bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hematological and Biochemical Laboratory Values in Older Cardiovascular Health Study Participants
Authors: Robbins John , Wahl Patricia , Savage Peter , Enright Paul , Powe Neil , Lyles Mary 
Published: April 2015

OBJECTIVE: To define reference hematologic and biochemical lab values in older individuals.DESIGN: Randomly selected, age‐ and gender‐stratified participants.SETTING: Visits by participants to four research clinics.PATIENTS: A total of 5201 participants in the Cardiovascular Health Study, an observational study of older Medicare‐eligible individuals living at home.MEASUREMENT: Information about health status, previous illness, and medication use was obtained from participants and/or their MDs. This information was used to define a healthy subset of the population. Blood samples were obtained for Cholesterol, HDL and LDL cholesterol, fasting and 2‐hour postload glucose and insulin, fibrinogen, factors VII and VIII, potassium, creatinine, albumin, uric acid, white blood count, hematocrit, hemoglobin, and platelet count.RESULTS: Significant differences were found for age group and/or gender for all mean values. Many tests were significantly different from the generally accepted reference ranges used in clinical laboratories.CONCLUSIONS: In some situations accepted laboratory norms for the general population can not be extrapolated to older adults. There are implications for both research and clinical practice. J Am Geriatr Soc 43:855–859, 1995.
Occult Caffeine as a Source of Sleep Problems in an Older Population
Authors: Brown S. Lori , Salive Marcel E. , Pahor Marco , Foley Daniel J. , Corti M. Chiara , Langlois Jean A. , Wallace Robert B. , Harris Tamara B. 
Published: April 2015

OBJECTIVE: To evaluate the impact of caffeine in medication on sleep complaints in a community population of persons aged 67 or older.DESIGN: Cross‐sectional analysis.SETTING: Iowa 65+ Rural Health StudyPARTICIPANTS: Those who completed their own interview, including a section on the use of medications, during the third annual in‐person follow‐up in 1984–1985.MEASUREMENTS: Main outcomes: trouble falling asleep or other sleep complaints. Covariates: use of caffeine‐containing medication, spasmolytic, or sympathomimetic drug; number of drugs used; depressive symptoms; self‐perceived health; comorbidity, hip fracture, arthritis, ulcer of stomach or intestines; and consumption of caffeinated beverages.RESULTS: The prevalence of caffeinated medication use by participants was 5.4%. Those reporting the use of any caffeine‐containing medication were at an increased risk of having trouble falling asleep (Odds Ratio [OR] = 1.79, 95% confidence interval [CI] = 1.19–2.68). There was no significant risk of other reported nighttime or daytime sleep problems associated with use of caffeine‐containing drugs. Even after adjusting for other factors that could interfere with initiation of sleep, such as painful disease, depressive symptoms, polypharmacy, use of specific medications known to interfere with sleep, and coffee consumption, the use of caffeine‐ containing medication still presented a significantly increased risk of having trouble falling asleep (OR = 1.60, CI = 1.04–2.46). Although those participants using over‐the‐counter analgesic medication containing caffeine had an increased risk of trouble falling asleep (OR = 1.88, CI = 1.22–2.90), there was no significant risk of trouble falling asleep for those who took similar noncaffeinated OTC analgesic drugs (OR = 1.26, CI = 0.87–1.83).CONCLUSIONS: The use of caffeine‐containing medication is associated with sleep problems. Healthcare providers
Temporal Order of Cognitive and Functional Loss in a Nursing Home Population
Authors: Cohen‐Mansfield Jiska , Werner Perla , Reisberg Barry 
Published: April 2015

OBJECTIVE: The order in which cognition and the ability to perform activities of daily living (ADLs) are lost in an institutionalized aged population was examined. Understanding the order of loss of function is important for preparing caregivers and planning of care.METHOD: The conditional probabilities of the inability to perform activity A when there exists the inability to perform activity B were explored in secondary analyses of cross‐sectional data describing 408 nursing home residents. Residents' abilities to perform ADLs were rated by nursing staff using Linn and Linn's Rapid Disability Rating Scale (RDRS‐2); cognitive functioning was rated by social workers and nursing staff using a modified version of Reisberg et al.'s Brief Cognitive Rating Scale (BCRS, with 4 axes: orientation, concentration, recent memory, and past memory).RESULTS: The results regarding ADLs confirm previous findings of a natural order of loss of ability (from the one lost first to last): bathing, dressing, grooming, toileting, walking, and eating. The examination of order in the loss of concentration, recent memory, past memory, and orientation revealed that these seem to be lost concurrently when the cutpoint was 3 (i.e., relatively normal functioning vs. moderate and severe dementia). When the cutpoint was 6 (i.e., severe dementia vs. higher levels of functioning), the order that emerged was: recent memory, past memory, concentration, and orientation.CONCLUSIONS: Although there is a significant relationship between loss of ability to perform ADLs and stage of cognitive impairment, the loss of any specific ADL is not uniquely related to any one stage of cognitive deterioration in this diverse population. This may be explained by the high prevalence of disease in this institutionalized population, as exemplified by the 60% suffering from arthritis and the 17% suffering from neurological disorders other than dementia.
A Follow‐Up Study of Age‐Associated Memory Impairment: Neuropsychological Predictors of Dementia
Authors: Hänninen Tuomo , Hallikainen Merja , Koivisto Keijo , Helkala Eeva‐Liisa , Reinikainen Kari J. , Soininen Hilkka , Mykkänen Leena , Laakso Markku , Pyörälä Kalevi , Riekkinen Paavo J. 
Published: April 2015

OBJECTIVE: To examine the clinical course of age‐associated memory impairment (AAMI) and to evaluate the value of neuropsychological tests in predicting cognitive decline in AAMI subjects in a follow‐up period of more than 3 years.DESIGN: Prospective cohort study.SETTING: The outpatient Memory Research Unit of the Department of Neurology at the University of Kuopio in Eastern Finland.PARTICIPANTS: A sample of 229 subjects (mean age 71.7 years) identified in two screening studies as having AAMI.MEASUREMENTS: A battery of neuropsychological tests and a structured inquiry for health status and subjective memory complaints were performed at baseline and follow‐up to diagnose AAMI according to the criteria proposed by a National Institute of Mental Health work group.RESULTS: Of the 229 subjects, 176 (76.9%) participated in the follow‐up for, on average, 3.6 years after the baseline. Of the participants, 104 (59.1%) still met the AAMI criteria. Other subjects were classified into five subgroups: (1) subjects showing decline in cognition meeting dementia diagnosis (16, 9.1% (13 of them AD)); (2) subjects with mild cognitive decline meeting neither dementia nor AAMI criteria (13, 7.4%); (3) subjects with memory performance now superior to AAMI criteria (17, 9.7%); (4) subjects having a disease classified as exclusion in the criteria (15, 8.5%); (5) subjects not now reporting subjective memory loss in everyday life (9, 5.1%). Two subjects (1.1%) were not classified because of incomplete data. Neuropsychological tests predicted which subjects would develop dementia during the follow‐up period. The best discriminators between these subjects and those who remained AAMI were memory and verbal fluency tests.CONCLUSION: The study suggests that, in general, AAMI is nonprogressive, but the AAMI population also includes subjects with early dementia and subjects without genuine memory loss. However, these subjects can be differentiated with a more detailed neuropsychological evaluation. J Am Geriatr Soc 43:1007–1015, 1995.
Community Physicians' Cooperation with a Program of In‐Home Comprehensive Geriatric Assessment
Authors: Büla Christophe J. , Alessi Cathy A. , Aronow Harriet U. , Yuhas Karen , Gold Marcia , Nisenbaum Rosane , Beck John C. , Rubenstein Laurence Z. 
Published: April 2015

OBJECTIVES: To study the cooperation of primary care physicians with a community‐based prevention and health promotion program for older persons, to study physician factors related to cooperation, and to determine any relationship between physician cooperation and patient adherence to program recommendations and patient satisfaction with health care.DESIGN AND SETTING: A survey administered in subjects' homes and physicians' offices in Santa Monica, California.PARTICIPANTS: Patients (n = 81) were intervention group subjects in a 3‐year, randomized, controlled trial of in‐home comprehensive geriatric assessment paired with prevention and health promotion. Physicians (n = 50) were selected if they had been contacted at least once by a study nurse practitioner about one of these patients.MEASUREMENTS: Physician cooperation was rated by study nurse practitioners. Physicians were interviewed to identify factors associated with cooperation. Patients' satisfaction with health care and adherence were measured prospectively throughout the 3‐year program.MAIN RESULTS: Physicians exhibiting better cooperation had fewer years in practice (P = .03) and were more likely to discuss the program with their patients (P = .005), see benefit for their patients from the program (P = .02), and rate program information as useful (P = .002). Higher physician cooperation did not predict higher patient satisfaction (P = .23) but did predict higher patient adherence to program recommendations (P = .02).CONCLUSIONS: Physicians rated as cooperative were more likely to have a positive appraisal of the program, and their patients had higher adherence to program recommendations. These findings suggest that strategies for increasing primary care physician cooperation might improve effectiveness of similar community‐based prevention and health promotion programs.
Assessment of Capacity to Comply with Medication Regimens in Older Patients
Authors: Fitten L. Jaime , Coleman Lenore , Siembieda Douglas W. , Yu Marian , Ganzell Steven 
Published: April 2015

OBJECTIVE: To develop an instrument that will facilitate and focus the assessment of a patient's capacity to adhere to a medication regimen before its initiation.DESIGN: This is a crossectional study that compares medical inpatients and outpatients to an age‐matched, community‐living, independent and relatively healthy group on their ability to adequately understand and implement hypothetical but realistic medication regimens.SETTING: Department of Veterans Affairs Medical Center, Sepulveda, California.PARTICIPANTS: Fifty‐five older subjects (65 years or older) were divided into three groups: (1) generally healthy comparisons (standard group) (n = 20); (2) medical outpatients (n = 15); and (3) medical inpatients ready for discharge (n = 20).MEASUREMENTS: Older subjects were first tested on their capacity to comply with a difficult medication regimen presented in scenario form. If scores on the first scenario did not meet a standard group‐derived cutoff point, further testing was conducted with a simpler scenario to identify greater levels of impairment.RESULTS: The outpatient group had significantly lower scenario scores than did the healthy comparison group (P < .03). The simpler scenario also showed a trend toward outpatient impairment (P = .06). In the comparison group, only 5% failed Scenario 1, and none failed Scenario 2. The outpatient group had the most difficulty, with 40% failing Scenario 1 and one‐third of those failing Scenario 2. This differed significantly from the comparison groups (Fisher's Exact P < .03). In the inpatient group 20% failed Scenario 1 and 75% of those failing Scenario 2. The sensitivity and specificity of the Folstein Mini‐Mental State Examination in identifying scenario‐impaired subjects were 73% and 80%, respectively. Question types were analyzed to determine which questions were most frequently missed. Memory and judgment questions were found overall to be the most frequently missed. Healthy controls missed some judgment questions; however, the outpatient group was significantly worse in this category (X2 = 5.08; P = .01). All three groups improved their scenario performance significantly with question cueing.CONCLUSION: A significant number of medically ill outpatients encountered difficulty in understanding or remembering correctly hypothetical but realistic medication regimens. This suggests that an older medical patient's cognitive and functional capacity to comply with medication regimens of differing complexity can be specifically assessed before the start of the regimen and probably should be assessed in patients whose compliance capacity is in question. The assessment instrument under development in this study may be helpful in detecting those who need assistance with medications, thus identifying the need for intervention before poor compliance can lead to increased morbidity, rehospitalization, and increased medical costs.
Understanding the Biology of Aging: The Key To Prevention and Therapy
Authors: Vijg Jan , Wei Jeanne Y. 
Published: April 2015

OBJECTIVE: To review recent progress and consider future approaches for basic research on aging with clinical applicability.DATA SOURCES: Peer‐reviewed publications on experimental gerontology and geriatrics.STUDY SELECTION AND DATA EXTRACTION: Studies were selected that described experimental approaches in gerontology and geriatrics, starting with the evolutionary basis of aging, through theories trying to explain its major causes, to novel experimental approaches, e.g., computer informatics, protein chemistry and genetics.DATA SYNTHESIS: Our increased understanding of the evolutionary basis of aging has made it possible to consider a number of experimental strategies more rationally. Most theories on the causes of aging involve some kind of somatic damage that accumulates with age, the rate of which is determined by environmental, genetic, and behavioral factors. The recent emergence of more powerful methodology offers new possibilities for identifying basic mechanisms of aging, which would increase our understanding of biologically based susceptibility to age‐related health problems.CONCLUSIONS: There is a growing awareness that age‐related deterioration will affect an ever growing number of people, in both absolute and relative terms. It can be expected that this will further increase the resources that will be made available for research on aging. Although ultimately unavoidable, aging is a process that appears to be experimentally accessible. Therefore, the mechanisms of senescence and death may eventually be more completely understood, with the promise of preventing and/or delaying many of the adverse effects associated with aging, including most of the common diseases, and possibly also of extending lifespan.
Lessons Learned from a Prospective Meta‐analysis
Authors: Margitić Susan E. , Morgan Timothy M. , Sager Mark A. , Furberg Curt D. 
Published: April 2015

OBJECTIVE: To describe the unique aspects of and the lessons learned in planning and conducting a pooled analysis of multiple trials evaluating interventions to reduce functional decline in hospitalized older persons. Specific examples from the Hospital Outcomes Project for the Elderly (HOPE) meta‐analysis are discussed.DESIGN: A prospective meta‐analysis (PMA) that compiled and pooled data from concurrently conducted clinical trials testing related but distinct interventions.SETTING: The Data Coordinating Center for the prospective meta‐analysis coordinated the collection and analysis of common outcome data from five university‐affiliated hospitals and one community hospital conducting the clinical trials.PARTICIPANTS: Acutely ill hospitalized elderly participants at least 65 to 75 years old.INTERVENTIONS: Treatments being evaluated included exercise, physical therapy, a multidisciplinary geriatric care unit, a multidisciplinary in‐hospital intervention with post‐discharge care, a nursing‐based geriatric care program, and a program to improve detection and evaluation of delirious patients.CONCLUSION: The prospective meta‐analysis provides selected advantages over independently conducted clinical trials and retrospective meta‐analyses. It does, however, pose special design and operational challenges that must be addressed well before initiation of the individual trials. Specific issues of concern include: maintaining scientific integrity of both the individual trials and the PMA; reaching consensus on PMA goals, what data to collect, how and when to collect them and how to maintain uniformly high quality data across all sites; defining the role of the Data Coordinating Center in a multicenter project that utilizes different trials and protocols; and establishing policies concerning analyses of the pooled data, publication of pooled analyses, and ownership of the pooled database.
Malnutrition, Tube Feeding and Pressure Sores: Data Are Incomplete
Authors: Finucane Thomas E. 
Published: April 2015

PURPOSE: To review data about the relationship between pressure sores and (1) nutritional status, (2) nutrient intake, and (3) tube feeding.DATA SOURCES: Medline search of terms associated with “decubitus ulcer” combined with terms associated with “pressure sore” from 1985 through August 1994. Hand review of all issues of the journal Decubitus (now Advances in Wound Care) through June 1994 and the Journal of Parenteral and Enteral Nutrition from January 1987 through May‐June 1994. Review of bibliography of pertinent articles. A small survey of experts.STUDY SELECTION: Articles where the title, Me SH terms, or abstract suggested an examination of the relationship between nutrition and pressure sores, and those suggested by the experts, were reviewed.DATA EXTRACTION: Study designs were disparate. Results were simply tabulated.RESULTS: In seven studies, low serum albumin was associated with development or presence of pressure sores; in five it was not. Most measures of nutritional status were not associated with pressure sore outcomes. Poor nutritional intake was associated with poor pressure sore outcome in four of seven studies. Tube feeding was positively associated with presence of pressure sores in one study. Special nutrition support was ineffective in improving pressure sore outcome in a second. Two studies showed better healing in patients receiving high‐protein formula: in one, all patients were tube fed; in the other, route of feeding was not stated.CONCLUSION: Data about the relationship between malnutrition and pressure sores are incomplete and contradictory. No randomized trials of tube feeding as prevention or treatment of pressure sores has been done. Routine use of tube feeding to prevent or treat pressure sores is not clearly supported by data.
Assessing Diagnostic Approaches to Depression in Medically Ill Older Adults: How Reliably Can Mental Health Professionals Make Judgments About the Cause of Symptoms?
Authors: Koenig Harold G. , Pappas Pamela , Holsinger Tracy , Bachar James R. 
Published: April 2015

OBJECTIVE: To evaluate the reliability of the DSM‐IV approach and five other schemes for counting symptoms toward the diagnosis of depression in hospitalized medically ill older patients and to examine whether mental health professionals can reliably make judgments about the etiology (medical or psychological) of depressive symptoms.METHOD: A sample of 38 patients aged 60 years or older admitted to the general medicine, cardiology, or neurology services at Duke University Medical Center were evaluated for depression using a structured psychiatric interview and the Hamilton Depression Scale. Interrater reliability for the diagnostic schemes, for unstructured clinical diagnoses, and for determinations of the causes of individual depressive symptoms was assessed by three pairs of mental health professionals.RESULTS: Agreement between raters for structured diagnoses was high regardless of diagnostic strategy, with the DSM‐IV approach being only slightly less reliable than the strict inclusive approach (Kappa 0.88 vs Kappa 1.0, respectively). For all diagnostic approaches, there was perfect agreement between raters for eight cases of major depression. Agreement for unstructured clinical diagnoses of depression (K = 0.50) was much lower than for the structured diagnoses. Agreement between raters on the etiology of individual depression criterion symptoms assessed by structured interview was greater than 80% for 14 of 19 symptoms. Correlation between raters' depression severity ratings on the Hamilton Scale using the DSM‐IV etiologic approach was equivalent to that using the strict inclusive approach (0.98 vs 0.95, respectively).CONCLUSIONS: Mental health professionals can be trained to make judgments reliably about the cause (medical or psychological) of symptoms in hospitalized older medical patients. The “strict inclusive” and other diagnostic schemes for counting symptoms toward the diagnosis of depression have only marginal, if any, benefit compared with the the current DSM‐IV approach.
Serum Anticholinergic Activity in Hospitalized Older Persons with Delirium: A Preliminary Study
Authors: Mach John R. , Dysken Maurice W. , Kuskowski Mike , Richelson Elliott , Holden Lori , Jilk Kris M. 
Published: April 2015

OBJECTIVE: To evaluate the relationship between total serum anticholinergic activity (SAA) and the presence or absence of delirium in older hospitalized persons on general medical wards.DESIGN: Case‐control study and within‐subjects repeated‐measures in recovered delirious patients.SETTING: Minneapolis Veterans Affairs Medical Center medical wards.PARTICIPANTS: Eleven male delirious patients (DSM‐III‐R criteria) aged 60 or older and 11 comparably aged male nondelirious controls.MEASUREMENTS: Radioreceptor bioassay of total SAA using tritiated quinuclidinyl benzilate (QNB) binding to muscarinic receptors. Results are expressed in terms of atropine equivalents (nm).MAIN RESULTS: Mean SAA was significantly elevated in the delirious group (mean ± SD = 6.05 ± 2.97 nm atropine equivalents) compared with the controls (3.38 ± 2.49; t(20) = 2.28, P < .05). At study entry, mean SAA was significantly higher in delirious subjects whose symptoms eventually resolved completely (mean ± SD = 7.77 ± 2.37) compared with subjects whose delirious symptoms persisted (3.99 ± 2.30; t(9) = 2.68, P < .05). All six patients in whom delirium resolved completely had a decrease in serum anticholinergic activity when measured during delirium (7.77 ± 2.37) and after symptom resolution (3.92 ± 2.61; t(5) = 3.29, P < .05).CONCLUSIONS: Our findings suggest that serum anticholinergic activity may play a role in delirium in medical inpatients. The relationships between SAA and delirium in medical patients and between total SAA and medication use warrant further study.