bluuebunny/crossref_metadata_2025_split huggingface dataset:
Who Cares for Missouri's Medicaid Nursing Home Residents? Characteristics of Attending Physicians
Authors: Lawhorne Larry W. , Walker Georgia , Zweig Steven C. , Snyder Judy 
Published: April 2015

Objective: To describe the characteristics of physicians attending Medicaid recipients in Missouri's certified nursing homes (NH).Design: Retrospective survey of multiple data sources.Setting: Missouri's certified nursing homes.Participants: 1,339 physicians attending 22,452 Medicaid recipients.Measurements: Physician characteristics were determined by reviewing a roster of medical directors of NHs compiled by the Missouri Department of Social Services' Division of Aging and physician directories compiled by the Missouri State Board of Registration for the Healing Arts, the AMA, the AOA, the ABFP, and the ABIM. Physician clinical activity was determined by examining NH inspection of care reports compiled by the Missouri Department of Social Services' Division of Aging.Results: Each physician attended a mean of 16.8 and a median of six Medicaid recipients in the nursing home. The skewed distribution is reflected by 426 (31.8%) of the physicians attending only one or two residents, and 28 (2.1%) of the physicians attending 100 or more residents. Twenty‐seven percent of the state's licensed osteopaths (DOs, 362) attended nursing home patients, compared with 11% of allopathic physicians (MDs, 977). Significantly more DOs than MDs attended more than the median number of patients (57% vs 45%, P < 0.001). Half were attended by the 605 (45%) physicians without board certification. Of those who were board certified, family physicians were more likely to include Medicaid nursing home patients in their practices than internists (43% vs 18%, P < 0.001). Physicians licensed for 11 to 20 years and rural physicians had the heaviest patient loads.Conclusions: Many doctors are caring for very few nursing home residents while a few doctors may be caring for too many patients. In addition, half the Medicaid recipients residing in Missouri's nursing homes in 1988 were attended by physicians without board certification, and almost one‐third were attended by physicians who may be retiring between 2000 and 2010.
Epidemic Keratoconjunctivitis in a Chronic Care Facility: Risk Factors and Measures for Control
Authors: Buffington Joanna , Chapman Louisa E. , Stobierski Mary Grace , Hierholzer John C. , Gary Howard E. , Guskey Louis E. , Breitenbach Ray A. , Hall William N. , Schonberger Lawrence B. 
Published: April 2015

Objective: To study patterns of transmission of epidemic keratoconjunctivitis (EKC) in a chronic care facility and to assess control measures and prevent future outbreaks in this setting.Design: A retrospective cohort study.Setting: A 120–bed, four‐unit, skilled nursing facility.Patients: Residents and employees of the above facility.Interventions: Increased frequency of cleaning; use of bleach disinfectant; universal precautions in handling eye secretions from residents with conjunctivitis; cohorting residents by unit; suspension of new admissions; closure of common gathering areas.Measurements: Resident demographics; possible risk factors for infection among residents (including mobility, underlying illness, medications, involvement in social activity, level of confusion) and among employees (including co‐morbid illnesses and eye conditions, exposures to persons with conjunctivitis, visits to eye care specialists, use of contact lenses or glasses); testing of conjunctival specimens from symptomatic persons for viral and bacterial agents.Results: Of 95 residents on three chronic care units, 47 (attack rate 49%) had onset of eye symptoms consistent with EKC between September 14 and December 7, 1990. Thirty‐eight (81%) of these had onset following the onset of symptoms in a resident with dementia who, despite habitual eye‐rubbing and wandering into other residents' rooms, was not isolated or restricted in any way. Attack rates were higher (though not statistically significant) among more mobile residents (60% for ambulatory residents) and among those considered by staff to be confused (56%). Rapid antigen detection and culture confirmed adenovirus type 37 as the etiologic agent.Conclusions: Transmission of infection with adenovirus type 37 was successfully interrupted following strict infection control, suspension of new admissions, cohorting of residents by unit, and change to a disinfectant that inactivates adenovirus. Recognition of conjunctivitis as an appropriate reason for restricting movement of an infected resident may have prevented extensive viral transmission in this outbreak.
Fever of Unknown Origin in Elderly Patients
Authors: Knockaert Daniel C. , Vanneste Laurent J. , Bobbaers Herman J. 
Published: April 2015

Objective: To describe the spectrum of diseases that may give rise to fever of unknown origin in elderly patients and to delineate the diagnostic approach in these patients.Design: Subgroup analysis of a prospectively collected case series followed more than 2 years.Setting: General Internal Medicine Service based at University hospital, Leuven, Belgium.Patients: Forty‐seven consecutive patients, older than 65 years, meeting the classic criteria of fever of unknown origin.Measurements: The final diagnosis established and the clinical value of diagnostic procedures.Results: Infections, tumors and multisystem diseases (encompassing rheumatic diseases, connective tissue disorders, vasculitis including temporal arteritis, polymyalgia rheumatica, and sarcoidosis) were found in 12 (25%), six (12%) and 15 patients (31%), respectively. Drug‐related fever was the cause in three patients (6%), miscellaneous conditions were found in five patients (10%), and six patients (12%) remained undiagnosed. Microbiologic investigations were diagnostic in eight cases (16%), serologic tests yielded one diagnosis, immunologic investigations had a diagnostic value in four cases, standard X‐rays yielded a diagnostic contribution in 10 cases, ultrasonography and computed tomography were diagnostic in 11 cases, Gallium scintigraphy had a diagnostic contribution in 17 cases, and biopsies yielded the final diagnosis in 18 cases.Conclusions: Multisystem diseases emerged as the most frequent cause of fever of unknown origin in the elderly, and temporal arteritis was the most frequent specific diagnosis. Infections, particularly tuberculosis, remain an important group. The percentage of tumors was higher in our elderly patients than in the younger ones but still clearly lower than in other recent series of FUO in adults. The number of undiagnosed cases was significantly lower in elderly patients than in younger individuals (P ≤ 0.01). The investigation of elderly patients with FUO should encompass routine temporal artery biopsy and extensive search for tuberculosis if the classic tests such as blood count, chemistry, urinalysis, cultures, chest X‐rays, and abdominal ultrasonography do not yield any clue. Gallium scintigraphy should be considered as the next step and not as a last‐resort procedure.
Joint Impairment and Ambulation in the Elderly
Authors: Gibbs James , Hughes Susan , Dunlop Dorothy , Edelman Perry , Singer Ruth , Chang Rowland 
Published: April 2015

Objective: To test the impact of joint impairment on ambulation in the elderly, using a multivariate model.Design: Cross‐sectional observational study (baseline data from an ongoing longitudinal study).Subjects: Five hundred thirty‐two persons over age 60, including continuing care retirement community (CCRC) (n = 222), homebound (n = 63), and ambulatory (n = 247) respondents. Mean age at assessment = 76.6 (SD = 6.6).Measurement: Independent variables included sociodemo‐graphics, physician measures of lower joint impairment, an index of cormorbidities derived from physical examination or chart abstract, self‐assessed arthritis pain, depression, and anxiety. The dependent variable, ambulation, was measured as walk‐rate, based on the time required to walk 50 feet.Main Results: For the total sample, 61% of the subjects were impaired in more than one lower joint group, with almost 50% of the homebound impaired in more than three joint groups. Demographics (particularly age and education) explained much of the variance in walk‐rate. After controlling for demographics and membership in the groups purposely sampled (CCRC, homebound, ambulatory), lower joint impairment accounted for an additional 7% of the variance in walk‐rate. Total amount of variance explained by the model was 56% (Adjusted R2 = .56). A 3‐point change in lower joint impairment score, equivalent to the maximum impairment score for a single joint group, is associated with a 4‐second change in the mean time required to walk 50 feet. The knee and lower spine joints contributed most to the impact of the lower joint impairment measure.Conclusions: Among the elderly, age and education are strong predictors of performance on a walk‐rate test. Independent of demographics and non‐musculoskeletal conditions, joint impairment is associated with diminished walking ability in this population.
Malnutrition in Institutionalized Elderly: How and Why?
Authors: Keller Heather H. 
Published: April 2015

Objective: To determine the prevalence of undernutrition and overnutrition in long‐term care elderly patients and the functional, behavioral, environmental, nutritional, and medical variables associated with this prevalence.Design: Cross‐sectional, observational.Setting: Long‐term care hospital in Canada.Subjects: Two hundred elderly patients (n = 166 male), average age 78.5 years.Measurements: Assessment of nutritional status and presence of specific behavioral, medical, environmental, and functional characteristics known to impact on nutritional status. Nutritional status was determined by weight, % weight loss, BMI, skinfolds, arm circumference, area measurements, and % body fat. Multiple regression analyses were performed to identify the factors associated specifically with undernutrition and overnutrition in this population.Results: Severe undernutrition was present in 18% (n = 36) and severe overnutrition in 10% (n = 20). Mild/moderate undernutrition was present in 27.5% (n = 55) and mild/moderate overnutrition in 18% (n = 36). Overnutrition was positively associated with primary diagnosis and number of medications and negatively associated with poor appetite, number of feeding impairments, protein intake, and mental state. Undernutrition was positively associated with dysphagia, slow eating, low protein intake, poor appetite, presence of a feeding tube, and age and negatively associated with primary diagnosis.Conclusions: Undernutrition exists at a level that is high (45.5%) but not unusual for this type of institutional setting. Behavioral, environmental, and disease‐related factors greatly influence nutritional status. Undernutrition appears to be affected by nutritional factors more than overnutrition. Efforts should be directed toward influencing some of these factors to decrease undernutrition in the institutionalized elderly.
L‐Deprenyl in the Treatment of Mild Dementia of the Alzheimer Type: Results of a 15–Month Trial
Authors: Burke William J. , Roccaforte William H. , Wengel Steven P. , Bayer Barbara L. , Ranno Anthony E. , Willcockson Nancy K. 
Published: April 2015

Objective: To examine the cognitive and behavioral effects of L‐deprenyl in persons with mild dementia of the Alzheimer type (DAT) over a 15‐month period.Design: A 15‐month randomized, double‐blind, placebo‐controlled trial using a parallel‐group design.Participants: 39 subjects with mild DAT (CDR 1) selected using NINCDS‐ADRDA criteria.Outcome Measures: A battery of neuropsychological tests and clinical rating scales.Results: The placebo and L‐deprenyl subjects were similar at baseline on the clinical and neuropsychological tests. The total score on the Brief Psychiatric Rating Scale (BPRS) was significantly less after 15 months in subjects taking L‐deprenyl. The only individual item of the BPRS which differed between groups was disorientation. There was no evidence of a L‐deprenyl effect on any other clinical or neuropsychological measure after 2, 8, or 15 months.Conclusion: L‐deprenyl did appear to have a slight effect on a single measure of psychopathology, the BPRS. It did not have a measurable impact on any other measure of behavior or cognitive function over a 15‐month period in this group of subjects with mild DAT and did not appear to slow the progression of the disease.
Non‐Hodgkin's Lymphoma in the Older Person: A Review
Authors: Ballester Oscar F. , Moscinski Lynn , Spiers Alexander , Balducci Lodovico 
Published: April 2015

Objective: To study the epidemiology of non‐Hodgkin's Lymphoma (NHL) in the older person and to explore treatment strategies for older persons with NHL.Design: Review of the English literature.Measurements: Incidence of NHL in patients of different ages; prevalence of NHL of different grades and stages in persons of different ages; and response to treatment, disease free survival, and survival, for patients of different ages.Results: The incidence of NHL in the aged has increased approximately 80% since 1970, and approximately one‐half of the 40,000 annual new cases occur in persons aged 60 and older in the USA. The 2–4 phenoxy pesticides may be partly responsible for this increment. The treatment of low grade lymphoma is mostly palliative and well tolerated by the aged. Age may have an adverse effect on the prognosis of intermediate grade lymphomas, and the prevalence of poor prognostic factors and comorbidity increases with age. Among persons aged 65–75, the complete response rate (CRR) of intermediate grade NHL to chemotherapy is approximately 50%, and approximately one‐third of complete responders remain alive and free of disease 5 years from diagnosis. Among those aged 75 and older, the CRR to chemotherapy is approximately 40%, and the median duration of response is 16 months. Strategies aimed to ameliorate treatment‐related toxicity include lower doses of chemotherapy, choice of drugs better tolerated by older individuals, and prevention of chemotherapy‐induced toxicity.Conclusions: NHL are an increasingly common problem for older persons. Approximately 80% of older patients with low grade lymphomas and 40%–50% of those with intermediate grade lymphomas may benefit from chemotherapy. Individualized treatment, based on life expectancy and comorbidity, is the key to effective management.
Prevalence of Low Plasma IGF‐I in Poliomyelitis Survivors
Authors: Rao Uma , Shetty Kaup R. , Mattson Dale E. , Rudman Inge W. , Rudman Daniel 
Published: April 2015

Objective: To compare plasma levels of insulin‐like growth factor‐I (IGF‐I, also termed somatomedin C) in polio survivors and healthy control subjects and to determine their relation to selected clinical characteristics.Design: Cross sectional study.Setting: Polio survivors living in the community recruited from the Wisconsin Polio Support Group.Participants: A total of 124 polio survivors (49 males and 75 females), ages 35 to 77 years, and 261 healthy control subjects (139 males and 122 females) of similar age.Measurements: Plasma IGF‐I levels were compared in polio survivors and age‐matched control subjects. In the polio survivor group, the relation of IGF‐I to selected clinical characteristics was examined before and after adjusting for co‐variates.Results: Statistical analyses showed that the IGF‐I concentrations were significantly lower in the polio survivors than in the controls. This difference was reflected in the means and standard errors of the two groups (0.45 ± 0.02 vs 0.60 ± 0.02 units/mL, P < 0.01). Plasma IGF‐I below 0.35 units/mL in adults indicates little or no growth hormone secretion. In polio survivors, 38% of the plasma IGF‐I values were <0.35 units/mL compared with 19% in the healthy group. Univariate analysis showed that IGF‐I in the polio survivors was significantly correlated with age, gender, and body mass index, and with dependency, pain, and difficulty in the activities of daily living (ADLs). The correlations with ADL dysfunction were independent of the correlations with age, gender, and body mass index. IGF‐I level did not correlate with the subjective report of recent decline in functional status.Conclusion: Lower levels of IGF‐I are seen in polio survivors, and this finding correlates with ADL dysfunction. The hy‐posomatomedinemic tendency of polio survivors may have an adverse effect on their neuromuscular function and quality of life.
Oral Health Problems and Involuntary Weight Loss in a Population of Frail Elderly
Authors: Sullivan Dennis H. , Martin Wendy , Flaxman Norman , Hagen Joan E. 
Published: April 2015

Objective: To evaluate whether poor oral health is a potentially reversible contributor to the development of significant involuntary weight loss in elderly rehabilitation patients.Design: Survey (cross‐sectional study).Setting: Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital.Patients: One hundred ten consecutive admissions to the GRU, of whom 99% were male and 80% were white. The average age of the study patients was 77 years.Measurements: At admission each patient completed a comprehensive medical, neuro‐psychological, social, nutritional, and dental assessment. Previous weights were documented by review of old medical records. Involuntary weight loss was considered significant if it was greater than 5% of pre‐weight‐loss weight within 6 months or 10% of pre‐weight‐loss weight within 1 year. Of the 97 variables evaluated, the strongest predictors of significant involuntary weight loss prior to GRU admission were identified using univariate and multivariate (stepwise logistic regression) analyses.Results: The number of general oral problems was the best predictor of significant involuntary weight loss within 1 year prior to GRU admission, followed by household income, age, smoking status, adequacy of nutrient intake prior to admission, and education. When all six of the variables were included in the stepwise logistical regression analysis, the model had a sensitivity of 63.2%, a specificity of 91.1%, and overall predictive accuracy of 86.2%. The number of general oral problems was also a strong predictor of significant weight loss within 6 months prior to GRU admission.Conclusions: Poor oral health may be an important contributing factor to the development of significant involuntary weight loss among the frail elderly. If this is true, it places even greater emphasis on the need for maintaining an optimal state of oral health in our elderly patients.
Blood Pressure and Cognitive Function in Healthy Old People
Authors: Starr John M. , Whalley Lawrence J. , Inch Susan , Shering P. Ann 
Published: April 2015

Objective: Since hypertension is a major risk factor for multi‐infarct dementia, this study aimed to evaluate the effect of blood pressure on cognitive function in elderly subjects on no medication and disease‐free.Design: A cross‐sectional survey.Setting: Community.Participants: 598 healthy community‐resident subjects aged 70 years and over who were on no treatment.Measurements: Blood pressure (BP) and MMSE score, an index of cognitive function.Results: Mean age of the sample was 75.7 years, mean BP 160/86 mmHg, mean MMSE 28.0. Systolic BP correlated negatively with MMSE (P < 0.05), but diastolic BP showed no significant overall correlation. To study possible J‐shaped curve effects of BP, the sample was stratified into three groups—low BP, normal BP, and high BP—at levels one standard deviation from the mean for both systolic and diastolic pressures. Mean MMSE scores for low, normal and high systolic BP were 28.3, 28.1, 27.5, respectively; for low, normal, and high diastolic BP scores were 28.0, 28.1, and 27.5 respectively. Multivariate analysis of variance found the differences between normal and high to be significant at P < 0.001 for systolic and P = 0.001 for diastolic BPs.Conclusion: High blood pressure is associated with cognitive impairment in healthy, drug‐free, older people.
Are Older Pedestrians Allowed Enough Time to Cross Intersections Safely?
Authors: Hoxie Russell E. , Rubenstein Laurence Z. 
Published: April 2015

ObjectiveTo describe the pedestrian traffic flow at a busy urban intersection and determine the percentage of older pedestrians at risk for injury as a result of reduced walking speeds.DesignObservational study.SettingThe intersection of Third Street and Fairfax Avenue in Los Angeles, California.ParticipantsAll pedestrians who started to cross the intersection during the legally acceptable parts of the traffic cycle during three days of observation (n = 1229) and a subsequent sample of 100 consecutive younger and 100 consecutive older crossers.MeasurementsThe ability of all subjects to cross the intersection in the allotted time was measured. A questionnaire was administered to pedestrians who were unable to cross the intersection in time. In addition, we measured the actual gait speed of a subsequent consecutive sample of 100 younger and 100 older pedestrians.ResultsOf the 592 older pedestrians observed, 27% were unable to reach the opposite curb before the light changed to allow cross traffic to enter the intersection, and one‐fourth of this group were stranded by at least a full traffic lane away from safety. All younger pedestrians were able to cross in the allotted time. Older pedestrians took significantly longer than younger pedestrians to cross the street (P < 0.0001). The mean walking velocity ±1 SD for older and younger pedestrians was 0.86 ± 0.17 and 1.27 ± 0.17 m per second, respectively. Fifty‐three percent of those older pedestrians unable to cross in time were willing to be surveyed. Mean age was 77 years, 74% considered the intersection to be “dangerous,” and 63% stated they cross the street at least once daily. City traffic reports revealed that over the preceding 5 years about one older pedestrian per year had been hit in this intersection, and 165 such injuries had occurred city‐wide per year.ConclusionThe timing of this pedestrian signal does not allow adequate time for many older pedestrians to cross and puts them at potential risk. Providing more crossing time may reduce pedestrian injuries and allow for an increased feeling of independence and confidence by older citizens.