bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Prevalence of Hearing Aid Use Among Older Adults with Hearing Loss: The Epidemiology of Hearing Loss Study
Authors: Popelka Michael M. , Cruickshanks Karen J. , Wiley Terry L. , Tweed Theodore S. , Klein Barbara E. K. , Klein Ronald 
Published: April 2015

OBJECTIVES: To measure the prevalence of hearing aid use among older adults with hearing loss and to identify factors associated with those currently using hearing aids.DESIGN: Population‐based cohort study.SETTING: The south‐central Wisconsin community of Beaver Dam.PARTICIPANTS: A total of 1629 adults, aged 48 to 92 years, who have hearing loss and are participating in the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study.MEASUREMENTS: A hearing‐related risk factor and medical history questionnaire, the Hearing Handicap Inventory for the Elderly (screening version), screening tympanometry, pure‐tone air‐ and bone‐conduction audiometry, and word recognition tests were administered by trained examiners using standard protocols.RESULTS: The prevalence of current hearing aid use among those with a hearing loss (pure‐tone average > 25 decibels hearing level over 500, 1000, 2000, and 4000 Hertz, worse ear) was 14.6%. The prevalence was 55% in a subset of the most severely affected participants. In univariate analyses, current hearing aid use was associated with age, severity of loss, word recognition scores, self‐reported hearing loss, self‐perceived hearing handicap, and history of noise exposure. Factors associated with current hearing aid use in multivariate logistic regression models were age, severity of loss, education, word recognition scores, Hearing Handicap Inventory for the Elderly (screening version) score, and self‐report of a hearing loss.CONCLUSIONS: Few older adults with hearing loss are currently utilizing hearing aids. Improved screening and intervention programs to identify older adults who would benefit from amplification are needed to improve hearing‐related quality of life for this large segment of the population.
The Effectiveness of Day Hospital Care on Home Care Patients
Authors: Pitkälä Kaisu 
Published: April 2015

OBJECTIVE: To study the effectiveness of rehabilitative and medically oriented day hospital care on community‐based long‐term care patients.DESIGN: A randomized, controlled trial.SETTING AND PARTICIPANTS: 177 patients on home‐care in a rural area were randomized into two groups. Patients in one group were offered a 2‐month period of rehabilitation and medical care in a recently opened day hospital, and in the other group patients were offered treatment, as before, in home care. Both groups were examined at the beginning and at 2, 5 and 12 months.INTERVENTION: Rehabilitative and medically oriented day hospital care.OUTCOME MEASURES: Use of health services, physical functioning measured by the Katz ADL Index, subjective health, symptoms, and satisfaction with care.RESULTS: The groups used hospitals (excluding the day hospital treatment) equally during the follow‐up year. The treatment group had significantly more specialist consultations than did the control group. There were no clinically significant differences in the changes in the Katz ADL Index although more changes were found in the treatment group. The number of symptoms was reduced significantly in the treatment group, whereas the number of symptoms remained unchanged in the control group. The patients' views of their own health improved in the treatment group.CONCLUSION: Day hospital care affects the quality of life of older people, but it does not reduce the use of other health services, nor does it clinically significantly improve the physical functioning of older people.
Impact of Integrated Home Care Services on Hospital Use
Authors: Landi Francesco , Gambassi Giovanni , Pola Roberto , Tabaccanti Sandro , Cavinato Tullio , Carbonin PierUgo , Bernabei Roberto 
Published: April 2015

OBJECTIVE: To examine the effect of a home care program based on comprehensive geriatric assessment and case management on hospital use and costs among frail older individuals.DESIGN: Quasi‐experimental study with a 6‐month follow‐up.SETTING: Vittorio Veneto, a town in northern Italy.PARTICIPANTS: One hundred fifteen frail older people who applied for integrated home care services.INTERVENTION: Each patient was assessed with the Minimum Data Set for Home Care, and, subsequently, a case manager and a multidisciplinary team delivered social and health care services as indicated.MAIN OUTCOME MEASURES: We determined the hospital admissions and days spent in the hospital for all subjects during the first 6 months after the implementation of the home care program and compared them with the rate of hospitalization that the same patients had experienced in the 6 months preceding the implementation of the program.RESULTS: After the implementation of the integrated home care program, there was a significant reduction in the number of hospitalizations compared with pre‐implementation (56% vs 46%, respectively; P < .001), associated with a reduction in the number of hospital days, both at the individual patient level (28 ± 23 days vs 18 ± 15 days, respectively; P < .01) and for each admission (16 ± 12 days vs 12 ± 8 days, respectively; P < .01). This resulted in a 29% cost reduction with an estimated savings of $1260 per patient.CONCLUSIONS: The implementation of an integrated home care program based on the use of a comprehensive geriatric assessment instrument guided by a case manager has a significant impact on hospitalization and is cost‐effective. J Am Geriatr Soc 47:1430–1434, 1999.
Vascular Compliance as a Measure of Biological Age
Authors: Bulpitt Christopher J. , Rajkumar Chakravarthi , Cameron James D. 
Published: April 2015

OBJECTIVES: To determine the measure of vascular compliance most closely related to age.DESIGN: A review of 22 studies relating aortic compliance to age and a discussion of other factors related to vascular compliance.MEASUREMENTS: Aortic compliance, elastic modulus, postmortem aortic changes, pulse wave velocity in the aorta, common carotid, lower limb and upper limb.RESULTS: 1. Aortic compliance and carotid artery compliance is closely related to age; 2. Compliance in the peripheral arteries, in 16 reports, appears less closely related to age; 3. There is evidence that aortic compliance is related to hypertension, cardiac function, and left ventricular hypertrophy and can be increased by exercise, hormonal therapy, antioxidant and antihypertensive treatment; and 4. Vascular compliance is more closely related to chronological age than other measures such as skin inelasticity, greying of hair, baldness etc.CONCLUSIONS: Because of the close relationship between aortic and carotid compliance and chronological age, deviation from the age‐predicted norm (biological age) may prove to be a good predictor of cardiovascular pathology. J Am Geriatr Soc 47:657–663, 1999.
Who Walks? Factors Associated with Walking Behavior in Disabled Older Women With and Without Self‐Reported Walking Difficulty
Authors: Simonsick Eleanor M. , Guralnik Jack M. , Fried Linda P. 
Published: April 2015

OBJECTIVES: To determine how severity of walking difficulty and sociodemographic, psychosocial, and health‐related factors influence walking behavior in disabled older women.DESIGN: Cross‐sectional analyses of baseline data from the Women's Health and Aging Study (WHAS).SETTING: An urban community encompassing 12 contiguous zip code areas in the eastern portion of Baltimore City and part of Baltimore County, Maryland.PARTICIPANTS: A total of 920 moderately to severely disabled community‐resident women, aged 65 years and older, identified from an age‐stratified random sample of Medicare beneficiaries.MEASUREMENTS: Walking behavior was defined as minutes walked for exercise and total blocks walked per week. Independent variables included self‐reported walking difficulty, sociodemographic factors, psychological status (depression, mastery, anxiety, and cognition), and health‐related factors (falls and fear of falling, fatigue, vision and balance problems, weight, smoking, and cane use).RESULTS: Walking at least 8 blocks per week was strongly negatively related to severity of walking difficulty. Independent of difficulty level, older age, black race, fatigue, obesity, and cane use were also negatively associated with walking; living alone and high mastery had a positive association with walking.CONCLUSIONS: Even among functionally limited women, sociocultural, psychological, and health‐related factors were independently associated with walking behavior. Thus, programs aimed at improving walking ability need to address these factors in addition to walking difficulties to maximize participation and compliance. J Am Geriatr Soc 47:672–680, 1999.
Association of Interleukin‐6 and Other Biologic Variables with Depression in Older People Living in the Community
Authors: Dentino Andrew N. , Pieper Carl F. , Rao K. Murali K. , Currie Mark S. , Harris Tamara , Blazer Dan G. , Cohen Harvey Jay 
Published: April 2015

OBJECTIVES: The prevalence of depression increases with age, as does the prevalence of higher levels of the cytokine interleukin‐6 (IL‐6). This analysis was performed to determine the association between increased levels of this cytokine and depression in a population‐based sample.DESIGN: Cross‐sectional cohort study.SETTING: Rural and urban counties in North Carolina.PARTICIPANTS: Community‐dwelling older people.MEASUREMENTS: The association between IL‐6 and other biologic variables with self‐report depression was examined in 1686 persons aged 70 years and older in the third in‐person survey wave (1991) of the Duke Established Population for Epidemiologic Studies of the Elderly (EPESE). Bivariate associations were established by the Spearman correlation, adjusted for age. A stepwise linear logistic regression model was used to derive a final model to assess multivariable effects on CES‐D scores.RESULTS: Depression was correlated with IL‐6 (P = .011), D‐Dimer (P = .017), alpha‐l‐globulin (P = .023), alphas‐2‐globulin (P = .002), and beta globulin (P = .012). After controlling for age, race, and gender, IL‐6 levels remained the only biologic variable significantly associated with depression (P = .035).CONCLUSION: These data suggest that the inflammatory marker, IL‐6, is associated with depression in older people in this cross‐sectional study. These results are compatible with the hypothesis of cytokine (IL‐6) stimulation in geriatric depression as part of an overall immunoendocrine dysregulation.
Diagnosis of Geriatric Patients with Severe Dizziness
Authors: Lawson J. , Fitzgerald J. , Birchall J. , Aldren C.P. , Kenny R.A. 
Published: April 2015

OBJECTIVE: To identify the causes of dizziness in older patients presenting to the general practitioner and the clinical characteristics at presentation that might guide the general practitioner to the likely cause of dizziness and the most appropriate specialty for subsequent referral if referral is required.DESIGN: A prospective case control study of older patients presenting with dizziness.SETTING: The initial assessment was made in four general practices, three urban practices and one inner city practice (Newcastle). Subsequent investigations were conducted randomly in the Neurocardiovascular Investigation Unit and the Otolaryngology (ENT) Unit at local University hospitals (Newcastle).PARTICIPANTS: Fifty consecutive patients more than 60 years of age presented with dizziness. Twenty‐two age‐ and sex‐matched case controls were recruited from the same general practices.MEASUREMENTS: Measurements were of diagnoses attributable to symptoms.RESULTS: Symptoms were of long duration (median 1 year). Forty‐six percent of patients had syncope and/or falls in addition to dizziness. Twenty‐eight percent had a cardiovascular diagnosis, 18% had a peripheral vestibular disorder, 14% had a central neurological disorder, 18% had more than one diagnosis, and 22% had no attributable cause of symptoms identified.A cardiovascular diagnosis was predicted by the presence of syncope (P < .001), dizziness described as lightheadedness (P l .001), the need to sit or lie down during symptoms (P < .001), pallor with symptoms (P < .001), symptom precipitation by prolonged standing (P < .05), and whether patients had coexisting cardiovascular disease (P < .05). The description of dizziness as “vertigo” predicted a peripheral vestibular disorder (P < .001). The predictive strength of these prognostic indicators was then validated on a separate sample of 50 additional older patients.CONCLUSIONS: Clinical characteristics can predict an attributable cause of dizziness in most older patients and thus guide general practitioners in treatment and appropriate specialist referral. The presence of syncope, falls, or cardiovascular comorbidity increases the likelihood of a cardiovascular diagnosis. Otolaryngological investigations are rarely diagnostic, but vertiginous symptoms do predict peripheral vestibular disorders.
Clinico‐Neuropathological Correlation of Alzheimer's Disease in a Community‐Based Case Series
Authors: Lim Alfredo , Tsuang Debby , Kukull Walter , Nochlin David , Leverenz James , McCormick Wayne , Bowen Jim , Teri Linda , Thompson Jill , Peskind Elaine R. , Raskind Murray , Larson Eric B. 
Published: April 2015

OBJECTIVES: Most clinico‐neuropathological correlative studies of Alzheimer's Disease (AD) are based on research cohorts that are not necessarily generalizable to patients seen in the general medical community. In this study, we examine the accuracy of the criteria used in diagnosing AD in a community‐based case series of patients with memory complaints.DESIGN AND PARTICIPANTS: Clinical and neuropathological diagnoses were obtained from 134 patients evaluated for dementia who subsequently underwent autopsy.SETTING: Subjects who exhibited new symptoms of dementia and were enrolled in the University of Washington/Group Health Cooperative Alzheimer's Disease Patient Registry were eligible for this study.MEASUREMENTS: Clinico‐pathological correlation was performed using NINCDS‐ADRDA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association) and CERAD (Consortium to Establish a Registry for Alzheimer's Disease) criteria.RESULTS: Ninety‐five of the 134 cases studied met CERAD neuropathological criteria for AD. The sensitivity of NINCDS‐ADRDA “probable AD” was 83% (diagnosing AD correctly) and overall clinical diagnostic accuracy was 75%. However, there was a high rate of additional neuropathological findings. Only 34 of the 94 cases had pure AD on neuropathology, whereas the remainder frequently had coexisting vascular or Parkinson's disease lesions.CONCLUSIONS: This study of a large series of community‐based incident dementia cases provides a way of judging the adequacy of currently available clinical diagnostic criteria. It also shows that co‐existing neuropathological findings are common in community‐based AD. J Am Geriatr Soc 47:564–569, 1999.
Economic Evaluation of Donepezil for the Treatment of Alzheimer's Disease in Canada
Authors: O'Brien Bernie J. , Goeree Ron , Hux Margaret , Iskedjian Michael , Blackhouse Gordon , Gagnon Michelle , Gauthier Serge 
Published: April 2015

BACKGROUND: Donepezil is a new drug recently approved in the United States and Canada for the treatment of Alzheimer's disease (AD). We estimated the cost‐effectiveness of donepezil 5 mg daily as an adjunct to usual care in the management of persons with mild‐to‐moderate AD defined as a Mini‐Mental Health State Examination (MMSE) score in the range 10 to 26.METHODS: Treatment effect data as MMSE change‐over‐baseline scores were obtained from a 30‐week placebo‐controlled trial of donepezil. MMSE scores beyond observed trial data were estimated using a Markov model with 10 cycles of 24 weeks based on the placebo MMSE progression observed in the trial. Data from AD subjects in the Canadian Study of Health and Aging were used to estimate costs of nursing home care, community services, medications, and caregiver time as a function of MMSE score. A clinic‐based cohort study from Alberta was used to estimate the distribution of AD patients by MMSE score presenting for treatment. The effectiveness measure for the economic model was expected time (over 5 years) spent with nonsevere AD (MMSE ≥ 10).RESULTS: Over 5 years of treatment, donepezil is predicted to reduce health care costs by CA$929 per patient but increase caregiver time costs by CA$48 per patient for an overall cost saving to society of CA$882 per patient. Patients not receiving donepezil are predicted to spend 2.21 years of the 5 years in nonsevere AD compared with 2.41 years for treated patients (a gain of just over 2 months). Sensitivity analysis reveals that cost savings per patient increase if more AD patients are assumed to survive to 5 years; however, if donepezil treatment continues when patients' MMSE score falls below 10, the incremental cost is higher for treatment at CA$1554 per patient.CONCLUSION: Based on the limited available data, our model predicts that the use of donepezil for mild‐to‐moderate AD in Canada is associated with lower 5‐year costs and less time spent with severe AD when compared with the alternative of usual care with no donepezil therapy. As more reliable long‐term data become available, these predictions should be confirmed and/or updated. J Am Geriatr Soc 47:570–578, 1999.
Orthostatic Hypotension and Cognitive Decline in Older People
Authors: Viramo Petteri , Luukinen Heikki , Koski Keijo , Laippala Pekka , Sulkava Raimo , Kivelä Sirkka‐Liisa 
Published: April 2015

OBJECTIVES: To establish the role of orthostatic hypotension (OH) as a risk factor for cognitive decline among home‐dwelling and institutionalized older people and to describe other predictors of cognitive decline.DESIGN: Follow‐up study with two clinical examinations.SETTING: A community‐based setting in northern Finland.PARTICIPANTS: All of the 1159 people aged 70 or more living in five rural municipalities around the town of Oulu in Northern Finland in 1991. At the time of the follow‐up examination, 2.5 years later, 884 of the original participants were alive and 651 were re‐examined.MEASUREMENTS: In 1991, 907 people (78.3% of the total population) were tested for orthostatic hypotension, and their cognitive capacity was assessed with the Mini‐Mental State Examination (MMSE). The calculation/spelling tasks were excluded from the final version used in the statistical analysis. The re‐assessment of cognitive capacity was made on 651 subjects (73.6% of those alive) who had participated in the first examination. The data were analyzed using polychotomous and linear regression analysis models.RESULTS: The prevalence of OH was 28.7%, with no age or sex differences. The mean sum score for the shortened MMSE in 1991 was 21.6 (±3.98) for persons with OH and 21.1 (±4.08) for non‐OH persons. During the follow‐up, the sum score declined in the OH group by .44 (±2.81) points and in the non‐OH group by .83 (±3.61) points. No type of OH (systolic or diastolic 1‐ or 3‐minute values or their combination) predicted cognitive decline; the only predictors were old age and low level of formal education.CONCLUSIONS: Orthostatic hypotension is a common clinical condition that affects every fourth person aged 70 years or older. By temporarily inducing cerebral hypoperfusion, it may cause or exacerbate cognitive dysfunction. In an unselected population, OH was not associated with cognitive deterioration, nor did it predict cognitive decline during a 2‐year follow‐up. J Am Geriatr Soc 47:600–604, 1999.
Blood Pressure Behavior in the Nursing Home: Implications for Diagnosis and Treatment of Hypertension
Authors: Auseon Alex , Ooi Wee L. , Hossain Monir , Lipsitz Lewis A. 
Published: April 2015

OBJECTIVES: To determine patterns of elevated blood pressure (BP) behavior, their clinical correlates, and the relationship to diagnosis and management of hypertension.DESIGN: A cross‐sectional, prevalence survey.SETTING: Forty‐five nursing homes owned or managed by a large national chain.PARTICIPANTS: A total of 857 older residents (mean age = 84 years).MEASUREMENTS: Supine and standing (1 and 3 minutes) BP and heart rate, taken four times in one day (before and after breakfast, and before and after lunch) by trained nurses using a random zero sphygmomanometer; medication profile; active medical diagnoses; functional status; sociodemographics.RESULTS: The prevalence of a single, elevated, supine systolic pressure (> 160 mm Hg) was 14.3%, and of two to four elevated measures was 14.9%. The pre‐breakfast reading was consistently the highest, and mean systolic pressures decreased after breakfast. Compared with those not treated, older residents taking antihypertensive medications had higher systolic pressures at all times and showed the same pattern of decline after breakfast. Isolated diastolic hypertension was uncommon (0.9%). Cardiovascular disease, orthostatic hypotension, diabetes, and use of angiotensin converting enzyme inhibitors or calcium channel blockers were more prevalent among older residents who had elevated pressures on multiple occasions (P < .03). Successful antihypertensive treatment was associated with a lower prevalence of orthostatic hypotension. Diuretic use was more likely to be associated with blood pressure control.CONCLUSION: The diagnosis of hypertension in frail older people would benefit from multiple, within‐day measures, including postural BP, taken before and after meals. Diuretic use alone, or in conjunction with ACE inhibitors or calcium channel blockers, was more likely to be associated with normalized blood pressures.
Identifying Patterns of Disruptive Behavior in Long‐Term Care Residents
Authors: Souder Elaine , Heithoff Kim , O'Sullivan Patricia S. , Lancaster Anne Elizabeth , Beck Cornelia 
Published: April 2015

OBJECTIVES: To determine the frequency, timing, and pattern of 45 operationalized disruptive behaviors (DB) in older people in long‐term care units.DESIGN: Nursing staff collected prospective descriptive data over 21 consecutive shifts for each patient to document prevalence, frequency, and co‐occurrences of DBs.SETTING: All of the eight long‐term care units and one acute/admission unit of a large Veterans Administration Medical Center (VAMC). Each 40‐bed unit had patients with varying levels of cognitive impairment and skilled nursing needs.PARTICIPANTS: The sample consisted of 240 hospitalized VA patients with a mean age of 72.8 (SD = 8.6) years and mean length of stay of 4.02 (SD = 8.6) years. Residents had dementia, a psychiatric diagnosis, or mixed dementia and psychiatric diagnoses.MEASUREMENTS: The Disruptive Behavior Scale (DBS), an instrument designed for collecting patient‐level data on 45 separate DBs.RESULTS: In a 24‐hour period, the average frequency was 3.6 DBs per subject. We found that 41.2% of DB occurred during the day shift, 39.2% during the evening shift, and 19.6% during the night shift. In 32% of observed occurrences, only one DB occurred within the hour. In the remaining 68% of observations, two or more DBs occurred within the same hour. We found two behaviors, Does Not Follow Directions and Excessive Motor Activity, to occur with multiple behaviors in multiple categories. Several characteristic patterns were noted; e.g., physically aggressive behaviors rarely co‐occurred with verbal DBs. Physically nonaggressive behaviors seemed to occur most frequently with other physically nonaggressive behaviors and, to a lesser extent, with verbal DBs.CONCLUSIONS: These findings lend support to the existence of patterns of DBs in long‐term care patients, a useful step toward targeting interventions early in the behavioral sequence.