bluuebunny/crossref_metadata_2025_split huggingface dataset:
Minimum Data Set Plus (MDS+) Scores Compared with Scores from Five Rating Scales
Authors: Frederiksen Kirsten , Tariot Pierre , De Jonghe Erik 
Published: April 2015

OBJECTIVE: To compare mandated Minimum Data Set Plus (MDS+) ratings of behavior, function, mood, communication, and cognition to ratings of these domains using analogous research instruments.DESIGN: Cross‐sectional correlational study of criterion‐related validity.SETTING: Three nursing homes in Rochester, New York.PARTICIPANTS: Fifty‐two nursing home residents.MEASUREMENTS: Nursing home staff completed the MDS+ for each subject. Research scales were completed by trained research clinicians, independently of and blinded to the MDS+ results, using the Mini‐Mental State Exam (MMSE), Brief Psychiatric Rating Scale (BPRS), Dementia Mood Assessment Scale (DMAS), Psychogeriatric Dependency Rating Scale (PGDRS), and Physical Signs and Symptoms Scale (PSMS).RESULTS: MDS+ measures of functional status, cognitive impairment, and communication were highly correlated with comparable research rating scale scores. Pearson correlation between MDS‐functional status and PSMS scores was 0.89, between MDS‐dementia and BPRS Factor 3 (representing cognitive dysfunction) and MMSE scores was 0.85 and 0.77, respectively, and between MDS‐communication and MMSE and PGDRS Item 6 (assessing communication) scores was 0.74 and 0.62, respectively. Behavior and mood scores did not correlate nearly as well with comparable research scale scores. Pearson correlation between MDS‐behavior and PGDRS and BPRS total scores was 0.54 and 0.51, respectively, and between MDS‐mood and BPRS Factor 1 (depression) and DMAS 1–17 subtotal (mood disturbance) scores was 0.20 and 0.20, respectively.CONCLUSION: This preliminary study in a small sample shows marked agreement between three of the five MDS+ components analyzed and comparable research rating scales and confirms that behavior and mood are difficult to assess with simple instruments. J Am Geriatr Soc 44:305–309, 1996.
Sequential Outbreak of Influenza A and B in a Nursing Home: Efficacy of Vaccine and Amantadine
Authors: Libow Leslie S. , Neufeld Richard R. , Olson Ellen , Breuer Brenda , Starer Perry 
Published: April 2015

OBJECTIVE: To describe the sequential occurrence of influenza A and B in a nursing home, and to determine the efficacy of influenza vaccine and/or amantadine treatment with respect to incidence and sequelae.SETTING: The Jewish Home and Hospital for Aged, a skilled‐care nursing facility.PARTICIPANTS: Of 499 frail older nursing home residents, 139 contracted influenza during the study period (mean age 87.5 years; SD = 6.7). The residents were followed from February through April 1988.INTERVENTION: Influenza vaccine and/or amantadine.MEASUREMENTS: Episodes of influenza and their sequelae, i.e., pneumonia, hospitalization, and death.RESULTS: The vaccine had no effect on the incidence of influenza‐like illness, length of illness, or the associated death rate. It reduced the rate of pneumonia secondary to influenza A and B (relative risk = .57; 95% CI: .37 to .89; P = .023). Amantadine did not affect the attack rate of influenza nor the rate of pneumonia secondary to influenza. It was associated with decreased mortality (relative risk = 0; P = .001), and shorter length of influenza A illness (PWilcoxon = .082). Although the combination of amantadine and vaccine did not affect length of influenza (A or B) illness, it was associated with a significantly lower rate of sequelae (relative risk = .58; 95% CI: .36 to .95; P = .024).CONCLUSION: In this epidemic, the combination of amantadine and vaccine was most effective in reducing the rate of influenza‐associated sequelae. The possibility of a “biphasic” epidemic prompts consideration of vaccinating nonimmunized nursing home residents, even though it may be late in the influenza season.
Prognostic Value of Noninvasive Risk Stratification in Younger and Older Patients Referred for Evaluation of Suspected Coronary Artery Disease
Authors: Shaw Leslee J. , Miller D. Douglas , Romeis James C. , Younis Liwa T. , Gillespie Kathleen N. , Kimmey James R. , Chaitman Bernard R. 
Published: April 2015

OBJECTIVES: The purpose of this investigation is to explore the relationship of patient gender and age on coronary artery disease diagnostic evaluation and to assess the impact of noninvasive testing results on coronary revascularization rates and cardiac event‐free survival.STUDY DESIGN: Retrospective observational cohort.PARTICIPANTS: From a series of 5322 consecutively tested patients from a Midwestern university tertiary medical center, a hospital cohort of 1345 patients with clinically suspected coronary artery disease was enrolled from 1988 through 1989.MEASUREMENTS AND RESULTS: Cardiac risk factor and symptom profiles were worse in women, whereas rates of positive test results were similar in both sexes. Multivariable‐adjusted risk for follow‐up diagnostic testing was 1.8 and 1.9 times greater, respectively, for men ≤ and > 65 years of age than for women (P < .01). Younger women were 4.9 times (P = .001) more likely to experience a cardiac event than younger men, with no differences between younger and older women (relative risk = 1.1; P > .20). Overall cardiac event rates were 2.3, 7.4, 16.7, and 20.2% for young men, young women, older women, and older men, respectively. Initial screening was delayed 2 to 7 times longer for older and younger women compared with men (P < .001); the greatest delays were observed for younger women. Diagnostic follow‐up and subsequent cost of total care from initial evaluation through 2 years of follow‐up were higher for men than for women (P < .0001), with older women having the lowest rate of subsequent diagnostic and interventional follow‐up. In the highest risk patients, subsequent utilization rates were 40 and 20% higher for younger and older men than for similarly aged women. In particular, diabetics were less likely to undergo follow‐up diagnostic testing and revascularization (67% younger women).CONCLUSIONS: Age appears to significantly and differently influence decisions regarding noninvasive and invasive medical service utilization in men and women and may partially account for variable outcomes in this and previous gender‐based comparisons.
Patient Factors Associated with Breast Cancer Screening Among Older Women
Authors: Marwill Sandra L. , Freund Karen M. , Barry Patricia P. 
Published: April 2015

OBJECTIVES: To identify patient factors that influence physicians' decisions to recommend screening mammograms for older women.DESIGN: A cross‐sectional survey including clinical case vignettes.PARTICIPANTS: Random sample of Massachusetts internists, obstetrician/gynecologists, family/general practice physicians, and geriatricians.OUTCOME MEASURE: Proportion of screening mammograms recommended for women in different versions of each case vignette.RESULTS: A total of 482 (65%) of the eligible participants responded to a mailed survey of questions about breast cancer screening practices, attitudes toward ACS guidelines, and four clinical vignettes. Vignettes tested the impact of patient's age, cognitive function, nursing home residence, functional limitations, and comorbidity on the physician's decision to recommend a mammogram.Ninety‐four percent of physicians reported often performing periodic clinical breast exams and mammograms for women aged 65 to 74. For women aged 75 to 84, 89% of physicians reported often performing periodic clinical breast exams, and 79% recommend mammograms. Only 48% strongly agreed with ACS guidelines for annual mammography for women over 65.Age, dementia, and nursing home residence were patient factors associated with decreased mammogram use, but limited mobility and chronic medical problems were not. Physicians were more likely to recommend a mammogram for a woman aged 65 to 74 than for a woman 75 to 84. (P = .002) Physicians were more likely to recommend a mammogram for a woman without dementia than for a woman with mild dementia (P < .05) and for a woman living with her daughter than a for a woman living in a nursing home (P < .001).CONCLUSIONS: Age older than 75, mild dementia, and nursing home residence are factors that negatively influence physicians' decisions to recommend mammography. Presence of chronic medical problems and functional limitations do not. Physicians appear to be using implicit judgments about quality of life and age rather than life expectancy based on comorbidity to determine breast cancer screening practices.
Relationship Between Baseline Insulin‐Like Growth Factor‐I (IGF‐I) and Femoral Bone Density in Women Aged Over 70 Years: Potential Implications for the Prevention of Age‐Related Bone Loss
Authors: Boonen Steven , Lesaffre Emmanuel , Dequeker Jan , Aerssens Jeroen , Nijs Jos , Pelemans Walter , Bouillon Roger 
Published: April 2015

OBJECTIVE: To test the hypothesis that the decline in femoral bone mass associated with healthy aging is partially accounted for by deficiency of the growth hormone‐insulinlike growth factor‐I (IGF‐I) axis.DESIGN: Cross‐sectional study.STUDY PARTICIPANTS: A sample of 245 community‐dwelling healthy women aged 70 and older. Exclusion criteria were diseases or medications known to affect the musculoskeletal system or the somatotrophic axis.MEASUREMENTS: Serum levels of IGF‐I, calcitriol, and osteocalcin were determined by radioimmunoassay; serum calcidiol was measured by competitive binding assay, and serum parathyroid hormone (PTH) was assessed immuno‐chemically. Urinary pyridinium crosslinks were measured by fluorescent detection after high‐pressure liquid chromatography. Isometric and isokinetic quadriceps strength was evaluated using an isokinetic dynamometer. Bone density (BMD) was assessed by dual‐energy X‐ray absorptiometry at the proximal femur. Multiple regression was used to adjust for potential confounders.RESULTS: At the proximal femur, BMD declined by 0.59–0.84% per year. In addition to body mass index and muscle strength, serum IGF‐I was found to be an independent predictor of BMD at all femoral sites.CONCLUSION: The data support the hypothesis that circulating IGF‐I not only reflects the integrated growth hormone secretion but also has a direct role in the endocrine regulation of bone remodeling. The present findings support the need for further studies to assess the potential of IGF‐I in attenuating age‐related femoral bone loss. J Am Geriatr Soc 44:1301–1306, 1996.
Estrogen Replacement Therapy In Older Women: A Neuropsychological And Brain MRI Study
Authors: Schmidt R. , Fazekas F. , Reinhart B. , Kapeller P. , Fazekas G. , Offenbacher H. , Eber B. , Schumacher M. , Freidl W. 
Published: April 2015

OBJECTIVE: To determine if postmenopausal women receiving estrogen perform better on demanding cognitive tests than women without estrogen replacement and if this beneficial effect on cognition is caused by estrogen‐related prevention of silent ischemic brain damage.DESIGN: Cross‐sectional study comparing postmenopausal estrogen users and non‐users.SETTING: Austrian Stroke Prevention StudyPARTICIPANTS: A total of 70 women currently using estrogen and 140 women who have never used estrogen from a subset of 222 postmenopausal women without neuropsychiatric or general disease undergoing extensive diagnostic work‐up in a large‐scale stroke prevention study among randomly selected community members.MEASUREMENTS: Neuropsychological test scores and focal brain abnormalities as well as size of ventricles and cortical sulci as assessed by 1.5 Tesla MRI.RESULTS: Estrogen users performed better than non‐users on almost all neuropsychological tests administered. When ANCOVA was used to correct for slight differences between groups in age, length of education, mean arterial blood pressure and self‐reported activation, values of P < .05 were noted on tasks assessing conceptualization, attention, and visuopractical skills. After adjustment for multiple comparisons, the differences in conceptualization and visuopractical skills remained significant. MRI showed a lower rate and extent of white matter hyperintensities and a significantly smaller total white matter hyperintensity area in women treated with estrogen (P = .043). The total white matter hyperintensity area was inversely related to the duration of estrogen replacement therapy (P = .040). However, there was no difference in neuropsychological performance between estrogen users with and without white matter abnormalities, and this was also supported by the lack of an association between cognitive test results and the extent of white matter disease.CONCLUSIONS: Our study demonstrated an association between estrogen replacement therapy and better cognitive functioning and a lower rate of clinically unsuspected ischemic brain damage in postmenopausal women. J Am Geriatr Soc 44:1307–1313, 1996.
Medical Care in Old Age: What Do Nurses in Long‐term Care Consider Appropriate?
Authors: Gillick Muriel R. , Mendes Marc L. 
Published: April 2015

OBJECTIVES: To determine whether nurses working in a long‐term care institution, who are knowledgeable about the full range of conditions common among older people, favor limitations of treatment in old age; and to study whether the level of intensity of care they regard as appropriate varies with the overall health status of the older individual.DESIGN: Participants were asked to complete an intervention‐specific advance directive for themselves, with scenarios representing terminal illness, dementia plus chronic illness, chronic illness in a nursing home resident, chronic illness in a community‐dwelling older person, and a robust, community‐dwelling older person.SETTING: A 725‐bed long‐term care institution, with residents having a mean age of 88 years and a wide range of physical and cognitive deficits.PARTICIPANTS: Full‐time nurses at the long‐term care facility were eligible and were given survey instruments; 102 of the 145 eligible nurses completed the questionnaire.MEASUREMENTS: The unit of analysis is the refusal rate, defined as the mean number of refusals of interventions for each respondent.MAIN RESULTS: The overall refusal rate for all five scenarios taken together was 72.1%. The refusal rate in the case of terminal illness was 90.9%, in the case of dementia plus chronic illness 81.8%, in the case of dementia in a nursing home 69.1%, for a homebound older person with chronic illness 70.9%, and for a previously healthy 85‐year‐old person living in the community, 50.0% (P < .001).CONCLUSIONS: Nurses working in a long‐term care institution have strong preferences about limiting a variety of interventions in old age. The greater the degree of physical and cognitive impairment, the more limitations they favor. This suggests the necessity of expanding advance planning to include a discussion of what constitutes appropriate treatment in a broad range of circumstances. J Am Geriatr Soc 44:1322–1325, 1996.
Rehabilitation of the Older Lower Limb Amputee: A Brief Review
Authors: Cutson Toni M. , Bongiorni Dennis R. 
Published: April 2015

OBJECTIVE: To review outcomes, over the last 25 to 30 years, of prosthetic rehabilitation in the older patient with a major lower limb amputation.DESIGN: Literature review of articles and reports about lower limb amputation, using key words elderly amputee, rehabilitation, and lower limb amputation, through a computerized Medline Search.CONCLUSIONS: Age alone should not determine prosthetic rehabilitation. Comorbidities and general health are important determinants. The more proximal the amputation, the more energy is demanded from the cardiovascular and pulmonary systems for prosthetic gait.Changes in surgical technique and revascularization procedures have allowed preservation of the knee, which decreases energy demands and allows more older patients a chance to undergo rehabilitation for ambulation. Although the ratio of below knee (transtibial) amputations to above knee (trans‐femoral) amputations has increased, overall postsurgical mortality (10–30%), long term survival (40–50% @ 2 years, 30–40% @ 5 years), and risk of loss of the contralateral leg (15–20% @ 2 years) has not changed significantly since the 1960s.Despite the lack of improvement in survival as a result of the systemic vascular disease, the older patient can benefit from rehabilitation efforts with goals of prosthetic ambulation or simply cosmesis. The shortened longevity emphasizes the need for timely rehabilitation to enhance the quality of the remaining years.The geriatrician can add to the presurgical care and preprosthetic phase of rehabilitation by attention to the problems common to the older patient, i.e., multiple comorbidities, polypharmacy, immobility, and depression. Postoperatively, early mobilization is crucial to avoid the deleterious effects of immobility in the older person.Further investigations into the psychosocial issues and cost benefits of limb loss and prosthetic rehabilitation are needed.In addition, comparison of the various rehabilitation protocols and the impact of cardiac testing before rehabilitation are needed. J Am Geriatr Soc 44:1388–1393, 1996.
The Prevention for Elderly Persons (PEP) Program: A Model of Municipal and Academic Partnership to Meet the Needs of Older Persons for Preventive Services
Authors: Reuben David B. , Hirsch Susan H. , Frank Janet C. , Maly Rose C. , Schlesinger Michael S. , Weintraub Nancy , Yancey Sharon 
Published: April 2015

OBJECTIVE: To create a program to identify preventive needs for community‐dwelling older persons and incorporate intervention strategies to improve implementation of these services.DESIGN: Program development and case‐series.SETTING: Community‐based meal sites, academically administered program.PARTICIPANTS: Persons 60 years of age or older attending meal sites and their primary care physicians.MEASUREMENTS: Demographic characteristics, self‐reported preventive health behaviors and services, blood pressure measurement.RESULTS: During the first 2 years of the program, 927 persons 60 years of age or older were screened. The most common physician‐initiated preventive recommendations were: tetanus booster (72%), aspirin prophylaxis (68%), pneumonia vaccination (61%), and colorectal cancer screening (51%). The most common self‐care recommendations have been: calcium supplementation (54% of women) and breast self examinations (51% of women). As part of the adherence intervention, we were able to complete health educator calls for 600 (65%) subjects. In addition, the physicians of 599 (65%) subjects were contacted either by telephone (n = 496) or by letter only (n = 97).CONCLUSION: A community‐based preventive services program can identify large numbers of unmet preventive services needs, and a dual intervention strategy aimed at meeting these needs can be delivered successfully to the majority of participants. Implementation rates of specific recommendations and impacts on health outcomes remain to be determined. J Am Geriatr Soc 44:1394–1398, 1996.
Balance and Strength Training in Older Adults: Intervention Gains and Tai Chi Maintenance
Authors: Wolfson Leslie , Whipple Robert , Derby Carol , Judge James , King Mary , Amerman Paula , Schmidt Julia , Smyers Donna 
Published: April 2015

OBJECTIVE: To determine the effect on balance and strength of 3 months of intensive balance and/or weight training followed by 6 months of low intensity Tai Chi training for maintenance of gains.DESIGN: Randomized control intervention. Four groups in 2 × 2 design: Control, Balance, Strength, Balance + Strength, using blinded testers.SETTING: Exercise and balance laboratory at University of Connecticut Health Center.PARTICIPANTS: Subjects were 110 healthy community dwellers (mean age 80) who were free of dementia, neurological disease, and serious cardiovascular or musculoskeletal conditions.INTERVENTIONS: Short‐term training (3 months) occurred 3 times/week (45 minutes Balance and Strength, 90 minutes Balance + Strength). Balance training included equilibrium control exercises on firm and foam surfaces and center‐of‐pressure biofeedback. Strengthening consisted of lower extremity weight‐lifting. All subjects then received long‐term group Tai Chi instruction (6 months, 1 hour, 1 time/week).MEASUREMENTS: Losses of balance during Sensory Organization Testing (LOB), single stance time (SST), voluntary limits of stability (FBOS), summed isokinetic torque of eight lower extremity movements (ISOK), and usual gait velocity (GVU).RESULTS AND CONCLUSIONS: Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger: LOB = −;2.0 ± 0.3 (adjusted paired differences, P < .005 ANOVA); SST = 7.0 ± 1.2 sec; and FBOS = 9.0 ± 2.0% of foot length (P < .05). Strengthening increased ISOK by 1.1 ± 0.1 Nm kg−1 (P < .005) There was no interaction between balance and strength training. Significant gains persisted after 6 months of Tai Chi, although there was some decrement.
Exercise with Physically Restrained Nursing Home Residents: Maximizing Benefits of Restraint Reduction
Authors: Schnelle John F. , MacRae Priscilla G. , Giacobassi Karen , MacRae Holden S. H. , Simmons Sandra F. , Ouslander Joseph G. 
Published: April 2015

OBJECTIVE: To evaluate an exercise protocol designed to improve strength and mobility, and to decrease injury risk factors in physically restrained nursing home residents.DESIGN: A randomized controlled trial.PARTICIPANTS: Ninety‐seven residents were randomized into either exercise or control groups. Thirty‐five exercise and 37 control group residents completed all post‐assessments after a 9‐week trial.INTERVENTION: Walking or wheelchair movement training was supplemented by rowing exercise three times per week. Practice in behaviors related to safe movement was provided incidental to the exercise.MEASUREMENT: Endurance, speed, and injury risk measures relevant to walking, wheelchair propulsion, and standing were assessed by standardized protocols. Rowing endurance, rowing range of motion, and handgrip strength measures were collected to assess the effect of the rowing component of the exercise protocol.RESULTS: Fifty‐four percent of the subjects who provided consent did not complete the protocol because of health status changes, lack of cooperation, or physical limitations that precluded exercise. The subjects who completed the exercise program showed significant improvement on injury risk and measures related to upper body strength (handgrip strength, rowing endurance, wheelchair endurance, and speed). Measures related to lower body strength did not significantly improve.CONCLUSION: Physically restrained residents are very frail, and it is difficult to implement a long‐term exercise program with many residents because of this frailty. However, a substantial proportion of residents did cooperate well with the exercise program and showed improvement on measures correlated with decreased injury risk. The exercise program could be easily modified to include more lower body exercise, and the resultant protocol would be an important adjunct to restraint reduction programs.