bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alcohol Use in Retirement Communities
Authors: Adams Wendy L. 
Published: April 2015

OBJECTIVESAnecdotal reports and two previous studies suggest that retirement communities have a particularly high prevalence of heavy drinking. The objective of this study was to verify or refute this finding and to identify characteristics associated with heavy drinking in retirement communities.METHODSThis cross‐sectional study used a mailed survey to gather information from three retirement communities in suburban Milwaukee, Wisconsin. The questionnaire included alcohol use questions adapted from the Khavari questionnaire and the CAGE questionnaire to screen for alcohol abuse.RESULTSThree hundred seventeen of 454 independent residents of the retirement communities completed and returned surveys for a response rate of 70%. Mean age of respondents was 83 ± 6 years, 100% were white, 77% were female. Forty‐seven percent used some alcohol, 15% had one to six drinks per week, 8% had seven or more drinks per week. Only two people screened positive on the CAGE questionnaire for abusive drinking. The majority of drinkers had decreased alcohol use since moving to the community. Male sex, socialization, lack of religious affiliation, and smoking were factors whose percentages increased significantly with increasing alcohol use. Although drinkers were more likely to smoke cigarettes, no indicators suggested that they were less healthy than abstainers.CONCLUSIONSDespite the advanced age of this population, regular alcohol use was prevalent. In contrast to previous reports from retirement communities, heavy and abusive drinking were uncommon by our measures, perhaps because of the older age and female predominance of the sample. Drinking appears to be associated with more social contacts and, possibly, better health status.
Use of Restraints and Bedrails in a British Hospital
Authors: O'Keeffe Shaun , Jack Catherine I.A. , Lye Michael 
Published: April 2015

OBJECTIVETo determine the prevalence of restraint and bedrail use in a British hospital.DESIGNCross‐sectional observational study.SUBJECTSSix hundred sixty‐eight patients in the acute medical, surgical, and geriatric beds of a large British teaching hospital on a single nightMEASUREMENTSObserved use of restraints and bedrails. Reasons for restraint use were determined by interviews with nursing staff and examination of the case notes.RESULTSFifty‐six (8.4%) patients had bedrails raised. No other restraints were in use. Reported indications for bedrail use were: prevention of falls (52 patients), prevention of wandering (1), and patient request (3). In stepwise logistic regression analysis, bedrail use was associated significantly with agitated confusion, age 70 years or more, and stroke, while patients on the acute geriatric wards were significantly less likely to have bedrails raised.CONCLUSIONSRestraint use is relatively uncommon in Britain. Nevertheless, inappropriate use of bedrails is a reason for concern.
Hearing Loss in Former Prisoners of War of the Japanese
Authors: Grossman Thomas W. , Kerr Harry D. , Byrd James C. 
Published: April 2015

OBJECTIVETo describe the prevalence, degree, and types of hearing loss present in a group of older American veterans who had been prisoners of war of the Japanese.DESIGNA descriptive study.SETTINGA Veterans Affairs university hospital.PARTICIPANTSSeventy‐five male veterans, mean age 68 (+/− 3.6) years.INTERVENTIONSHearing aids were prescribed for eight veterans.MEASUREMENTSSubjects were examined, and pure tone air and bone conduction, speech reception threshold, and speech discrimination were determined. Results were compared with age‐ and sex‐matched controls from the largest recent American population study of hearing loss.RESULTS95% of subjects had been imprisoned longer than 33 months. Starvation conditions (100%), head trauma (85%), and trauma‐related loss of consciousness (23%) were commonly reported. A total of 73% complained of hearing loss, and 29% (22/75) dated its onset to captivity. Most of those with the worst losses in hearing and speech discrimination were found in this subgroup. When the entire group was compared with published age‐ and sex‐matched controls from the Framingham Study, no significant differences were found.CONCLUSIONSWe advocate screening examinations and long‐term follow‐up of populations with similar histories of starvation, head trauma, and torture.
Pulmonary Aspiration in a Long‐term Care Setting: Clinical and Laboratory Observations and An Analysis of Risk Factors
Authors: Pick Neora , McDonald Anne , Bennett Nancy , Litsche Mildred , Dietsche Linda , Legerwood Robert , Spurgas Richard , LaForce F. Marc 
Published: April 2015

OBJECTIVE: To determine the incidence and risk factors associated with aspiration in a high risk group in a long‐term care setting.DESIGN: A prospective study of demographic, nutritional, clinical, dental, and survival characteristics in 69 patients who suffered 98 aspiration events from May 1, 1990, to December 31, 1990. Demographic and nutritional data from 192 patients who did not aspirate were collected from September 1991 to December 1991.SETTING: A long‐term care VA facility.PATIENTS: Long‐term care residents, most of whom were neurologically debilitated.MEASUREMENTS: The incidence of aspiration was measured and the clinical and microbiological characteristics of aspiration‐associated nosocomial pneumonia described. Mortality and demographic, clinical, and nutritional characteristics were compared between patients who aspirated and those who did not.MAIN RESULTS: Twenty‐five percent of the study group aspirated during the 8‐month observational period, and 56% of the aspiration events progressed to roentgenographically proven cases of nosocomial pneumonia. Six bacteremic episodes were documented, and results of sputum cultures were consistent with mixed Gram‐positive and Gram‐negative infections. During the study period, patients who aspirated were at three times the risk of dying compared with patients who did not aspirate. Three years later, only 17% of the original group of patients who aspirated were still alive compared with 60% of the patients who had not aspirated. Multivariate analysis identified tube feeding, presence of a hyperextended neck or contractions, malnutrition, and the use of benzodiazepines and anticholinergics as risk factors.CONCLUSIONS: Pulmonary aspiration is a common and serious event in neurologically impaired long‐term care patients. Some risk factors are amenable to change.
Atrophy of the Corpus Callosum in Alzheimer's Disease Versus Healthy Aging
Authors: Janowsky Jeri S. , Kaye Jeffrey A. , Carper Ruth A. 
Published: April 2015

OBJECTIVE: To investigate the specificity of atrophic changes in the corpus callosum (CC) compared with the cerebellum and pons in patients with Alzheimer Disease (AD), healthy elderly subjects (HE), and a sample of prospectively studied subjects who have developed cognitive decline or “incipient dementia” (ID).DESIGN: Cross‐sectional comparison by age using quantitative MRI.SETTING: Ambulatory research unit.PARTICIPANTS: Sixty HE subjects (mean age 78.2 years; range 66–95), 20 ID subjects (mean age 88.1 years; range 78–98) and 39 AD subjects (mean age 72.2 years; range 52–91) were enrolled in longitudinal studies of healthy aging or AD. The population was selected for optimal health; all were examined to exclude medical, neurological and psychiatric illnesses.MEASUREMENTS: Brain atrophy by quantitative MRI.RESULTS: AD subjects had smaller CC than HE or ID subjects, who did not differ from each other. All three sectors of the CC were smaller in AD than in HE or ID subjects. The cross sectional area of the cerebellum and pons did not differ between groups. HE and ID subjects showed a significant decline in CC size with age. No age‐related decline was found for AD subjects. The regional atrophy of the CC in AD subjects was significantly related to cognitive function but not to disease duration.CONCLUSIONS: Atrophy of the CC differentiates HE and ID from AD subjects and tracks the cognitive decline of this disease. In addition, optimally healthy subjects show an age‐related decline in callosum size. The atrophy is specific to the CC, a cortical projection system, and does not occur in cerebellum or pons.
Cognitively Impaired Spouses as Primary Caregivers for Demented Elderly People
Authors: Boucher Lucie , Renvall J. , Jackson J. Edward 
Published: April 2015

OBJECTIVE: To describe problems of dementia patients whose spousal caregivers are also cognitively impaired.DESIGN: Retrospective chart review.SETTING: The geriatric assessment clinic at University of California, San Diego, which is one center for the California State sponsored Alzheimer's Disease Diagnosis and Treatment Center Program.PATIENTS: During the period from January 1992 through May 1994, 65 patients completed the assessment and met the entry criteria of being demented and having a spousal caregiver. Twelve of the spouses scored six or more error points on the Katzman Short Orientation‐Memory‐Concentration Test.MEASUREMENTS: Patient data included age, living situation, other caregivers, use of formal and informal support systems, profiles of medical, cognitive, and functional ability, caregiver interactions, and recommendations from the evaluation.MAIN RESULTS: Dementia patients with cognitively impaired spouses utilized fewer community resources (P = .021) and experienced difficulty with medication compliance (P = .041) more often than those with cognitively normal spousal caregivers.CONCLUSIONS: Older caregivers of patients suffering from dementia should be screened for cognitive problems.
A Clinical Approach to “Idiopathic” Normocytic‐Normochromic Anemia
Authors: Elis Avishay , Ravid Mordchai , Manor Yosef , Bental Tamir , Lishner Michael 
Published: April 2015

OBJECTIVES: Normocytic‐normochromic anemia is frequently found in patients with chronic disorders. The pathogenesis, epidemiological and clinical characteristics of normocytic normochromic anemia of unknown cause are not well established. We evaluated the role of bone marrow examination and the clinical course of patients with “idiopathic” normocytic‐normochromic anemia.DESIGN: Patients with normocytic‐normochromic anemia underwent a noninvasive evaluation according to a predetermined protocol. Bone marrow aspiration and biopsy were performed in those patients in whom no explanation for the anemia was found. They were later followed at 3 to 6 month intervals.RESULTS: Thirty‐one patients (23 females and 8 males) with “idiopathic” normocytic‐normochromic anemia (mean hemoglobin concentration was 10.0 + 0.6 g/dL) were detected. No patient had symptoms related to the anemia. Twenty‐nine bone marrow aspirations and 21 biopsies were performed. Iron deficiency and mild myelofibrosis were found in one patient each. The rest of the bone marrow examinations were normal. During 15.5 ± 10.3 months of follow‐up, the hemoglobin level rose marginally to 10.9 + 1.0 g/dL (P < .0002). No changes in clinical or laboratory variables that could be ascribed to anemia were detected.CONCLUSION: Normocytic‐normochromic anemia of unknown cause is encountered infrequently in clinical practice and is found mainly in older patients. The evaluation should be noninvasive to exclude correctable causes of the anemia. Bone marrow examination is only rarely contributive in this setting. The prognosis of these patients is excellent.
HEALTH SERVICES RESEARCH: The Effectiveness and Efficiency of Outpatient Geriatric Evaluation and Management
Authors: Engelhardt Joseph B. , Toseland Ronald W. , O'Donnell John C. , Richie Jill T. , Jue Donald , Banks Steve 
Published: April 2015

OBJECTIVES: To compare the effectiveness of geriatric evaluation and management (GEM) with usual primary care (UPC).DESIGN: A 2 × 3 randomized controlled group design.SETTING: A 450‐bed Department of Veterans Affairs Medical Center (VAMC) that provides general medical and surgical care to eligible veterans.PARTICIPANTS: One‐hundred sixty male subjects (mean age = 72 years), who were above average users of VAMC outpatient clinics and who had at least two Activity of Daily Living (ADL) or Instrumental Activity of Daily Living (IADL) impairments, were assigned to GEM (n = 80) or UPC (n = 80).MEASUREMENTS: Data were collected about patients' (1) health and functional status, (2) psychosocial well‐being, (3) quality of health and social care, (4) health care utilization, and (5) health care costs. Data were obtained before randomization, and again at 8 and 16 months.RESULTS: The results indicated that GEM was more effective than UPC in improving some aspects of the quality of health and social care and in increasing patient satisfaction with care. GEM also reduced emergency room use, and showed a trend toward decreasing acute admissions. It was not effective, however, in improving patients' psychosocial well‐being. Except for a short‐term survival advantage, it was also not effective in preventing deterioration in their health and functional status. Further, GEM did not reduce overall utilization of outpatient or inpatient services, and it significantly increased total outpatient health care costs.CONCLUSIONS: Outpatient GEM improves patient satisfaction and some aspects of the quality of care patients' receive but does not reduce the cost of outpatient or inpatient care. Longer‐term follow‐up studies are needed to determine whether reductions in emergency room use and inpatient admissions persist over time and result in reductions in the overall cost of care.
Hospital‐Acquired Pressure Ulcers and Risk of Death
Authors: Thomas David R. , Goode Patricia S. , Tarquine Paige Huber , Allman Richard M. 
Published: April 2015

OBJECTIVE: To evaluate the impact of in‐hospital pressure ulcer development on mortality among older, high‐risk, hospitalized patients up to 1 year post‐hospital discharge, after adjusting for baseline patient characteristics, disease severity, hospital complications, and discharge activity level.DESIGN: A prospective, inception, cohort study.SETTING: An urban, tertiary, acute care, university teaching hospital.PATIENTS: A total of 286 patients aged 55 or older, expected to be confined to bed or chair for at least 5 days, who were admitted to the hospital without a Stage 2 or greater pressure ulcer.MEASUREMENTS: The primary outcome measurement was time to death from admission to 1‐year post‐hospital discharge. Baseline information included demographic, medical, functional, and nutritional variables known to be associated with increased mortality. Measures of global disease severity and co‐morbidity included the admitting physician's estimate of illness severity and life expectancy, the acute physiology score of APACHE II, the Co‐morbidity Damage Index, and the Medicus Nursing Classification Score. Baseline infections, incident infections, and noninfectious hospital complications were determined. Functional activity level was determined at hospital discharge. Post‐discharge vital status was determined by telephone interviews at 3, 6, 9, and 12 months after discharge and confirmed by death certificate review.MAIN RESULTS: Development of an in‐hospital pressure ulcer was associated with greater risk of death at 1 year (59.5% vs 38.2%, P = .02). However, pressure ulcer development did not remain independently associated with decreased survival after adjusting for other predictors of mortality. Predictors of mortality at hospital admission by multivariate Cox regression analysis included weight loss in the 6 months before admission (RR 2.4, CI 1.6, 3.6), physician estimate of life expectancy (RR 2.1, CI 1.7, 2.6), and the Co‐morbidity Damage Index (RR 1.1, CI 1.0, 1.2). Multivariate predictors of 1‐year mortality at discharge included physician estimate of life expectancy (RR 2.2, CI 1.8, 2.6), weight loss in the 6 months before admission (RR 2.2, CI 1.5, 3.2), remaining confined to bed or chair (RR 1.9, CI 1.2, 3.1), and the total number of hospital complications (RR 1.3, CI 1.2, 1.5).CONCLUSIONS: Pressure ulcers that develop during acute hospitalization are not associated with reduced 1‐year survival among high risk older persons after adjusting for nutritional and functional status, global measures of disease severity and co‐morbidity, and noninfectious hospital complications.
A Population‐Based Study on the Incidence of Dementia Disorders Between 85 and 88 Years of Age
Authors: Aevarsson Olafur , Skoog Ingmar 
Published: April 2015

OBJECTIVE: To investigate the incidence of Alzheimer's disease, vascular dementia and other dementias in a population between 85 and 88 years of age.DESIGN: Prospective cohort study. Longitudinal population study of the very old.SETTING: Systematic sample of a birth cohort living in the community or in institutions in the city of Gothenburg, Sweden.PARTICIPANTS: A representative population sample of nondemented 85‐year‐old residents (n = 347).MEASUREMENTS: The study included neuropsychiatric, neuropsychological, and physical examinations, key informant interviews, comprehensive laboratory tests, electrocardiography, chest radiography and computed tomography (CT‐scan) of the head. Information on subjects lost during the follow‐up period as a result of death or refusal was traced in medical records. Dementia was defined according to the criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition, revised), Alzheimer's disease according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, and vascular dementia according to criteria proposed by Erkinjuntti.RESULTS: Sufficient information was obtained about 92% of the subjects at risk. Sixty‐three subjects (18.2%) became demented between ages 85 and 88, giving an incidence of 90.1/1000/year (61.3/1000/year for men and 102.7/1000/year for women; P = .085). The incidence of Alzheimer's disease was 36.3/1000/year, vascular dementia 39.0/1000/year (P = 1.000), and that of other dementias 9.1/1000/year.CONCLUSION: This study shows that almost one‐tenth of nondemented persons between the ages of 85 and 88 become demented each year, emphasizing the magnitude of the dementia problem in the very old, the fastest growing segment of western populations.
Factors Affecting Sample Selection in a Randomized Trial of Balance Enhancement: The FICSIT Study
Authors: Pacala James T. , Judge James Oat , Boult Chad 
Published: April 2015

OBJECTIVE: To determine demographic, functional, and health‐related factors that may have influenced the selection of older adults for a randomized trial of balance enhancement.DESIGN: Comparison of participants with nonparticipants at various stages of the recruiting process.SETTING: Northeastern suburban community.PARTICIPANTS: Registered voters aged 75 and older (n = 7191).MEASUREMENTS: Demographic, health‐related, functional, balance, gait, and falling characteristics.RESULTS: The overall participation rate in the randomized trial was 1.5%. Compared with nonparticipants, participants were significantly more likely to be male, married, living with others, living in a house, highly educated, healthy, and physically active.CONCLUSION: Recruiting older subjects by mail to studies of rigorous interventions can produce significant selection biases that may limit the population to which results can be generalized. J Am Geriatr Soc 44:377–382, 1996.
Intraindividual Reproducibility of Postprandial and Orthostatic Blood Pressure Changes in Older Nursing‐Home Patients: Relationship with Chronic Use of Cardiovascular Medications
Authors: Jansen René W.M.M. , Kelley‐Gagnon Margaret M. , Lipsitz Lewis A. 
Published: April 2015

OBJECTIVES: Although postprandial and orthostatic hypotension are commonly observed in nursing home residents, their reproducibility, relationship to each other, and association with chronic use of cardiovascular medications are poorly understood.DESIGN: We examined blood pressure (BP) and heart rate (HR) before and after postural change, and before and after a 419‐kcal meal in 22 nursing home residents (mean age 89 ± 5 (SD) years), each on two occasions, to determine reproducibility of changes. These studies were repeated in 17 residents, with and without previous administration of cardiovascular medications, in random order.SETTING: Hebrew Rehabilitation Center for the Aged, an academic long‐term care facility.RESULTS: Systolic BP declined an average (± SE) of 16 ± 4 mm Hg and 12 ± 4 mm Hg during the first and second meal studies, respectively. Mean intra‐class correlation of postprandial systolic BP values during the two studies was 0.88 (95% CI 0.85–0.97). Systolic BP increased significantly during the first posture test to a maximum of 8 ± 6 mm Hg at 6 minutes. There was no significant difference over time in postural systolic BP between the two tests. Repeated postural studies showed a mean intra‐class correlation of 0.72 (95% CI 0.62–0.92) for changes in systolic BP. Cardiovascular medications had no additional effect on mean postprandial or orthostatic BP and HR changes. During the first studies, 10 subjects had postprandial hypotension, and three subjects had orthostatic hypotension, but only two of 22 subjects had both.CONCLUSIONS: Patterns of systolic BP response to meals or postural change are reproducible. BP responses to meals and postural change seem to be unaffected by potentially hypotensive medications in chronic users. Postprandial hypotension is distinct from orthostatic hypotension, occurring more commonly than orthostatic hypotension and infrequently together in the same patients. J Am Geriatr Soc 44:383–389, 1996.
Breast Cancer in Women 70 Years of Age or Older
Authors: Masetti Riccardo , Antinori Armando , Terribile Daniela , Marra Alessandro , Granone Pierluigi , Magistrelli Paolo , Picciocchi Aurelio 
Published: April 2015

OBJECTIVES: To investigate the impact of age as a prognostic factor in older patients with breast cancer and to discuss the role of surgery in this category of patients.DESIGN: A retrospective study.SETTING: A tertiary care university teaching hospital.PARTICIPANTS: One hundred ninety patients aged 70 years or older (mean age: 75 years) were treated for breast cancer from 1967 through 1991. These patients were compared with 190 younger patients (mean age: 52 years) and matched on the basis of T and N categories (TNM staging system) and surgical procedures.MEASUREMENTS: Disease‐free survival, breast cancer‐specific survival.RESULTS: The 10‐year actuarial breast cancer‐specific survival was 66% for older patients and 56% for younger patients (P= .224). The 10‐year actuarial disease‐free survival was 54% for older patients and 45% for younger patients (P= .136). Univariate and multivariate survival analysis revealed that tumor size and nodal stage were significant prognostic factors for both older and younger patients.CONCLUSION: Treatment with curative intent, similar to that adopted in younger patients, is appropriate for women over the age of 70 with breast cancer.J Am Geriatr Soc 44:390–393, 1996.