bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics of Nonresponders in A Community Survey of the Elderly
Authors: Norton Maria C. , Breitner John C. S. , Welsh Kathleen A. , Wyse Bonita W. 
Published: April 2015

OBJECTIVE: To identify predictors of nonresponse in a community survey of cognitive status in the elderly.DESIGN: Cross‐sectional community survey with two stages of recruitment: an initial, less‐intensive method, followed by a more aggressive approach that included face‐to‐face contact. Characteristics of initial nonresponders and responders were compared.SETTING: A close‐knit rural community with higher than usual proportions of elderly, especially the very old. Subjects were interviewed in their homes. Collateral informants were subsequently interviewed by telephone.PARTICIPANTS: Utah heads of household aged 75 and older who resided in a noninstitutionalized setting.MEASUREMENTS: Mini‐Mental State Examination (MMSE), Dementia Questionnaire, and an autobiographical risk factor and family history questionnaire provided measures for all independent variables. The dependent variable was status as initial responders or initial nonresponders.RESULTS: An initial participation rate of 63% was achieved, but a final rate of 93% was achieved when initial nonresponders were contacted later face‐to‐face. MMSE score was significantly related to responder status when analyzed alone (p = ‐.19, P = 0.02) and remained a significant predictor after adjusting for education and whether born in Cache County (P = ‐.16, P = 0.041) or current drinking, diabetes, or “other” health problems (P = ‐.18, P = 0.028). After controlling for the informant report of subject's problems with activities of daily living, MMSE score fell just below statistical significance (P = ‐.16, P = 0.079).CONCLUSIONS: Nonresponders in community surveys of the elderly appear to be disproportionately cognitively impaired. The increase in participation rates achieved after more persistent recruitment suggests that many initial nonresponders can still be recruited if intensive methods are used.
Personality Disorder Correlates of Late and Early Onset Depression
Authors: Abrams Robert C. , Rosendahl Eileen , Card Cheryl , Alexopoulos George S. 
Published: April 2015

OBJECTIVE: To compare the lifetime personality dysfunction of geriatric patients having late and early onset of major depression.DESIGN: Group comparisons.SETTING: Inpatient geriatric psychiatry unit and hospital‐based geriatric psychiatry outpatient clinic.PATIENTS: Volunteer sample of recovered elderly depressives with history of early onset of major depression (age < 60) (n = 16) and history of late onset of major depression (age > 60) (n = 14).MAJOR OUTCOME MEASURE: Personality Disorder Examination, containing diagnostic and dimensional scores for DSM‐III‐R personality disorders.RESULTS: The two groups had similar demographic profiles and levels of depression after treatment. Early onset subjects had significantly higher mean dimensional scores in the avoidant, dependent, and not otherwise specified NOS personality disorders, and higher dimensional scores with a trend toward significance in 6 additional personality disorders.CONCLUSIONS: Early onset geriatric depressives may have more lifetime personality dysfunction than late onset subjects. Greater personality dysfunction in early onset subjects may reflect postdepressive changes, predisposition, or a low grade depressive subtype.
Silent Exertional Myocardial Ischemia in the Elderly: A Quantitative Analysis of Anginal Perceptual Threshold and the Influence of Autonomic Function
Authors: Ambepitiya Gamini , Roberts Mark , Ranjadayalan Kulasegaram , Tallis Raymond 
Published: April 2015

OBJECTIVE: To assess the perception of angina in the elderly and its relationship to autonomic function.DESIGN: Prospective cohort study of patients with exertional ischemia.SETTING: Medical, geriatric and cardiac outpatient clinics in two centers.PARTICIPANTS: All subjects had ischemic heart disease as evidenced by positive treadmill stress tests and, in some, diagnostic angiography and/or documented Q wave infarction. In the first study (I), 37 older patients (range 70–82 years) and 39 younger patients (range 42–59 years) were studied. In a subsequent study (II), a further 49 patients were divided into 2 groups: those with good perception of angina (Anginal Perception Threshold < 15 seconds, group A, 26 patients) and those with no angina despite ischemia (group B, 23 patients).MEASUREMENTS: Anginal perceptual threshold (APT), age, cardiovascular autonomic function, and blood pressure were measured. APT was defined as the time between onset of 1 mm ST depression to the onset of angina during treadmill stress testing. Autonomic function was studied using heart rate ratios before and after the valsalva maneuver, heart rate responses to deep breathing, and heart rate and blood pressure responses to standing.RESULTS: In study I, APT in the older patients was delayed by a median value of 49 seconds [79 (range 15–188) versus 30 (–99 to 97) seconds in the younger patients, P < 0.001]. There was no significant correlation between prolonged APT and autonomic dysfunction when younger and older groups were analyzed independently or together. When, however, the high APT subgroup (APT > 30 seconds) was analyzed separately, there was a significant correlation between APT prolongation and impaired valsalva response (r = −0.4; P < 0.005).In study II, 21 of 23 patients (91.3%) with positive exercise test but with no angina (group B) had at least one abnormal autonomic function test compared with 5 of 26 (19%) patients with good anginal perception (group A). Of note, group A was significantly younger than group B [60 (53–63) years vs 66 (62–70 years, P < 0.001].CONCLUSION: Elevation of APT in the elderly suggests that warning of critical myocardial ischemia is delayed. Autonomic dysfunction may be one of the underlying mechanisms.
Fall Frequency and Characteristics and the Risk of Hip Fractures
Authors: Cumming Robert G. , Klineberg Robin J. 
Published: April 2015

OBJECTIVES: The 2 objectives of this study were to investigate the association between history of falls and risk of hip fracture and to identify characteristics of falls that determine whether or not a hip fracture will occur.DESIGN: Population‐based case‐control study.SETTING: Subjects were selected from the community and from nursing homes in Sydney, Australia.PATIENTS: There were 412 subjects (205 cases, 207 controls) in the part of the study concerned with falls frequency and risk of hip fracture (age range 65–100 years). Differences between hip fracture‐related falls and other falls were studied in 209 cognitively intact subjects: 84 controls who had fallen at least once in the previous 3 years and 125 cases.MEASUREMENTS: Data were collected with an interviewer‐administered questionnaire.MAIN RESULTS: There was a strong relationship between reported number of falls in the past year and risk of hip fracture. This relationship was stronger among men than among women. There was only 1 statistically significant fall characteristic associated with risk of hip fracture; falling while turning was much more likely to lead to a hip fracture than falling when walking in one direction (age‐ and sex‐adjusted odds ratio: 7.9, 95% confidence interval: 1.4–43.0).CONCLUSIONS: (1) Taking a simple falls history is a useful way of identifying elderly people, particularly men, at increased risk of hip fracture; (2) The direction of a fall is an important determinant of hip fracture occurrence.
Longitudinal Study of Depression and Health Services Use Among Elderly Primary Care Patients
Authors: Callahan Christopher M. , Hui Siu L. , Nienaber Nancy A. , Musick Beverly S. , Tierney William M. 
Published: April 2015

OBJECTIVE: To describe the prevalence and 9‐month incidence of depressive symptoms among a cohort of elderly primary care patients and to determine whether different patterns of depression are associated with different patterns of health services use.DESIGN: Prospective study of depressive symptoms as measured by the Center for Epidemiologic Studies Depression (CES‐D) scale and identification of patients' outpatient health services use through an electronic medical record system.SETTING: An academic primary care group practice at an urban ambulatory care clinic.PATIENTS/PARTICIPANTS: 1711 patients aged 60 and older who completed the CES‐D at baseline and 9 months later; 935 of these patients also completed the CES‐D at 6 months.MEASUREMENT AND MAIN RESULTS: The prevalence of significant symptoms of depression (CES‐D ≥ 16) was 17.1% at baseline and 18.8% at 9 months; 26.8% of patients exceeded the threshold on the CES‐D either at baseline or 9 months, and the 9‐month incidence was 11.7%. Among the patients re‐interviewed at both 6 and 9 months, the 6‐month incidence was 12%, and the incidence between the 6‐ and 9‐month assessments was 10%. Of the 292 patients with depression at baseline, 140 (47.6%) remained depressed at the 9‐month follow‐up. Baseline and 6‐month CES‐D score, in addition to perceived health at 6 months, explained 45% of the variance in the 9‐month CES‐D score. Patients above the threshold on the CES‐D at any time were more likely to rate their health as fair or poor (69.8% vs 43.7%) and more likely to have an emergency room visit (40.4% vs 29.4%). These patients also had 38% more outpatient visits (7.7 vs 5.6) and 61% higher total outpatient charges ($1209 vs $751) than patients who never exceeded the CES‐D threshold over the 9‐month window (all P values < 0.01).CONCLUSIONS: Depressive symptoms were frequent and often persistent in this patient population. We identified patterns of oscillating severity of symptoms within individuals but relatively stable incidence and prevalence rates over a 9‐month period. Patients who exceeded the threshold on the CES‐D at any time during the study had significantly greater health services use and poorer perceived health.
Psychological Factors Associated with Chronic Dizziness in Patients Aged 60 and Older
Authors: Sloane Philip D. , Hartman Marilyn , Mitchell C. Madeline 
Published: April 2015

OBJECTIVE: To identify the prevalence and character of psychological disorders accompanying chronic dizziness in older patients.DESIGN: Case series of patients from a geriatric dizziness clinic, with comparison data from age‐ and sex‐matched healthy community controls. Both cases and controls received screening psychological testing; all cases were evaluated by a clinical psychologist as part of the dizziness clinic evaluation.SETTING: Multidisciplinary Geriatric Dizziness Clinic.PARTICIPANTS: Fifty six consecutive patients with chronic dizziness, evaluated by a multidisciplinary Geriatric Dizziness Clinic, and 68 healthy volunteers whose age and sex distribution matched that of the dizziness clinic patients.MEASUREMENTS: Standardized questionnaire for medical, functional, and demographic data; the anxiety, depression, somatization, and phobic anxiety subscales of the Symptom Checklist‐90 (SCL‐90‐R); the Tinetti gait and motor screen; a physical therapy evaluation; selected laboratory tests; evaluation by a geriatrician; and a formal evaluation by a clinical psychologist, including a semi‐structured interview. Psychological diagnoses were assigned based on DSM‐III‐R criteria.MAIN RESULTS: Of these patients with chronic dizziness, 37.5 percent had a psychological diagnosis causing or contributing to their dizziness problem. Of these, only 3 were felt to have a primary psychological cause of their dizziness, and 18 had secondary psychological diagnoses. Anxiety disorders, depression, and adjustment reactions were the most common diagnoses. On multivariate analysis, factors predicting a psychological diagnosis were a positive response to hyperventilation testing, a high score on the SCL‐90 anxiety subscale, and fatigue as a precipitant of dizziness. In addition, dizziness clinic patients scored significantly higher (P< 0.001) on all 4 subscales of the SCL‐90 when compared with the healthy elderly, suggesting a greater degree of psychological distress among these elderly with chronic dizziness.CONCLUSIONS: Psychological disorders are rare as primary causes but are common as contributing or modulating factors in older persons with dizziness.
Serum Vitamin B12 Levels and Incidence of Dementia in a Healthy Elderly Population: A Report from the Bronx Longitudinal Aging Study
Authors: Crystal Howard A. , Ortof Elizabeth , Frishman William H. , Gruber Amy , Hershman Dawn , Aronson Miriam 
Published: April 2015

OBJECTIVE: To determine whether low serum B12 levels are associated with an increased incidence of dementing illness.DESIGN: Longitudinal cohort study, 5‐year follow‐up.PARTICIPANTS: Volunteer cohort of 410 nondemented ambulatory subjects aged 75 to 85 years.MEASUREMENTS: Annual serum B12 determinations and neuropsychological assessments including the Blessed Test of Information, Memory and Concentration (BIMC) and the Fuld Object Memory Evaluation (FOME). If subject met criteria for a major cognitive change (as defined by an increase of 4 or more points on the BIMC), a work‐up that included CT, EEG, and neurologic assessment was performed. Clinical diagnoses were made according to established criteria.RESULTS: Mean serum B12 level of entire sample was 558 pg/mL. Twenty‐two subjects had low B12 levels defined as values <150 pg/mL. Three of these 22 subjects (13.6%) became demented, compared with 57 of 388 subjects (14.7%) with higher levels. The incidence of Alzheimer disease among the low B12 group was 4.5% compared with 7.5% in the higher B12 group. The mean B12 level at time of diagnosis in subjects who did develop Alzheimer disease was 551 pg/mL. There was no evidence of hematologic disorder among the 22 subjects with low B12. Of the 3 low B12 subjects who did become demented, none responded to monthly B12 injections.CONCLUSION: A low B12 level may not be a risk factor for dementia in general or Alzheimer disease in particular.
Muscle Strength and Fall Rates Among Residents of Japanese and American Nursing Homes: An International Cross‐Cultural Study
Authors: Lipsitz Lewis A. , Nakajima Ikumasa , Gagnon Margaret , Hirayama Takako , Connelly Carolyn M. , Izumo Hiroko , Hirayama Toshio 
Published: April 2015

OBJECTIVE: In Western society, aging is often associated with adoption of a sedentary lifestyle and associated disuse muscle atrophy and weakness. Recent studies suggest a relationship between quadriceps muscle weakness and falls in elderly residents of US nursing homes (NHs). We hypothesized that fall rates would be lower in Japanese NHs, where lifestyle differences such as squatting to toilet or sleeping on the floor may maintain quadriceps strength and result in fewer falls. Therefore, we examined the relationships between falls, muscle strength, lifestyle, and other clinical characteristics in residents of a Japanese and an American NH.DESIGN: Cross‐culture, prospective, cohort study.MEASUREMENTS: We evaluated disease histories and current medications, quadriceps strength, and mobility of ambulatory American (n = 76) and Japanese (n = 89) NH residents, then followed these residents prospectively for the development of falls. Project staff from both sites trained together to assure uniform data ascertainment.MAIN RESULTS: During a 6‐month follow‐up period, fall rates were nearly 4‐fold higher in the American than in the Japanese residents (49% vs 13%, respectively; P < 0.0001). In the American sample, fall rates declined with increasing muscle strength, while in Japan there was no relationship between fall rates and quadriceps strength. Residents also differed in number of medical diagnoses and use of medications, which were greater among American residents. The Japanese had slower gait speeds. Very few Japanese residents practiced squatting behaviors while living in the NH.CONCLUSIONS: The relationship between muscle weakness and falls is probably modified by multiple characteristics of the individual, their culture, and their environment. Information from cross‐cultural studies may provide new insights into effective fall prevention strategies for nursing home residents.
Prevalence of Associated Diseases in Different Types of Dementia Among Elderly Institutionalized Patients: Analysis of 3447 Records
Authors: Holstein Josiane , Chatellier Gilles , Piette François , Moulias Robert 
Published: April 2015

OBJECTIVE: To determine the prevalence of dementia in a population of hospitalized or institutionalized elderly patients, and that of associated diseases according to dementia type.DESIGN: Retrospective analysis of a database of diagnostic codes.SUBJECTS: All patients admitted to 1 of the 4 geriatric units participating in the study at the Charles Foix Hospital between 1980 and 1989.MEASUREMENTS: All diagnoses mentioned in the discharge summary that could cause or contribute to hospitalization were recorded for each patient. A final list of 54 different diagnoses could be recorded for each patient. Dementia was subdivided into 3 subtypes: Alzheimer dementia (DAT), vascular dementia (VD), and other types of dementia (unclassifiable dementia).MAIN RESULTS: The study involved 3447 patients aged 81.0 ± 8.3 years, of whom 27.7% were men. Dementia was the most frequent disease in this population (34.3%); Alzheimer disease was responsible for 15%, vascular dementia for 9.5%, and other types for 9.8%. The average number of associated diseases was 3.23 ± 2.10 in the Alzheimer dementia group, 4.73 ± 2.38 in the vascular dementia group, and 3.96 ± 2.26 in the nondemented group. Parkinson disease was present in 15.5% of patients with unclassifiable dementia, compared with 7.6% in the nondemented group (P < 0.001). There were significantly more diseases commonly seen in bedridden patients in the group of patients with both other types of dementia and Parkinson disease than in the group of other types of dementia patients without Parkinson disease (P < 0.01).CONCLUSION: Dementia was the most common disease observed in our elderly institutionalized population. Alzheimer patients had significantly fewer associated diseases than nondemented patients, whereas the reverse was found in the vascular dementia group. The co‐existence of Parkinson disease and dementia in our population was associated with the poorest health status, as these patients were more likely to present simultaneously such conditions as pressure sores, incontinence, dehydration, or iatrogenesis.
Is the Phenotypic Combination A1B8Cw7DR3 a Marker for Male Longevity?
Authors: Rea I. M. , Middleton D. 
Published: April 2015

OBJECTIVE: To study whether individual Human Leucocyte Antigens (HLA) at the HLA 1 or 11 loci or the phenotypic combination A1B8Cw7DR3 were associated with longevity.DESIGN: Direct comparison of the > 90‐year‐old subjects with a control group.SETTING: Northern Ireland population with little migratory mobility.SUBJECTS: The > 90‐year‐old group (79 females, 38 males) was compared with a control group consisting of 150 unrelated blood donors (81 females, 69 males).MEASUREMENTS: Human Leucocyte Antigen (HLA) Class 1 typing was carried out on 117 nonagenarians (mean age 93.7 years) and 150 younger controls (mean age 33.7 years) using conventional serological methods; HLA DR typing was carried out on 102 of the 117 > 90‐year‐old subjects, together with the 150 control subjects, and performed using restriction fragment length polymorphisms. The frequency of the phenotypic combination A1B8Cw7DR3 was measured in both groups.RESULTS: There were no significant differences in the HLA antigen frequencies between the very elderly groups and the younger subjects at the A, B, C, and DR loci. The phenotypic combination A1B8Cw7DR3 was significantly increased (×3) in nonagenarian men compared with young men but not between elderly women and young women. There was a trend for increased representation of this phenotype in elderly men compared with women of the same age.CONCLUSIONS: The frequency of the supratype A1B8Cw7DR3 was significantly increased in very elderly men but not in elderly women. Since this phenotypic combination has been associated with immune surveillance and/or hyperactivity in Caucasians, there is the suggestion that it could influence longevity through immune mechanisms but that sex differences may exist in its influence and expression.
Physical Activity and Related Factors Among Nursing Home Residents
Authors: Ruuskanen J. M. , Parkatti T. 
Published: April 2015

OBJECTIVE: The purpose of this study was to examine physical activity and the predictors of physical activity and exercise among nursing home residents.DESIGN: Population study.PARTICIPANTS: The sample (n = 190) was obtained by selecting every man and every second women from the entire nursing home population (n = 346) in the city of Jyväskylä, central Finland, in autumn 1989. Information was eventually collected by interview from 158 persons (49 men and 109 women).SETTING: An in‐home interview carried out among nursing home populations.MEASUREMENTS: Independent variables were the questions describing physical activity among nursing home populations. Dependent variables were the predictors of physical activity: depression, contentment with nursing home living, activities outside the nursing home, and self‐rated functioning.MAIN RESULTS: Walking and home gymnastics were the most common forms of physical exercise. The intensity of overall exercise was rather low, and the men carried out physical exercise more intensively than the women. More than 30% of the respondents reported decreased physical activity during their stay in the nursing home. However, attitudes toward physical exercise among the residents were largely positive. The primary factor limiting physical exercise was poor health status. Among the men, physical exercise was significantly associated with self‐rated functioning, depressive symptoms, and contentment with life in the nursing home. Among the women, higher contentment with the nursing home and less depression were associated with a physically active life.CONCLUSIONS: The results suggest that living conditions and factors related to health and functional capacity affect the level of physical activity among nursing home residents. In order to encourage this population to be physically active, attention should be paid not only to physical exercise but also to associated factors, such as satisfaction with everyday life and health.
Voluntary Active Euthanasia and Physician‐Assisted Suicide in Dutch Nursing Homes: Requests and Administration
Authors: Van der Wal G. , Muller M. T. , Christ L. M. , Ribbe M. W. , van Eijk J. Th. M. 
Published: April 2015

Objective: To learn how many requests for voluntary active euthanasia and/or physician‐assisted suicide (EAS) are made to Dutch nursing home physicians (NHPs) and how often these requests are honored.Design: Retrospective survey.Setting: The Netherlands.Participants: All Dutch NHPs affiliated with the Dutch Association of Nursing Home Physicians (n = 713).Measurements: An anonymous postal questionnaire was sent to all Dutch NHPs affiliated with the Dutch Association of Nursing Home Physicians (n = 713). Respondents were asked how often they had received an explicit request for EAS and whether they had complied with that request. Those who had complied were asked questions about the last occasion on which they had administered either voluntary active euthanasia or physician‐assisted suicide.Results: The response rate was 86% (n = 582). Of the respondents, 88% had never administered EAS in nursing homes. The remaining 12% (n = 69) had received 164 requests for voluntary active euthanasia and 53 requests for physician‐assisted suicide in the period 1986 through mid‐1990. Of these requests, 74 were granted (51 voluntary active euthanasia and 23 physician‐assisted suicide). Dutch NHPs together receive an average of 300 requests for EAS a year. They comply with 25 of such requests annually.Conclusion: Not many requests for EAS are made in Dutch nursing homes. Of these requests, fewer than 1 in 10 result in the actual administration of EAS. The data presented are relatively constant for the 4.5‐year period studied.