bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urinary Incontinence: Does it Increase Risk for Falls and Fractures?
Authors: Brown Jeanette S. , Vittinghoff Eric , Wyman Jean F. , Stone Katie L. , Nevitt Michael C. , Ensrud Kristine E. , Grady Deborah 
Published: April 2015

OBJECTIVE: To determine if urge urinary incontinence is associated with risk of falls and non‐spine fractures in older women.METHODS: Type and frequency of incontinent episodes were assessed by 6049 community‐dwelling women using a self‐completed questionnaire. Postcards were subsequently mailed every 4 months to inquire about falls and fractures. Incident fractures were confirmed by radiographic report. Logistic and proportional hazard models were used to assess the independent association of urge urinary incontinence and risk of falling or fracture.RESULTS: The mean age of the women was 78.5 (± 4.6) years. During an average follow‐up of 3 years, 55% of women reported falling, and 8.5% reported fractures. One‐quarter of the women (1493) reported weekly or more frequent urge incontinence, 19% (1137) reported weekly or more frequent stress incontinence, and 708 (12%) reported both types of incontinence. In multivariate models, weekly or more frequent urge incontinence was associated independently with risk of falling (odds ratio = 1.26; 95% confidence interval (CI), 1.14‐1.40) and with non‐spine nontraumatic fracture (relative hazard 1.34; 95% CI, 1.06‐1.69; P = .02). Stress incontinence was not associated independently with falls or fracture.CONCLUSIONS: Weekly or more frequent urge incontinence was associated independently with an increased risk of falls and non‐spine, nontraumatic fractures in older women. Urinary frequency, nocturia, and rushing to the bathroom to avoid urge incontinent episodes most likely increase the risk of falling, which then results in fractures. Early diagnosis and appropriate treatment of urge incontinence may decrease the risk of fracture. J Am Geriatr Soc 48:721–725, 2000.
Outcome and Utilization Differences for Older Persons with Stroke in HMO and Fee‐for‐Service Systems
Authors: Kramer Andrew M. , Kowalsky Jacqueline Cahill , Lin Michael , Grigsby James , Hughes Richard , Steiner John F. 
Published: April 2015

OBJECTIVES: To compare treatment and outcomes for older persons with stroke in Medicare health maintenance organizations (HMOs) and fee‐for‐service (FFS) systems.DESIGN: Inception cohort stratified by payer and followed for 1 year.SETTING: Six HMOs and five FFS systems with large Medicare populations in the West, Midwest, and Eastern United States.PARTICIPANTS: A total of 429 randomly selected stroke patients receiving rehabilitation in nursing homes or rehabilitation hospitals (RHs) from June 1993 to June 1995.MEASUREMENTS: Improvement in activities of daily living (ADLs) during rehabilitation, and ADL recovery, community residence, and utilization until 12 months after stroke. Outcomes were adjusted for premorbid function, marital status, comorbid illness, posthospital function, cognition, psychological problems, and stroke deficits.RESULTS: At baseline, HMO patients were more likely to be married, and less likely to be blind or have psychiatric diagnoses. HMO patients had shorter hospitalizations (P < .001), were less likely to be admitted to RHs (13% vs 85%, P < .001), and received fewer therapy and physician specialist visits (P < .001) but more home health visits (P < .001). During rehabilitation, FFS patients made greater improvement in ADLs (difference, 0.73 ADLs; 95% CI, .37‐1.09). At 1 year, there was no difference in ADL recovery (difference, −0.24 ADL; 95% CI, −0.64‐0.16), but FFS patients were more likely to reside in the community (adjusted OR, 1.8; 95% CI, 1.1–3.1), and HMO patients were more likely to reside in nursing homes (adjusted OR, 2.4; 95% CI, 1.1–5.5).CONCLUSION: Study findings suggest that short‐term functional outcomes and eventual community residence rates are poorer for Medicare HMO patients with stroke than for stroke patients receiving FFS care, consistent with the lower intensity of rehabilitation (in nursing homes vs RHs) and less specialty physician care. J Am Geriatr Soc 48:726–734, 2000.
Postmenopausal Hormone Therapy and Cognitive Function in Healthy Older Women
Authors: Grodstein Francine , Chen Jennifer , Pollen Daniel A. , Albert Marilyn S. , Wilson Robert S. , Folstein Marshal F. , Evans Denis A. , Stampfer Meir J. 
Published: April 2015

OBJECTIVE: Accumulating biologic evidence suggests that estrogen is related to cognitive function. Several epidemiologic investigations have reported that hormone therapy may reduce the risk of Alzheimer's disease. However, fewer studies have examined the relation of postmenopausal hormone use to general cognitive function in nondemented older women. Thus, we examined the association of hormone therapy to performance on four cognitive tests among healthy participants of the Nurses' Health Study.DESIGN: Cohort study.SETTING: The Nurses' Health Study, an ongoing prospective cohort study begun in 1976.PARTICIPANTS: From the Nurses' Health Study, 2138 women aged 70–78 years.MEASUREMENTS: From 1995–1999 we administered four cognitive tests (Telephone Interview for Cognitive Status (TICS), immediate and delayed recall of the East Boston Memory Test (EBMT), and verbal fluency) by telephone. Hormone use was ascertained from biennial questionnaires beginning in 1976. Linear and logistic regression models were used to calculate multivariate‐adjusted differences in scores and relative risks of a low score for never users compared to current and past hormone users.RESULTS: After adjustment for confounders, neither current nor long‐term hormone users demonstrated better performance on an overall measure of cognition (TICS), or on three tests of verbal memory (immediate and delayed recall of the EBMT, immediate recall of the TICS 10‐word list) than never users. On the test of verbal fluency, current hormone users scored significantly better than never users (linear regression estimate of the difference in score = 0.78 points, 95% confidence interval (CI) 0.19‐0.38, P = .01 for any current use; and 0.91 points, 95% CI 0.28‐1.54, P = .005 for ≥5 years current use). Current hormone users also had a 30% decrease (RR = 0.70,95% CI 0.45‐1.09) in their risk of a low score on the test of verbal fluency. These results were similar for women taking estrogen alone and estrogen combined with a progestin.CONCLUSIONS: Verbal fluency may be enhanced among women taking postmenopausal hormones, however, there is little support for better overall cognitive function in hormone users than nonusers. J Am Geriatr Soc 48:746–752, 2000.
Effect of Voluntary Weight Loss on Bone Mineral Density in Older Overweight Women
Authors: Chao Dinnie , Espeland Mark A. , Farmer Deborah , Register Thomas C. , Lenchik Leon , Applegate William B. , Ettinger Walter H. 
Published: April 2015

OBJECTIVES: To examine the effect of diet and exercise‐induced weight loss on bone mineral density in overweight postmenopausal womenDESIGN: A 1‐year prospective, randomized clinical trial.SETTING: Two university medical school research centers.PARTICIPANTS: Sixty‐seven overweight postmenopausal women, a subset of the women who participated in the Trial of Nonpharmacological Interventions in the Elderly (TONE) to control hypertension. The participants were assigned randomly to one of four groups: usual care, weight loss only, sodium restriction only, or combined weight loss/sodium restriction.INTERVENTION: All TONE participants in the treatment groups attended regular dietary intervention sessions to lose weight, reduce sodium intake, or both that they might refrain from using antihypertensive medications for a period of 15 to 36 months (median = 29 months).MEASUREMENTS: Bone mineral density (BMD) assessed by dual energy X‐ray absorptiometry (DXA), serum and urine markers of bone metabolism, and other demographic and clinical data were collected at baseline, 6 months, and 12 months.RESULTS: Women assigned to the weight loss interventions lost 9.2 ± 1.2 lbs (mean ± SE) at 6 months and 7.7 ± 2.0 lbs at 12 months compared with 1.8 ± 1.0 lbs at 6 months and 1.9 ± 1.6 lbs at 12 months for those assigned to no weight loss intervention (P < .0001). Weight loss was correlated with a decrease in total body BMD (P = .004) and an increase in osteocalcin (P = .004) after controlling for baseline bone measures, intervention assignment, and other baseline covariates. Regression analyses indicated that total body BMD decreased by 6.25 ± 2.06 g/cm2 × 10−4 for each pound of weight loss.CONCLUSIONS: Voluntary weight loss in overweight postmenopausal women is associated with modest decrease in total body BMD. Clinicians recommending weight loss for older postmenopausal women may need to include recommendations for reducing the risk of bone loss. J Am Geriatr Soc 48:753–759, 2000.
The Relationship Between Alcohol Problems and Health Functioning of Older Adults in Primary Care Settings
Authors: Blow Frederic C. , Walton Maureen A. , Barry Kristen Lawton , Coyne James C. , Mudd Sharon A. , Copeland Laurel A. 
Published: April 2015

OBJECTIVE: The purpose of this study was to determine the relationship between alcohol use and health functioning in a sample of older adults screened in primary care settings.DESIGN: A cross‐sectional study.SETTING: Thirty‐seven primary care clinics.PARTICIPANTS: Older adults (n = 8578; aged 55–97) with regularly scheduled appointments in primary care clinics were screened.MEASUREMENTS: Participants were categorized based on alcohol consumption levels as abstainers, low‐risk drinkers, and at‐risk drinkers (women: 9 or more drinks/week; men: 12 or more drinks/week). Dependent variables were eight SF‐36 health functioning scales.RESULTS: Sixty‐one percent of participants were abstainers, 31% were low‐risk drinkers, and 7% were at‐risk drinkers. ANCOVAs found significant effects of drinking status on General Health, Physical Functioning, Physical Role Functioning, Bodily Pain, Vitality, Mental Health, Emotional Role, and Social Functioning, controlling for age and gender, with low‐risk drinkers scoring significantly better than abstainers. At‐risk drinkers had significantly poorer mental health functioning than low‐risk drinkers. Few significant gender differences were found on SF‐36 scales.CONCLUSIONS: Older adults who are at‐risk drinkers may not present with poor physical health functioning. Future studies are needed to determine the relationship between drinking limits for older adults and other areas of physical and psychosocial health. J Am Geriatr Soc 48:769–774, 2000.
Cognitive Impairment Without Dementia in Older People: Prevalence, Vascular Risk Factors, Impact on Disability. The Italian Longitudinal Study on Aging
Authors: Di Carlo Antonio , Baldereschi Marzia , Amaducci Luigi , Maggi Stefania , Grigoletto Francesco , Scarlato Guglielmo , Inzitari Domenico ,   for the Italian Longitudinal Study on Aging Working Group
Published: April 2015

OBJECTIVES: To investigate prevalence of “cognitive impairment, no dementia” (CIND) in the Italian older population, evaluating the association with cardiovascular disease and the impact on activities of daily living (ADL). CIND may provide pathogenic clues to dementia and independently affect ADL.DESIGN: Cross‐sectional examination in the context of the Italian Longitudinal Study on Aging.SETTING: Random population sample from eight Italian municipalities.PARTICIPANTS: A total of 3425 individuals aged 65–84 years, residing in the community or institutionalized.MEASUREMENTS: Study participants were screened for cognitive impairment by using the Mini‐Mental State Examination. Trained neurologists examined those scoring <24. CIND diagnosis relied on clinical and neuropsychological examination, informant interview, and assessment of functional activities. Age‐related cognitive decline (ARCD) was diagnosed in CIND cases without neuropsychiatric disorders responsible for the cognitive impairment.RESULTS: Prevalence was 10.7% for CIND and 7.5% for ARCD, increased with age, and was higher in women. Age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.06‐1.12), stroke (OR, 2.05; 95% CI, 1.26‐3.35) and heart failure (OR, 1.73; 95% CI, 1.11‐2.68) were significantly and positively associated with CIND at multivariate analysis. Education (OR, 0.61; 95% CI, 0.56‐0.65) and smoking (OR, 0.72; 95% CI, 0.54‐0.98) showed a negative correlation. Age and myocardial infarction were positively associated with ARCD, whereas a negative correlation was found for education and smoking. The effect of smoking was no more significant either on CIND or ARCD considering current habits or “pack year” exposure. CIND showed an independent impact on ADL (OR, 1.88; 95% CI, 1.41‐2.49).CONCLUSIONS: CIND is very frequent in older people. The effect of demographic variables and vascular conditions offers opportunities for prevention. The association with functional impairment is useful to evaluate the burden of disability and healthcare demands. J Am Geriatr Soc 48:775–782, 2000.
A High Diagnostic Rate in Older Patients Attending an Integrated Syncope Clinic
Authors: Youde J. , Ruse C. , Parker S. , Fotheby M. 
Published: April 2015

OBJECTIVES: To describe the findings in the first year of an integrated syncope clinic for older patients and to review the published literature on “integrated” syncope clinics investigating older people.DESIGN: Review of syncope clinic database and Medline search for relevant literature.SETTING: Outpatient syncope clinics in two district hospitals in the same city.PARTICIPANTS: Secondary referrals from the in‐ and outpatient population with recurrent unexplained presyncopal and syncopal symptoms.RESULTS: The results of testing in 76 patients over the age of 60 years were available for analysis. A diagnosis was achieved in 67 (88%) of the patients with 76% of the diagnoses being cardiovascular in origin. The prevalence rates of neurocardiogenic syncope (32%) and carotid sinus syndrome (17%), however, differed from previously reported rates.CONCLUSIONS: Evaluation of presyncopal and syncopal events in an “integrated syncope clinic” achieves a high diagnostic yield in older subjects. J Am Geriatr Soc 48:783–787, 2000.
Association of Alzheimer's Disease and Smoking: The Case for Sibling Controls
Authors: Debanne Sara M. , Rowland Douglas Y. , Riedel Tatiana M. , Cleves Mario A. 
Published: April 2015

OBJECTIVES: To study the association between cigarette smoking and Alzheimer's Disease (AD).DESIGN: Intrafamily case‐control, with sibling controls and a variable number of controls per case.SETTING: AD cases were identified through the Research Registry of the University Hospitals of the Cleveland/Case Western Reserve University Alzheimer Center.PARTICIPANTS: Study subjects were 86 probable AD cases (index cases) and all of their full siblings, alive or dead, aged ≥ 50 years, a total of 238 subjects.MEASUREMENTS: Exposure for each individual was ascertained with a questionnaire answered by several informants. Cognitive status of siblings of the AD cases (impaired or intact) was ascertained by telephone using validated instruments. Diagnosis of dementia in cognitively impaired siblings of index cases was not attempted.RESULTS: Chi‐square analysis tested for departure from a random distribution of disease across smokers and non‐smokers within families. No significant departure was found utilizing all families (P > .40) nor utilizing those families where only the index case was affected (P > .90). Conditional logistic regression evaluated the association within families, controlling for age, sex, and education. Analyses both included and excluded secondary cases of cognitive impairment. No association was found between smoking and disease (OR = 1.26; 95% confidence interval, 0.66‐2.42, and OR = 1.42; 95% confidence interval, 0.69‐2.89, respectively).CONCLUSIONS: No significant association was found between smoking and cognitive status. Further, analyses based on the comparison of persons with AD with their unaffected siblings also suggest that smoking does not decrease the risk of AD. J Am Geriatr Soc 48:800–806, 2000.
Pharmacotherapy of Lower Limb Diabetic Ulcers
Authors: Temple Mary E. , Nahata Milap C. 
Published: April 2015

OBJECTIVE: To discuss the pathophysiology, microbiology, and pharmacotherapy of lower extremity (LE) diabetic ulcers.DATA SOURCES: A MEDLINE search from 1966 to April 1999 was conducted. The search was limited to humans and English‐language journals. Key search words included “diabetic ulcer,” “fluoroquinolones,” “beta‐lactam,” “hyperbaric oxygen,” “diabetes mellitus,” “diabetic foot,” and “growth factor.”STUDY SELECTION: Randomized and nonrandomized studies were selected for review. Results of randomized, placebo‐controlled studies were emphasized more than nonrandomized results.DATA SYNTHESIS: LE ulcers are a common cause of hospitalization, and cause significant morbidity and mortality. Staphylococcus aureus is the most common pathogen in non‐limb‐threatening infections; Gram‐negative bacteria and anaerobes are most prevalent in limb‐threatening and life‐threatening infections. Oral antibiotic therapy may be used in non‐limb‐threatening infections, if adequate response is achieved in 24–48 hours; otherwise, intravenous antibiotics should be started. Intravenous antibiotics should be the initial therapy for limb‐threatening or life‐threatening ulcers. Antimicrobial therapy of at least 10–14 days has been effective in treating LE ulcers in the absence of osteomyelitis. Growth factors offer another treatment alternative, although only becaplermin is currently approved for diabetic ulcers.CONCLUSION: Antibiotic therapy has been effective for the treatment of LE diabetic ulcers. However, further studies are required to identify optimal antibiotics and dosage regimens. Growth factors may have a role but additional research is needed to determine when best to initiate this therapy. J Am Geriatr Soc 48:822–828, 2000.
Pressure Ulcers Among Patients Admitted To Home Care
Authors: Ferrell Bruce A. , Josephson Karen , Norvid Peter , Alcorn Harry 
Published: April 2015

CONTEXT: Pressure ulcers are an understudied problem in home care.OBJECTIVE: To determine the prevalence of pressure ulcers among patients admitted to home care services, describe the demographic and health characteristics associated with pressure ulcers in this setting, and identify the percentage of these patients at risk for developing pressure ulcers.DESIGN: Cross‐sectional survey of patients on admission to home care agencies.SETTING: Forty‐one home care agencies in 14 states.PATIENTS: A consecutive sample of 3048 patients admitted March 1 through April 30, 1996 (86% of all admissions). Subjects had a mean age of 75 years; 63% were female and 85% white.MAIN OUTCOME MEASURES: Demographic, social, and clinical characteristics, functional status (Katz activities of daily living scale and Lawton instrumental activities of daily living scale), mental status (Katzman Short Memory‐Orientation‐Concentration test), pressure ulcer risk (Braden Scale), pressure ulcer status (Bates‐Jensen Pressure Ulcer Status Tool), and a checklist of pressure‐reducing devices and wound care products being used.RESULTS: In the total sample of 3048 patients, 9.12% had pressure injuries: 37.4% had more than one ulcer and 14.0% had three or more ulcers. Considering the worst ulcer for each subject, 40.3% had Stage II and 27% had Stage III or IV injuries. Characteristics associated with pressure ulcers included recent institutional discharge, functional impairment, incontinence, and having had a previous ulcer. About 30% of subjects were at risk for new pressure ulcers. Pressure‐relieving devices and other wound care strategies appeared to be underutilized and often indiscriminately applied.CONCLUSIONS: There is substantial need for pressure ulcer prevention and treatment in home care settings.
Outcomes of Percutaneous Endoscopic Gastrostomy Among Older Adults in a Community Setting
Authors: Callahan Christopher M. , Haag Kathy M. , Weinberger Morris , Tierney William M. , Buchanan Nancy N. , Stump Timothy E. , Nisi Rod 
Published: April 2015

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) has become the preferred method to provide enteral tube feeding to older adults who have difficulty eating, but the impact of PEG on patient outcomes is poorly understood. The objective of this study was to describe changes in nutrition, functional status, and health‐related quality of life among older adults receiving PEG.DESIGN: A prospective cohort study.SETTING: A small community of approximately 60,000 residents served by two hospital systems.PARTICIPANTS: One hundred fifty patients aged 60 and older receiving PEG from one of the four gastroenterologists practicing in the targeted community.MEASUREMENTS: Patients were assessed at baseline and every 2 months for 1 year to obtain clinical characteristics, process of care data, physical and cognitive function, subjective health status, nutritional status, complications, and mortality.RESULTS: Over a 14‐month period, 150 patients received PEG tubes in the targeted community; the mean age was 78.9. The most frequent indications for the PEG were stroke (40.7%), neurodegenerative disorders (34.7%), and cancer (13.3%). All measures of functional status, cognitive status, severity of illness, comorbidity, and quality of life demonstrated profound and life‐threatening impairment; 30‐day mortality was 22% and 1‐year mortality was 50%. Among patients surviving 60 days or more, at least 70% had no significant improvement in functional, nutritional, or subjective health status. Serious complications were rare, but most patients experienced symptomatic problems that they attributed to the enteral tube feeding.CONCLUSIONS: PEG tube feeding in severely and chronically ill older adults can be accomplished safely. However, there are important patient burdens associated with the PEG and there was limited evidence that the procedure improves functional, nutritional, or subjective health status in this cohort of older adults. The issues raised in this descriptive study provide impetus for a randomized trial of PEG tube feeding compared with alternative methods of patient care for older adults with difficulty eating.