bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional and Mobility Impairments Associated with Paget's Disease of Bone
Authors: Lyles Kenneth W. , Lammers J. Eugene , Shipp Kathy M. , Sherman Lawrence , Pieper Carl F. , Martinez Salutario , Gold Deborah T. 
Published: April 2015

OBJECTIVE: To determine if patients with Paget's disease of bone involving the tibia, femur, and/or acetabular portion of the ilium had more impairments in function and mobility than age‐ and sex‐matched control subjects.PATIENTS AND METHODS: A case control study with Paget's disease patients selected from a center for bone disease at a tertiary medical center; control subjects were volunteers from the Duke University Aging Center subject registry. Demographic characteristics, physical examination and serum alkaline phosphatase levels were obtained. Radiographs of the pelvis and lower extremities were evaluated by a radiologist. All participants completed a Functional Status Questionnaire (FSQ). Mobility measures included mobility skills protocol, 10‐foot walk time, 360‐degree turn left (number of steps), and 6‐minute walk distance.RESULTSThe 12 Paget's disease patients were no different in age (70.7 ± 6.2 years) than the 12 control subjects (69.5 ± 6.2 years). Serum alkaline phosphatase levels were elevated in Paget's patients (539 ± 530 IU/L), and normal in control subjects (85 ± 17 IU/L). In addition to Paget's disease, radiographs showed joint space loss in joints proximate to the diseased bone. On the FSQ scales Paget's disease patients had significantly lower scores in basic activities of daily living (P < .05), instrumental activities of daily living (P < .001), and social activity than control subjects (P < .05). There was no difference between the groups on scales measuring mental health and quality of social interaction. On mobility measurements, Paget's disease patients showed significant impairments when compared with control subjects: mobility skills protocol score (22.5 ± 2.5 vs 25.6 ± 0.7, P < .001); 10‐foot walk (3.96 ± 1.3 vs 2.55 ± 0.5 seconds, P < .001); 360 degree turn left (8.0 ± 1.0 vs 5.9 ± 0.6 steps, P < .001); and 6‐minute walk (342.0 ± 108.5 vs 519.4 ± 100 meters, P < .001).CONCLUSION: When compared with control subjects, patients who have Paget's disease of bone involving the tibia, femur, or acetabular portion of the ilium have clinically and statistically significant functional and mobility impairments compared to age‐ and gender‐matched controls.
Do Surgical Brain Lesions Present as Isolated Dementia? A Population‐Based Study
Authors: Alexander Elizabeth M. , Wagner Edward H. , Buchner David M. , Cain Kevin C. , Larson Eric B. 
Published: April 2015

OBJECTIVE: To determine the incidence of clinically important subdural hematoma (SDH), hydrocephalus not associated with a recent intracranial bleed, and intracranial tumor that is not obviously metastatic, and to test the sensitivity of a promising decision rule for computerized tomography (CT) in dementia.DESIGN: Population‐based, retrospective, sequential case series.SETTING: Staff model health maintenance organization (HMO).PATIENTS: Patients aged 65 years and older with one of the three lesions, diagnosed over a 4.5‐year period, identified mainly through computerized databases of hospital discharge diagnoses and a registry of malignant tumors.MEASUREMENTS: Clinical data were based on chart review. The decision rule, based on one that had been previously proposed and tested, stated that CT would be required if any one of 11 clinical criteria were met by a patient with cognitive impairment. Rule sensitivity was evaluated using clinical information recorded before CT.MAIN RESULTS: One hundred forty‐five clinically important lesions were identified among 137,100 person‐years at risk. Average annual incidence per 100,000 was 46.7 (95% CI 36.0, 59.6) for SDH, 5.8 (95% CI 2.5, 11.5) for hydrocephalus not associated with a recent intracranial bleed, and 53.2 (95% CI 41.7, 66.9) for intracranial tumors that were not obviously metastatic. Using the 65 to 74‐ year age strata as a reference, the relative risk for SDH was 4.8 (95% CI 2.7, 8.5) in 75 to 84‐year‐olds and 13.1 (95% CI 7.7, 22.5) in the 85 and older strata. Among 59 patients who presented with cognitive impairment, without altered sensorium or physical evidence of trauma, decision rule sensitivity was 93.2% (95% CI 83.5%, 98.1%). Sensitivity was 90.7% (95% CI 77.9%, 97.4%) in the subgroup that presented to an ambulatory care clinic rather than to an emergency department.CONCLUSIONS: These three lesions, which are the most common surgical lesions that may present as dementia, are rare. Most cases have presentations that easily distinguish them from typical Alzheimer's disease. This case series indicates that it may be feasible to develop a decision rule for the selective use of CT in dementia. Disease spectrum will influence measures of decision rule performance such as sensitivity and specificity.
Weight Gain Impacts Morbidity and Mortality in Institutionalized Older Persons
Authors: Keller Heather H. 
Published: April 2015

OBJECTIVE: To determine if a significant weight change in previously undernourished older persons is associated with mortality and morbidity.DESIGN: Retrospective survey.SETTING: A chronic care hospital in Canada.SUBJECTS: Follow‐up survey from an original data set (Time 1) on 88 previously diagnosed undernourished and 60 adequately nourished. Average age was 78 years; average length of residence was 40 months. Of the 148 subjects, 120 were male.MEASUREMENTS: Average time to follow‐up (Time 2) was 319 days from Time 1. Data was collected on weight change, reported incidence of infection, use of antibiotics, number of falls, and admissions to acute centers, as well as incidence and cause of death. Three‐day diet intake records were available on 15% of subjects within 1 month of Time 2. Five nutritional groups existed within this follow‐up population: those previously undernourished who gained at least 5% of Time 1 weight (Group 1), those undernourished who lost at least 5% of Time 1 weight (Group 2), those undernourished who maintained their weight (Group 3), those adequately nourished who lost at least 5% of original weight (Group 4), and those who remained adequately nourished (Group 5).RESULTS: Forty‐one of the 148 patients died; this was significantly associated with nutrition group (X2 = 11.23, P = 0.02), with fewer deaths in Groups 1, 3, and 5. As well, primary diagnosis (x2 = 32.6, P = 0.001), length of residence (X2 = 25.6, P = 0.01), and time to death (X2 = 26.4, P = 0.009) were significantly associated with nutrition group. Diet intake records indicated an improvement in energy and protein intake in Group 1 during the follow‐up. Energy and protein change, whether increased or decreased from the original study, was significantly associated with nutrition group. Total number of feeding impairments and presence of dysphagia were significantly associated with nutrition group. Other morbidity events were not significantly associated with nutrition group, but trends suggest a positive effect of weight gain on incidence of falls, incidence of more than two infections, and incidence of recurring infections.CONCLUSIONS: A weight increase of at least 5% of body weight in previously undernourished patients is associated with a decreased incidence of death and may reduce morbidity events. Feeding impairments may affect ability of patients to gain weight, but dysphagia is associated with weight increase. Other nonnutritional variables of diagnosis, number of medications, and declining medical status also affect mortality and morbidity outcomes.
A Simple Model for Predicting Postoperative Delirium in Older Patients Undergoing Elective Orthopedic Surgery
Authors: Fisher Bruce W. , Flowerdew Gordon 
Published: April 2015

OBJECTIVE: To determine the incidence, and severity of postoperative delirium (POD) in older patients undergoing elective orthopedic procedures and to identify potential preoperative risk factors.DESIGN: A prospectively studied cohort of elective orthopedic surgery patients.SETTING: A University teaching hospital.PATIENTS: Eighty patients who attended a preadmission clinic and, subsequently, underwent elective orthopedic surgery. All patients were aged 60 years or older, and all spoke English.MEASUREMENTS: Patients underwent preoperative medical, cognitive, and activities of daily living assessment with standardized instruments and were followed postoperatively with daily visits, telephone interviews with attending nurses using a modified confusion assessment model (CAM), and repeated cognitive testing. Suspected delirium was verified by direct physician assessment.RESULTS: The elective group had 14 (17.5%) cases of POD, of which six (7.5%) were severe. These incidences are low compared with those of nonelective surgery groups reported elsewhere in the literature. Stepwise multiple logistic regression identified two POD risk factors: clock‐drawing scores ≤ 6 (OR = 9.0, CI, 2.8 to 45.6) and male gender (OR = 5.6, CI 1.9 to 33.8).CONCLUSION: A simple model using clock‐drawing scores and male gender for preoperative identification of elective patients at greatest risk for POD appears sensitive, predictive, and practical for the preadmission clinic setting, but it should be validated in a prospective trial.
Functional Incidental Training, Mobility Performance, and Incontinence Care with Nursing Home Residents
Authors: Schnelle John F. , MacRae Priscilla G. , Ouslander Joseph G. , Simmons Sandra F. , Nitta Misty 
Published: April 2015

OBJECTIVE: To determine if an exercise intervention, Functional Incidental Training (FIT), results in improvements in mobility endurance and physical activity when compared with prompted voiding (PV) among cognitively and mobility impaired nursing home residents.DESIGN: Residents from four nursing homes were randomized into either a PV only (PV) or a PV plus FIT (FIT) intervention group for 8 weeks. Research staff implemented all intervention and measurement protocols.PARTICIPANTS: Seventy‐six incontinent nursing home residents completed all phases of the trial.MEASURES: The standing, walking, and wheelchair endurance, physical activity, and frequency of agitation of all residents were assessed before, during, and after the 8‐week intervention.RESULTS: The average length of time that subjects could walk or wheel was 2.6 and 4.6 minutes, respectively, at baseline. There was a significant group × time interaction after intervention, with only the FIT group showing improvements in walking, wheelchair, and standing endurance (Manova F = 4.56,2.62, and 5.98, respectively; P < .05 in all cases). The frequency with which agitation was observed showed a significant drop over time in both groups (F = 14.3, P < .001), with no significant group X time interaction.CONCLUSION: The FIT intervention, which requires 6 minutes more nurses' aide time than does PV, increases both physical activity and mobility endurance in extremely frail and deconditioned nursing home residents. The increased cost of this intervention must be evaluated both in terms of clinical outcomes and by the reality that the target group for this intervention is very frail and will continue to require nursing home care, even assuming an excellent response to the intervention.
Dental, Visual, Auditory and Olfactory Complications in Paget's Disease of Bone
Authors: Wheeler Timothy T. , Alberts Marco A. M. , Dolan Teresa A. , McGorray Susan P. 
Published: April 2015

OBJECTIVE: To determine the prevalence of dental problems in Paget's patients and in a control population without Paget's disease. The relationship of localization of bony involvement of Paget's disease with the prevalence of dental, auditory, visual, and smell changes is examined.DESIGN: Cross‐sectional national surveyPARTICIPANTS: Four hundred ninty‐eight subjects with Paget's disease were generated randomly from the mailing list of the Paget Foundation.INTERVENTION: Each subject was sent a cover letter, two questionnaires, and a stamped, addressed return envelope. One questionnaire contained questions specific for the individual with Paget's disease. Subjects were asked to give the other questionnaire, which contained the same questions except for those asking about the specifics of Paget's disease, to an unaffected spouse or a similar aged friend.MEASUREMENTS: All subjects were asked about their age, gender, race, educational level, income, living situation, chronic medical conditions, self‐rating of their general physical and dental health, the number of teeth present, and the presence of dental, auditory, visual, and olfactory problems. Paget's subjects were also asked to indicate which bones were affected.RESULTS: Paget's disease subjects assessed their oral health to be poorer than the controls. Paget's subjects were more likely to report pain when opening the mouth and were more likely to have had dental extractions. A significantly higher percentage of Paget's individuals with facial or maxillo‐mandibular involvement reported having heart trouble. Paget's individuals with skull, facial or maxillo‐mandibular involvement were more likely to report a change in their hearing, sight, and smell than Paget's subjects without involvement of the craniofacial complex. Dental problems were reported by 93% of those Paget's subjects with maxillomandibular involvement, compared with only 10% for those with skull involvement only or involvement at sites distant to the craniofacial complex.CONCLUSIONS: Patients with Paget's disease of bone involving facial or maxillo‐mandibular parts of the skeleton have a higher prevalence of change in hearing, sight, smell, and dental problems. We also have found an association of heart disease in patients who have involvement of facial or maxillo‐mandibular bones.
Weight Change and Physical Function in Older Women: Findings from the Nun Study
Authors: Tully Christine L. , Snowdon David A. 
Published: April 2015

OBJECTIVE: To investigate the association between change in weight and decline in physical function in older women.DESIGN: Longitudinal study of a defined population of Catholic sisters (nuns) whose weight and function were assessed twice, an average of 584 days apart.SETTING: Unique life communities (convents) located throughout the United States.PARTICIPANTS: 475 Catholic sisters who were 75 to 99 years of age (M = 82.1, SD = 4.8) and were independent in at least one Activity of Daily Living (ADL) at the first assessment of weight and function.INTERVENTIONS: None.MEASUREMENTS: At each assessment, weight, ADLs, and cognitive function were evaluated as part of the Nun Study‐a longitudinal study of aging and Alzheimer's disease. Annual percent weight change was calculated using weights from the two assessments, as well as the number of days that elapsed between assessments.RESULTS: Mean weight at first assessment was 140 pounds (range 78 to 232, SD = 27). The mean annual percent weight change was 0.1% (range 22% loss to 16% gain, SD = 3.8). Age‐ and initial weight‐adjusted findings indicated that those participants with an annual percent weight loss of 3% or greater had 2.7 to 3.9 times the risk of becoming dependent in each ADL, compared to the sisters with no weight change. The elevated risk persisted in those who were mentally intact or were independent in their eating habits.CONCLUSION: Monitoring of weight may be an easy and inexpensive method of identifying older individuals at increased risk of disability.
Psychotropic Use Among Older Residents of Board and Care Facilities
Authors: Spore Diana , Mor Vincent , Hiris Jeffrey , Larrat E. Paul , Hawes Catherine 
Published: April 2015

OBJECTIVE: To describe patterns of psychotropic use as well as clinically relevant and concurrent nonpsychotropic use among older residents of board and care facilities in 10 states.METHODS: Weighted use rates were based on data from a sample of 2054 residents aged 65 and older from 410 facilities in 10 states, drawn via a complex, multistage sampling design. Data, including drug name, use frequency, and PRN use, were collected on all drugs taken by the resident during a 7‐day period. During face‐to‐face interviews with residents and/or proxies, data were also collected on resident characteristics.SUBJECTS: The majority of subjects were female, white, and widowed. Average age was 82 years. Approximately 25% had a current mental or emotional condition, and 8% had been hospitalized for a psychiatric condition during the year before admission. More than half needed help with at least one activity of daily living. Forty percent had moderate or severe cognitive impairment, and 18% had received mental health care during the previous year.ANALYSES: Weighted descriptive analyses were performed with Software for Survey Data Analysis (SUDAAN), which accounts for the complex, multistage sampling design.RESULTS: Approximately 35% of the older residents used at least one psychoactive agent, with 30% of psychotropic users receiving two to four different psychotropic medications. Use rates decline with age, for psychotropics overall and for therapeutic classes. Results revealed potentially problematic polypharmacy in relation to drug duplication within therapeutic classes, use of multiple psychotropics across classes, and concurrent nonpsychotropic use.CONCLUSIONS: Compared with community‐dwelling older adults, this study revealed high psychotropic use rates among older board and care facility residents. Overall, our results suggest that serious consideration be given to the apparent need for systematic drug utilization review, a potentially useful program that is mandated in other settings.
Effects of Resistance Training on Strength, Power, and Selected Functional Abilities of Women Aged 75 and Older
Authors: Skelton Dawn A. , Young Archie , Greig Carolyn A. , Malbut Katie E. 
Published: April 2015

OBJECTIVE:To determine the effects of 12 weeks of progressive resistance strength training on the isometric strength, explosive power, and selected functional abilities of healthy women aged 75 and over.DESIGN:Subjects were matched for age and habitual physical activity and then randomly assigned into either a control or an exercise group.SETTING:The Muscle Function Laboratory, Royal Free Hospital School of Medicine, London.PARTICIPANTS:Fifty‐two healthy women were recruited through local and national newspapers. Five dropped out before and seven (4 exercisers and 3 controls) during the study. Pre‐ and posttraining measurements were obtained from 20 exercisers (median age 79.5, range 76 to 93 years) and 20 controls (median age 79.5, range 75 to 90 years).INTERVENTIONS:Training comprised one supervised session (1 hour) at the Medical School and two unsupervised home sessions (supported by an exercise tape and booklet) per week for 12 weeks. The training stimulus was three sets of four to eight repetitions of each exercise, using rice bags (1–1.5 kg) or elastic tubing for resistance. The exercises were intended specifically to strengthen the muscles considered relevant for the functional tasks, but were not to mimic the functional measurements. No intervention was prescribed for the controls.MEASUREMENTS:Pre‐ and posttraining measurements were made for isometric knee extensor strength (IKES), isometric elbow flexor strength (IEFS), handgrip strength (HGS), leg extensor power (LEP), and anthropometric indices (Body impedance analysis, arm muscle circumference, and body weight). Functional ability tests were chair rise, kneel rise, rise from lying on the floor, 118‐m self‐paced corridor walk, stair climbing, functional reach, stepping up, stepping down, and lifting weights onto a shelf. Pre‐ and posttraining comparisons were made using analysis of variance or analysis of covariance (using weight as a covariate) for normally distributed continuous data and one‐sided Fishers exact test (2times2 table) for discontinuous data.RESULTS:Improvements in IKES (mean change 27%,P= .03), IEFS (22%,P= .05), HGS (4%,P= .05), LEP/kg (18%,P= .05) were associated with training, but the improvement in LEP (18%,P= .11) did not reach statistical significance. There was an association between training and a reduction in normal pace kneel rise time (median change 21%,P= .02) and a small improvement in step up height (median 5%,P= .005). The other functional tests did not improve.CONCLUSIONS:Progressive resistance exercise can produce substantial increases in muscle strength and in power standardized for body weight in healthy, very old women. However, isolated increases in strength and LEP/kg may confer only limited functional benefit in healthy, independent, very old women.
Does Physical Activity Improve Sleep in Impaired Nursing Home Residents?
Authors: Alessi Cathy A. , Schnelle John F. , MacRae Priscilla G. , Ouslander Joseph G. , Al‐Samarrai Nahla , Simmons Sandra F. , Traub Shauna 
Published: April 2015

OBJECTIVES: To determine if two physical activity programs of varying intensity would result in improved sleep among incontinent and physically restrained nursing home residents.DESIGN: Controlled trials of two physical activity programs.SETTING: Seven community nursing homes in the Los Angeles area.PARTICIPANTS: Residents were included if they had urinary incontinence or were physically restrained. Sixty‐five subjects were studied. Mean age was 84.8 years, 85% were female, mean length of residency in the nursing home was 19.9 months, and mean Mean Mini‐Mental State Exam score was 13.1.INTERVENTION: The first physical activity program involved sit‐to‐stand repetitions and/or transferring and walking or wheelchair propulsion. These activities were performed every 2 hours during the daytime, 5 days per week for 9 weeks. The second, less frequent physical activity program involved rowing in a wheelchair‐accessible rowing machine plus walking or wheelchair propulsion once per day three times per week for 9 weeks.MEASUREMENTS: The physical function measures reported here include mobility endurance (maximum time walking or wheeling) and physical activity as measured by motion sensors (Caltrac). Nighttime sleep was estimated by wrist activity monitors. Nighttime sleep measures included total time asleep, percent sleep, average duration of sleep, and peak duration of sleep. Daytime sleep was measured by timed behavioral observations of sleep versus wakefulness performed every 15 minutes during the day.RESULTS: Nighttime sleep was markedly disrupted in both groups at baseline. Across all subjects at baseline, the average total sleep time was 6.2 hours and the percent sleep was 72.0%, but the average duration of sleep episodes was only 21.2 minutes and the peak duration of sleep episode averaged only 83.8 minutes. During the daytime, subjects were observed asleep during 14.5% of observations. Although there was improvement in mobility endurance in the intervention subjects compared with controls (MANOVA F = 4.36, P = .042), there were no differences in the night and day sleep measures at follow‐up testing. Even among a subgroup of intervention subjects who showed a 30% or greater improvement in mobility endurance, sleep did not improve at follow‐up compared with baseline.CONCLUSION: This study supports our previous findings of marked sleep disruption in impaired nursing home residents. In addition, despite documented improvements in physical function with activity, we did not find improvements in sleep in the intervention versus control groups. These results suggest that increasing daytime physical activity alone is not adequate to improve sleep in impaired NH residents. Future efforts to improve sleep in this population should take into account the multifactorial nature of sleep disruption, including individual health problems that effect sleep and the disruptive nature of the nighttime NH environment.