bluuebunny/crossref_metadata_2025_split huggingface dataset:
Admission Health Status Differences of Black and White Indigent Nursing Home Residents
Authors: Stegbauer Cheryl Cummings , Engle Veronica F. , Graney Marshall J. 
Published: April 2015

OBJECTIVE: To compare the health status of newly admitted lower socioeconomic status (SES) southern black (n = 81) and white (n = 53) nursing home residents.DESIGN: The study data were part of a larger prospective study on the health of newly admitted nursing home residents.SETTING: A 575‐bed, government‐funded nursing home providing care for indigent residents in a large southern city.PARTICIPANTS: Newly admitted black and white nursing home residents aged 60 and older.MEASUREMENTS: Mental status was measured using the Short Portable Mental Status Questionnaire, activities of daily living by Scaled Outcome Criteria, and medical status by medical diagnoses and medications.MAIN RESULTS: Blacks entering the nursing home were more cognitively and functionally impaired and had 3.7 years less education than white residents, but average age was not significantly different for black and white residents.CONCLUSIONS: Many common health status measures showed no significant black‐white differences for institutionalized older adults when region and SES were constants. However, mental status, self‐care activities, and marital status were significantly different. These findings indicate a possible impact of lifelong poverty or low educational attainment on the increased disability of indigent black older adults. Black residents in our study had less spousal support to remain in the community.
A Cost and Value Analysis of Two Interventions with Incontinent Nursing Home Residents
Authors: Schnelle John F. , Keeler Emmett , Hays Ron D. , Simmons Sandra , Ouslander Joseph G. , Siu Albert L. 
Published: April 2015

OBJECTIVE: More than half of nursing home residents suffer from urinary incontinence. These residents typically have long stays and, because of comorbid cognitive and physical impairments, have little hope of living again in a noninstitutional environment The value of interventions to change functional status of this chronically institutionalized population is often questioned. This paper explores this value issue in the context of two incontinence management interventions that have been shown to improve functional status: (1) Functional Incidental Training (FIT), and (2) Prompted Voiding (PV). The relative value of the different interventions for the nursing home population was estimated using paired preferences.DESIGN: The cost of two interventions (FIT and PV) that target incontinent nursing home residents was related to the value of these interventions as perceived by consumers of nursing home services. Both interventions decrease incontinence frequency, and one intervention also improves mobility endurance.PARTICIPANTS: Ninety incontinent nursing home residents received the intervention; 37 older nondemented board and care residents and 31 family members of the nursing home residents provided estimates of the intervention's value.MEASUREMENT: The staff‐time allocations involved in implementing both interventions were documented in more than 85 resident care episodes. These time data were converted to labor cost based on the cost of nursing aides who would actually implement the intervention. The value of each intervention was assessed by asking consumers to make choices between the intervention and its associated outcomes (such as increased dryness) and other nursing home services of known cost (e.g., moving to a private room).RESULTS: Both interventions had labor costs that were greater than “usual care” costs. The additional cost was estimated to be $4.31 per resident per day for PV and $6.42 per resident per day for FIT if these programs were implemented from 7 AM to 7 AM. Consumer preference data indicated that consumers preferred the FIT and PV outcomes to more expensive alternative services, calculated to cost $10.00 per day, often marketed to consumers,CONCLUSION: Consumers may prefer the FIT and PV interventions relative to the typical services often marketed to the nursing home consumer. The analysis completed in this paper suggests that both interventions have value for frail residents likely to live out their lives in a nursing home.
Falls Among Older People: Relationship to Medication Use and Orthostatic Hypotension
Authors: Liu Barbara A. , Topper Anne K. , Reeves Richard A. , Gryfe Cyril , Maki Brian E. 
Published: April 2015

OBJECTIVE: To assess the risk of falls attributable to medication use and orthostatic hypotension.DESIGN: Prospective cohort study.SETTING: Two self‐care, apartment‐style residential facilities in the Toronto area.PARTICIPANTS: A total of 100 consecutive older volunteers (mean age = 83, range 62–96) who were independent in activities of daily living and able to stand unaided.MEASUREMENTS: Prescription medications used by each subject were documented at baseline. Blood pressure measurements were performed supine, immediately after standing, and after 5 minutes. Subjects reported falls weekly, by postcard, for a period of 1 year; nonreporters were contacted by telephone.RESULTS: Fifty‐nine percent of subjects fell at least once during the 1‐year follow‐up. Antidepressant use was associated with an increase in the risk of experiencing one or more falls (RR = 1.6, P = .02). The use of other drug classes examined, including diuretics and sedative‐hypnotics, was not associated with an increased risk of falling. Orthostatic hypotension was not predictive of falls. Surprisingly, there was an increase in the diastolic blood pressure of fallers, after 5 minutes, that was not seen in the nonfallers (3.3 vs −0.2 mm Hg, P = .05). Possible explanations for this previously unreported observation are explored.CONCLUSION: Patients using antidepressants should be followed closely because the risk of falls is increased. Previously reported relationships between benzodiazepines and diuretics and falls are not supported by the present findings. Clinical detection of orthostatic hypotension is unlikely to be useful in predicting future risk of falling.
Risk Factors For Motor Vehicle Crashes Among Older Drivers in a Rural Community
Authors: Foley Daniel J. , Wallace Robert B. , Eberhard John 
Published: April 2015

OBJECTIVE: To estimate the motor vehicle crash rate in a cohort of older drivers from a rural community and to identify health‐related conditions that increase their risk for crash involvement.DESIGN: Cohort study with 5 years of crash‐record surveillance.SETTING: The Iowa 65+ Rural Health Study, one of four Established Populations for Epidemiologic Studies of the Elderly (EPESE).PARTICIPANTS: A total of 1791 drivers aged 68 years and older.MAIN MEASURES: Exposure measures of physical, mental, and sensory well‐being from a health interview survey; outcome measure of police‐reported crashes maintained by the Iowa Department of Motor Vehicles.RESULTS: Between 1985 and 1989, 206 drivers were involved in 245 state‐recorded crashes. The estimated annual crash involvement rate for these rural older drivers (28 per 1000 driving‐years) was about 20% less than the national average for drivers aged 65 years and over (36 per 1,000). An increased risk for motor vehicle crashes was associated with episodes of back pain (Relative Risk = 1.4, P < .05), use of nonsteroidal anti‐inflammatory drugs (RR = 1.7, P < .01), and poor performance on a free‐recall memory test (RR = 1.4, P < .05).CONCLUSIONS: If these and other geriatric conditions are confirmed as risk factors for motor vehicle crashes, medical guidelines for license renewal may need updating and health professionals may need new instruments to detect older patients at high risk for unsafe driving.
Literacy and Performance on the Mini‐Mental State Examination
Authors: Weiss Barry D. , Reed Richard , Kligman Evan W. , Abyad Abdul 
Published: April 2015

OBJECTIVE: Mini‐Mental State Examination (MMSE) scores are associated with age, education, and ethnicity. The objective of this research was to determine the relationship between MMSE and literacy.DESIGN: Cross‐sectional.SETTING: A Community population in Tucson, Arizona.PARTICIPANTS: Senior citizens in public assistance housing.MEASUREMENTS: MMSE score, reading level, and socio‐demographic variables.MAIN RESULTS: A total of 214 subjects were tested. The mean age was 72.3 (±8.01), and the mean education level was 10.3 years (range 0–20 years). Reading levels ranged from grade 0 (non‐reader) to 8 (maximum value for the test used), with a mean of 4.8 (±2.8). MMSE scores ranged from a mean of 21.9 (±4.6) for non‐readers to a mean of 28.0 (±2.0) for subjects with ≥8th grade reading skills.Multiple regression using reading level, education, age, and ethnicity as independent variables, and MMSE score as the dependent variable, showed the highest correlation was between MMSE and reading level (R2 = .265). Education level made only a small additional contribution; age and ethnicity did not enter the regression equation. Correlations between reading level and individual MMSE subsections were highest between reading level and MMSE language items (r = .499).CONCLUSIONS: The correlation between MMSE score and reading skills is stronger than the correlation with other sociodemographic variables. Proper interpretation of MMSE scores requires knowledge of patients' reading levels.
Factors Influencing Users' Return Home on Discharge from a Geriatric Intermediate Care Facility in Japan
Authors: Ishizaki Tatsuro , Kai Ichiro , Hisata Mitsuru , Kobayashi Yasuki , Wakatsuki Ken‐ichi , Ohi Gen 
Published: April 2015

OBJECTIVES: To determine the factors that influence users' destinations on discharge from Geriatric Intermediate Care Facilities (GICFs), which were established in Japan in 1987 to help hospitalized older people return home.DESIGN: Retrospective chart review.SETTING: A 94‐bed GICF attached to Saku Central Hospital in Japan.SUBJECTS: Charts of all users (N = 437) aged 65 years and older, discharged from the GICF between July 1987 and February 1991, were reviewed.MEASUREMENTS: The independent variables, obtained from users' admission records, were age, sex, place of residence before admission, length of stay, intellectual impairment (assessed by Karasawa's diagnostic criteria for senile dementia), ability to perform activities of daily living (ADLs), and living arrangement of users in the GICF. The dependent variable was destination after discharge from the GICF.MAIN RESULTS: Multiple logistic regression analyses revealed that, compared with users who were able to successfully return home, users with little ability to perform ADLs, male users, and those admitted from other institutions were more likely to be hospitalized. Such analyses also revealed that users who came from institutions, had low ability to perform ADLs, and lived alone were more likely to be institutionalized in nursing homes.CONCLUSIONS: Evaluating a user's physical, mental, and socioeconomic conditions at an early stage of admission to a GICF may allow us to predict whether the user can be successfully discharged to his or her home or will have to remain at the GICF for an extended period.
Resilience to Exercise Detraining in Healthy Older Adults
Authors: Sforzo Gary A. , McManis Beth G. , Black Donna , Luniewski Dawn , EdD Kent C. Scriber 
Published: April 2015

OBJECTIVE: To determine the effects of stopping and restarting two types of exercise programs in older adults.DESIGN: A controlled, longitudinal study that utilized random assignment of volunteers. Treatments were exercise programs designed to improve cardiovascular or neuromuscular fitness.MEASUREMENTS: Dependent variables measured before and after implementation of treatments were: maximum oxygen consumption, oxygen pulse, treadmill and cycle training workloads, quadriceps isokinetic peak torque, quadriceps isokinetic total work, and quadriceps training workload.MAIN RESULTS: Exercise training was highly effective in improving cardiovascular endurance or muscular strength. Ten weeks of exercise detraining resulted in small losses in newly gained cardiovascular capacity but more noticeable losses in muscular strength. Exercise retraining was accomplished easily using cardiovascular or resistive exercises. The functional benefits of restarting a cardiovascular exercise program appeared additive despite a 10‐week intervening period of exercise detraining. In this age group, cardiovascular exercise produced limited improvements in muscular strength, and resistive exercise training positively influenced cardiovascular exercise performance.CONCLUSIONS: Older adults are fairly resilient to 10 weeks of cardiovascular detraining and retain newly gained muscular strength for at least 5 weeks, despite an interruption of formal exercise. An occasional missed exercise session or temporary cessation of habitual exercise should not be a cause for distress in exercising older adults. Instead, they should realize the ease with which they may restart their exercise program and also appreciate the generalizable fitness benefits that can be ascribed to becoming more active. J Am Geriatr Soc 43: 209–215, 1995.
Medical Care Utilization Among Older HMO Members With and Without Hypertension
Authors: Ried L. Douglas , Johnson Richard E. , Brody Kathleen K. , Vogt Thomas M. 
Published: April 2015

OBJECTIVES: To compare hospital utilization, health status, and sociodemographic characteristics of older persons with and without hypertension and to examine the nature of the association of hypertension with medical care utilization.DESIGN: A retrospective, nonexperimental study.SETTING: A large health maintenance organization (HMO), located in the Portland, Oregon and Vancouver, Washington areas, that provides comprehensive, prepaid benefits to its members.PARTICIPANTS: Approximately 4200 older (≥65 years) members enrolled in the Social HMO Demonstration Project.MEASUREMENTS: The dependent variables were (1) whether a member was hospitalized (0 = no; 1 = yes) and (2) the number of hospitalizations during the 12‐month period before the return of the Health Status Form, a mail questionnaire. The predictor variables were high blood pressure and other medical conditions, health status, and sociodemographic characteristics. Patients classified as hypertensive were those who self‐reported high blood pressure and who received two or more dispensings for antihypertensive medications.RESULTS: Older hypertensives were more likely than older nonhypertensives to have been hospitalized (odds ratio (OR) = 1.14 (95% CI 1.01,1.27)), self‐report their health as only good or fair (P < .001), self‐report IADL functional limitations (P < .001), and to be younger than nonhypertensives (P < .001). Utilization differences were similar after controlling for patients' age and gender. Factors independently associated with an increased likelihood of hospitalization were: male gender (OR = 1.14 (1.00,1.31)), age (OR = 1.35 (1.00,1.81)), poor (OR = 1.32 (1.02,1.72)) or fair (OR = 1.20 (1.01,1.44)) self‐rated health status, functional limitations in activities of daily living (OR = 1.74 (1.48,2.03), and self‐reported heart trouble (OR = 1.50 (1.34,1.68)), stroke (OR = 1.37 (1.15,1.64)), or cancer (OR = 2.89 (1.72,4.84)). Factors independently associated with a decreased likelihood of hospitalization were excellent self‐reported health (OR = 0.65 (0.47,0.90)), no physical impairments (OR = 0.59 (0.48,0.72)), and no circulation problems (OR = 0.85 (0.74,0.98)).CONCLUSIONS: Older hypertensive patients had poorer self‐reported health, more functional limitations, used more hospital services, and were not as old as nonhypertensive older patients. To the extent that general health is improved by treatment of hypertension, appropriate treatment of high blood pressure may not only improve health, it may also reduce medical care utilization. Our findings offer further support for hypertension prevention, detection, and treatment programs designed to reduce or minimize hypertension's later medical complications and to reduce future utilization. J Am Geriatr Soc 43: 222–229, 1995.
Health Outcomes of Post‐Hospital In‐Home Team Care: Secondary Analysis of a Swedish Trial
Authors: Melin Anna Lisa , Wieland Darryl , Harker Judith O. , Bygren Lars Olov 
Published: April 2015

Health Outcomes of Post‐Hospital In‐Home Team Care: Secondary Analysis of a Swedish TrialOBJECTIVE: To determine patient and treatment‐related factors predictive of health outcomes.DESIGN: Secondary analysis of a randomized trial with 6‐month follow‐up. After using bivariate and three‐way analysis in the total sample to screen outcome predictors and interactions among baseline variables, multivariate logistic regression was used to model outcomes.SETTING: A county general hospital in central Stockholm, and patients' homes nearby.PATIENTS: Hospital inpatients stable for discharge from acute care having at least one chronic condition, and dependent in 1 to 5 Katz activities of daily life (ADLs) were included. Subjects (mean age = 81.1 years) were randomized to “team” (n = 150) or “usual care” (n = 99).INTERVENTIONS: Team patients were eligible for in‐home primary care by an interdisciplinary team that included a physician, physical therapist, and 24‐hour nursing services and geriatric consultation where necessary. “Usual‐care” patients received standard district nurse‐administered services at home upon hospital discharge.MEASUREMENTS: Demographic, functional status, and medical characteristics were measured at randomization. Outcomes included survival and higher ADL, instrumental ADL (IADL), and outdoor ambulation scores.CONCLUSIONS: Heterogeneous clinical populations of older patients contain many prevalent characteristics important to outcomes. Secondary analysis of trials including interactions identifies treatable and untreatable risks, what program components may be effective, and who benefits. J Am Geriatr Soc 43: 301–307, 1995.
Increased Fall Rates in Nursing Home Residents After Relocation to a New Facility
Authors: Friedman Susan M. , Williamson Jeff D. , Lee Ben H. , Ankrom Michael A. , Ryan Stephen D. , Denman Susan J. 
Published: April 2015

OBJECTIVE: To examine the change in fall rates after relocation of nursing home residents from one facility to another and to identify resident risk factors for changes in falls following relocation.DESIGN: Retrospective review of incident reports to identify falls, followed by chart review of a longitudinal cohort.SETTING: An academic nursing home whose residents and programs moved from a 125‐ year‐old, 233‐bed facility to a newly constructed 255‐bed facility.PATIENTS: A total of 210 nursing home residents were moved from one facility to the other. Of these, 133 individuals who lived in the old facility for 9 months before the move and in the new facility for 6 months after the move formed the longitudinal cohort.RESULTS: In the 3 months after the move, the fall rate increased from 0.34 to 0.70 falls per resident per quarter in the entire nursing home population (P < .001) and subsequently returned to baseline. In the longitudinal subgroup the fall rate went from 0.26 to 0.60 (P < .005). Fall‐related injuries in the longitudinal subgroup went from 0.058 injuries per resident per quarter at baseline to 0.15 (P < .001). However, the injury rate per fall did not change. There were no characteristics associated with being a faller in the quarter before the move. Dementia and not being bedbound were associated with being a faller after the move. Individuals who were ambulatory or wheelchair mobile had a significant risk of increasing the number of falls after the move, and individuals with dementia had a strong but insignificant trend in this direction.CONCLUSIONS: The incidence of falling doubled after relocation of nursing home residents to a new facility. An increase in falls was seen in individuals who were not bed‐bound. Although nursing home relocation may be a relatively uncommon occurrence, it is reasonable to infer that older individuals who change their living environments are at increased risk for falls and fall‐related injuries.
The Neuropsychological Differentiation of Patients with Very Mild Alzheimer's Disease and/or Major Depression
Authors: desRosiers Gabriel , Hodges John R. , Berrios German 
Published: April 2015

OBJECTIVE: To evaluate the usefulness of standardized neuropsychological tests in the psychometric differentiation of patients with very mild or mild Alzheimer's Disease (AD) and/or major depression presenting in a tertiary clinic with memory/attention complaints.DESIGN: Controlled prospective clinicoexperimental design.SETTING: Multidisciplinary Memory Clinic at Addenbro‐oke's Hospital, Cambridge, England.PARTICIPANTS: Twenty‐four patients with a clinical diagnosis of Alzheimer's disease (12 with major depression and 12 without), 12 patients with major depressive illness but without AD, and 12 healthy control subjects, all matched for age, sex, education levels, and estimates of premorbid intellectual potential.MEASUREMENTS: Mini‐Mental State Examination (MMSE), Wechsler's Logical Memory (WLM) and Visual Reproduction (WVR), immediate and delayed reproduction, Wechsler's paired Associate Learning (WPAL), including the Easy and Hard subsets. Warrington's Recognition Memory for Faces (WRMF), Kendrick's Object Learning (KOLT) and Digit Copying (KDCT)Tests.OUTCOME MEASURES: Minimum 2‐year follow‐up diagnosis.RESULTS: Statistically, patients with very mild AD were distinguished clearly from those without AD on most tests of memory functions. Psychometrically, only KOLT and an index of retention on WLM and WVR were specific enough to avoid false positives, a requirement for second‐stage tools. They also proved sensitive enough to suggest their role as first‐stage instruments when screening for primary dementia in high‐functioning patients scoring above the cut‐point on MMSE.CONCLUSIONS: As efforts intensify to develop more powerful means to identify patients with Alzheimer's disease in its earliest stages, inclusion of specialist tests posing greater cognitive challenge than standard mental status scales has been one strategy. Our study explored how some of these neuropsychological tools behave psychometrically when analyzed on a single‐case basis, and the results suggest a few are sensitive enough to boost detection above base rates alone while also being specific enough to reduce false alarms. Retention on Wechsler's Logical Memory and Visual Reproduction tasks and scores on Kendrick's Object Learning Test helped decrease the degree of ambiguity when cognitive profiles were used to distinguish depressed patients with Alzheimer disease from those without.