bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceived Efficacy in Patient‐Physician Interactions (PEPPI): Validation of an Instrument in Older Persons
Authors: Maly Rose C. , Frank Janet C. , Marshall Grant N. , DiMatteo M. Robin , Reuben David B. 
Published: April 2015

OBJECTIVE: To develop and validate a brief instrument – the Perceived Efficacy in Patient‐Physician Interactions Questionnaire (PEPPI) – to measure older patients' self‐efficacy in obtaining medical information and attention to their medical concerns from physicians.DESIGN: Two consecutive validation surveys.SETTING: Eleven senior multipurpose centers in Los Angeles County California.POPULATION: A convenience sample of 163 community‐dwelling older persons (Survey 1: n = 59, mean age = 77.1 years, 76.3% female; Survey 2: n = 104, mean age = 77.4 years, 57.7% female).MEASURES: The 10‐item PEPPI, subscales of the Patient Satisfaction Questionnaire, the Medical Outcomes Study (MOS) Coping Scale, the Mastery Scale, and global self‐reported health and restricted activity days items.RESULTS: The full 10‐item and a 5‐item short form of PEFPI demonstrated Cronbach's alphas of 0.91 and 0.83, respectively. PEPPI demonstrated discriminant and convergent validity as hypothesized, correlating negatively with avoidant coping (r = ‐.27, P =.001) and positively with active coping (r =.17, P =.03) and with patient satisfaction with physician interpersonal manner (r =.49, P <.0001) and communication (r =.51, P <.0001) (values from the overall sample). Further, in the second survey, PEPPI correlated positively with self‐reported health (r =.42, P <.0001), education (r =.24, P =.01) and self‐mastery (r =.29, P =.01) and negatively with restricted activity days (r = ‐.25, P =.01). PEPPI‐5 demonstrated correlations similar in magnitude, direction, and statistical significance.CONCLUSION: In either the 5‐ or 10‐item version, PEPPI is a valid and reliable measure of older patients' perceived self‐efficacy in interacting with physicians. This instrument may be useful in measuring the impact of empowerment interventions to increase older patients' personal sense of effectiveness in obtaining needed health care.
A Nonpharmacologic Sleep Protocol for Hospitalized Older Patients
Authors: McDowell Jane A. , Mion Lorraine C. , Lydon Thomas J. , Inouye Sharon K. 
Published: April 2015

OBJECTIVES: To evaluate the feasibility of and adherence to a nonpharmacologic sleep protocol targeted to nurses for acutely ill older patients and to test the effectiveness of the protocol on enhancing sleep and reducing sedative‐hypnotic drug (SHD) use.DESIGN: Prospective cohort study.SETTING: A 34‐bed general medical unit in a university‐affiliated teaching hospital.PARTICIPANTS: A total of 175 consecutive admissions aged 70 years or older.INTERVENTION: A nonpharmacologic sleep protocol consisting of a back rub, warm drink, and relaxation tapes was administered by nursing personnel to patients who complained of difficulty initiating sleep or who requested a SHD. After 1 hour, if the patient still requested it, the nurse administered the SHD.MEASUREMENTS: The main outcomes of sleep quality and SHD use were measured by patient interview and chart abstraction. Feasibility and adherence to the protocol were tracked daily by patient and nurse interviews and chart abstraction.RESULTS: A cohort of 111 patients, mean age 79.3 (± 6.4), 68% women, received the sleep protocol. Patients required the protocol for a mean of 4.9 days per patient, totalling 539 patients‐days. The overall adherence rate was 400/539 (74%) patient‐days. The rate of complete nonadherence was 139/539 (26%), with reasons for nonadherence including nurse nonadherence in 30 (6%), patient refusal in 104 (19%), and medical contraindications in five (1%). The quality of sleep correlated strongly with the number of parts of the protocol received, suggesting a dose‐response relationship, with the highest correlation for receiving two to three parts (ρ = .64, P < 0.001). The sleep protocol was successful in reducing SHD use from the baseline preintervention rate of 51/94 (54%) to 34/111 (31%) (P < .002). The sleep protocol had a stronger association with quality of sleep (ρ = .75, P = .001) than did SHDs (ρ = .07, P = .45). However, chronic SHD users were more likely to refuse the protocol than nonusers (64% vs 41%, P < .03) and received SHDs 4.5 times more often than nonusers (67% vs 15%, P = .001).CONCLUSION: The nonpharmacologic sleep protocol provides a feasible, effective, and nontoxic alternative to SHDs to promote sleep in older hospitalized patients. Use of the protocol can substantially decrease use of SHDs.
Apolipoprotein E Phenotypes, Dementia and Mortality in a Prospective Population Sample
Authors: Tilvis Reijo S , Strandberg Timo E , Juva Kati 
Published: April 2015

OBJECTIVE: To study the relationships between apoE phenotypes, dementia, and mortality.SETTING: A population‐based study in Helsinki, Finland (the Helsinki Ageing Study).DESIGN: A prospective birth cohort study with 5‐year follow‐up.PARTICIPANTS: A total of 550 subjects of three birth cohorts of 75 (n = 182), 80 (n = 185), and 85 (n = 183) years of age.MEASUREMENTS: ApoE phenotype was determined from baseline blood samples. The cognitive function of the subjects was tested at baseline and at a 5‐year follow‐up using the Mini‐Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR). Diagnosis and type of dementia were determined by a neurologist. The cohorts were followed for 5 years, and causes of death were determined. Cox proportional hazards model was used for survival analyses. Analyses were performed comparing the apoE e4 allele and others.RESULTS: At baseline, the apoE e4 allele was found in 148 of 550 subjects (27%), in 24% of nondemented persons, in 51% of patients with probable or uncertain Alzheimer's disease (AD), and in 34% patients with vascular dementia. The CDR score was worse among subjects with an e4 allele compared with others at baseline (P < .001) and after a 5‐year follow‐up (P = .007). The crude mortality rates of subjects with and without an e4 allele were 48% (n = 71) and 37% (n = 148), respectively. After controlling for age and gender, the hazard ratio of an e4 allele was 1.61 (95% CI, 1.21–2.14) for all‐cause mortality, deaths caused by dementia 2.20 (95% CI, 1.03–4.72), and presence of AD 3.24 (95% CI, 1.67–6.25).CONCLUSIONS: In a population aged 75 to 85 years, the presence of an apoE e4 allele is associated with impaired cognitive function, clinical dementia, AD, and excess 5‐year mortality resulting from dementia and all causes.
The Association of Weight Change in Alzheimer's Disease with Severity of Disease and Mortality: A Longitudinal Analysis
Authors: White Heidi , Pieper Carl , Schmader Ken 
Published: April 2015

OBJECTIVE: To describe weight loss in relation to the severity of Alzheimer's disease (AD), to identify confounders that might account for weight loss, and to investigate the association of weight change with mortality.METHODS: This study included 666 subjects with AD from the Consortium to Establish a Registry for Alzheimer's Disease, a longitudinal study of subjects with AD studied for ≤6 years. Body weight was measured on entry and at annual follow‐up examinations as part of standardized clinical assessments. Hierarchical linear models were used to estimate weight change per change in stage of AD, as measured by the Clinical Dementia Rating scale, and to assess the impact of possible confounders on the tendency for weight loss. Linear correlation of the trajectories of weight and CDR over time were used to determine the association between weight change and stage change. The association between weight change and mortality was modeled using the Cox proportional hazards model.RESULTS: Each change in stage of AD was associated with an estimated average weight loss of nearly 2 lb (P = .0001). The correlation between change in stage of AD and weight change was statistically significant (r = −0.09, P = .005), which indicates a greater tendency toward weight loss with progression of AD. Weight loss of 2:5% in any year before death was a significant predictor of mortality. When weight loss in the year before death or censoring was analyzed as a continuous variable, it was a significant predictor of mortality. Additionally, the relative risk of death increased as weight loss increased. In contrast, weight gain decreased the risk of mortality.CONCLUSION: The risk of weight loss tends to increase with severity and progression of AD. Weight loss is a predictor of mortality among subjects with AD, whereas weight gain appears to have a protective effect.
Discussions About End‐of‐Life Care in Nursing Homes
Authors: Bradley Elizabeth H. , Peiris Vasum , Wetle Terrie 
Published: April 2015

OBJECTIVE: To measure the frequency with which nursing home residents and their surrogates discuss with clinicians the resident's wishes concerning future treatment and to assess the influence of the Patient Self Determination Act (PSDA) on the frequency and nature of such discussions.DESIGN: Retrospective cohort study of residents admitted to nursing homes before and after the PSDA.SETTING: Six large (at least 120 licensed chronic care beds), randomly selected nursing homes in Connecticut.PARTICIPANTS: Six hundred randomly selected nursing home residents admitted during 1990 and 1994 to one of the six study nursing homes.MEASUREMENTS: Documented discussions concerning future treatment wishes were abstracted from residents' nursing home medical records. Participants in the discussion, as well as the timing (i.e., date) and content of the documented discussions were recorded. Sociodemographic and health status factors were also obtained from the medical record.RESULTS: A large majority of residents (71.5%) had no discussion of future treatment wishes documented in their medical record. However, the percentage of residents with documented discussions had increased since the implementation of the PSDA (36.7% post‐PSDA vs 20.3% pre‐PSDA). Of those in the post‐PSDA cohort who had had discussions, 90% had only one discussion within the first year of admission, and more than half (58.1%) of those who had discussions discussed only life‐support systems (cardiopulmonary resuscitation, artificial nutrition and hydration, and ventilation) rather than broader preferences for future treatment, including proxy decision‐making.CONCLUSIONS: Despite the increased prevalence of discussions about future treatment wishes since the enactment of the PSDA, no discussions were documented for most residents. For those with documented discussions, such conversations occurred rarely and were narrow in scope, suggesting that residents' and families' roles in medical decision‐making in nursing homes may be limited.
Influence of Patient Preferences and Local Health System Characteristics on the Place of Death
Authors: Pritchard Robert S. , Fisher Elliott S. , Teno Joan M. , Sharp Sandra M. , Reding Douglas J. , Knaus William A. , Wennberg John E. , Lynn Joanne ,   SUPPORT Investigators
Published: April 2015

OBJECTIVE: To examine the degree to which variation in place of death is explained by differences in the characteristics of patients, including preferences for dying at home, and by differences in the characteristics of local health systems.DESIGN: We drew on a clinically rich database to carry out a prospective study using data from the observational phase of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT component). We used administrative databases for the Medicare program to carry out a national cross‐sectional analysis of Medicare enrollees place of death (Medicare component).SETTING: Five teaching hospitals (SUPPORT); All U.S. Hospital Referral Regions (Medicare).STUDY POPULATIONS: Patients dying after the enrollment hospitalization in the observational phase of SUPPORT for whom place of death and preferences were known. Medicare beneficiaries who died in 1992 or 1993.MAIN OUTCOME MEASURES: Place of death (hospital vs non‐hospital).RESULTS: In SUPPORT, most patients expressed a preference for dying at home, yet most died in the hospital. The percent of SUPPORT patients dying in‐hospital varied by greater than 2‐fold across the five SUPPORT sites (29 to 66%). For Medicare beneficiaries, the percent dying in‐hospital varied from 23 to 54% across U.S. Hospital Referral Regions (HRRs). In SUPPORT, variations in place of death across site were not explained by sociodemographic or clinical characteristics or patient preferences. Patient level (SUPPORT) and national cross‐sectional (Medicare) multivariate models gave consistent results. The risk of in‐hospital death was increased for residents of regions with greater hospital bed availability and use; the risk of in‐hospital death was decreased in regions with greater nursing home and hospice availability and use. Measures of hospital bed availability and use were the most powerful predictors of place of death across HRRs.CONCLUSIONS: Whether people die in the hospital or not is powerfully influenced by characteristics of the local health system but not by patient preferences or other patient characteristics. These findings may explain the failure of the SUPPORT intervention to alter care patterns for seriously ill and dying patients. Reforming the care of dying patients may require modification of local resource availability and provider routines.
Differences Among Geriatricians, General Internists, and Cardiologists in the Care of Patients with Heart Failure: A Cautionary Tale of Quality Assessment
Authors: Chin Marshall H. , Wang John C. , Zhang James X. , Sachs Greg A. , Lang Roberto M. 
Published: April 2015

OBJECTIVES: To describe differences in the characteristics, processes of care, and resource utilization of patients with heart failure cared for by geriatricians, general internists, cardiologists, and combinations of physicians.DESIGN: A retrospective cohort study.SETTING: An urban academic medical center.PARTICIPANTS: A total of 439 outpatients with a billing diagnosis of heart failure or cardiomyopathy who were treated by geriatricians, general internists, cardiologists, and combinations of physicians.MEASUREMENTS: Demographic and clinical characteristics, medication use, diagnostic testing, hospitalizations, and inpatient and outpatient costs were measured.RESULTS: Compared with patients of cardiologists, patients cared for by geriatricians were older, more likely to have hypertension, diastolic dysfunction, and high comorbidity, and less likely to undergo echocardiography, cardiac catheterization, and electrocardiography. Use of angiotensin‐converting enzyme inhibitors was similar among patients with reduced systolic function. Patients cared for by geriatricians had the same costs, rates of hospitalization, and likelihood of being symptomatic as patients of cardiologists.CONCLUSIONS: The processes of care for patients with heart failure seen solely by geriatricians differ from those for patients seen by other physicians, but the case‐mix also varies. Assessment of left ventricular function by geriatricians probably needs to be increased. However, although they were older and had more comorbidity, patients of geriatricians had total costs and symptomatology similar to those of patients of cardiologists. Future work is needed to identify those patients most likely to benefit from treatment by geriatricians and to determine how care can be optimally coordinated among different types of physicians and health providers.
The Ankle Brachial Index Independently Predicts Walking Velocity and Walking Endurance in Peripheral Arterial Disease
Authors: McDermott Mary McGrae , Liu Kiang , Guralnik Jack M. , Mehta Shruti , Criqui Michael H. , Martin Gary J. , Greenland Philip 
Published: April 2015

OBJECTIVES: Maintaining function among older men and women is an important public health goal as the population lives longer with chronic disease. We report the relationships between lower extremity peripheral arterial disease (PAD), PAD severity, and PAD‐related symptoms with walking velocity and endurance among men and women aged 55 and older.DESIGN: A cross‐sectional design.SETTING: An academic medical center.PARTICIPANTS: Participants with PAD were men and women aged 55 and older identified from a blood flow laboratory or a general medicine practice (n = 158). Randomly selected controls without PAD were identified from the general medicine practice (n = 70).MEASUREMENTS: PAD was diagnosed and quantified using the ankle brachial index (ABI). Subjects were categorized according to whether they had severe PAD (ABI <0.40), mild to moderate PAD (ABI 0.40 to <0.90), or no PAD (ABI 0.90 to <1.50). Walking endurance was assessed with the 6‐minute walk. Usual walking velocity and maximal walking velocity were assessed with “usual” and “maximal” paced 4‐meter walks, respectively.RESULTS: Average distances achieved in the 6‐minute walk were 1569 ± 390 feet for subjects with ABI 0.90–1.50, 1192 ± 368 feet for subjects with ABI 0.40 to <0.90, and 942 ± 334 feet for subjects with ABI < 0.40 (trend P value < .001). Walking velocities for both the usual and maximal paced 4‐meter walks were slowest among subjects with ABI < 0.40 and fastest among subjects with ABI 0.90 to <1.50. Subjects with PAD who had pain at rest had slower walking velocity and poorer walking endurance than other subjects with PAD. In multiple linear regression analyses that included subjects with PAD only, ABI level was an independent predictor of 6‐minute walk performance (regression coefficient = 159 ft/0.40 ABI units, P = .011), usual paced 4‐meter walk (regression coefficient = .095 meters/sec/0.40 ABI units, P = .031), and maximal paced 4‐meter walk (regression coefficient = .120 meters/sec/0.40 ABI units, P = .050) adjusting for age, sex, race, leg symptoms, and comorbid diseases known to affect functioning. Pain at rest was associated independently with the maximally paced 4‐meter walk (−0.201 meters/sec, P = .024), but not with the other walks.CONCLUSION: ABI level has a measurable and independent association with walking endurance and both usual and maximal walking velocity. These data suggest that PAD may impair lower extremity function by diminishing function of both Type I (“slow twitch”) and Type II (“fast twitch”) muscle fibers. Because walking velocity has important prognostic implications for functioning, these data also suggest that ABI may be used to identify patients at increased risk of mobility loss.
Development and Validation of a Geriatrics Attitudes Scale for Primary Care Residents
Authors: Reuben David B. , Lee Ming , Davis James W. , Eslami Michelle S. , Osterweil Daniel G. , Melchiore Susan , Weintraub Nancy T. 
Published: April 2015

OBJECTIVE: To develop and validate an instrument measuring attitudes toward older persons and caring for older patients.DESIGN: Cross‐sectional and longitudinal studies.SETTING: An academic medical center.PARTICIPANTS: Initial Study: 121 primary care residents (n = 96), fellows (n = 14), and faculty (n = 11) participated in instrument development in 1995. Longitudinal Study: 95 residents (n = 87) and fellows (n = 8) of the initial cohort participated in the 1996 follow‐up study, and 61 of the initial cohort (57 residents and 4 fellows) participated in the 1997 follow‐up study. Cross Validation Study: 96 first‐year residents (n = 78) and fellows (n = 18) participated in this study.MEASUREMENTS: A 14‐item geriatrics attitudes scale was developed. The items were selected from a pool of 37 items administered to the 121 participants in the initial study.RESULTS: The instrument demonstrated high reliability (Cronbach's α = .76) and known‐groups and construct validity. Attitudes were progressively more positive with more medical training (P < .001), and residents with greater career interest in geriatrics scored higher than those less interested (P = .007). Cross validation results supported the reliability and validity of the instrument. Longitudinal data showed significantly different trends of attitude changes among groups of residents and fellows over a 2‐year period.CONCLUSIONS: The 14‐item geriatrics attitudes scale developed in this study shows sound reliability, validity, and sensitivity to change among primary care residents. The performance of other groups of medical trainees and the relationship of attitude changes to specific medical training warrant further investigation.
Prevalence Rates of Hearing Impairment and Comorbid Conditions in Older People: The Veneto Study
Authors: Maggi Stefania , Minicuci Nadia , Martini Alessandro , Langlois Jean , Siviero Paola , Pavan Mara , Enzi Giuliano 
Published: April 2015

OBJECTIVES: To investigate the prevalence rate of hearing impairment, assessed by both the Sanders' questionnaire and the speech audiometry test, and its association with health‐related factors in the older population of the Veneto region of Italy.DESIGN: A cross‐sectional survey.SETTING: A community‐based population.PARTICIPANTS: 2398 noninstitutionalized individuals aged 65 years and older residing in the Veneto region of Italy.MEASUREMENTS: Prevalence rates of hearing impairment and odds ratios for its association with potential risk factors.MAIN RESULTS: The prevalence of self‐reported hearing impairment at home was 8.1% in men and 7.4% in women, and in a social environment it was 11.1% and 9.3%, respectively. Women were less likely to report hearing difficulties in both environments, and increased risks were found for depression, age, and poor self‐rated health. Participants with diabetes or cognitive impairment had increased odds only at home, in contrast to people with a low education level, who had increased odds only in a social environment. The prevalence assessed by speech audiometry was 19% in both sexes. Increased age, diabetes, and poor self‐rated health were associated with impaired speech intelligibility, cognitive impairment was associated with 4‐fold increased odds among past users of alcohol, and men with a low education level were about three times as likely as others to have hearing impairment.CONCLUSIONS: Speech audiometry testing detected a higher prevalence of hearing impairment than use of a self‐reported questionnaire and was associated with poor self‐rated health, history of diabetes, and cognitive impairment among past users of alcohol and among men with low levels of education. The association between hearing deficit and depressive symptomatology was confirmed only with self‐reported hearing impairment.