bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antipsychotic Prescribing Patterns and the Treatment of Extrapyramidal Symptoms in Older People
Authors: Kalish Susan C. , Bohn Rhonda L. , Mogun Helen , Glynn Robert J. , Gurwitz Jerry H. , Avorn Jerry 
Published: April 2015

OBJECTIVES: We have previously identified antipsychotic use as a risk factor for the use of both dopaminergic and anticholinergic antiparkinsonian drugs in older people. This study examines whether and how such antipsychotic regimens were adjusted before the addition of an antiparkinsonian drug.DESIGN: Retrospective comparison studyPARTICIPANTS: There were 1307 antipsychotic users begun on anticholinergic antiparkinsonian drugs and 345 antipsychotic users begun on dopaminergic drugs; 1864 antipsychotic users not prescribed antiparkinsonian drugs served as comparison subjects. Data were drawn from health care claims of patients aged 65–99 in the New Jersey Medicaid Program from 1981 to 1990.MEASUREMENTS: We determined if antipsychotic regimens were discontinued, reduced in dosage, or modified to reduce extrapyramidal toxicity before the institution of antiparkinsonian therapy.RESULTS: Thirty‐five percent of the patients begun on dopaminergic drugs had their antipsychotic medication discontinued before beginning antiparkinsonian therapy; the antipsychotic was discontinued in only 12% of patients who started anticholinergic medications (P < .001). Among the smaller subset of patients with sufficient duration of antipsychotic exposure to examine changes in dose, 54% of patients begun on dopaminergic agents had their antipsychotic regimen reduced or discontinued before antiparkinsonian therapy, whereas 33% of patients begun on anticholinergic agents had one of these regimen changes (P < .001). Controlling for potential clinical and demographic confounders using multivariate logistic regression did not substantively alter these results.CONCLUSIONS: These data indicate that physicians frequently fail to discontinue or modify an antipsychotic regimen before adding a new drug to treat probable drug‐induced extrapyramidal symptoms. Such prescribing patterns preceding use of dopaminergic antiparkinsonian drugs suggest that addition of such drugs may represent an inappropriate attempt to treat presumed idiopathic Parkinson's disease in many cases.
Potential for Adverse Drug‐Alcohol Interactions Among Retirement Community Residents
Authors: Adams Wendy L. 
Published: April 2015

OBJECTIVES: Medications and alcohol are both used commonly by older people. Thus, the potential for adverse drug‐alcohol interactions is very high in this population, but data on actual concurrent use of alcohol and medicines likely to interact with alcohol are lacking. The objectives of this study were to determine the frequency of alcohol and medication use and the potential for specific adverse drug‐alcohol interactions in residents of retirement communities.DESIGN: Cross‐sectional study using a mailed survey.SETTING: Three retirement communities in suburban Milwaukee, Wisconsin.PARTICIPANTS: All 454 independently living residents of the communities were surveyed. Of these, 311 residents (68%) returned completed questionnaires. Mean age of respondents was 83 ± 6 years, 100% were white, 77% were female.MEASUREMENTS: The questionnaire included alcohol use questions adapted from the Khavari questionnaire and the CAGE questionnaire to screen for alcohol abuse. Respondents were asked to list all prescription and nonprescription medications.RESULTS: Thirty‐eight percent of the population reported using both alcohol and a high risk medication. Six percent had seven or more drinks per week and took a high risk medication. High risk drugs commonly used by drinkers were antihypertensives in 50%, aspirin in 27%, nonsteroidal antiinflammatory drugs in 20%, medication for congestive heart failure in 18%, antacids or H2 blockers in 16%, sedatives in 11%, narcotics in 5%, and warfarin in 5%.CONCLUSIONS: Concurrent use of alcohol and medications is common in residents of these retirement communities. Many of the drugs taken by regular drinkers have potential for adverse drug‐alcohol interactions even at moderate levels of alcohol use. This represents a strong possibility of adverse outcomes and a need for increased awareness on the part of both the public and physicians of the potential for interactions between drugs and alcohol.
Screening for Alcohol Use Disorders in the Nursing Home
Authors: Joseph Carol L. , Ganzini Linda , Atkinson Roland M. 
Published: April 2015

OBJECTIVES: To determine the prevalence of Alcohol Use Disorders (AUDs) among residents of a Veterans Affairs (VA) nursing home (NH) using DSM‐III‐R criteria for alcohol abuse and dependence, and to examine the demographic variables associated with AUDs among NH residents. A third objective was to assess the sensitivity, compared with DSM‐III‐R criteria, of three screening tests for AUDs in the NH: the CAGE, the MAST‐G, and the two‐question instrument developed by Cyr and Wartman.DESIGN: A cross‐sectional design, with DSM‐III‐R criteria determined by the alcohol module of the Diagnostic Interview Schedule (DIS) as the criterion standard.PATIENTS: Patients older than age 50 admitted consecutively to a VA NH, n = 117.MAIN OUTCOME MEASURES: Sensitivities, specificities, positive predictive values for the CAGE, MAST‐G, and Cyr and Wartman Screening questionnaires; receiver operating characteristic (ROC) curves for the CAGE and MAST‐G.MAIN RESULTS: Forty‐nine percent of study participants met DSM‐III‐R criteria for lifetime alcohol abuse or dependence (18% active, 31% inactive). The sensitivities and specificities of the three screening questionnaires were as follows: CAGE‐82% and 90%; MAST‐G‐93% and 65%; Cyr and Wartman‐70% and 92%, respectively. The area under the ROC curve was 0.94 for the CAGE and 0.90 for the MAST‐G.CONCLUSIONS: The prevalence of lifetime alcohol abuse and dependence was high in this VA NH population. Both the CAGE and MAST‐G are sensitive to AUDs in this setting. The areas under the ROC curves were not significantly different and indicate both tests discriminated well between NH residents with and without AUDs.
Immediate and Long‐Term Survival After Intra‐aortic Balloon Pumping: Is Advanced Age an Independent, Unfavorable Prognostic Factor?
Authors: Marchionni Niccoló , Fumagalli Stefano , Di Bari Mauro , Boncinelli Lorenzo , Ferrucci Luigi , Tarantini Francesca , Matteucci Luca , Masotti Giulio 
Published: April 2015

OBJECTIVE: To determine whether advanced age is an independent prognostic factor that may increase the risk of complications and reduce the immediate and long‐term survival after treatment with intra‐aortic balloon pumping (IABP) for acute ischemic heart disease.DESIGN: Retrospective analysis of a clinical series and long‐term follow‐up study.PATIENTS: A total of 142 patients (age range 23–86 years) in whom IABP was indicated following a standardized protocol.MEASUREMENTS: Univariate analysis of the association between age and anamnestic, clinical, and hemodynamic data significantly affecting prognosis; multivariate logistic regression analysis of variables showing significant associations.RESULTS: IABP‐related complications were independent of age. At univariate analysis, pre‐existing, noncardiac, associated conditions (chronic renal failure, stroke, bronchopulmonary disease) (P < .001), an indication to IABP for hemodynamic complications of acute myocardial infarction rather than for medically refractory myocardial ischemia (P < .001), a lack in hemodynamic response to IABP (P < .002), a prolonged delay to IABP initiation (P < .003), and advanced age (P < .025) were all predictors of in‐hospital mortality. However, older patients were also more frequently affected by chronic comorbid conditions and by acute left ventricular failure as an indication to IABP. When these variables were entered into logistic regression models, the association between age and mortality was no longer statistically significant. Similarly, advancing age was associated (P < .012) with an increased mortality rate during an average follow‐up of 94 ± 9 months, but, again, such a significant association disappeared when simultaneously adjusting for New York Heart Association functional class, which was the single most important predictor of long‐term mortality.CONCLUSIONS: Several anamnestic and clinical variables, rather than advanced age itself, are independent, prognostic factors negatively affecting the outcome of treatment with IABP. Technique‐related complications are independent of age. Thus, old age should not be considered as a criterion to exclude any patient, a priori, from the potential benefits of this type of cardiocirculatory assistance.
Effect of Sustained Resistance Training on Basal Metabolic Rate in Older Women
Authors: Taaffe Dennis R. , Pruitt Leslie , Reim Jennifer , Butterfield Gail , Marcus Robert 
Published: April 2015

OBJECTIVE: To determine if basal metabolic rate (BMR) could be elevated in older women undertaking a program of progressive resistance exercise of up to 52‐weeks duration.DESIGN: Randomized controlled trial with subjects assigned to either a control (CO), high‐intensity (HI), or low‐intensity (LO) training group for 15 weeks. BMR, body composition, energy intake and expenditure, and muscle strength were assessed at baseline and after 15 weeks. Subjects were encouraged to continue in their assigned exercise group for an additional 37 weeks, after which time they were reevaluated.SETTING: An exercise facility at a medical center.SUBJECTS: Thirty‐six community‐dwelling healthy women aged 65 to 79 years.INTERVENTION: Exercise groups performed three sets of 10 exercises, 3 days/week, at either 80% of one‐repetition maximum (1‐RM) for seven repetitions (HI) or 40% of 1‐RM for 14 repetitions (LO).MEASURES: BMR by indirect calorimetry, body composition by dual energy X‐ray absorptiometry, energy intake and expenditure from 4‐day dietary and activity records, and dynamic muscle strength by 1‐RM.RESULTS: Muscle strength increased, on average (±SEM), by 40 ± 6% and 36 ± 7% in the HI and LO groups after 15 weeks, respectively, compared with 4 ± 1% in the nonexercising subjects (P = .0001). Fat mass decreased after 15 weeks in LO exercisers by 1.0 kg (P < .05), whereas there was a trend for fat‐free mass (FFM) to increase in the HI group by 0.7 kg (P = .08). No change occurred in any group for BMR. From weeks 15 to 52, muscle strength increased a further 9 ± 2% and 11 ± 2% in HI and LO groups, respectively, compared with 3 ± 1% in nonexercisers (P < .005). There was no change in BMR or any body composition parameter during this time period.CONCLUSIONS: Neither training program significantly altered BMR and both produced only minimal changes in body composition. However, both the HI and LO exercise regimens resulted in similar and substantial gains in upper and lower body muscle strength that persisted over the course of the year. This suggests that either exercise regimen may prove an effective strategy for preventing frailty and maintaining functional independence in older adults.
Protein‐Energy Undernutrition and the Risk of Mortality Within One Year of Hospital Discharge: A Follow‐Up Study
Authors: Sullivan Dennis H. , Walls Robert C. , Bopp Melinda M. 
Published: April 2015

OBJECTIVE: The primary objective of this study was to confirm the results of a previous study that demonstrated a strong independent correlation between the severity of protein‐energy undernutrition and the risk of 1‐year postdischarge mortality in a population of older rehabilitation patients.DESIGN: Prospective survey (cohort study)SETTING: The Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospitalPARTICIPANTS: Of 350 randomly selected admissions to the GRU, 322 were discharged alive from the hospital. These 322 patients represented the study population, of whom 99% were male, and 75% were white. The average age of the study patients was 76 years.MEASUREMENTS: At admission and again at discharge, each patient completed a comprehensive medical, functional, neuropsychological, socioeconomic, and nutritional assessment. After discharge, each subject was tracked for 1 year.MAIN RESULTS: Within the 1‐year posthospital discharge follow‐up period, 64 study subjects (20%) died. This included 17% of the patients discharged home and 34% of the patients discharged to a nursing home (P < .01). Based on the Cox Proportional Hazards survival model, the variable most strongly associated with mortality was the discharge serum albumin, followed by discharge weight expressed as a percentage of ideal, self‐dressing ability, and a discharge diagnosis of cardiac arrhythmia (usually atrial fibrillation). When all four of these variables were included in the analysis, the model was able to differentiate the survivors from those who died by years end with a sensitivity of 69%, a specificity of 69%, and an overall predictive accuracy of 69%. When tested using the data from the previous study, the model differentiated the patients who died from those who had not at a sensitivity of 62%, a specificity of 68%, and an overall predictive accuracy of 64%.CONCLUSIONS: Protein‐energy undernutrition appears to be a strong independent risk factor for 1‐year postdischarge mortality.
Older Nursing Home Residents Have a Cardiac Arrest Survival Rate Similar to That of Older Persons Living in the Community
Authors: Ghusn Husam F , Teasdale Thomas A , Pepe Paul E. , Ginger Vicki F. 
Published: April 2015

OBJECTIVE: To determine the survival rates of older nursing home residents after cardiopulmonary resuscitation (CPR) and to compare it with that of older persons who experienced cardiac arrest in an outpatient setting. To identify patient characteristics, arrest characteristics, and effort characteristics that are associated with higher survival rates.DESIGN: Retrospective review of emergency medical service charts and hospital medical records of a cohort of older nursing home residents (n = 114) after cardiopulmonary resuscitation and a matched cohort of community‐residing older persons (n = 228) matched on age, gender, and year of cardiac arrest.SETTING: A large metropolitan city served by a tiered emergency medical service.MEASUREMENTS: Independent variables related to patient, cardiac arrest, and resuscitation effort characteristics. Dependent variables were defined as immediate survival after cardiopulmonary resuscitation and survival status at discharge.RESULTS: The mean age of nursing home residents was 80.3 years; 62.3% were females. The majority of cardiac arrests for both groups were unwitnessed (67%) and had agonal rhythms (asystole and electromechanical dissociation). Emergency medical service efforts were similar for the two cohorts. Among nursing home residents, 26.3% had a return of blood pressure for more than 5 minutes, 70.2% were pronounced dead in the emergency room, and 10.5% were discharged from hospitals alive. In the matched community‐residing subjects, 22.7% had a return of blood pressure, 78.1% were pronounced dead in the emergency room, and 9.2% were discharged alive. Between‐group comparisons of these variables revealed no significant differences even though our sample size was adequate.CONCLUSIONS: We conclude that survival after cardiac arrest of older persons residing in nursing homes is low; however, with an appropriate CPR/DNR selection process and an effective emergency medical system, survival of certain groups of nursing home residents following cardiac arrest could be comparable to that of community‐residing older persons. Despite the reasonably good survival rates for older persons seen above, our analyses indicated that patients who have unwitnessed arrests are not likely to survive to discharge and that patients with initial rhythms such as asystole or electromechanical dissociation rarely survive. These data suggest that patients who have an unwitnessed arrest in the nursing home should not receive resuscitation attempts, and in those patients for whom paramedics are called, resuscitation efforts should not proceed any further if their original rhythm is asystole or electromechanical dissociation. Thus, modification in nursing home policies regarding CPR efforts is needed.
Does the ECA Underestimate the Prevalence of Late‐Life Depression?
Authors: Heithoff Kim 
Published: April 2015

OBJECTIVE: This research addresses the most frequently cited methodological criticism of the Epidemiologic Catchment Area (ECA) surveys ‐ which might lead to significantly lower estimates of true prevalence rates for late‐life depression ‐ the inability of the Diagnostic Interview Schedule (DIS) to distinguish between somatic symptoms of depression that result from physical causes and those that result from psychiatric causes.DESIGN: The data for this study come from the ECA Wave Two surveys sponsored by the National Institute of Mental Health. In this analysis, symptoms of depression the respondent always attributed to physical causes are recoded to be equivalent to those having a psychiatric cause. The third edition of the Diagnostic and Statistical Manual (DSM‐III) scoring algorithm for depression (i.e., dysphoria plus four of the eight Criterion B symptoms) was then applied to the recoded data set.RESULTS: Recoding somatic symptoms of depression, originally attributed to physical or medical explanations, to psychiatric symptoms does not result in a disproportionate rise in diagnosable depression in the older age groups.CONCLUSIONS: This analysis provides additional support for the ECA survey's prevalence estimate of late‐life depression. This research failed to find evidence that the highly structured nature of the DIS makes it unsuitable for ascertaining symptoms of depression in the elderly.
Code Status Decision‐Making in a Nursing Home Population
Authors: Kellogg F. Russell , Ramos Aida 
Published: April 2015

OBJECTIVES: To examine the clinical utility of prehospital code status discussions in a nursing home (NH) setting and the health care outcomes of the decisions made. Also to identify patient factors and other variables associated with these decisions.DESIGN: Retrospctive uncontrolled observational study carried out through record review.SETTING: A single skilled‐level teaching NH and its affiliated university hospital.PATIENTS: All of the 350 individuals who resided at the NH during a 2‐year period.MAIN RESULTS: Code status decisions were routinely sought through discussion involving primary care physician/social worker teams and residents or surrogates of demented patients. Choices were made for 80% of the NH residents, most (73%) by surrogates and most (80%) for do‐not‐resuscitate (DNR) orders, usually within 10 weeks of NH admission. Neither short‐term measures of NH care intensity nor hospital use changed after a DNR decision. Most (80%) hospital transfer records included code status documentation. At the NH, both the likelihood of decisions and their directions were associated with involvement by specific physician/social worker teams. Additionally, a dementia diagnosis, white race, and older age were associated with a nursing home DNR decision. At the hospital, a DNR order was associated with white race, the presence of nursing home DNR documentation in the transfer records, hospital attending care by certain NH physicians, and a terminal hospital stay. Hospital inpatient medical and surgical therapy use, except for intensive care procedures, was similar for DNR and non‐DNR inpatients. Residents with DNR orders had a higher mortality rate, yet most survived at least 1 year after the order. In the short term, a DNR order had no impact on measured health care resource consumption, but, for those in the final months of life, in‐patient hospital use was less for the DNR group, and most of these died at the nursing home.CONCLUSIONS: Prehospital code status decisions can be made effectively within the NH setting. Outside of medical intensive care, DNR orders have no impact on NH and hospital care intensity in the short term. In the final 6 months of life, however, hospital use is less for the DNR subgroup.
Minimal Trauma Fractures in Older Nursing Home Residents: The Interaction of Functional Status, Trauma, and Site of Fracture
Authors: Kane Richard S. , Burns Edith A. , Goodwin James S. 
Published: April 2015

OBJECTIVE: This study was conducted to determine the incidence of long bone fractures in institutionalized older persons and to describe preceding traumatic events and the functional status of individuals sustaining fractures.DESIGN: A 1‐year, prospective, cumulative incidence survey.SETTING: Eleven skilled nursing care facilities in the state of Wisconsin.PATIENTS: All residents of the 11 facilities.MEASUREMENTS: All incident reports of long bone fractures, description of events preceding the fractures, and functional status of the fracture cases. In addition, demographic and medical information was collected on fracture cases and the general nursing home population.MAIN RESULTS: Overall long bone fracture incidence was 3.52 per 100 subjects per year. Minimal trauma fracture incidence was 0.84 per 100 subjects per year. Fracture location was significantly related to type of trauma. Functional status was significantly related to fracture location and to the type of trauma preceding the fracture. Minimal trauma fractures occurred in individuals who were less mobile and more likely to be bed‐bound, and the location was more likely to be the lower extremity below the hip.CONCLUSION: This is the first prospective survey of long bone and spontaneous fracture incidence rates in multiple nursing home facilities. Minimal trauma fractures are common in the nursing home, and most have no clear precipitating factors other than severely impaired mobility.
Changes in Small‐Intestine Permeability with Aging
Authors: Saltzman John R. , Kowdley Kris V. , Perrone Gayle , Russell Robert M. 
Published: April 2015

OBJECTIVE: To evaluate small‐intestine mucosal integrity and permeability with advancing age as measured by the lactulose/mannitol absorption test in healthy subjects.DESIGN: Prospective cohort study.SETTING: Clinical research unit of the USDA Human Nutrition Research Center on Aging.STUDY PARTICIPANTS: Fifty‐six subjects were recruited in three age groups: 20 to 39 years (n = 20), 40 to 59 years (n = 19), and ≥60 years (n = 17). Subjects were healthy, community‐dwelling volunteers.INTERVENTION: After an 8‐hour fast, all subjects ingested 10 g of lactulose and 5 g of mannitol. Urine was collected for 6 hours and analyzed for lactulose and mannitol by high performance liquid chromatography. Twenty‐four‐hour urinary creatinine clearances were determined.MAIN OUTCOME MEASURES: Percentages of lactulose and mannitol excreted, the lactulose/mannitol ratio (x100), and the 24‐hour creatinine clearance.RESULTS: With increasing age, both the percentage of lactulose excreted (P = 0.09) and the percentage of mannitol excreted (P = 0.05) tended to decrease progressively. The lactulose/mannitol ratio (x100) did not change with increasing age (P = 0.65) because both the percentages of lactulose and mannitol excreted declined. The creatinine clearance decreased markedly with advancing age (P < .001) and accounted for the decline in percentages of lactulose and mannitol excreted (P < .02).CONCLUSIONS: There is a progressive decline in the ability to excrete lactulose and mannitol with increasing age. This is probably attributable to a decline in renal function with advancing age. However, because of parallel decreases in lactulose and mannitol excretion, the lactulose/mannitol ratio does not change. Thus small‐intestine “leakiness” does not increase with aging as measured by the lactulose/mannitol absorption test.