bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contrasting Results Between Caregiver's Report and Direct Assessment of Activities of Daily Living in Patients Affected by Mild and Very Mild Dementia: The Contribution of the Caregiver's Personal Characteristics
Authors: Zanetti Orazio , Geroldi Cristina , Frisoni Giovanni B. , Bianchetti Angelo , Trabucchi Marco 
Published: April 2015

OBJECTIVE: To determine the level of agreement between the primary caregiver's report on patient activities of daily living (ADLs) and ADLs assessed directly in a sample of patients affected by very mild and mild dementia and to assess whether this agreement is influenced by the caregiver's depressive symptoms and burden.PATIENTS AND METHODS: Data were obtained from the baseline sample of the Mild Dementia Longitudinal Study, consisting of 111 consecutive patients affected by dementia with very mild to mild functional impairment (grades .5 and 1 on the Clinical Dementia Rating Scale). As is usual for patients referred to our Alzheimer's Unit, anamnestic, cognitive, functional and behavioral information are collected from the primary caregiver. Along with sociodemographic characteristics, caregivers' depressive symptoms (Beck Depression Inventory Scale) and burden (Nowak and Guest's Caregiver Burden Inventory Scale) were also evaluated. Patients underwent a performance‐based assessment of the activities of daily living (DAFS) and direct assessment of physical function with the Physical Performance Test (PPT). Caregiver's report and direct observation have been compared for the following ADLs: dressing, toileting, walking, telephone use, shopping, and money use. Discriminant analyses were conducted to examine the degree of agreement between caregiver‐report functional status and performance‐based measures and whether additional agreement is attributable to caregiver's burden and depressive symptoms.RESULTS: The strength of the association between the caregiver's report and performance‐based measures of ADLs is high for motor performance (walking), moderate to good for dressing, but only moderate for telephone, money use, and shopping. No association was found for toileting. The discrepancies between caregiver report and performance‐based assessment were influenced substantially by the burden caused by demands and restrictions on a caregiver's time.CONCLUSIONS: With the exception of motor performance (walking), the caregiver's report and the performance‐based assessment of functional status measure different aspects of a patient's functional status. Contrasts between the caregiver's report and observed ADL performance in mildly and very mildly demented patients are influenced by the caregiver's burden. J Am Geriatr Soc 47:196–202, 1999.
Low Serum Calcidiol Concentration in Older Adults with Reduced Muscular Function
Authors: Mowé Morten , Haug Egil , Bøhmer Thomas 
Published: April 2015

OBJECTIVE: To examine the association between muscular function and the serum concentrations of 25‐hydroxyvitamin D (calcidiol) and 1,25‐dihydroxyvitamin D (calcitriol).DESIGN: A randomized population survey. Baseline measurements of serum calcidiol and calcitriol concentrations and assessment of muscular function (hand grip strength, ability to climb stairs, outdoor activity, and fall occurrence).SETTING: The Medical department, Aker University Hospital, Oslo, and subjects' homes.PARTICIPANTS: Two hundred forty‐six recently hospitalized older patients and 103 randomly selected older people living at home.MEASUREMENTS: Serum concentration of calcidiol and calcitriol in relation to muscle function.MAIN RESULTS: Reduced muscle function was associated with low calcidiol levels. In both the hospital group and the home group, calcidiol concentrations correlated positively to arm muscle strength (r = .22, P < .001, r = .37, P < .001), ability to climb stairs (r = .16, P < .05; r = ‐.42, P = <.001), physical activity (r = ‐.27, P < .001; r = ‐.31, P < .001), and the absence of fall occurrences (r = ‐.27, P < .001; r = ‐.31, P = .004). Calcitriol showed an association with physical activity in the hospital group (r = ‐.19, P < .05), and with fall last month in the home group (r = ‐.22, P < .05).CONCLUSIONS: Older people with reduced muscle function often had reduced levels of calcidiol serum concentration. Low levels of calcidiol were not associated with signs of general undernutrition, such as low body mass, or with reduced arm‐muscle circumference or triceps skinfold thickness. This finding may suggest a physiological role for calcidiol in muscle function. Reduced muscle strength increased disability in our older subjects, which may be improved by vitamin D supplementation in vitamin D‐deficient subjects. J Am Geriatr Soc 47:220–226, 1999.
A Patient‐Centered Approach to Advance Medical Planning in the Nursing Home
Authors: Gillick Muriel , Berkman Susan , Cullen Lorraine 
Published: April 2015

OBJECTIVE: The objective of this study is to determine whether nursing home residents or their surrogates are willing and able to prioritize their goals for care and to demonstrate how these rankings can form the basis of a specific pattern of medical care.DESIGN: A prospective, descriptive study.SETTING: A 40‐bed nursing unit for residents with mild to moderate impairments in a 725‐bed teaching nursing home.RESULTS: Overall, 78% of patients or their families were willing to prioritize their goals, allowing the investigators to infer a pattern of care. The goals were interpreted as implying an intensive pattern in 21%, a comprehensive pattern in 16%, a basic pattern in 18%, palliation in 18%, and comfort only in 6% of residents. Goals chosen by residents who were able to select for themselves translated into more aggressive care than did the goals selected by surrogates.CONCLUSION: Goal‐centered advance medical planning can be initiated in nursing homes by asking residents or their surrogates to prioritize their goals of care. These prioritizations can form the foundation for specific patterns of care. J Am Geriatr Soc 47:227–230, 1999.
Once‐Weekly Resistance Exercise Improves Muscle Strength and Neuromuscular Performance in Older Adults
Authors: Taaffe Dennis R. , Duret Camille , Wheeler Steve , Marcus Robert 
Published: April 2015

OBJECTIVE: To determine the effect of frequency of resistive training on gain in muscle strength and neuromuscular performance in healthy older adults.DESIGN: A randomized controlled trial with subjects assigned either to high‐intensity resistance training 1 (EXl), 2 (EX2), or 3 (EX3) days per week for 24 weeks or to a control group (CO).SETTING: An exercise facility at an academic medical center.SUBJECTS: Forty‐six community‐dwelling healthy men (n = 29) and women (n = 17) aged 65 to 79 years.INTERVENTION: Progressive resistance training consisting of three sets of eight exercises targeting major muscle groups of the upper and lower body, at 80% of one‐repetition maximum (1‐RM) for eight repetitions, either 1,2, or 3 days per week.MEASURES: Dynamic muscle strength (1‐RM) using iso‐tonic equipment every 4 weeks, bone mineral density and body composition by dual energy X‐ray absorptiometry (DXA), and neuromuscular performance by timed chair rise and 6‐meter backward tandem walk.RESULTS: For each of the eight exercises, muscle strength increased in the exercise groups relative to CO (P < .01), with no difference among EXl, EX2 and EX3 groups at any measurement interval. Percent change averaged 3.9 ± 2.4 (CO), 37.0 ± 15.2 (EXl), 41.9 ± 18.2 (EX2), and 39.7 ± 9.8 (EX3). The time to rise successfully from the chair 5 times decreased significantly (P < .01) at 24 weeks, whereas improvement in the 6‐meter backward tandem walk approached significance (P = .10) in the three exercise groups compared with CO. Changes in chair rise ability were correlated to percent changes in quadriceps strength (r = −0.40, P < .01) and lean mass (r = −0.40, P < .01).CONCLUSIONS: A program of once or twice weekly resistance exercise achieves muscle strength gains similar to 3 days per week training in older adults and is associated with improved neuromuscular performance. Such improvement could potentially reduce the risk of falls and fracture in older adults.
Strength Training Normalizes Resting Blood Pressure in 65‐ to 73‐Year‐Old Men and Women with High Normal Blood Pressure
Authors: Martel G. F. , Hurlbut D. E. , Lott M. E. , Lemmer J. T. , Ivey F. M. , Roth S. M. , Rogers M. A. , Fleg J. L. , Hurley B. F. 
Published: April 2015

OBJECTIVE: To determine the effects of heavy resistance strength training (ST) on resting blood pressure (BP) in older men and women.DESIGN: Prospective intervention study.SETTING: University of Maryland Exercise Science Laboratory.PARTICIPANTS: Twenty‐one sedentary, healthy older men (69 ± 1 year, n = 11) and women (68 ± 1 year, n = 10) served as subjects for the study.INTERVENTION: Six months of progressive whole body ST performed 3 days per week using Keiser K‐300 air‐powered resistance machines.MEASUREMENTS: One‐repetition maximum (1 RM) strength was measured for seven different exercises before and after the ST program. Resting BP was measured on six separate occasions before and after ST for each subject.RESULTS: Substantial increases in 1 RM strength were observed for upper body (UB) and lower body (LB) muscle groups for men (UB: 215 vs 265 kg; LB: 694 vs 838 kg; P < .001) and women (UB: 128 vs 154 kg; LB: 441 vs 563 kg; P < .001). The ST program led to reductions in both systolic (131 ± 2 vs 126 ± 2 mm Hg, P < .010) and diastolic (79 ± 2 vs 75 ± 1 mm Hg, P < .010) BP. Systolic BP was reduced significantly in men (134±3vsl27±2 mm Hg, P < .01) but not in women (128 ± 3 vs 125 ± 3mmHg, P < .01), whereas diastolic BP was reduced following training in both men (81 ± 3 vs 77 ± 1, mm Hg, P = .054) and women (78 ± 2 vs 74 ± 2 mm Hg, P = .055).CONCLUSIONS: Six months of heavy resistance ST may reduce resting BP in older persons. According to the latest guidelines from the Joint National Committee for the Detection, Evaluation, and Treatment of Hypertension, the changes in resting BP noted in the present study represent a shift from the high normal to the normal category.
Using Admission Characteristics to Predict Return to the Community from a Post‐Acute Geriatric Evaluation and Management Unit
Authors: Naughton Bruce J. , Saltzman Susan , Priore Roger , Reedy Karen , Mylotte Joseph M. 
Published: April 2015

OBJECTIVE: To compare the Cumulative Illness Rating Scale (CIRS) and the Nursing Severity Index (NSI) as independent predictors of discharge outcome from a post‐acute GEM unit and to define a multivariate model for predicting the same outcome.DESIGN: Retrospective chart review for the entire sample. The sample was split into two cohorts, a derivation cohort (n = 298) and a validation cohort (n = 154).SETTING: A 20‐bed, post‐acute GEM unit in a nonproprietary skilled nursing facility.PARTICIPANTS: All 452 patients admitted to the GEM from the unit's inception in December 1994 until January 1998.MEASUREMENT: Demographics, CIRS, NSI, functional status, and social support variables were measured using data available on admission to the GEM unit. The discharge outcome was dichotomized as return to the community or not.RESULTS: A total of 99.7% of the individuals in the derivation cohort were living in the community before the index hospital‐ization; 75.8% of patients in the derivation cohort returned to the community. The NSI, individual “severe” items from the CIRS, age, and social support were in the final logistic regression model fitted to the derivation cohort. A total of 87.7% of the observed discharge outcomes were predicted when the model was applied to the validation cohort and the calculated probability of return to the community.CONCLUSIONS: Variables for severity of illness, function, social support, and age combined into a logistic regression equation that predicted more than 80% of the dichotomized discharge outcome in the derivation cohort. The proportion of discharge outcomes that were predicted with the validation cohort remained high at 87.7%. The NSI and CIRS were each important to a model that is anticipated to refine the selection of geriatric patients for post‐acute services. J Am Geriatr Soc 47:1100–1104,1999.
Drinking Habits Among Older Persons: Findings from the NHANES I Epidemiologic Follow‐up Study (1982–84)
Authors: Moore Alison A. , Hays Ron D. , Greendale Gail A. , Damesyn Mark , Reuben David B. 
Published: April 2015

OBJECTIVES: To describe alcohol use and its sociodemographic correlates among persons aged 65 years and older in a US probability sample.DESIGN: Cross‐sectional analysis of a national probability sample‐based cohort study.SETTING: Multiple sites throughout the United States.PARTICIPANTS: A total of 3448 persons aged 65 and older who participated in the first wave of the NHANES I Epidemiologic Follow‐up Study (1982–84).MEASUREMENTS: We describe the alcohol use behaviors and demographic characteristics of 3448 persons aged 65 and older. Least squares regression models were used to assess associations between older persons' sociodemographic characteristics and alcohol use.:RESULTS: Sixty percent of the sample reported having 12 or more drinks of alcohol in at least 1 year of their lives. Seventy‐nine percent of these older drinkers were currently drinking. Twenty‐five percent of all drinkers drank daily (31% men, 19% women). Using gender‐specific definitions (men >2 drinks/day; women >1 drink/day), 16% of men drinking alcohol and 15% of women drinking alcohol were heavy drinkers. Younger age, male gender, and higher income were associated with greater alcohol use.CONCLUSIONS: Most older persons who ever drank alcohol in their lifetimes were currently drinking. In addition, a substantial number of older persons were drinking currently at levels that may place them at risk of adverse health consequences.
Equilibrium and Limb Coordination in Mild Cognitive Impairment and Mild Alzheimer's Disease
Authors: Franssen Emile H. , Somen Liduïn E.M. , Torossian Carol L. , Reisberg Barry 
Published: April 2015

OBJECTIVE: To examine changes in equilibrium and limb coordination in normal aging, mild cognitive impairment, and moderate cognitive impairment associated with early probable Alzheimer's disease (AD), by means of parametric clinical measures.DESIGN: Case seriesSETTING: Out‐patient clinic.PARTICIPANTS: A consecutive sample of 365 community‐ residing ambulatory volunteers (137 men, 228 women; mean age 70.4 ± 9.4 years; mean educational attainment 14.6 ± 3.1 years), who were followed in an ongoing longitudinal study of aging and AD, comprising cognitively intact individuals, persons with mild cognitive impairment, and patients with mild AD.MEASUREMENTS: For general magnitude of cognitive function, the Global Deterioration Scale (GDS). For cognition, the Mini‐Mental State Examination (MMSE). Equilibrium was assessed with parametric measurements of single leg stance (SLS) and tandem walking (TW). Limb coordination was assessed with parametric measurements of foot tapping (FT), alternating pronation and supination (PS), and sequential finger to thumb tapping (FTH).MAIN RESULTS: After adjustment for age, persons with mild cognitive impairment or mild AD had significantly poorer performance on parametric clinical tests of equilibrium and limb coordination compared with cognitively intact individuals (P <. 05).CONCLUSIONS: Changes in equilibrium and limb coordination are clinically demonstrable in persons with mild cognitive impairment and mild AD using simple parametric tests. Such tests could potentially identify individuals with increased risk of falling. Early diagnosis and treatment of conditions that can jeopardize equilibrium and limb coordination, as well as balance and coordination training, might help cognitively impaired older people to maintain optimal function and may decrease the risk of falls and injuries.
Alzheimer's Disease Symptom Severity in Blacks and Whites
Authors: Shadlen Marie‐Florence , Larson Eric B. , Gibbons Laura , McCormick Wayne C. , Teri Linda 
Published: April 2015

OBJECTIVE: In order to determine whether there are racial differences in Alzheimer's Disease (AD) symptom severity and vascular comorbidities, we compared African‐American (black) and Caucasian (white) patients with AD from similar socioeconomic backgrounds at the time the disease was first recognized.DESIGN: Cross‐sectional observational study from a population‐based dementia registry.PARTICIPANTS: Patients were enrolled from an HMO base population of 23,000 persons more than age 60 in Seattle, Washington. This study examines 453 subjects with probable AD (38 blacks (mean age 76.5, SD 6.4), and 415 whites (mean age 79.7, SD 6.7)).MEASUREMENTS: Measured were patient demographics, age at onset of AD, AD symptom duration, Mini‐Mental State Exam (MMSE) score, Blessed Dementia Rating Scale, presence of psychiatric symptoms, and vascular comorbidities.RESULTS: Blacks had significantly lower mean cognitive scores (MMSE = 17.2, SD 5.6) compared with whites (MMSE = 20.2, SD 5.2, unpaired t test P <. 01). The significant racial difference in MMSE scores persisted after controlling for education, duration of AD symptoms, age, and ADL impairment. Blacks and whites did not differ significantly regarding gender distribution, education level, income, or percent with early age of onset of AD. No statistically significant race‐related differences were found in impairments in activities of daily living or symptoms of paranoia, hallucinations, or agitation. Blacks had significantly higher rates of hypertension (56%) compared with whites (34%) (Fisher's exact test, P =. 013), but the rates of stroke and ischemic heart disease were similar.CONCLUSIONS: Despite uniform detection methods and controlling for reported duration of dementia symptoms, measured cognitive impairment is significantly more severe when AD is recognized in blacks compared with whites. The significantly higher prevalence of hypertension among black AD cases was not associated with excess cerebrovascular disease comorbidity. This study highlights a need for normative measurements of cognitive function in minority AD groups in order to distinguish differential cognitive symptom severity from possible measurement bias.
Estimating the True Extent of Cognitive Decline in the Old Old
Authors: Brayne Carol , Spiegelhalter David J. , Dufouil Carole , Chi Lin‐Yang , Dening Tom R. , Paykel Eugene S. , O'Connor Daniel W. , Ahmed Anne , McGee Magnus A. , Huppert Felicia A. 
Published: April 2015

OBJECTIVE: To measure cognitive change using a brief measure over a period of 9 years and to adjust for attrition in the sample.DESIGN: The Cambridge City over 75 Cohort (CC75C), a complete sample of the 75 years and older age group from five group general practices in the city of Cambridge with a systematic one‐third of a further practice, all followed on four occasions.SETTING: Cambridge city, UK, the respondents' place of residence.PARTICIPANTS: A total of 2106 subjects were included at study entry.MEASUREMENTS: A brief interview, administered by a trained interviewer, containing a short cognitive scale and the Mini‐Mental State Examination (MMSE) at baseline, 2.4 years, 6 years, and 9 years.RESULTS: Decline in MMSE scores occurred across the population and was greater in the oldest age groups. Attrition at later stages of the follow‐up was associated with greater decline at earlier stages. Adjusting the results for loss to the sample leads to considerably higher estimates of decline, with the older age groups declining faster from lower levels.CONCLUSIONS: To date, cognitive decline in the very old has been considerably underestimated by longitudinal studies. If studies of population samples are to reflect the health and social needs of this frail group accurately, adjustments for the effect of attrition must be included before true decline can be estimated. J Am Geriatr Soc 47:1283–1288, 1999.
Fire Fatalities in Older People
Authors: McGwin Gerald , Chapman Victoria , Curtis Jonathan , Rousculp Matthew 
Published: April 2015

OBJECTIVE: To compare the epidemiology of fire‐related fatalities among older, middle‐aged, and young people.DESIGN: Retrospective case series.SETTING: Alabama, 1992–1997.PARTICIPANTS: All persons fatally injured in fire‐related incidents in the state of Alabama from 1992 to 1997.MEASUREMENTS: The State Fire Marshal's Office provided both demographic and autopsy information about the victim. In addition, information regarding the nature and circumstances of the fire was also obtained.RESULTS: Between 1992 and 1997, there were 674 fire‐related deaths in the state of Alabama. The fire‐related fatality rate was highest among older persons. The fatality rate was particularly high among older black people. The rate of fatal fires caused by heating devices was higher (15.0%) among older people compared with their young and middle‐aged counterparts (6.3% and 4.5%, respectively). Fatalities among older people were least likely (26.0%) to occur if smoke detectors were present, compared with deaths among young and middle‐aged persons (38.3% and 33.5%, respectively). There were fewer smoke detectors present in the fatal fires of older rural black adults and white adults (0.0% and 29.0%, respectively) compared with their urban counterparts (25.0% and 47.0%, respectively). Alcohol was not a factor in fatal fires involving older adults (29.0%) compared with those involving the young (52.0%) and middle‐aged adults (73.9%).CONCLUSIONS: With the growth of the percentage of older people in the population, the problem of fire‐related deaths in this age group is likely to increase. Interventions focused on this age group are necessary for the state of Alabama to meet the National Health Objectives for the year 2000. J Am Geriatr Soc 47:1307–1311,1999,.