bluuebunny/crossref_metadata_2025_split huggingface dataset:
MODELS OF GERIATRIC PRACTICE: Progress Toward a Restraint‐Free Environment in a Large Academic Nursing Facility
Authors: Reuben David B. , Levine Jeffrey M. , Marchello Vincent , Totolos Elizabeth 
Published: April 2015

OBJECTIVE: To review the implementation and evolution of a successful physical restraint reduction program in a large nursing facility.INTERVENTION AND MEASUREMENTS: An initiative to reduce physical restraint began in March of 1990 with formation of a Restraint Review Committee (RRC), which developed and guided a program of inservice education, policy change, and procedural innovation. Progress was measured by monthly prevalence surveys of restraint use, both unit‐specific and facility‐wide.PATIENTS AND SETTING: The study took place in an 816‐bed not‐for‐profit nursing facility with academic affiliation and closed medical staff. Mean age of residents was 85.5; 74% were female and 26% male.RESULTS: Physical restraint prevalence in our facility was reduced from 39% to 4% over 3 years, with marked decrease in variation among nursing units. Prevalence initially decreased to 20% after policy modifications and inservice education programs. Further innovations in procedure and policy resulted in continued reduction of physical restraint to 4%. The facility‐wide rate of falls and accident‐related injuries did not change over the 3‐year period. Decrease in physical restraint was not accompanied by a change in the percentage of residents prescribed psychotropic medications such as benzodiazepines and neuroleptics.CONCLUSIONS: In response to the mandate to provide a least‐restrictive environment, our institution has developed a successful system resulting in a dramatic reduction in physical restraint use. Changes in institutional culture and barriers to change are discussed, as well as issues of cost and generalizability. J Am Geriatr Soc 43:914–918, 1995.
Late Physical and Functional Effects of Osteoporotic Fracture in Women: The Rancho Bernardo Study
Authors: Greendale Gail A , Barrett‐Connor Elizabeth , Ingles Sue , Haile Robert 
Published: April 2015

OBJECTIVE:To examine the associations between osteoporotic fractures and difficulty performing selected physical and functional activities.DESIGN:Cross sectional analysis of a cohort study.SETTING:Geographically defined cohort located in Rancho Bernardo, California.PARTICIPANTS:Community‐dwelling women aged 55 and older who participated in a study of osteoporosis between 1988–1991. Eighty percent of eligible women participated in the study.MAIN OUTCOME MEASURES:Self‐reported difficulty performing seven physical activities and four functional tasks.RESULTS:The mean age of the 1010 women was 72.6 years. A total of 160 first minimal trauma fractures occurred between 1972 and 1991, including 62 wrist, 29 rib, 25 hip, and 23 spine fractures. The mean time since fracture was 6.7 years (range, 1 to 17 years). In multiply adjusted analyses, having experienced any osteoporotic fracture was significantly associated with a 1.7 to 3.0‐fold increase in difficulty bending, lifting, reaching, walking, climbing stairs, and descending stairs. Any fracture was significantly associated with 1.9 to 6.7 times more difficulty in dressing, cooking, shopping, and performing heavy housework. Compared with the relative odds of physical limitation associated with any osteoporotic fracture, hip fractures were more strongly associated with difficulty walking (OR 3.6) and descending stairs (OR 4.1), whereas spine fractures demonstrated a stronger association with difficulty bending (OR 3.1), lifting (OR 3.4), and descending stairs (OR 4.2).CONCLUSIONS:Among older women, remote osteoporotic fracture at any site is associated with an approximate doubling of the risk of physical limitations and an even higher risk of functional limitations. Although this cross‐sectional analysis cannot secure the direction of the association, the specificity of the effect of particular fractures on discrete activities supports causality.
Comparing the Performance of Health Status Measures for Healthy Older Adults
Authors: Andresen Elena M. , Patrick Donald L. , Carter William B. , Malmgren Judith A. 
Published: April 2015

OBJECTIVES: The specific goals of the study were to compare three health status measures among older adults for their correlations with similar scales and to examine whether extreme (positive) health states might lead to measurement problems. We also report on practical administration and response problems among older adults.DESIGN: Eligible and randomly selected health plan enrollees aged 65 and older were sent a baseline survey about their health. A random sample of persons who returned this survey was recruited to participate in the comparative study. Additional questionnaires were completed by mail and telephone interviews. Measures were repeated at a 1‐year follow‐up mailing.SETTING: This study was conducted at Group Health Cooperative (GHC) of Puget Sound, a large prepaid health maintenance organization.PARTICIPANTS: Subjects were 200 of the 283 older adults selected (68.2% response). Mean age was 72.5 years.MEASUREMENTS: The primary measures were the Sickness Impact Profile (SIP), the Quality of Well‐being Scale (QWB), and three scales of the Medical Outcomes Study Short‐Form 36 (SF‐36). Also included were a stress scale, the Positive Affect Scale, and the Chronic Disease Score (CDS) computed from the automated pharmacy data.RESULTS: SIP scores showed a very strong skew toward low (good health) scores with a mean of 3.4% (±SD 4.4). The QWB scores ranged from .50 to .90 (mean .73 ± .09). For the MOS SF‐36 scales, scores of 100 (good health) were common for both of the physical health scales but not for general health. Analyses showed the SIP, QWB, and MOS SF‐36 scales were moderately to strongly correlated with similar measurement scales and with the independent measure of chronic disease and psychosocial health. Scales repeated at 1 year were highly correlated: intraclass correlation coefficients between baseline and 1 year ranged from an r = .51 to .73.CONCLUSIONS: Our results suggest that the SIP is not a useful tool for rating healthy, community‐dwelling older adults. Two MOS SF‐36 measures used in this study showed some tendency for “ceiling” measurement effects. The QWB demonstrated an acceptable distribution of scale scores; however, it is the most complex of the three measures to administer. Among the broad range of older adults, no one tool appears to apply to every situation.
Heart Failure with Normal Systolic Function: A Common Disorder in Older People
Authors: Tresch Donald D. , McGough Martin F. 
Published: April 2015

OBJECTIVE: To review the incidence, pathophysiology, significance, diagnosis, and treatment of heart failure with normal systolic function in older patientsDATA SOURCE: Scientific reports of diastolic ventricular dysfunction in both the general population and the geriatric population were identified from repeated searches of the MEDLINE database and citations from appropriate articles.STUDY SELECTION: Studies were included only if they demonstrated proper methodology, were from a reputable source, and were published in a peer‐reviewed journal.DATA EXTRACTION AND SYNTHESIS: Relevant data were obtained from the articles, with special importance placed on studies designed to examine older patients exclusively or as part of a subgroup in a larger study. Emphasis was placed on data pertaining to the pathophysiology, prognosis, and diagnosis of patients with diastolic dysfunction compared with normals and patients with systolic dysfunction as an etiology of heart failure. Therapeutic interventions were selected for the presence of prospective data with concrete end points such as mortality, functional class, exercise capacity, and regression of left ventricular hypertrophy.CONCLUSION: Diastolic ventricular dysfunction is a significant problem in older people, with at least 40% of older heart failure patients having diastolic dysfunction as the etiology of their heart failure. The pathophysiology of diastolic dysfunction is varied but usually involves impaired left ventricular relaxation and/or increased ventricular stiffness, each partially related to normal aging changes, as well as underlying cardiovascular diseases. The significance of heart failure caused by diastolic dysfunction is great, with increased morbidity and mortality compared with other cardiac diseases that have the same preserved systolic function. Diagnosis of diastolic dysfunction can be clinically difficult and often requires further testing to determine if diastolic dysfunction is present. At this time, no therapy specifically treats diastolic dysfunction, but several medications, such as diuretics, calcium channel blockers, beta blockers, and angiotension‐converting enzyme inhibitors, offer symptomatic relief and may prevent progression of the disorder.
The Impact of Nursing Home Transfer Policies At the End of Life on a Public Acute Care Hospital
Authors: Smith Wally R. , Kellerman Arthur , Brown James S. 
Published: April 2015

OBJECTIVES: To determine whether nursing homes transferred their terminal care patients to one public hospital, and if so, the impact of these transfers on nursing home and hospital mortality rates.DESIGN: A retrospective cohort study using both Medicare claims and hospital data to construct a mortality prediction model, as well as a cross‐sectional descriptive comparison of state nursing home mortality rates.SETTING: A public hospital, one of 32 hospitals designated as overall mortality outliers for each of the first three Medicare mortality reports.PARTICIPANTS: Patients (n = 1235) included in the index hospital's 1988 Medicare mortality report; nursing homes (n = 289) included in state data on 1988 nursing home mortality rates.MEASUREMENTS AND RESULTS: Patients transferred from nursing homes to the index hospital were nearly twice as likely to die as the hospital's other Medicare patients in univariate (P = .0001) as well as multivariate analysis (OR = 1.68, 95% CI = 1.17–2.40). Terminal care admissions accounted for 33.9% of deaths from nursing homes but only 16.2% of other deaths (P = .009). The 1988 death/discharge rate at one of two nursing homes responsible for nearly all transfers was 15.2%, less than half the state average. Yet it contributed 59.3% of nursing home deaths and 22.7% of terminal care patients to the hospital. The hospital's 20.0% 1988 Medicare mortality rate was just above the expected range.CONCLUSIONS: Two nursing homes transferred terminal care to a single hospital. This resulted in a lower‐than‐average mortality rate for one of the nursing homes and a higher‐than‐expected Medicare mortality for the hospital. Without these end‐of‐life transfers, the hospital's Medicare mortality rate would have been within the expected range.
Involuntary Weight Loss in Older Outpatients: Incidence and Clinical Significance
Authors: Wallace Jeffrey I. , Schwartz Robert S. , LaCroix Andrea Z. , Uhlmann Richard F. , Pearlman Robert A. 
Published: April 2015

OBJECTIVES: To describe the incidence, anthropometric parameters, and clinical significance of weight loss in older outpatients.DESIGN: Four‐year prospective cohort study.SETTING: University‐affiliated Veterans Affairs Medical Center.PATIENTS: Two hundred forty‐seven community‐dwelling male veterans 65 years of age or older.MEASUREMENTS: Anthropometrics (weight, height, skinfolds, and circumferences), health status measures (Sickness Impact Profile scores, health care utilization, self‐reported ratings of health), and bloodwork (cholesterol, albumin, others) were obtained at baseline and followed annually for 2 years. Outcome measures (hospitalization, nursing home placement, and mortality rates) were followed for a minimum of 2 years after any identified weight change.MAIN RESULTS: The mean annual percentage weight change for the study population was −0.5% (SD: ± 4.0%; range: −17% to +25%). Four percent annual weight loss was determined to be the optimal cutpoint for defining clinically important involuntary weight loss using ROC curve analysis. The annual incidence of this degree of involuntary weight loss was 13.1%. At baseline, involuntary weight losers were similar to nonweight losers in age (73.9 ± 7.9 vs 73.3 ± 6.7 years), body mass index (26.8 ± 3.9 vs 26.9 ± 4.1 kg/m2), and all other anthropometric, health status, and laboratory measures. Relative to nonweight losers, involuntary weight losers had significantly (P ≤ .05) greater decrements in central skinfold and circumference measures (subscapular skinfolds, −2.9 vs −0.4 mm; suprailiac skinfolds, −4.2 vs −0.2 mm; and waist to hip ratio, −.01 vs + .00). Both groups had significant decreases in their triceps skinfolds (an estimate of peripheral subcutaneous fat), whereas arm muscle area and albumin levels did not decline significantly in either group. Over a 2‐year follow‐up period, mortality rates were substantially higher (RR = 2.43; 95% CI = 1.34–4.41) among involuntary weight losers (28%) than among nonweight losers (11%). Of interest, a similar increase in 2‐year mortality (36%) was also observed among subjects with voluntary weight loss (by dieting). Survival analyses adjusting for differences between weight losers and nonweight losers in baseline age, BMI, tobacco use, and other health status and laboratory measures yielded similar results.CONCLUSIONS: These results indicate that involuntary weight loss occurred frequently (13.1% annual incidence) in this population of older veteran outpatients. When involuntary weight loss occurred, the predominant anthropometric changes were decrements in measures of centrally distributed fat (trunkal skinfolds and circumferences). Finally, involuntary weight loss greater than 4% of body weight appears to be clinically important as an independent predictor of increased mortality.
Drug Utilization in the Old Old and How it Relates to Self‐Perceived Health and All‐Cause Mortality: Results from the Bronx Aging Study
Authors: Hershman Dawn L. , Simonoff Paul A. , Frishman William H. , Paston Francine , Aronson Miriam K. 
Published: April 2015

OBJECTIVE: To characterize medication use in a “well” very old population and relate the quantity and type of medication use to 10‐year mortality.DESIGN AND SUBJECTS: A longitudinal, 10‐year, follow‐up study involving 488 healthy, community‐dwelling volunteers aged 75 to 85 years. The subjects underwent a detailed baseline evaluation and annual assessments that included comprehensive physical exams, laboratory and diagnostic tests, and related interviews. Prescription and nonprescription drug use was determined by self report, confirmation through hospital records, and reports by subjects and significant others.RESULTS: At study baseline, the mean number of prescription and nonprescription medications used was 2.3 and 1.5, respectively. Female subjects (n = 315), those older than 80 years, or those who reported themselves to be in fair or poor health on initial health self‐report were found to show significantly increased use of prescription medications. The most commonly used classes of medications were cardiovascular drugs and analgesics. Subjects who were consuming a greater number of prescription and nonprescription medications did not have higher mortality rates. After correcting for differences in cardiovascular health status between users and nonusers, only digoxin approached significance as an independent predictor of death (P < .08).CONCLUSION: This study confirmed that medication use in an ambulatory, old old population is not excessive. The oldest subjects in the cohort consumed more medications than did the younger subjects. Women used more prescription drugs than men. Increased medication use was associated with worse ratings on health self report. Medication use alone, however, was not a predictor of 10‐year mortality in this population. Questions are raised about the inappropriate prescription of digoxin in older subjects.
Predictive Validity of a Questionnaire That Identifies Older Persons at Risk for Hospital Admission
Authors: Pacala James T. , Boult Chad , Boult Lisa 
Published: April 2015

OBJECTIVE: To determine the predictive validity of a mailed questionnaire designed to measure older adults' risk of repeated hospitalization.DESIGN: Prospective cohort study.SETTING: Ramsey County, Minnesota.PARTICIPANTS: Medicaid recipients aged 70 and older who completed the questionnaire.MEASUREMENTS: Responses were used to calculate the subjects' probability of repeated admission (Pra) to hospitals within 4 years. Subjects were classified as low‐risk (Pra < 0.5) or high risk (Pra ≥ 0.5). One year later, Medicaid claims data were analyzed to determine the subjects' actual use of hospitals.RESULTS: One‐fifth of the respondents (20.6%) were classified as high‐risk at baseline. During the following year, the high‐risk subjects used hospitals at approximately twice the rate of the low‐risk subjects (4.5 vs 2.4 days/person‐year, P = .009).CONCLUSIONS: The instrument, which was previously found to be valid in a national sample of Medicare beneficiaries, appears to be valid also in a local sample of Medicaid beneficiaries. Older adults at risk of heavy hospital use can be identified prospectively through their responses to this brief, mailed, self‐administered questionnaire. The instrument may be useful in targeting older persons for interventions designed to prevent the need for hospital care.
ADL Dependence and Medical Conditions in Chinese Older Persons: A Population‐Based Survey in Shanghai, China
Authors: Chen Peijun , Yu Elena S.H. , Zhang Mingyuan , Liu William T. , Hill Robert , Katzman Robert 
Published: April 2015

OBJECTIVE: To describe the prevalence of activities of daily living (ADL) dependence and medical conditions and the relationship between illnesses and ADL performance in the older population of Shanghai, China.DESIGN: Probability sample survey of community residents.SETTING: The Jing An district of Shanghai, China. The interviews were carried out at the homes of the older persons.PARTICIPANTS: There were 3763 noninstitutionalized elders screened, 3745 of whom completed the interview.MEASUREMENTS: The dependent variables were the five basic ADL items: eating, dressing, transferring, toileting, and bathing. The independent variables were dementia and 19 self‐reported medical conditions, along with age, gender and education level.MAIN RESULTS: Of those in Shanghai aged 65 and older, 8.28% (6.52% of males, 9.17% of females) were functionally dependent in one or more ADLs. The most prevalent self‐reported illness was cardiovascular disease, including hypertension (29.12%) and heart disease (26.65%). ADL performance was associated with dementia and a number of medical conditions in univariate analysis. The best predictors of functional dependence in both age groups (65–74 years; 75 years and older), based on the multiple logistic regression analysis and after controlling for age, gender, and education, were stroke, dementia, Parkinson's disease, diabetes, and emphysemaCONCLUSIONS: The authors have successfully applied five ADL items selected and culturally adapted from Older Americans Resources and Services to the study of older Chinese. A consistent and reliable estimate of functional dependence among older persons is obtained. The prevalence of dementia and many self‐reported illness, as well as the ADL status by medical condition, are reported. The findings reveal certain patterns of relationship between illness conditions and ADL performance. J Am Geriatr Soc 43:378–383, 1995.
Foot Pain and Disability in Older Persons: An Epidemiologic Survey
Authors: Benvenuti Francesco , Ferrucci Luigi , Guralnik Jack Michael , Gangemi Salvatore , Baroni Alberto 
Published: April 2015

OBJECTIVE: To investigate the prevalence of foot pain in older people and its association with pathological conditions of the feet and with disability in basic and instrumental activities of daily living.DESIGN: Cross‐sectional survey of a community‐dwelling older population.PARTICIPANTS: A total of 459 subjects, 73% of the population aged 65 years and older living in Dicomano, Florence, Italy.MEASUREMENTS: A standardized medical examination was performed by a geriatrician to collect information on the presence of pain, specific problems of the feet, gait, and several indicators of physical health status. Disability in basic and instrumental activities of daily living was evaluated by self‐report.RESULTS: The prevalence of foot pain was very high, especially in subjects affected by calluses or corns, hallux deformities, hammer toes, pes planus, and edema and among those who complained of difficulty in looking after the basic needs of the feet. Patients with foot pain needed a greater number of steps and longer time to walk the same distance. Foot pain was associated with a higher prevalence of disability in instrumental activities of daily living, particularly those related to standing and ambulation capacities, but it was not related to higher prevalence of disability in basic activities of daily living.CONCLUSIONS: Foot pain is associated with specific conditions of the feet and disability in instrumental activities of daily living. Adequate assessment and treatment of foot problems may prevent foot pain and potentially reduce risk of disability. This hypothesis needs to be tested in longitudinal studies and specific intervention trials.
Cost of Pressure Ulcer Prevention in Long‐Term Care
Authors: Xakellis George C. , Frantz Rita , Lewis Anne 
Published: April 2015

OBJECTIVE: To describe the total cost of pressure ulcer prevention, component costs of each intervention, and the relationship of costs to subjects' risk level.DESIGN: 3‐month cohort trial.SETTING: A 600‐bed, state‐supported, long‐term care facility.PATIENTS: A total of 539 war veterans, 83% of whom were male; mean age was 73 years.MAIN OUTCOME MEASURES: Cost to facility for using each of four preventive interventions: turning, pressure‐reducing mattresses, chair cushions, miscellaneous preventive devices.RESULTS: Sixty‐eight percent of subjects received a preventive intervention. Total 3‐month facility cost of prevention was $132,114, and 97% of the cost was consumed by 30% of the subjects. Turning was the most expensive component, accounting for $99,567. The daily cost of turning for subjects who received it was $8.83 ± 1.66. Cost increased with subject risk level. Low cost devices were instituted for lower risk subjects, whereas high cost interventions (turning) were reserved for the highest risk subjects.CONCLUSIONS: This long‐term care facility expended substantial resources on prevention, and most resources (97%) were expended on less than half (30%) of subjects. Turning was, by far, the most expensive intervention, and the nursing staff reserved it for highest risk subjects. Strategies that substitute moderately priced mattresses for frequent turning may decrease the cost of prevention, as long as mattress cost is less than the daily turning costs it replaces. Future research to define the optimum combinations of preventive interventions for patients of various risk levels is needed.