective (mood) functions and the prevalences of symptoms and comorbidity, specifically coronary heart disease (CHD), diabetes, hypertension, and hyperlipidemia.DESIGN AND SETTING: A cross‐sectional study of equal numbers of Hispanic and NHW men and women selected randomly from the Health Care Financing Administration (Medicare) rolls and recruited for a home interview followed by a 4‐hour interview/examination in a senior health clinic.PARTICIPANTS: 883 volunteers, mean age 74.1 years, participated in interviews/examinationsMEASUREMENTS: Serum TSH was determined in 825 participants responding to questions about thyroid replacement therapy. Serum free thyroxine (free T4) concentrations were determined in 139 participants with elevated TSH concentrations (>4.6 μU/mL). Symptoms, cognitive tests, a screen for depression, comorbidities (e.g., CHD), and risk factors (e.g., lipid abnormalities, diabetes, and hypertension) were compared in participants with high versus normal TSH values.RESULTS: Subclinical hypothyroidism is more common in women than in men and in non‐Hispanic white women compared with Hispanic women. No differences were observed between participants with TSH elevations from 4.7 to 10 μU/mL and those with normal TSH concentrations, and only a few differences were observed in those with TSH concentrations above 10.CONCLUSIONS: Subclinical hypothyroidism is a common condition in community‐living older people, especially women. However, it appeared to have no effect on any of the measures of health status utilized until serum TSH concentrations exceeded 10 μU/mL, and even then the effects were rarely significant. J Am Geriatr Soc 47:703–709, 1999.
The Efficacy of Omeprazole‐Based Short‐Term Triple Therapy in Helicobacter pylon‐Positive Older Patients with Dyspepsia
Authors: Moshkowitz Menachem , Brill Shlomo , Konikoff Fred M. , Reif Shimon , Arber Nadir , Halpern Zamir 
Published: April 2015

OBJECTIVE: To evaluate the efficacy of 1‐week triple therapy with omeprazole, clarithromycin, and tinidazole (OCT) in Helicobacter pylori‐positive older patients with dyspepsia.DESIGN: A prospective, nonrandomized therapeutic study.SETTING: The primary care and referral center of a gastroenterological outpatient clinic at a central university hospital serving an urban population (>1 million) in Israel.PARTICIPANTS: The study group consisted of 134 patients (71 men, and 63 women) more than 60 years old who were referred for evaluation of symptoms of dyspepsia and were endoscopically diagnosed as H. pylori positive. The patients were divided into two groups: those who received their first course of anti‐H. Pylori therapy during this study (Group 1) and those who had previously received standard metronidazole and bismuth combination therapies that failed to eradicate the H. pylori (Group 2).MEASURMENTS: All the patients underwent upper gastrointestinal endoscopy, and H. pylori infection was confirmed by a rapid urease test (CUTest) and/or histological staining. Therapeutic efficacy was assessed by a 13C‐urea breath test 4 weeks after completion of treatment.RESULTS: The mean age of the study population was 68.8 years (range 60–87). There were 112 patients in Group 1 and 22 patients in Group 2. Endoscopic findings were: gastritis (in 46), gastric ulcer (8), duodenal ulcer (52), and duodenitis (28). The H. pylori eradication rate was significantly higher in Group 1 patients (104/112, 92.9%) than in patients of Group 2 (15/22, 68.2%). There was no difference in the eradication rate in relation to gender, endoscopic diagnosis, more advanced age, place of birth, or smoking habits. The compliance in both groups was equally good, and no major side effects were recorded.CONCLUSIONS: A 1‐week OCT triple therapy is well tolerated and effective as first line therapy for H. pylori among older people. It is less effective in patients previously treated. J Am Geriatr Soc 47:720–722, 1999.
Long‐Term Functional Outcome After Intensive Care
Authors: Roche Vivyenne M.L. , Kramer Andrew , Hester Eric , Welsh Carolyn H. 
Published: April 2015

OBJECTIVE: Although age‐related mortality after intensive care unit (ICU) admission has been studied, functional recovery for different age groups following ICU admission is not well characterized. We hypothesized that compared with younger age groups, fewer patients older than age 65 admitted to an ICU would regain their full prehospitalization functional ability and that their recovery would be slower than that of younger patients.DESIGN: A prospective observational cohort study with convenience sampling.SETTING: Intensive care units of an urban university‐affiliated Veterans Administration Medical Center.PARTICIPANTS: A total of 222 patients during the first 72 hours after entry to a medical or surgical ICU at the Denver Veteran's Administration Medical Center between September 1991 and July 1992.MEASUREMENTS: We collected baseline data on patient demographics and on the severity of acute illness using the Acute Physiology and Chronic Health Evaluation (APACHE II), Acute Physiology Score (APS), and functional status (highest level of physical activity level 1 month before admission). We recorded survival and patient‐perceived global functional status at 6 weeks and 6 months after admission. Post‐ICU function was adjusted for baseline function, age, APACHE II, and APS using multiple regression.RESULTS: Average patient age was 62 ± .74 years (mean ± SEM). Fifty‐two percent of the entire cohort returned to baseline function at 6 months. Although baseline function was better for younger people, there was no difference in recovery at 6 weeks in older compared with younger patients. Most functional recovery occurred by 6 weeks, with maintenance of this recovery at 6 months. Baseline function was the major determinant of both 6 week recovery (P < .001) and 6 month recovery (P < = .002), whereas APACHE II was not (P = .3). Age predicted recovery significantly (P = .04) at 6 months but not at 6 weeks (P = .26). APACHE II (P < .001) and baseline function (P = .03) predicted mortality.CONCLUSIONS: Older people had worse functional ability at ICU admission, but the proportion of older people who recovered and their rate of recovery was the same as for younger people. Baseline functional status, rather than abnormal physiologic status (as measured by APACHE II) on admission, was the major determinant of recovery, whereas APACHE II was the main correlate of mortality. Together, baseline function and physiologic status provide valuable complementary information for clinically relevant outcomes following an ICU admission.