bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mobility After Hip Fracture Predicts Health Outcomes
Authors: Fox Kathleen M. , Hawkes William G. , Hebel J. Richard , Felsenthal Gerald , Clark Meredith , Zimmerman Sheryl Itkin , Kenzora John E. , Magaziner Jay 
Published: April 2015

OBJECTIVES: Balance and gait are essential to physical functioning and the performance of activities of daily living. The objective of this study was to determine the predictive value of a balance and gait test on subsequent mortality, morbidity, and healthcare utilization among older hip fracture patients.DESIGN: A prospective study of hip fracture recovery.SETTING: Patients with a new hip fracture admitted from the community to one of eight Baltimore hospitals and followed in their homes for 2 years postfracture.PARTICIPANTS: A total of 306 patients with hip fracture, 65 years of age and older, who completed a gait and balance assessment at 2 months postfracture.MEASUREMENTS: The relationship between gait and balance test performance at 2 months postfracture and mortality, physician visits, rehospitalizations, nursing home placement, and falls up to 24 months postfracture was assessed by Cox proportional hazards and least squares regression.RESULTS: After adjusting for age, sex, race, and comorbidity, the balance score and the summary mobility score predicted mortality. A 17% increase in the risk of mortality was demonstrated for each unit decrease in the balance score (range 0–17), and a 10% increase was demonstrated for each decrease in the summary score (range 0–26). Unsteady balance during immediate standing, turning, sitting down, and rising from a chair were associated significantly with increased mortality. Poor balance, but not poor gait, was associated with an increase in hospitalizations up to 24 months postfracture. Both poor balance and poor gait were associated with nursing home placement, with 20% and 17% increased odds, respectively. Mobility did not predict future physician visits or falls.CONCLUSIONS: These findings demonstrate that balance and gait are predictive of future health outcomes for older hip fracture patients.
The Nighttime Environment and Incontinence Care Practices in Nursing Homes
Authors: Cruise Patrice A. , Schnelle John F. , Alessi Cathy A. , Simmons Sandra F. , Ouslander Joseph G. 
Published: April 2015

OBJECTIVES: To determine the variability in noise, light, and incontinence care practices between nursing homes (NHs) and the association between these factors and residents' nighttime sleep.DESIGN: Prospective descriptive study of a sample of incontinent NH residents.SETTING: Ten nursing homes.SUBJECTS: Two hundred twenty‐five incontinent NH residents.MAIN OUTCOME MEASURES: Measurements of residents' sleep by wrist actigraphs, bed mobility by pressure sensitive Kynar strips, and environmental noise and light changes were recorded by bedside monitors in consecutive 2‐minute intervals for two 10‐hour nighttime data collection periods (7 PM to 5 AM).RESULTS: Forty‐two percent of waking episodes lasting 4 minutes or longer were associated with noise, light, or incontinence care events. Twenty‐two percent of waking episodes of 4 minutes or longer were associated with noise alone, 10% with light or light + noise, and 10% with incontinence care routines. Seventy‐six percent of all incontinence care practices resulted in awakenings. There was variability between the 10 NHs, with the percentage of waking episodes associated with environmental events (noise, light, or incontinence care events) ranging from 23.6 to 66.0%.CONCLUSION: Noise and incidents of incontinence care practices were associated with a substantial amount of sleep disruption in residents in all 10 nursing homes, even though there was variability between homes. Interventions minimizing such environmental events are needed to promote better sleep in incontinent NH residents.
MODELS OF GERIATRICS PRACTICE: When the Patient Cannot Come to the Doctor: A Medical Housecalls Program
Authors: Reuben David B. , Fried Terri R. , Wachtel Tom J. , Tinetti Mary E. 
Published: April 2015

OBJECTIVES: To describe a medical housecalls program and to assess its ability to meet the medical needs of homebound patients.PROGRAM STRUCTURE: The housecalls program is part of a larger ambulatory practice situated in a senior center staffed by geriatricians and nurse practitioners. The practice serves as the major teaching site of outpatient geriatrics for a medical residency program. Scheduled visits are made every 3 to 4 months, and unscheduled visits are made weekday days for acute problems.PARTICIPANTS: Patients are eligible for the housecalls program if they live within a 15‐ minute drive of the center and are unable to leave their home.PROGRAM EVALUATION: The majority of the 71 patients in the housecalls program between 1993 and 1995 were female (81%), aged 85 years or older (52%), and dependent in one or more activities of daily living: 65% were dependent in bathing and 42% in dressing. A substantial minority (16%) had severe cognitive impairment. Patients received a mean of 5.0 visits per patient‐year. The majority of patients (59%) were treated at home for an acute illness or symptom ranging from upper respiratory tract infections to pneumonia and congestive heart failure. Approximately one‐quarter of the patients or their proxies elected to avoid hospitalization; several of these patients had complex illnesses managed in their homes.CONCLUSIONS: A wide range of medical problems can be addressed in patients' homes. Because our patients could not leave their homes easily, or at all, it is probable they would not have received routine medical care and would have used the emergency room for evaluation of acute problems if the housecalls program were not available. Despite their potential value in the care of frail older patients, housecalls will likely not become a widespread practice until barriers to their performance cited by physicians are addressed.
Lack of an Association Between Insulin‐like Growth Factor‐I and Body Composition, Muscle Strength, Physical Performance or Self‐Reported Mobility Among Older Persons with Functional Limitations
Authors: Kiel Douglas P. , Puhl Jacqueline , Rosen Clifford J. , Berg Katherine , Murphy John B. , MacLean David B. 
Published: April 2015

OBJECTIVE: The hypothesis that decreased growth hormone (GH) secretion contributes to the functional decline that occurs with aging is far from substantiated. There have been few studies addressing the distribution and correlates of IGF‐I, an indicator of GH activity, in nonclinical populations. As part of a growth hormone intervention trial, we examined the cross‐sectional relations between IGF‐I levels and multiple measures of physical function, body composition, and strength in a group of older men and women exhibiting mild to moderate reductions in measured physical performance.METHODS: Using a variety of advertising techniques, 155 older subjects were recruited from a metropolitan area to participate in a growth hormone and exercise intervention study. At baseline, all subjects had blood drawn for IGF‐I and underwent testing of body composition using dual X‐ray absorptiometry, muscle strength using isokinetic dynamometry, and functional assessment using timed performance measures and self‐report. Associations between levels of IGF‐I, body composition, strength, and physical function were assessed after dividing men and women separately into tertiles of IGF‐I as well as treating IGF‐I as a continuous variable.RESULTS: Men had higher IGF‐I levels than women, and a significant inverse correlation was observed between age and IGF‐I in men (r = −0.29, P =.009). There were no clear trends for associations between tertiles of IGF‐I, and any of the variables tested. Linear regression models with IGF‐I treated as a continuous measure were not associated significantly with any of the measures of physical function, body composition, or strength (all P > 0.05).CONCLUSIONS: In conclusion, although IGF‐I levels declined with age in men, these data did not demonstrate an association between IGF‐I and measures of muscle strength, body composition, or physical functioning. These findings support the growing body of evidence that IGF‐I levels may not be an indicator of growth hormone activity in older persons.
Nontreatment and Aggressive Narcotic Therapy Among Hospitalized Pancreatic Cancer Patients
Authors: Brown Norman K. , Thompson Donovan J. , Prentice Ross L. 
Published: April 2015

OBJECTIVES: Strong feelings about patient autonomy as expressed in living wills, polls, and legislative referenda have been challenging the medical establishment to increase nontreatment, defined as foregoing a life‐prolonging treatment, and even to provide treatments having life‐shortening potential to selected patients. Because there are little data about the actual practice of these procedures, including aggressive narcotic therapy as defined herein, we studied the terminal management of 417 pancreatic cancer patients.DESIGN AND PARTICIPANTS: The medical records of 417 residents of King County, Washington, who died of pancreatic cancer in the time periods 1959–1962, 1969–1972, and 1985–1990, were reviewed to study the frequency of, and risk factors for, end‐of‐life nontreatment decisions and aggressive narcotic therapy decisions, defined here as the decision to administer treatment doses of narcotics or major sedatives to already comatose patients within 4 hours of death.RESULTS: Antibiotics were not provided to 71% of the 70 febrile patients (two readings > 38.33–38.83°C or one reading of 38.88°C), intravenous fluid was not provided to 43% of 294 dehydrated patients (oral intake < 500 mL/24 hours), transfusions were not provided to 39% of 57 severely anemic patients (hematocrit < 20%), and laparotomy was not performed for 86% of 36 patients with abdominal emergencies (obstruction, bleeding, dehiscence). Also, 46% of the 118 patients who were comatose for at least 24 hours before death received aggressive narcotic therapy, as defined above. A total of 335 of the 417 patients had documentation of at least one of the above life‐threatening conditions or were comatose for at least 24 hours before death, and 289 (86%) of these patients experienced nontreatment of one or more of these conditions or received aggressive narcotic therapy. Nontreatment decisions for febrile, dehydrated, or anemic patients tended to be more frequent if the patient was comatose (P =.004,.010, and.065, respectively), if there was a nontreatment statement in the medical record (P =.009,.035, and.001, respectively), or if the patient was described as terminal (P =.262,.029, and.002, respectively). Aggressive narcotic therapy in comatose patients was more common among patients who had regular visitors (P =.002), who had pre‐coma pain (P =.006), who had nontreatment statements in their charts (P =.031), whose in‐charge physician was an oncologist (P <.001), who were treated in a community nonprofit hospital compared with a Catholic hospital (P =.007), or who were treated in recent years (P =.011).CONCLUSION: Both nontreatment and aggressive narcotic therapy forms of medical management have been occurring commonly in terminal pancreatic cancer patients in King County, Washington, during the past 3 decades, the latter with greater frequency in recent years.
Assessing Life Expectancies of Older Nursing Home Residents
Authors: Breuer Brenda , Wallenstein Sylvan , Feinberg Ghana , Camargo Maria‐Jose F. , Libow Leslie S 
Published: April 2015

OBJECTIVE: Care of nursing home (NH) residents is often based on the usual survival of the home's residents. In order to improve our understanding of this population, and, thus, ultimately facilitate individualization of their care, we developed a mathematical model that predicts their survival.SETTING: The Jewish Home and Hospital (JHH), a nursing home.PARTICIPANTS: 1145 older residents who were at the JHH from January 1, 1986, through July 1, 1986.MEASUREMENTS: Information abstracted from medical records and JHH computerized data: clinical, demographic, and dependencies in activities of daily living (ADLs). Main outcome measure: survival from July 1, 1986.DESIGN: Retrospective cohort study via medical chart review. The study period covered admission to JHH through January 17, 1996. Accelerated failure time (AFT) models generated the life expectancy model derived from 50% of the study group and were validated on the remaining sample. We computed predicted AFT and proportional hazards (PH) life expectancies.RESULTS: Significant, independent predictors of decreased survival were male gender, increased age, increase in summary ADL index, and impairment of cardiac, respiratory, neurological, and endocrine/metabolic systems. The interaction between gender and respiratory system impairment was significant. The Spearman correlation coefficients between the observed survivals and those predicted by the Phase I model are 0.49 for Phase I residents and 0.42 for Phase II residents. Our sample life table includes NH residents with different risk profiles and their associated survival estimates as well as interquartile ranges. AFT and PH survivals were similar.CONCLUSION: This first comprehensive model that predicts survival of NH residents can help formulate public health policies and identify appropriate NH residents for clinical trials. The model is a promising step toward improving the health care of NH residents. J Am Geriatr Soc 46:954–962, 1998.
Risk of Left Ventricular Dysfunction in Patients with Probable Alzheimer's Disease with APOE*4 Allele
Authors: van der Cammen T.J.M. , Verschoor C.J. , van Loon C.P.M. , van Harskamp F. , de Koning I. , Schudel W.J. , Slooter A.J.C. , Van Broeckhoven C. , van Duijn C.M. 
Published: April 2015

OBJECTIVE: To examine the association between the APOE genotype and cardiovascular disease in Alzheimer's disease (AD) patients.DESIGN: Case register study of 100 consecutive referrals to a Memory Clinic where type of dementia and cardiovascular comorbidity were diagnosed and APOE genotype was determined.SETTING: The Memory Clinic, University Hospital Rotterdam Dijkzigt.PARTICIPANTS: One hundred Memory Clinic patients, 59 to 91 years of age, who attended the Memory Clinic in the period between January 1994 and March 1996.MEASUREMENTS: Relative risk of cardiovascular morbidity in probable AD, based on clinical and ECG findings.RESULTS: The diagnosis of probable AD was more frequent in APOE*4 allele‐carrying AD patients. When comparing homozygotes for APOE*4 with homozygotes for APOE*3, a nine‐fold increase in prevalence of cardiac ischemia on ECG was found in the former. When grouping parameters of left ventricular dysfunction, the prevalence was 7.2 (95% confidence interval 1.2–42.6) times greater in probable Alzheimer patients with APOE4/4.CONCLUSIONS: In patients with probable AD, APOE*4 is associated with cardiac disease indicative of left ventricular dysfunction. J Am Geriatr Soc 46:962–967, 1998.
Race and Stress in the Incidence of Herpes Zoster in Older Adults
Authors: Schmader Kenneth , George Linda K. , Burchett Bruce M. , Hamilton John D. , Pieper Carl F. 
Published: April 2015

OBJECTIVES: To examine the effect of black race and acute (negative life events) and chronic (lack of social support) psychological stress on the risk of herpes zoster in late life.DESIGN: A population‐based, prospective cohort study.SETTING: Central North CarolinaPARTICIPANTS: Duke Established Populations for Epidemiological Studies of the Elderly, a stratified probability sample of community‐dwelling persons more than 65 years of age.MEASUREMENTS: Interviewers administered a comprehensive health survey to the participants in 1986–1987 (P1, n = 4162), 1989–1990 (P2, n = 3336), and 1992–1994 (P3, n = 2568). Incident cases of zoster between P1 and P2 and P2 and P3 served as the dependent variable. Hypothesis‐testing variables included race, negative life events, and five measures of social support. Control variables included age, sex, education, cancer, chronic diseases, basic ADLs, instrumental ADLs, depression, self‐rated health, hospitalization, and cigarette smoking. Statistical analyses employed chi‐square tests and proportional hazards model.RESULTS: At baseline, the sample had a mean age of 73.6 years and was 55% black, 45% white, and 65% female. There were 65 cases of zoster between P1 and P2 and 102 cases of zoster between P2 and P3. From P1 to P2, 1.4% of blacks and 3.4% of whites developed zoster (P <.001). From P2 to P3, 2.9% of blacks and 7.5% of whites developed zoster (P <.001). After controlling for the above variables, blacks were significantly less likely to develop zoster (adjusted risk ratio = 0.35; 95% confidence interval (CI), 0.24–0.51; P <.001). Negative life events increased the risk of zoster, but the result was borderline for statistical significance (adjusted RR = 1.38, 95% CI 0.96–1.97; P =.078). No measures of social support were significantly associated with zoster.CONCLUSION: Black race decreased the risk of zoster in late life significantly. Measures of stress were not significantly related to zoster, but study limitations preclude definitive conclusions. Future research should focus on these factors in larger samples and different populations. J Am Geriatr Soc 46:973–977, 1998.
Prevalence Estimation of Dementia in a Rural Area of Korea
Authors: Woo Jong Inn , Lee Jung Hie , Yoo Keun‐Young , Kim Chang‐Yup , Kim Yong‐Ik , Shin Young Soo 
Published: April 2015

OBJECTIVES: A cross‐sectional survey was conducted to estimate prevalence of dementia and to determine factors related to dementia among residents in a rural area, Yonchon county, Korea, in 1993.PARTICIPANTS: Of the study population more than 65 years of age (n = 2171), 1674 persons participated in the cross‐sectional survey using the Korean version of the Mini‐Mental State Examination (MMSE‐K).DESIGN: Subjects were defined as having dementia according to NINCDS‐ADRDA criteria through direct interview by psychiatrists. A total of 436 subjects were selected randomly according to MMSE‐K scores, and cases were confirmed as having either Alzheimer's or vascular dementia.RESULTS: The adjusted prevalence of dementia was estimated at 9.5%. The prevalence of total dementia was 8.8% for men and 9.9% for women. The prevalence of Alzheimer's disease was 3.2% for men and 5.3% for women and that of vascular dementia 3.1% and 2.1%, respectively. Age‐standardized prevalence of Alzheimer's disease was 4.5%, whereas that of vascular dementia was 2.5%. Using DSM‐III‐R criteria to stratify dementia patients according to severity showed the prevalence of mild, moderate, and severe Alzheimer's disease was 3.4%, 0.7%, and 0.5%, respectively.CONCLUSION: These results showed that the prevalence of dementia in Korea was similar to its presence in Western countries but different from that previously reported in other Asian countries, e.g., China and Japan. J Am Geriatr Soc 46:983–987, 1998.
Features of Cancer in Nonagenarians and Centenarians
Authors: Saltzstein Sidney L , Behling Cynthia A. , Baergen Rebecca N. 
Published: April 2015

OBJECTIVE: To describe the incidence rates and sites of cancer, the causes of death, and gender and ethnic variations in patients with cancer in a population of people 90 years of age and older.DESIGN: Analysis of the 14,088 cases of cancer in this age group, accessioned by the California Cancer Registry from 1988 through 1993, and comparison with those less than age 90.MEASUREMENTS: Incidence rates and numbers and percents of cases with various features (gender, ethnicity, site of tumor, stage, causes of death).RESULTS: The peak age‐specific incidence (ASI) of cancer is in the group 80 to 84 years of age. Those 90 to 94 years of age had a higher ASI than any group except those ages 75 to 89. There are ethnic variations in the sites of cancer in people aged 90 or older. Colorectal cancer accounts for more than one‐fifth of the new cases of cancer in people 90 or older. In women aged 90 or older, the most common sites of cancers are colorectal, breast, and lymphoma/leukemia. In men of the same age, prostate, colorectal, and lung/bronchus are the most common sites. As age increases, fewer people have their cancers staged, and for lung/bronchus, prostate, and breast, more cancers are first diagnosed in the distant stage in people aged 90 and older. Of the people with cancer who die, the proportion dying of cancer decreases as age increases.CONCLUSION: Cancer is a common disease in nonagenarians and centenarians and will be an increasing healthcare problem. Knowledge of its features is essential to those planning, delivering, and financing health care. J Am Geriatr Soc 46:994–998, 1998.
A Study of Force and Cross‐Sectional Area of Adductor Pollicis Muscle in Female Hip Fracture Patients
Authors: Phillips S.K. , Woledge R.C. , Bruce S.A. , Young A. , Levy D. , Yeo A. , Martin F.C. 
Published: April 2015

OBJECTIVES: To determine the extent of muscle weakness in older female hip fracture patients compared with healthy older and young women; to determine the extent to which this weakness is caused by a decline of the force produced per unit area of muscle rather than by a decline in muscle bulk; and to investigate the mechanism of the decline in force per unit area.DESIGN: This was an open study of three groups of subjects, two age matched older groups and one young group.SETTING: University College London, Royal Free Hospital, and St. Thomas's Hospital, London.PARTICIPANTS: Twenty‐nine older female hip fracture patients (mean age 85.6 ± 0.9 SEM), 18 healthy older women (mean age 84.7 ± 1.2 SEM), and 43 young women (mean age 28.9 ± 1.2 SEM).MEASUREMENTS: Adductor pollicis muscle maximum voluntary force (MVF) during isometric and pliometric contractions and cross‐sectional area (CSA), body weight, height, and demi‐span.RESULTS: Isometric MVF was lowest in the hip fracture group. In both older groups, isometric MVF and CSA were lower than in the young women. Only part of this weakness in the older groups could be explained by the smaller CSAs. The isometric force per unit area (MVF/CSA) was also lower in both older groups, the hip fracture patients again having the lowest values. Analysis of variance showed a significant difference between groups. The age‐related declines in pliometric force were much less than the declines in isometric force. This resulted in an increase in the pliometric/isometric force ratio both for the hip fracture patients and for the healthy older women compared with that for young women.CONCLUSION: In comparison with the results from young women, the adductor pollicis muscles of female hip fracture patients were even weaker than those of healthy older women when normalized for muscle size. This decline in isometric MVF/CSA accounted for at least half of the overall weakness in the hip fracture patients. Inasmuch as pliometric force is maintained in situations where weakness is caused by a decline in the force produced per muscle cross‐bridge, this is the likely mechanism of the declines in isometric MVF/CSA observed in this study. J Am Geriatr Soc 46:999–1002, 1998.