bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asymptomatic Bacteriuria, Urinary Antibody, and Survival in the Institutionalized Elderly
Authors: Nicolle L. E. , Brunka J. , McIntyre M. , Murray D. , Harding G. K. M. 
Published: April 2015

ObjectiveTo compare clinical status of elderly institutionalized subjects with asymptomatic bacteriuria and normal urinary antibody to those with elevated urinary antibody to the major outer membrane of Escherichia coli.DesignRetrospective review.SettingLong term facility for the elderly.ParticipantsConvenience sample of 63 elderly subjects, 26% of those resident in the institution, aged 78.8 ± 8.4 years with urine specimens collected and stored in 1987.Main Outcome MeasuresDifferences in clinical or functional status, demographic features, and outcome during 3‐years follow‐up between bacteriuric subjects with normal and elevated urine antibody.ResultsThirteen subjects had no bacteriuria, and 12 had infrequent, intermittent bacteriuria; 38 (60%) had persistent bacteriuria, including four with frequent, intermittent infections. In the persistently bacteriuric group, 18 (47%) had persistently elevated urine antibody. There was no significant differences between bacteriuric residents with normal vs elevated urine antibody in clinical or functional status, age, duration of residence, or infecting organisms. However, 11 of 20 in the cohort with normal urine antibody were alive at 3 years compared to 3 of 18 with elevated urine antibody (P = 0.014).ConclusionsElderly institutionalized subjects with persistent bacteriuria and elevated urine antibody have decreased survival compared to those with normal urine antibody. No differences in underlying illness or clinical course to explain this survival difference were identified.
An Overview of Allocation and Rationing: Implications for Geriatrics
Authors: Pawlson L. Gregory , Glover Jacqueline J. , Murphy Donald J. 
Published: April 2015

Geriatricians are faced with increasing pressure from insurers and the public to control costs. At the same time, sub‐specialist colleagues, patients, and the courts often demand ever more costly high‐technology interventions. This conflict will only intensify given the sustained increase in the percentage of GNP spent on medical care. A number of prominent biomedical ethicists and others have explored rationing of medical care services as one response to these concerns.This is the second§ in a series of articles in the Journal in response to the Oregon Health Decisions Initiative and is designed to provide (1) a brief ethical perspective on rationing and allocation; (2) an analysis of our present, largely implicit, approach to rationing and allocation; and (3) some suggestions that might move the United States closer to a more coherent and reasonable means of allocating and rationing health care.
Mild Vitamin D Deficiency and Secondary Hyperparathyroidism in Nursing Home Patients Receiving Adequate Dietary Vitamin D
Authors: McMurtry Cynthia T. , Young Shari E. , Downs Robert W. , Adler Robert A. 
Published: April 2015

ObjectiveTo compare the vitamin D metabolite and nutritional status of institutionalized elderly males with a non‐institutionalized control group.DesignCase‐control study.SettingVeterans Administration Medical Center Nursing Home (NH) in Richmond, Virginia.PatientsFifty‐seven consecutive nursing home subjects were screened. After excluding blacks, those receiving anticonvulsants, glucocorticoids, or vitamin supplements, and those with liver or renal failure (creatinine > 1.5 mg/dL), 35 subjects were enrolled, and 22 completed the study. The noninstitutionalized control group (n = 18) consisted of consecutive volunteers, meeting the above criteria, from either a senior citizen group or a geriatric clinic.Measurements and Main ResultsThe serum 25‐hydroxyvitamin D level in the NH residents was significantly lower than in community dwellers (17.4 ± 5.2 ng/mL vs 31.2 pg/mL ± 8.0 ng/mL, P < 0.0001). No significant difference was demonstrated in 1,25‐dihydroxyvitamin D levels (36.5 pg/mL ± 10.5 in NH residents vs 42.0 pg/mL ± 11.1 in controls). In the NH group PTH levels were inversely correlated with 25 OHD levels (P < 0.008) and positively correlated with length of stay in the NH (P < 0.016). There was no significant seasonal variation in vitamin D metabolite levels in the NH group. In the NH patients, the mean dietary intake of vitamin D was 232 ± 378 mg/day and of calories was 1811 ± 447 kcal/day.ConclusionDespite apparently adequate calories, calcium, and vitamin D intake, hypovitaminosis D with compensatory PTH elevations occurs, regardless of season, in the nursing home population.
Safety And Efficacy of Metoprolol in the Treatment of Hypertension in the Elderly
Authors: LaPalio Lawrence , Schork Anthony , Glasser Stephen , Tifft Charles 
Published: April 2015

ObjectiveTo assess the short‐term efficacy and safety of metoprolol in the treatment of hypertension in a large population of older patients.DesignProspective, open‐label surveillance study.SettingMulticenter outpatient offices.Participants21,692 patients with mild‐to‐moderate hypertension between the ages of 50 to 75 years. Patients were excluded if they had a contraindication to beta‐blocker therapy.InterventionPatients were treated with 100 mg of metoprolol once daily for 4 weeks. If the blood pressure was controlled, therapy was continued for an additional 4 weeks. If adequate blood pressure was not achieved after 4 weeks, 25 mg of hydrochlorothiazide was added. At the end of 8 weeks, final therapy decisions were recorded. If the blood pressure was controlled, therapy was continued for an additional 4 weeks.Main Outcome MeasuresBlood pressure, heart rate and side‐effects.ResultsAfter 4 weeks of therapy, mean systolic and diastolic blood pressures decreased significantly from 162/95 to 148/87 mm Hg (P < 0.001). Fifty‐eight percent of the patients had satisfactory blood pressure control. At the end of 8 weeks, mean systolic and diastolic blood pressure decreased to 143/84 mm Hg. Blood pressure response was similar in all age groups. At the termination of the study, 50% of the patients were continued on monotherapy, and 27% were continued on combined therapy. Overall, there was less than a 5% incidence of medical problems, and excellent or good tolerability was noted for 94% of the patients.ConclusionsMetoprolol administered as monotherapy or in combination with hydrochlorothiazide was effective in normalizing blood pressure in a majority of elderly hypertensive patients. Both drug regimens were well tolerated.
Reducing the Use of H2‐Receptor Antagonists in the Long‐Term‐Care Setting
Authors: Gurwitz Jerry H. , Noonan James P. , Soumerai Stephen B. 
Published: April 2015

ObjectivesTo examine the patterns of H2 blocker use in the long‐term‐care setting and to assess the effect of educational interventions designed to improve H2 blocker utilization patterns.DesignTime‐series quasi‐experimental study and retrospective chart review.SettingA large academically‐oriented long‐term‐care facility.PatientsInstitutionalized elderly patients with a mean age of 88 years receiving H2 blocker therapy.InterventionsTwo interventions involving group discussions with the medical staff, supporting educational materials, and physician‐specific listings of patients receiving H2 blockers were employed sequentially over a 32‐month period.ResultsEach intervention resulted in substantial reductions in medication use (59.6% and 32.1%, respectively). Indications for H2 blocker use were determined retrospectively for patients identified as receiving therapy prior to the interventions (n = 110). Forty‐one percent were found to be receiving therapy for reasons unsubstantiated by the medical literature. These patients were more likely to be discontinued from therapy than those receiving therapy for substantiated indications (P < 0.01), consistent with the primary focus of the educational interventions.ConclusionsThese results suggest that the excessive use of H2 blocker therapy in the long‐term care setting responds to educational interventions with therapeutically appropriate reductions in utilization. Repeated interventions are necessary to maintain such reductions over time although there may be some reduction in the effectiveness of the intervention with repetition.
Reducing and Managing Restraints in Long‐Term‐Care Facilities
Authors: Schnelle John F. , Newman Daniel R. , White Marilyn , Volner Timothy R. , Burnett Juanita , Cronqvist Agnita , Ory Marcia 
Published: April 2015

ObjectiveTo evaluate a management system designed to improve staff adherence to a federal regulation that stated restrained residents should be released, exercised, and repositioned every 2 hours.DesignA delayed intervention, controlled, cross‐over design with three phases. During phase one, baseline, the length of intervals that residents remained in restraints was monitored. The intervention was implemented at site A in Phase two while site B remained in baseline. During Phase three, the intervention was replicated at site B.SettingTwo long‐term care proprietary nursing facilities.PatientsSixty‐three physically restrained residents in the two facilities.InterventionThe intervention was a system of restraint release using colored pads corresponding to specific hours. The management rule was that the resident should be on a different colored pad every 2 hours. Staff had to lift residents to place the pad, and the colors made the system easy for supervisors to check.Main Outcome MeasuresChecks by research personnel by black light and invisible ink, to detect movement of the knot tying the restraints.ResultsDuring the baseline phase, the majority of residents at both sites were inappropriately restrained longer than 2 hours (site A: 54.1%; site B: 60.1%). The percentage of residents restrained over 2 hours was significantly reduced during the intervention phase to 13.9% (site A) and 19.4% (site B). Three weeks after the end of the intervention, inappropriate use of restraints remained low, 14.2%, but rose to 47.7% after another 3 weeks.ConclusionThe management system is an effective way to increase the consistency with which nursing‐home staff release and reposition restrained residents.
Prevalence and Characteristics of Symptomatic Gastroesophageal Reflux Disease in the Elderly
Authors: Räihä I.J. , Impivaara O. , Seppälä M. , Sourander L. B. 
Published: April 2015

Objective: To study prevalence and characteristics of symptomatic gastroesophageal reflux disease in the elderly.Objective: Survey by questionnaire of stratified random sample.Setting: City of Turku, Finland.Subjects: Population‐based random sample consisting of non‐institutionalized subjects aged 65 years or over. A questionnaire was sent to 559 subjects. The response rate was 92%. Twenty‐nine incompletely filled forms were rejected. Thus, the questionnaires from 487 subjects, representing 87% of the original number, constitute the basis for the study.Measurements: The questionnaire inquired about the following symptoms: heartburn, regurgitation, chest pain, dysphagia, dyspepsia, respiratory symptoms, vomiting, and belching.Results: The age‐adjusted prevalence of daily symptoms suggestive of gastroesophageal reflux disease was 8% in men and 15% in women (P < 0.05). Fifty‐four percent of men and 66% of women reported that they had symptoms at least once a month (P < 0.05). The prevalence of symptoms was roughly the same across age groups. The occurrence of chest pain, dyspepsia, vomiting, belching, dysphagia, chronic cough, hoarseness, and wheezing were associated with symptoms suggestive of gastroesophageal reflux disease.Conclusions: Symptoms suggestive of gastroesophageal reflux disease are common in elderly subjects. Women suffer from these symptoms more frequently than men. Typical reflux symptoms are often associated with atypical complaints, such as abdominal symptoms, chest pain, or respiratory symptoms. J Am Geriatr Soc 40:1209–1211
An Audit of Cardiac Pacing in the Elderly: Effect of Myocardial Infarction on Outcome
Authors: Rashid A. , Shah I. U. , Haboubi N. Y. , Hudson P. R. 
Published: April 2015

ObjectiveTo audit the outcome of temporary endocardial pacing in an elderly population.DesignRetrospective case‐series analysis.SettingThe Department of Medicine for the Elderly at the Wrexham Maelor Hospital, a District General Hospital with 612 beds serving a catchment population of 220,000.SubjectsA sample of 50 consecutive elderly patients, with an age range of 65 to 99 years, undergoing transvenous cardiac pacing.Main Outcome MeasuresLength of stay in hospital, complications of the pacing procedure, whether a permanent pacemaker was installed, and whether the patient died within 1 month of admission.ResultsThere was no difference in length of stay between those with a myocardial infarction and those without. Minor complications occurred in three patients (one local infection and two “failures to pace”). Major complications occurred in two patients (septicemia and pneumonia). More patients without a myocardial infarction (86.9%) went on to implantation of a permanent pacemaker than those with an infarction (11.1%, P = 0.001), and fewer of them died (8.7% compared with 48.1%, P = 0.0025). In those patients with a myocardial infarction who died, there was no difference between the proportions who had inferior (7/18) and anterior (5/9) infarctions.ConclusionCardiac pacing seems to be a safe and reliable procedure in the elderly, although long term morbidity and mortality may be dependent on the presence or absence of myocardial ischaemic disease. Myocardial infarction in the elderly is an event of major significance, carrying with it a high mortality rate, particularly if accompanied by cardiogenic shock and the need for cardiac pacing.
Correlates of Cognitive Function Scores in Elderly Outpatients
Authors: Mangione Carol M. , Seddon Johanna M. , Cook E. Francis , Krug Joseph H. , Sahagian Christine R. , Campion Edward W. , Glynn Robert J. 
Published: April 2015

ObjectiveTo determine medical, ophthalmologic, and demographic predictors of cognitive function scores as measured by the Telephone Interview for Cognitive Status (TICS), an adaptation of the Folstein Mini‐Mental Status Exam. A secondary objective was to perform an item‐by‐item analysis of the TICS scores to determine which items correlated most highly with the overall scores.DesignCross‐sectional cohort study.SettingThe Glaucoma Consultation Service of the Massachusetts Eye and Ear Infirmary.Subjects472 of 565 consecutive patients age 65 and older who were seen at the Glaucoma Consultation Service between November 1, 1987 and October 31, 1988.MeasurementsEach subject had a standard visual examination and review of medical history at entry, followed by a telephone interview that collected information on demographic characteristics, cognitive status, health status, accidents, falls, symptoms of depression, and alcohol intake.ResultsA multivariate linear regression model of correlates of TICS score found the strongest correlates to be education, age, occupation, and the presence of depressive symptoms. The only significant ocular condition that correlated with lower TICS score was the presence of surgical aphakia (model R2 = .46). Forty‐six percent (216/472) of patients fell below the established definition of normal on the mental status scale. In a logistic regression analysis, the strongest correlates of an abnormal cognitive function score were age, diabetes, educational status, and occupational status. An item analysis using step‐wise linear regression showed that 85 percent of the variance in the TICS score was explained by the ability to perform serial sevens and to repeat 10 items immediately after hearing them. Educational status correlated most highly with both of these items (Kendall Tau R = .43 and Kendall Tau R = .30, respectively).ConclusionEducation, occupation, depression, and age were the strongest correlates of the score on this new screening test for assessing cognitive status. These factors were stronger correlates of the TICS score than chronic medical conditions, visual loss, or medications. The Telephone Interview for Cognitive Status is a useful instrument, but it may overestimate the prevalence of dementia in studies with a high prevalence of persons with less than a high school education.
The Problems of Pain and Its Detection among Geriatric Nursing Home Residents
Authors: Sengstaken Elizabeth A. , King Steven A. 
Published: April 2015

ObjectiveTo assess physicians' detection of pain among geriatric nursing home residents and to determine if there are factors that may interfere with their ability to do this.DesignChart review and patient interview.SettingGeriatric nursing home.ParticipantsOne hundred nursing home residents age 65 or older. Seventy‐six were communicative.MeasurementsDemographic information, diagnoses, and medication use were compared for several groups of residents to determine their effects on the detection of pain.ResultsSixty‐six percent of the communicative residents were identified as having chronic pain. Treating physicians did not detect this problem in 34% of these residents. Those whose pain was not so identified were more likely to have a neurologic disorder other than dementia. When non‐communicative residents were compared with those who were communicative, the physicians were found to have identified pain less frequently in the former cohort.ConclusionsChronic pain is a common problem among geriatric nursing home residents and is frequently undetected. Identification of this problem among communicative residents may be markedly improved by direct questioning about this problem at frequent intervals. New methods of assessing pain need to be created to assist in its detection among the non‐communicative population.
Public Opinion Regarding Consent to Treatment
Authors: Singer Peter A. , Choudhry Sujit , Armstrong Jane 
Published: April 2015

ObjectiveTo examine public opinion regarding certain elements of consent: disclosure, advance directives, substitute decisions, emergency treatment, and advocacy.DesignCross‐sectional random‐digit‐dialing telephonic survey.SettingGeneral public.ParticipantsOne thousand randomly‐selected adults living in Ontario.InterventionsNone.Main Outcome MeasuresSelf‐reported attitudes and behaviors.ResultsOf 5,708 telephone numbers drawn, 641 were non‐valid or non‐residential, 1,283 were not in service, 1,068 had no answer, a busy line, or an unavailable respondent, 147 subjects had a language barrier, 1,497 subjects refused, 72 interviews were incomplete, and 1,000 interviews were completed. With regard to disclosure, 33% of respondents said that a doctor should withhold information from a patient if asked to do so by the patient's family. With regard to advance directives, 36% of respondents had had advance discussions with their families, and 12% had completed a living will. With regard to substitute decisions, 77% of respondents said that they would want their wishes followed if they were unable to make medical decisions for themselves; 58% wanted their spouse or partner to make such decisions for them. With regard to emergency treatment, 48% of respondents stated that a doctor should give a life‐saving blood transfusion to an unconscious adult carrying a card stating that blood transfusion was against his or her religious beliefs. With regard to advocacy, 78% of respondents supported mandatory advocacy services for serious health decisions such as whether to have heart surgery; 33% supported advocacy services for less serious decisions such as whether to have a dental filling.ConclusionsThese data highlight the need to reconsider legislative provisions regarding and/or target public education programs toward specific consent‐related issues including disclosure, advance directives, substitute decisions, emergency treatment, and advocacy.
Observations on the Prevalence of Protein‐Calorie Undernutrition in VA Nursing Homes
Authors: Abbasi Adil A. , Rudman Daniel 
Published: April 2015

ObjectiveTo determine the prevalence of underweight and hypoalbuminemia in Veterans Affairs nursing home residents and the frequency with which physicians, nurses, and dieticians documented their awareness of the presence of underweight and hypoalbuminemia.DesignRetrospective survey of medical records.SettingTwenty‐six Department of Veterans Affairs nursing homes located in the Department's Central Region.Patients2811 residents.Main Outcome Measures(1) Prevalence of underweight (defined as body weight less than 80% of standard) and hypoalbuminemia (defined as serum albumin less than 3.5 g/dl); (2) frequency with which physicians, nurses, and dieticians documented the prevalence of underweight and hypoalbuminemia in the records.ResultsThree hundred thirty‐two (11.8%) of the patients were underweight and 772 (27.5%) were hypoalbuminemic. The prevalence of the two conditions varied widely across nursing homes. The prevalence of low serum albumin ranged from 5% to 58% in the 26 institutions, and the prevalence of body weight less than 80% of standard ranged from 2% to 20%. In the Region as a whole, the dietician's notes in the medical charts mentioned underweight in an average of 95% of affected cases but mentioned the suboptimal albumin level in only 82% of the hypoalbuminemic individuals. In the nurses's notes, these figures were only 80% and 45%, respectively, and in the physician's notes, only 62% and 46%, respectively. The frequency of documented awareness of underweight and hypoalbuminemia by nurses and physicians varied tremendously across the 26 facilities (as few as 7% of the undernourished cases in one nursing home, 100% of the affected individuals in another).ConclusionsThis study showed a high prevalence of calorie and protein undernutrition in the nursing home residents of VA nursing homes, wide variation in the prevalence across nursing homes, and frequent lack of documentation of these nutritional deficiencies by physicians and nurses.
The Nursing Home Medical Director Role in Transition
Authors: Elon Rebecca 
Published: April 2015

ObjectiveTo compare the self‐reported role of nursing home medical directors in 1989 (prior to the implementation of the nursing home reform amendments of OBRA 87 in 1990) with the role outlined in the Joint Commission on Accreditation of Healthcare Organizations Long Term Care Standards Manual.DesignSurvey.MeasurementsUsing a telephone interview survey, physicians were questioned about their role as nursing home medical director. Responses were compared with the definition of the medical director's role in the Long Term Care Standards Manual. Information about time spent per month and reimbursement received for medical direction was also obtained.ParticipantsPhysicians serving as nursing home medical directors in 1989 in Houston/Harris County, Texas.ResultsOf 50 nursing home medical director positions in Houston/Harris County in 1989, interviews were completed for 36 (72%). The majority of the medical directors met the criteria for having a signed agreement with the facility, assuring continuous medical coverage, developing emergency procedures, and participating in quality assurance activities. Twenty‐eight percent of the medical directors received no monetary compensation for their work. Of those who were paid, the mean monthly earnings for nursing home medical direction were $345.ConclusionAlthough all nursing facilities are now required by regulation to have medical directors, a wide variation in medical directors' level of involvement and commitment was documented.