bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Advance Care Planning in Nursing Homes Before and After the Patient Self‐Determination Act: Report of a 10‐State Survey
Authors: Teno Joan M , Branco Kenneth J. , Mor Vincent , Phillips Charles D. , Hawes Catherine , Morris John , Fries Brant E. 
Published: April 2015

OBJECTIVE: The Patient Self‐Determination Act (PSDA) implemented in 1991 has focused national attention on the right of patients to be involved in decision‐making and on the use of written advance directives. We report changes in advance care planning with the PSDA and other historical events in nursing homes in 10 states.DESIGN: Pre‐ and Post‐observational cohort studyPATIENTS: Nursing home residents, residing in 270 long‐term care facilities in 10 states, stratified to ensure representation of urban and rural facilities in each state. In 1990, 2175 patients were sampled, and 2088 different patients from the same facilities were sampled in 1993. Six‐month follow‐up was obtained at both time periods.MAIN OUTCOME MEASURES: Advance care planning was defined as the documentation in the medical record of a living will, a durable power of attorney, a “Do Not Resuscitate” (DNR) order, a “Do Not Hospitalize” (DNH) order, or an order to forgo artificial nutrition or hospitalization.RESULTS: The rate of chart documentation of living wills increased from 4.2% in 1990 to 13.3% in 1993, and DNR orders increased dramatically from 31.1% to 51.5%. The rates of DNH and orders to forgo artificial hydration and nutrition remained less than 8% in both years. We found striking variations in advance care planing among the 10 states. In 1990, having a DNR order varied from 10.1% to 69.2% across the 10 states. With the exception of Oregon, where 69.2% of patients already had a DNR order, the states saw a 1.5 to 3.1 times increase in the rate of DNR orders in 1993 compared with 1990.CONCLUSION: With the implementation of the PSDA, there was modest increase in documentation of living wills, but DNH and orders to forgo artificial hydration and nutrition remained the same. There was a substantial increase in DNR orders that began before the PSDA implementation. This increase was associated both with the implementation of the PSDA and the increased debate about the appropriateness of CPR for nursing home residents. This increase varied considerably among geographic areas from the 10 states. Future research is needed to understand this geographic variation.
CONGESTIVE HEART FAILURE IN OLDER ADULTS*: Epidemiology, Pathophysiology, and Etiology of Congestive Heart Failure in Older Adults
Authors: Rich Michael W. 
Published: April 2015

OBJECTIVES: To review the epidemiology, pathophysiology, and etiology of congestive heart failure (CHF) in older adults.METHODS: Published reports relevant to the epidemiology, pathophysiology, and etiology of CHF were systematically reviewed. Studies involving older adults and more recent studies were emphasized.RESULTS: More than 75% of patients with CHF in the United States are older than 65 years of age, and CHF is the leading cause of hospitalization in older adults. CHF is also a major cause of chronic disability, and annual expenditures for CHF currently exceed $10 billion. In addition, both the incidence and prevalence of CHF are increasing, largely as a result of the aging of the population.Older adults are predisposed to developing CHF as a result of age‐related changes in the cardiovascular system and the high prevalence of hypertension, coronary artery disease, and valvular heart disease in this age group. Although the fundamental pathophysiology of CHF is similar in younger and older patients, older individuals are more prone to develop CHF in the setting of preserved left ventricular systolic function. This syndrome, referred to as diastolic heart failure, accounts for up to 50% of all cases of CHF in adults more than 65 years of age.Coronary heart disease and hypertension are the most common etiologies of CHF in older adults, and they often coexist. Valvular heart disease, especially aortic stenosis and mitral regurgitation, are also common in older adults, whereas nonischemic dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy occur less frequently.CONCLUSIONS: Congestive heart failure is a major public health problem in the United States today as a result of its high and increasing prevalence in the older population as well as its substantial impact on healthcare costs and quality of life. There is an urgent need to develop more effective strategies for the prevention and treatment of CHF in older individuals.
The Sequelae of Hospitalization for Congestive Heart Failure Among Older Adults
Authors: Wolinsky Fredric D. , Smith David M. , Stump Timothy E. , Overhage J. Marc , Lubitz Robert M. 
Published: April 2015

OBJECTIVES: To estimate the independent effect of hospitalization for congestive heart failure (CHF) on subsequent mortality, readmission for CHF, hospitalization for any reason, and change in functional status.DESIGN: Secondary analysis of the nationally representative Longitudinal Study on Aging. Baseline (1984) interview data are linked to Medicare hospitalization and death records for 1984–1991 and to functional status reports at three biennial follow‐ups.SETTING: In‐home and telephone interviews.PARTICIPANTS: a total of 7527 noninstitutionalized older adults aged 70 years or older at baseline.MEASUREMENTS: Hospitalization for CHF was defined as having one or more episodes with primary or secondary discharge ICD9‐CM codes of 428. Multivariable proportional hazards, logistic and linear regression, as well as multiple classification analysis, were used to estimate the independent effects of having been hospitalized for CHF.RESULTS: The adjusted risk ratios for having a primary or secondary hospital discharge diagnosis of CHF on mortality (compared with not having any CHF hospital discharge diagnoses) were 1.58 (CI95% = 1.40 to 1.78) and 1.29 (CI95% = 1.15 to 1.45), respectively (P < .001). CHF readmission and rehospitalization rates were substantial, ranging from 16.0 to 47.5% at 1 year, depending on the criteria employed. The adjusted odds ratios for having any subsequent hospitalizations associated with having a primary or secondary hospital discharge diagnosis of CHF (compared with not having any CHF hospital discharge diagnoses) were 7.70 (CI95% = 6.20 to 9.57) and 2.99 (CI95% = 2.51 to 3.56), respectively (P < .001). The percent increases in the number of hospital episodes, total charges, and total length of stay attributable to having been hospitalized for CHF were significant (P < .001) and ranged from 15.5 to 66.7%. Having been hospitalized for CHF was also related significantly to greater increases in the mean number of functional limitations at follow‐up.CONCLUSION: Hospitalization for CHF among older adults increases substantially the risk of subsequent mortality, readmission for CHF, rehospitalization for any reason, and greater functional decline. Therefore, greater attention to the prevention and management of CHF is needed.
Increased Coronary Heart Disease Mortality After the Hanshin‐Awaji Earthquake Among the Older Community on Awaji Island
Authors: Kario Kazuomi , Ohashi Takaharu 
Published: April 2015

OBJECTIVES: To investigate the characteristics of earthquake (EQ)‐induced coronary heart disease (CHD) deaths.SETTING AND PARTICIPANTS: On January 17, 1995, the south part of Hyogo Prefecture in Japan was struck by a major EQ (Hanshin‐Awaji EQ) measuring 7.2 on the Richter scale. We investigated the characteristics of EQ‐induced CHD deaths (myocardial infarction and sudden death) in the Tsuna region, which is a community with a large older population (31% of the total of 64,000 residents are 60 years of age or older) and includes the epicenter and one of the most heavily damaged areas.MEASUREMENTS: EQ‐related CHD mortality on the basis of direct access to records of physicians who were able to continue services for the EQ victims without interruption by this disaster situation.RESULTS: Coronary heart disease deaths increased for a few months after the EQ, and the total number from January 17 to April 30,1995, was 45, which was significantly (1.5 times) higher than the 31 deaths during the same period of the previous year (1994). The CHD deaths after the EQ all occurred in individuals more than 60 years of age and had a positive correlation with EQ‐induced damages. Concerning the onset time, CHD deaths occurred 1.8 times more often (P < .05) in the nighttime (11 PM to 5 AM) and 1.4 times as often during the morning (5 AM to 11 AM), whereas their occurrence did not vary during a 12‐hour period from 11 AM to 11 PM.CONCLUSION: Deaths of older individuals from CHD persisted for a few months after the EQ and were especially prominent during the nighttime and morning. Reduction of stress and related coronary risk factors in this period may suppress CHD deaths after a major EQ.
Geropsychiatric Restraint Use
Authors: DeSantis Joe , Engberg Sandra , Rogers Joan 
Published: April 2015

OBJECTIVES: To investigate predictors and reasons for restraint use with geropsychiatric patients.DESIGN: A prospective, correlational study.SETTING: The geriatric unit of an acute‐care psychiatric hospital.PARTICIPANTS: Twenty‐one staff nurses and 131 patients admitted consecutively over a period of 6 months.MEASUREMENTS: Disruptive behaviors were measured with the Nursing Home Behavior Problem Scale (NHBPS), cognitive function was measured with the Mini‐Mental State Examination (MMSE), mobility was measured with a Functional Mobility Screen (FMS), and reasons for restraint use were obtained with a questionnaire completed by nurses.RESULTS: Patients with a diagnosis of dementia, impaired mobility, or behavioral problems were more likely to be restrained. The most frequent reasons given by staff for restraint use were an unsteady gait and a risk of falling. The incidence of restraint use was 27.1%.CONCLUSION: The use of restraint with geropsychiatric patients may be more common than previously reported and requires further investigation. J Am Geriatr Soc 45:1515–1518, 1997.
Pain in the Oldest‐Old During Hospitalization and Up to One Year Later
Authors: Desbiens Norman A. , Mueller‐Rizner Nancy , Connors Alfred F. , Hamel Mary Beth , Wenger Neil S. 
Published: April 2015

OBJECTIVE: To evaluate the pain experience of very old hospitalized patients during and up to 1 year after hospitalization. To understand the relationship of level of pain to demographic, psychological, and illness‐related variables.DESIGN: Prospective cohort study.SETTING: Four teaching hospitals.PARTICIPANTS: 1266 patients at least 80 years of age in the Hospitalized Elderly Longitudinal Project (HELP).MEASUREMENTS: Pain interviews during hospitalization and 2 and 6 months later. Ordinal logistic regression was used to study the association of variables with level of pain.RESULTS: Interviews about symptoms were available for 806 (64.6% of survivors) patients during hospitalization, 614 (57.9% of survivors) at 2‐months, and 416 (48.0% of survivors) at 12 months; of these, 45.8, 49.8 and 53.6%, respectively, reported pain, and 12.9% of those with pain during hospitalization were dissatisfied with its control.Multivariable analysis revealed that study hospital, admission diagnosis, depressed mood, alertness, and level of activity 2 weeks before admission were associated with pain during hospitalization, and pain reported during hospitalization, study site, patient level of activity 2 weeks before hospital admission, and patient education were associated with pain 2 months later.CONCLUSIONS: Frequency of pain among very old hospitalized patients and at follow‐up is similar to that reported for other hospitalized patients. Further studies of strategies to better control pain during and after hospitalization in very old patients are needed. These studies will have to adjust for other variables associated with pain in the oldest‐old.
Urinary and Fecal Incontinence in a Community‐Residing Older Population in Japan
Authors: Nakanishi Noriyuki , Tatara Kozo , Naramura Hiromi , Fujiwara Hitoshi , Takashima Yoshihiro , Fukuda Hideki 
Published: April 2015

OBJECTIVE: To estimate the prevalence and risk factors of urinary and fecal incontinence among a community‐residing older population in Japan.DESIGN: Population‐based cross‐sectional study.SUBJECTS: A randomly selected sample of 1473 people aged 65 years and older living in the City of Settsu, Osaka, in 1992.MEASURES: Data collected via in‐home visits were used to estimate the prevalence of urinary and fecal incontinence and to provide information regarding potential risk factors of urinary and fecal incontinence.RESULTS: Data were obtained from 1405 older adults, a response rate of 95.4%. The prevalence of any degree of urinary incontinence was 98/1000 in both sexes, and 87/1000 men and 66/1000 women admitted to some degree of fecal incontinence. Daily, 34/1000 and 20/1000 of the population were incontinent of urine and feces, respectively.There was an increasing prevalence of urinary and fecal incontinence with age in both sexes, but the expected greater prevalence in women was not found.By univariate analyses, age older than 75 years, poor general health as measured by Activities of Daily Living, stroke, dementia, no participation in social activities, and lack of life worth living (Ikigai) were associated significantly with both urinary and fecal incontinence. In the multivariate analyses using logistic regression, age older than 75 years, poor general health, and stroke were independent risk factors for any type of incontinence. Diabetes was an independent risk factor for isolated fecal incontinence, and dementia and no participation in social activities were independent risk factors for double incontinence.CONCLUSIONS: Incontinence of urine and feces is a prevalent condition among very old people living in the community in Japan and is associated highly with health and psychosocial conditions.
Program of All‐inclusive Care for the Elderly (PACE): An Innovative Model of Integrated Geriatric Care and Financing
Authors: Eng Catherine , Pedulla James , Eleazer G. Paul , McCann Robert , Fox Norris 
Published: April 2015

OBJECTIVES: The Program of All‐inclusive Care for the Elderly (PACE) is a long‐term care delivery and financing innovation. A major goal of PACE is prevention of unnecessary use of hospital and nursing home care.SETTING: PACE serves enrollees in day centers and clinics, their homes, hospitals and nursing homes. Beginning at On Lok in San Francisco, the PACE model has been successfully replicated across the country. In 1995, PACE was fully operational in 11 cities in nine states.PARTICIPANTS: To enroll in PACE, a person must be 55 years of age or older, be certified by the state as eligible for care in a nursing home and live in the program's defined geographical catchment area. PACE participants are ethnically diverse. In 1995, the average PACE enrollee was 80.0 years old and had an average of 7.8 medical conditions and 2.7 dependencies in Activities of Daily Living. A significant number have bladder incontinence (55%). Many enrollees (39%) live alone in the community, and 14% have no means of informal support.INTERVENTION: Medicare and Medicaid waivers allow delivery of services beyond the usual Medicare and Medicaid benefits. The PACE service delivery system is comprehensive, uses an interdisciplinary team for care management, and integrates primary and specialty medical care. PACE receives monthly capitation payments from Medicare and Medicaid. Patients ineligible for Medicaid pay privately.RESULTS: Outcomes of PACE programs have been positive. There has been steady census growth, good consumer satisfaction, reduction in use of institutional care, controlled utilization of medical services, and cost savings to public and private payers of care, including Medicare and Medicaid.CONCLUSION: The growing number of older people in the United States challenges healthcare providers and policy makers alike to provide high quality care in an environment of shrinking resources. The PACE model's comprehensiveness of health and social services, its cost‐effective coordinated system of care delivery, and its method of integrated financing have wide applicability and appeal.
Elevated Fasting Plasma Insulin in a General Aged Population: An Innocent Companion of Cardiovascular Diseases
Authors: Lindberg Otto , Tilvis Reijo S. , Strandberg Timo E. , Valvanne Jaakko , Sairanen Sirpa , Ehnholm Christian , Tuomilehto Jaakko 
Published: April 2015

OBJECTIVE: Although high insulin levels have been linked to cardiovascular disease, the role of insulin as an independent risk factor has been questioned. Our objective was to examine the association of fasting plasma insulin with cardiovascular disease as well as to investigate the prognostic value of insulin with respect to survival.DESIGN: A 5‐year follow‐up of random samples from four birth cohorts aged 65 (n = 660), 75 (n = 194), 80 (n = 179), and 85 (n = 162) years at baseline.SETTING: Two urban communities in southern Finland.MEASUREMENTS: Clinical and laboratory investigation at base line with collection of date and cause of death information during follow‐up.RESULTS: Subjects with cardiovascular disease generally had higher levels of fasting plasma insulin than did subjects without cardiovascular disease (13.9 mU/L vs 11.2 mU/L, P < .001). Heart failure and hypertension were associated with significant 30 to 80% elevations of insulin levels in all but the oldest group. In the 65‐year‐old group, all vascular diseases were associated with significantly elevated insulin. The associations were generally not explained by body mass index or by use of diuretics or beta‐blockers. During the follow‐up, insulin was generally not associated with an impaired survival. On the contrary, in subjects with manifest cardiovascular disease, high insulin was associated with a rather favorable 5‐year survival prognosis. Exclusion of subjects who died during the first 500 days of follow‐up did not change these associations.CONCLUSION: Albeit fasting plasma insulin appeared to be secondarily associated with cardiovascular disease in this general aged population, it was related to a fair or favorable survival prognosis.
Association of Postprandial Hypotension With Incidence of Falls, Syncope, Coronary Events, Stroke, and Total Mortality at 29‐Month Follow‐Up in 499 Older Nursing Home Residents
Authors: Aronow Wilbert S. , Ahn Chul 
Published: April 2015

OBJECTIVE: To investigate whether a marked decrease in postprandial systolic blood pressure correlates with a higher incidence of falls, syncope, new coronary events, new stroke, and total mortality at long‐term follow‐up in older nursing home residents.DESIGN: In a prospective study of 499 nursing home residents aged 62 years or older, at 29‐month mean follow‐up, the maximal reduction in postprandial systolic blood pressure was correlated with the incidence of falls, syncope, new coronary events, new stroke, and total mortality.SETTING: A large long‐term health care facility. PATIENTS: The 499 ambulatory or wheelchair‐bound residents included 354 women and 145 men, mean age 80 ± 9 years (range 62–100).MEASUREMENTS AND MAIN RESULTS: The mean follow‐up was 29 ± 10 months (range 1–36). At follow‐up, falls had occurred in 199 persons (40%), syncope in 72 persons (14%), new coronary events in 139 persons (28%), new stroke in 61 persons (12%), and total mortality in 199 persons (40%). The mean maximal decrease in postprandial systolic blood pressure was 20 ± 5 mm Hg for persons with falls and 12 ± 4 mm Hg in persons without falls (P < 0.001); 23 ± 5 mm Hg in persons with syncope and 14 ± 5 mm Hg in persons without syncope (P < 0.001); 18 ± 6 mm Hg in persons with coronary events and 14 ± 5 mm Hg in persons without coronary events (P < 0.001); 21 ± 6 mm Hg in persons with stroke and 15 ± 5 mm Hg in persons without stroke (P < 0.001); and 17 ± 6 mm Hg in persons who died and 15 ± 5 mm Hg in persons who did not die (P < 0.001). Maximal decrease in postprandial systolic blood pressure was an independent risk factor for falls, syncope, new coronary events, new stroke, and total mortality. Age was an independent risk factor for new coronary events and for total mortality. Male sex was an independent risk factor for syncope, new coronary events, stroke, and total mortality. Prior falls was an independent risk factor for new falls. Prior syncope was an independent risk factor for new syncope. Prior stroke was an independent risk factor for new stroke.CONCLUSIONS: A marked reduction in postprandial systolic blood pressure in older nursing home residents was associated at long‐term follow‐up with a higher incidence of falls, syncope, new coronary events, new stroke, and total mortality.
A Survey of Grief and Bereavement in Nursing Homes: The Importance of Hospice Grief and Bereavement for the End‐Stage Alzheimer's Disease Patient and Family
Authors: Murphy Kathleen , Hanrahan Patricia , Luchins Daniel 
Published: April 2015

OBJECTIVES: To determine the prevalence of grief and bereavement services in nursing homes. To highlight the importance of grief and bereavement as provided in the Medicare hospice benefit for the end‐stage Alzheimer's Disease (AD) patient and family residing in long‐term care facilities.DESIGN: Telephone survey of nursing homes.PARTICIPANTS: One hundred twenty‐one nursing homes in the Lower Peninsula of the state of Michigan.MEASUREMENTS: The facilities were asked questions about on‐site grief and bereavement services, services routinely offered by licensed hospice agencies. RESULTS: Fifty‐five percent of the homes sent sympathy cards after the patients death. Ninety‐nine percent of the facilities surveyed did not provide materials to the family or primary caregiver on the grieving process or bereavement after the death. None of the facilities sent a letter after the patients death informing them of local, community or on‐site bereavement support group meetings. Seventy‐six percent of the homes were not able to offer a referral to a counseling or psychiatric professional when bereavement intervention was deemed appropriate. Fifty‐four percent of the homes usually went to the funeral home or the funeral of a patient who died at their facility. Ninety‐eight percent of the nursing homes neither visited, made phone calls, nor provided written communication (i.e., bereavement newsletter) to the family members after the patients death.CONCLUSION: The study demonstrated few grief and bereavement services for families of patients residing in long‐ term care facilities. Because grief and bereavement is part of the career of most Alzheimer's caregivers, access to the Medicare hospice benefit should be encouraged for families of patients with end‐stage Alzheimer's Disease residing in nursing facilities. J Am Geriatr Soc 45:1104–1107, 1997.