bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Treatment of Urinary Incontinence with Electrical Stimulation in Nursing Home Patients: A Pilot Study
Authors: Lamhut Penny , Jackson Thomas W. , Wall L. Lewis 
Published: April 2015

ObjectivesTo test the effectiveness of electrical stimulation in the treatment of urinary incontinence in female nursing home patients.SettingA community long term care facility.ParticipantsNine unselected female nursing home patients with urinary incontinence. All patients were moderately to severely cognitively impaired. By bedside cystometry, six patients had involuntary detrusor contractions while two had inconclusive results.InterventionParticipants were treated with electrical stimulation for 8 weeks using the Microgyn II device. A current with a frequency of 20 hertz and a pulse width of 1 millisecond was delivered repeatedly for 2 seconds on, 4 seconds off for 15 minutes twice a week.MeasurementsThe number of every‐2‐hour wet episodes during a 48‐hour period (Wet) was recorded by a blinded observer at baseline and after 4 and 8 weeks of treatment. We evaluated the overall effect of electrical stimulation by averaging the Wet at 4 and 8 weeks for each patient and comparing it to Wet at baseline.Main ResultsThe mean ± standard deviation of intensity of electrical stimulation was 12 ± 5 milliamps. Mean Wet at baseline was 11.8 ± 4.2. For all patients mean Wet increased by 2.3 ± 3.2, P = 0.07. Analysis of patients with documented involuntary detrusor contractions showed a mean increase in Wet of 2.6 ± 3.6, P = 0.16. The volume of fluid at which an involuntary contraction occurred during cystometry showed a mean increase of 48.3 ± 52.6 mL, P = 0.07 after 8 weeks of treatment.ConclusionsElectrical stimulation is well tolerated in elderly nursing home patients. However, it was ineffective in improving urinary incontinence. In fact, there was a tendency for the treatment to worsen the incontinence.
Endoscopic Biliary Endoprosthesis in Elderly Patients with Large Bile Duct Stones: Long‐Term Follow‐Up
Authors: Van Steenbergen Werner , Pelemans Walter , Fevery Johan 
Published: April 2015

ObjectiveTo assess the long‐term evolution of elderly patients with large or impacted bile duct stones, treated by an endoscopic biliary endoprosthesis.DesignCase series.SettingTertiary care center.PatientsTwenty‐three patients with a mean (± SD) age of 86 ± 5 years (range, 77–97 years). On admission, 96% were highly symptomatic. These patients represent 8.4% of a group of 273 elderly patients (≧70 years old) with choledocholithiasis treated by endoscopic sphincterotomy between November 1984 and May 1989.InterventionEndoscopic insertion of a biliary endoprosthesis.ResultsEighty‐seven percent (20/23) remained completely free of biliary symptoms and died of unrelated illness (48%) after a mean follow‐up of 23 months or are still alive (39%) with a mean follow‐up of 52 months. In four cases, this asymptomatic evolution now extends for more than 5 years.ConclusionInsertion of a biliary endoprosthesis offers an effective method for long‐term treatment of non‐extractable biliary stones in elderly patients.
Delusions and Behavioral Disturbances in Cognitively Impaired Elderly Persons
Authors: Lachs Mark S. , Becker Marion , Siegal Alan P. , Miller Ronald L. , Tinetti Mary E. 
Published: April 2015

ObjectiveTo compare cognitive function and the prevalence of selected behavioral problems in delusional and non‐delusional dementia patients.DesignRetrospective medical record review.SettingAn outpatient geriatric assessment center.Participants114 consecutive patients with dementia.Main Outcome MeasuresDelusions as recorded in a consultation report.ResultsDelusions were described in 25.5% of patients. A variety of behavioral disturbances were more common in delusional than non‐delusional patients, including agitation, angry or hostile outbursts, urinary incontinence, wandering or pacing, and insomnia. While cognitive function as measured by the MMSE was similar in delusional and non‐delusional patients (18.9 ± 3.8 and 19.2 ± 5.9, respectively), there was a statistically borderline tendency for delusions to occur more often in patients in the mid‐range of cognitive impairment (17 ≤ MMSE ≤ 23) compared with patients with greater or lesser degrees of cognitive impairment (32% vs 17% respectively).ConclusionDelusions in dementia are associated with a variety of behavioral problems. Further studies are needed to clarify the role of delusions in the development of disruptive behaviors in dementing illness.
Elderly Subjects Aged 70 Years and Above Have Different Risk Factors for Ischemic and Hemorrhagic Strokes Compared to Younger Subjects
Authors: Woo J , Lau E. , Kay R. 
Published: April 2015

ObjectiveTo compare risk factors for ischemic and hemorrhagic strokes in subjects aged 70 years and above with those in younger subjects.DesignCase control study, with controls matched for age and sex in 5‐year age groups.SettingA general district hospital in Hong Kong with a catchment population of over 1 million.PatientsAll patients admitted consecutively over a 6‐month period. Classification of stroke was by neurological examination and CT scan, or autopsy if death occurred before CT scanning could be performed. Exclusion criteria: onset of ictus >48 hours before admission, those with previous stroke, subarachnoid hemorrhage, or embolic stroke from rheumatic heart disease, and those with liver, renal, biliary, or thyroid diseases. For ischemic strokes, 78 pairs <70 years and 121 pairs ≥70 years were recruited. For hemorrhagic strokes, the numbers were 40 and 39, respectively.ResultsFor ischemic strokes, atrial fibrillation and the presence of ischemic heart disease were risk factors only for those aged 70 years and above, while smoking and left ventricular hypertrophy were risk factors only for those below 70 years. Hypertension and glucose intolerance were risk factors for both age groups, although the effect of glucose intolerance was less marked in the older group. No marked difference in serum lipids and lipoproteins as risk factors was observed between the two age groups. Hypertension was the only demonstrable risk factor for hemorrhagic stroke in the younger, but not in the older, group.ConclusionRisk factors for ischemic and hemorrhagic strokes are different in elderly compared with younger subjects, with the possibility that certain risk factors for ischemic strokes, in contrast to those for hemorrhagic strokes, may be modifiable even in subjects aged 70 years or above.
Screening for Drinking Disorders in the Elderly Using the CAGE Questionnaire
Authors: Buchsbaum David G. , Buchanan Robin G. , Welsh Josephine , Centor Robert M. , Schnoll Sidney H. 
Published: April 2015

ObjectiveTo assess the performance of the CAGE questionnaire in identifying elderly medicine outpatients with drinking problems.DesignCross‐sectional design, with the alcohol module of the Diagnostic Interview Schedule as the criterion standard.SettingThe outpatient medical practice of an urban university teaching hospital.PatientsConsecutive patients 18 years or older who signed a consent form approved by the university's institutional review board. For this study, 323 patients ≥60 years old.Main Outcome MeasuresSensitivity, specificity, receiver operating characteristics (ROC) curve and positive predictive value for CAGE scores of 0–4 for patients 60 years or older.ResultsThirty‐three percent of the sample group met study criteria for a history of drinking problems, including 63% of the male patients and 22% of the female patients. The sensitivity and specificity for a cut‐off score of one for all patients was 86% and 78%, respectively, and 70% and 91% for a cut‐off of two. The calculation of the area under the ROC curve was .86, and the positive predictive value of CAGE scores of 0–4 were 33%, 66%, 79%, 82%, and 94%, respectively. The predictive value for any score was higher in males than females, reflecting the higher prevalence of problems in the male population.ConclusionsThe CAGE can effectively discriminate elderly patients with a history of drinking problems from those without such a history. The chosen cut‐off score should consider the prevalence of drinking problems in the population being tested.
Geriatricians' Attitudes toward Assisting Suicide of Dementia Patients
Authors: Watts David T. , Howell Timothy , Priefer Beverly A. 
Published: April 2015

ObjectiveTo identify geriatricians' attitudes toward assisting suicide of dementia patients, with particular reference to the case of Janet Adkins/Dr. Kevorkian.DesignMailed questionnaire survey.SettingFour distinct geographical regions of the US: Far West, Midwest, Southeast, and Northeast.ParticipantsAll 1,381 ABIM‐certified internist geriatricians in the four regions; 727 (52.6%) responded.Main Outcome MeasuresPositive, negative, or unsure responses to questionnaire items; comparison of responses between geographical regions.ResultsSixty‐six percent of respondents felt that Dr. Kevorkian's assistance of Janet Adkins' suicide was not justifiable, while 14% stated it was morally justifiable. Twenty‐nine percent felt Janet Adkins' decision to commit suicide was morally wrong, while 49% stated it was not morally wrong. If the responding geriatricians themselves were diagnosed as having a dementing illness, 41% would consider suicide a possible option; 39% would not consider suicide. Twenty‐six percent favored easing restrictions on physician‐assisted suicide of competent dementia patients, while 57% opposed this. If current restrictions were eased, 21% would consider assisting suicide of competent dementia patients, and 66% would not. Respondents' attitudes showed some significant (P ≤ 0.05) variations by geographical region. Where regional differences were observed, respondents in the Midwest tended to show more conservative attitudes toward physician‐assisted suicide than those in the Far West and Northeast.ConclusionsMost responding geriatricians would not consider assisting suicide of dementia patients, and most oppose easing restrictions on physician‐assisted suicide. Many, however, could accept the (unassisted) suicide of a competent dementia patient, and many would consider suicide themselves if stricken with dementia.
A Comparison of Caregivers for Elderly Stroke and Dementia Victims
Authors: Draper Brian M. , Poulos Christopher J. , Cole Andrew M. D. , Poulos Roslyn G. , Ehrlich Frederick 
Published: April 2015

ObjectiveTo compare elderly co‐resident caregivers of stroke and dementia patients on measures of burden and psychological morbidity.DesignCohort study.SettingCaregivers interviewed at home.SubjectsConvenience sample, 99 co‐resident caregivers of dementia and stroke patients registered with a community rehabilitation and geriatric service and who were 60 years or over.Main Outcome MeasuresCaregiver burden as measured by self‐administered questionnaire and subsequent interview, using the Relatives Stress Scale (RSS) and psychological morbidity as measured on the General Health Questionnaire (GHQ).ResultsForty‐six percent of caregivers had significant psychological morbidity (GHQ >4). Mean RSS score was 12.2 (SD 5.4). No significant differences were found between stroke and dementia caregivers on these measures. Caregiver burden was significantly correlated with psychological morbidity in both caregiver groups. Behavior and mood disturbance in the patient was significantly correlated with burden (dementia caregivers r = 0.66; stroke caregivers r = 0.49, P < 0.0001) and psychological morbidity (dementia caregivers r = 0.44, P < 0.01; stroke caregivers r = 0.30, P < 0.05). Caregiver's dissatisfaction with participation in life activities was correlated with burden (dementia caregivers r = 0.58; stroke caregivers r = 0.63, P < 0.0001) and psychological morbidity (dementia caregivers r = 0.67, stroke caregivers r = 0.56, P, 0.0001).ConclusionElderly co‐resident caregivers for stroke and dementia patients experience similar degrees of burden and high levels of psychological morbidity. Psychiatric aspects of chronic disability, rather than physical aspects, were found to be more stressful to caregivers. All assessments of the disabled elderly should include measures of caregiver burden and psychological distress.
The Mini‐Mental State Examination: A Comprehensive Review
Authors: Tombaugh Tom N. , McIntyre Nancy J. 
Published: April 2015

ObjectiveThe purpose of this paper is to provide a comprehensive review of information accumulated over the past 26 years regarding the psychometric properties and utility of the Mini‐Mental State Examination (MMSE).ParticipantsThe reviewed studies assessed a wide variety of subjects, ranging from cognitively intact community residents to those with severe cognitive impairment associated with various types of dementing illnesses.Main Outcome MeasuresThe validity of the MMSE was compared against a variety of gold standards, including DSM‐III‐R and NINCDS‐ADRDA criteria, clinical diagnoses, Activities of Daily Living measures, and other tests that putatively identify and measure cognitive impairment.ResultsReliability and construct validity were judged to be satisfactory. Measures of criterion validity showed high levels of sensitivity for moderate‐to‐severe cognitive impairment and lower levels for mild degrees of impairment. Content analyses revealed the MMSE was highly verbal, and not all items were equally sensitive to cognitive impairment. Items measuring language were judged to be relatively easy and lacked utility for identifying mild language deficits. Overall, MMSE scores were affected by age, education, and cultural background, but not gender.ConclusionsIn general, the MMSE fulfilled its original goal of providing a brief screening test that quantitatively assesses the severity of cognitive impairment and documents cognitive changes occurring over time. The MMSE should not, by itself, be used as a diagnostic tool to identify dementia. Suggestions for the clinical use of the MMSE are made.
Pentoxifylline in Cerebrovascular Dementia
Authors: Black Ronald S. , Barclay Laurie L. , Nolan Karen A. , Thaler Howard T. , Hardiman Stephen T. , Blass John P. 
Published: April 2015

ObjectiveTo test the effect of pentoxifylline, a hemorheologic agent used to treat intermittent claudication, on the course of vascular dementia.DesignRandomized, double‐blind, placebo‐controlled, parallel group trial.SettingOutpatient tertiary care center.Patients64 patients meeting DSM‐III criteria for multi‐infarct dementia with modified Hachinski ischemic scores ≥6, 38 of whom completed the trial.InterventionPentoxifylline (Trental®) 400 milligram tablets three times daily vs placebo for 36 weeks.Main Outcome MeasureAlzheimer's Disease Assessment Scale (ADAS).ResultsBaseline demographic values and psychometric variables were similar in the placebo and control groups; endpoint statistical analysis was used to allow the use of data from all patients in this clinically high‐risk group. For the total group, the slowing of deterioration did not reach statistical significance (by 2‐tailed t test), as measured by scores on the total ADAS (P = 0.058) or on the cognitive (ADAS items 1–11; P = 0.064) or non‐cognitive subscales (ADAS items 12–21; P = 0.234), although it was significant on the cognitive subscales excluding memory (ADAS items 2–6, 8–10; P = 0.036). For the subgroup of 40 patients who had CT and/or MRI evidence of stroke as well as meeting the other inclusion criteria, treatment with pentoxifylline was associated with significantly slower deterioration, as measured by the total ADAS (P = 0.023) and cognitive subscores (P = 0.020) but not non‐cognitive subscores (P = 0.118). For the subgroup of 37 patients who had at least one discrete clinical stroke, treatment with pentoxifylline was associated with significantly less deterioration on the total ADAS (P = 0.002) and both the cognitive (P = 0.001) and non‐cognitive (P = 0.017) subscores.ConclusionTreatment with pentoxifylline may slow the progression of dementia in patients who meet DSM‐III criteria for “multi‐infarct dementia” and who also have clinical and neuroradiological evidence of cerebrovascular disease.
Self‐Reported Functional Status Predicts Change in Level of Care in Independent Living Residents of a Continuing Care Retirement Community
Authors: Falconer Judith , Naughton Bruce J. , Hughes Susan L. , Chang Rowland W. , Singer Ruth H. , Sinacore James M. 
Published: April 2015

ObjectiveTo test the hypothesis that self‐reported functional status predicts change in level of care from independent to dependent in residents of a continuing care retirement community (CCRC).DesignTwo‐year longitudinal descriptive study of change in level of care and survival.SubjectsOne hundred fifty‐two residents in the independent‐living unit of a non‐profit CCRC. Mean age at initial evaluation was 82.3 years, SD 6.2.MeasurementPredictor variables assessed at baseline were age, sex, physician estimate of functionally significant disease, self‐reported functional status, and performance‐based hand function. Criterion variables collected at 2‐year follow‐up were level of care (independent/dependent) and survival (alive/dead).Main ResultsSelf‐reported functional status (P < 0.01) and age (P < 0.05) were significant predictors of change in level of care in a logistic regression analysis containing all predictor variables. No variable predicted survival.ConclusionsSelf‐reported functional status may help to predict dependency in older adults in good health who have few markers of dependency risk.
The Use of Goal Attainment Scaling in a Geriatric Care Setting
Authors: Stolee Paul , Rockwood Kenneth , Fox Roy A. , Streiner David L. 
Published: April 2015

ObjectiveGoal attainment scaling (GAS) is a measurement approach used extensively in mental health. It accommodates multiple individual patient goals, yet retains mathematical properties allowing comparisons between patients. This study was carried out to investigate the feasibility and measurement properties of GAS in a geriatric care setting.DesignProspective descriptive study.SettingThe geriatric restorative care service and geriatric assessment unit at Camp Hill Hospital, a 350‐bed tertiary care facility in Halifax, Canada.PatientsFifteen patients aged 65 to 94 who were consecutively admitted to the two geriatric services (mean age 79 years, mean length of stay 37 days, 9 females).InterventionGoal Attainment follow‐up guides were developed independently for each patient by two geriatricians after a comprehensive assessment of the patient. These guides were later compared to assess level of agreement in goal setting and scale development. A single goal attainment follow‐up guide was then developed for each patient by consensus of the two geriatricians. At the end of the follow‐up, the guides were scored independently for each patient by one of the geriatricians and by the patient's primary care nurse.Main Outcome MeasuresGAS scores were determined on admission and discharge. Each patient also received admission and discharge ratings on the Barthel Index as well as a global rating of outcome (on a subjective 10‐point scale) by a geriatrician who was blinded to the Goal Attainment follow‐up score.ResultsGAS proved feasible, requiring 15–20 minutes to scale an average of six goals per patient. GAS also appears reliable. Of 87 goals, 71 (82%) were identified independently by two geriatricians, and the remainder were determined by consensus. This is also a measure of content validity. The physician‐nurse inter‐rater reliability was 0.87 (intraclass correlation). Concurrent validity was assessed by correlation with the Barthel Index (r = 0.86) and the global clinical outcome rating (r = 0.82). Content validity was also assessed by comparing our goal areas with those identified in recent consensus reports on geriatric assessment. Of these 13 assessment areas, 12 appeared to be reasonably well covered while one assessment area (sexual problems) was not identified for any of the 15 patients.ConclusionsGAS appears to be a feasible method of goal setting and outcome evaluation in geriatric care settings, with promising reliability and validity.
The Equivalency of Infrared Tympanic Membrane Thermometry with Standard Thermometry in Nursing Home Residents
Authors: Castle Steven C. , Toledo Santiago D. , Daskal S. Lorraine , Norman Dean C. 
Published: April 2015

Objective: To compare the equivalence of infrared tympanic membrane (TM) measure of body temperature with standard electronic oral (PO) and rectal (R) measures in a nursing home population.Objective: Randomized repeated‐measurement design.Methods: For the study, 82 randomly selected residents (mean age 79 ± 10 years) of the Nursing Home Care Unit of the VAMC West Los Angeles had PO, R, and TM temperatures measured before arising (6–8 am). An otoscopic exam and the age, sex, presence of neurologic disease, and compliance with thermometry was noted. Also, repeated measures of PO and TM temperatures were performed three times to assess variability. The Pearson's correlation coefficient was determined for PO versus R and for TM versus R temperatures. Stepwise regression analysis was performed with the dependent variable of R temperature and the independent variables of the mean TM temperature, age, sex, presence of neurologic disease, position of the resident, and extent of ear canal occlusion.Results: The correlation of TM versus R (r = .39, P = .004) was better, though not significantly, than of PO versus R (r = .28, P = .04). TM had less variability than PO (pooled standard deviation .38 vs .45° F, respectively) and TM was implemented successfully more often than PO or R (96% vs 81% vs 81%).Conclusion: Therefore, TM was at least equivalent or better than PO measures of temperature in this population. The efficacy of fever detection and the use and durability of long‐term use by nursing staff needs to be studied. J Am Geriatr Soc 1212–1216, 1992
The Effect of Geriatric Evaluation and Management on Medicare Reimbursement in a Large Public Hospital: A Randomized Clinical Trial
Authors: Rubin Craig D. , Sizemore Mark T. , Loftis Paula A. , Adams‐Huet Beverley , Anderson Ron J. 
Published: April 2015

Objective: To study the effect of a geriatric evaluation and management program on health care charges and Medicare reimbursement.Design: Prospective randomized controlled trial during a 1‐year study period.Setting: Large medical school‐affiliated public hospital in an urban community.Subjects: Patients at least 70 years old admitted to the medicine service were screened and randomized into two groups of 100 patients each.Intervention: Patients randomized to the experimental group underwent initial comprehensive geriatric evaluation and once discharged from the hospital were enrolled in a geriatric care management and treatment program. The control group received usual care only. The major intervention of this study was in outpatient long‐term care.Main Outcome Measure: Total charges for services billed to Medicare Part A and Part B and total Medicare reimbursement. The Medicare charge and reimbursement data were obtained by use of the Medicare Automated Data Retrieval System, a linked Medicare Part A and Part B utilization file.Results: Total charges and reimbursement were greater for the control group but not significantly so. Subset analysis revealed significantly greater inpatient charges (P < 0.03) and Medicare reimbursement (P < 0.005) for the control patients and a greater likelihood of utilization of home health care services in the experimental group (P < 0.01).Conclusion: A geriatric evaluation and management program appeared to shift utilization and Medicare expenditures from inpatient services to home health care services. There was no evidence that the experimental program resulted in increased expenditures for Medicare. In selected populations, geriatric evaluation and management programs may contribute to cost containment. J Am Geriatr Soc 40: 989–995, 1992