bluuebunny/crossref_metadata_2025_split huggingface dataset:
Constipation in the Elderly
Authors: Harari Danielle , Gurwitz Jerry H. , Minaker Kenneth L. 
Published: April 2015

Objective: To explore the distinction between true clinical constipation and the subjective complaint of constipation in elderly people and to review the pathophysiology, symptoms, diagnosis, causes, and treatment.Data Sources: A computer‐assisted and manual search of the English language literature using MEDLINE 1966–1991, Index Medicus 1988–1992, reference lists of selected articles, and relevant textbooks.Study Selection: Studies that provide information on lower bowel function and laxative and enema use in the elderly subjects were reviewed. Article selection was not limited by study design.Data Extraction: Relevant data were abstracted from the results of physiological, cohort and case‐control studies, and clinical trials. The text discusses the methodological strengths and flaws of these studies and excludes management approaches formulated from uncontrolled clinical observation.Results of Data Synthesis: Constipation of the elderly is not well defined in the current literature. Self‐reported constipation and laxative use increase with age, while a similar escalation in true clinical constipation is not shown. Physiological changes in the lower bowel predisposing toward constipation do not occur with normal aging. Patient selection criteria for studies examining the pathophysiology of constipation differ in their definition of constipation and their inclusion of coexisting chronic illness. Nevertheless, there is consistent evidence for prolonged transit through the sigmoid colon and rectum, especially in frail elderly patients, and reduced rectal tone with impaired sensation, particularly in patients with rectal impaction. Few studies rigorously examine “risk factors” and non‐pharmacological interventions in constipation. The results of most laxative trials require cautious interpretation because of inclusion of patients without diagnostically proven constipation, use of combined laxative preparations, and unreliable outcome measures. Certain laxative agents however appear more appropriate for use in elderly people.Conclusion: Although the subjective complaint of constipation and habitual laxative use increase with age, the epidemiological data suggest that true clinical constipation does not. Physiological changes predisposing toward constipation are not an inevitable consequence of aging, but appear to be specific to the condition. The available data do not confirm many suspected “risk factors” nor the benefits of commonly used non‐pharmacological and pharmacological treatments, but they do provide enough information to formulate a practical approach to constipation in elderly persons. J Am Geriatr Soc 41:1130–1140, 1993
Over 80 Years and No Evidence of Coronary Heart Disease: Characteristics of a Survivor Group
Authors: MD A. John Campbell , Busby Wendy J. , Robertson M. Clare 
Published: April 2015

Objective: To determine factors that characterize those 80 years and over free of clinical coronary heart disease (CHD).Design: Cross‐sectional intergroup comparison.Setting: Rural New Zealand town.Subjects: All those 70 years and over registered with the sole health center. Seven hundred eighty‐two subjects were seen, a 91.4% response rate. Subjects were divided by World Health Organization cardiovascular questionnaire criteria, history, examination, and coded 12‐lead electrocardiogram into four groups: 1) those 70–79 years of age with evidence of CHD; 2) those 80 years and older with evidence of CHD; 3) those 70–79 years of age free of CHD; and 4) those 80 years and older free of clinical CHD.Measurements: Mean values and distributions of cholesterol, high‐density lipoprotein (HDL) cholesterol, apolipoproteins (apos), triglycerides, insulin, glucose, anthropometric measurements, and psychosocial variables.Results: In the initial analysis of variance there was a significant difference in the mean values among the four groups for body mass index (BMI), HDL cholesterol, apo A1, and triglycerides. Using the Duncan procedure, the mean value of HDL cholesterol in the group 80 years and older with no evidence of clinical CHD was significantly higher than in each of the other groups. The group 80 years and older without clinical CHD had a significantly higher mean value for apo A1 and significantly lower mean values for triglycerides and BMI than the group 70–79 years old with CHD (P < 0.05).Three‐factor analysis of variance showed those free of clinical CHD had significantly higher values of HDL cholesterol (P = 0.024) and apo A1 (P = 0.022), and lower values of BMI (P = 0.017) and triglycerides (P = 0.018) compared with those who had CHD after controlling for age and sex. Those 80 years and older had lower values of BMI (P = 0.001) and triglycerides (P = 0.018) than those 70–79 years old after controlling for CHD and sex.The group who were 80 years and older and free of clinical CHD had a significantly narrower distribution of values for insulin (P < 0.001), glucose (P = 0.001), diastolic blood pressure (P = 0.001), BMI (P = 0.001), and waist‐hip ratio (P = 0.002) when compared with those 80 years and older with CHD; a significantly narrower distribution of values for insulin (P = 0.024), glucose (P = 0.003), and BMI (P = 0.002) when compared with those 79–79 years old with CHD and a significantly narrower distribution of glucose (P = 0.002) and BMI (P = 0.014) when compared with those 70–79 years old and free of clinical CHD.Conclusion: Those 80 years and older who were free of clinical CHD were characterized by differences in lipid and anthropometric values, particularly higher HDL cholesterol and apo A1 levels. Results were also consistent with this survivor group maintaining tighter homeostatic control over a number of variables.
The Yale Geriatric Care Program: A Model of Care To Prevent Functional Decline in Hospitalized Elderly Patients
Authors: Inouye Sharon K. , Acampora Denise , Miller Ronald L. , Fulmer Terry , Hurst Leslie D. , Cooney Leo M. 
Published: April 2015

Objective: To describe the structure and implementation of the Yale Geriatric Care Program, an innovative, nursing‐centered model for developing geriatric nursing expertise throughout an acute‐care hospital.Design: Descriptive study of an intervention in a prospective cohort of patients.Setting: University teaching hospital.Patients: Two hundred forty four patients aged 70 years and older on four non‐intensive care intervention units during the study period (July 9, 1990 to July 31, 1991).Intervention: The Geriatric Care Program involved an integrated model of primary nurses, specially trained unit‐based geriatric resource nurses, gerontological nurse specialists, and geriatric physicians. The intervention included surveillance and identification of frail older patients, unit‐based geriatric educational programs for all nurses, special education and support for the geriatric resource nurses, and twice‐weekly rounds of the Geriatric Care Team.Results: The Geriatric Care Program has been successfully implemented on four units. The interventions ranged from general clarification of goals in 226 (92%) to specific recommendations for management of immobility in 100 (41%), bladder/bowel problems in 99 (41%), pressure ulcer treatment or prevention in 61 (25%), confusion evaluation or management in 62 (25%), and adjustment of medications in 43 (18%). Overall, 68% of the specific recommendations were documented to have been implemented. Barriers to implementation of the program have included initial difficulties with recruitment and retainment of geriatric resource nurses (due to high nursing turnover and the increased time commitment required), breakdown in communication and carryover of recommendations between nursing shifts, and obstacles to communication between the nursing and medical staff.Conclusions: An innovative model of care, in which geriatric nursing was integrated as part of standard nursing care on selected medical and surgical units, has been designed and implemented. Evaluation of the effectiveness and costs of this intervention are currently underway.
A Controlled Trial of a Nursing‐Centered Intervention in Hospitalized Elderly Medical Patients: The Yale Geriatric Care Program
Authors: Inouye Sharon K. , Wagner D. Raye , Acampora Denise , Horwitz Ralph I. , Cooney Leo M. , Tinetii Mary E. 
Published: April 2015

Objective: To test the effectiveness of a nursing‐centered intervention to prevent functional decline among hospitalized elderly medical patients.Design: Prospective cohort study with stratified and matched cohort analyses.Setting: General medicine wards of a university teaching hospital.Patients: Two hundred sixteen patients aged ≥70 years (85 intervention and 131 control patients).Intervention: The intervention included identification and surveillance of frail older patients, twice‐weekly rounds of the Geriatric Care Team, and a nursing‐centered educational program.Main Outcome Measure: Functional decline, defined as a net decline in five activities of daily living (ADLs).Results: In stratified analyses, the intervention resulted in a beneficial effect with a relative risk of 0.82 (95% confidence interval [CI] 0.54 to 1.24) in patients (n = 106) with one of four geriatric target conditions at baseline (eg, delirium, functional impairment, incontinence, and pressure sores). The intervention had no effect in patients without target conditions at baseline (n = 110); thus, this subgroup was excluded from further analyses.When patients were matched on number of target conditions and risk for functional decline at baseline (n = 66), the intervention resulted in a significant beneficial effect, with a reduction in functional decline from 64% in controls to 41% in the intervention group, for a relative risk of 0.64 (95% CI, 0.43 to 0.96). The intervention group had significantly less decline in ADL score and in individual ADLs than control subjects. Specific interventions aimed at maximizing function, such as physical therapy, were received more often by intervention patients; however, the beneficial effects of the intervention were achieved without increasing per‐day hospital costs.Conclusions: The intervention appears effective to decrease functional decline in targeted elderly hospitalized medical patients.
Efficacy of Heavy‐Resistance Training for Active Women over Sixty: Muscular Strength, Body Composition, and Program Adherence
Authors: Nichols Jeanne F. , Omizo Debra K. , Peterson Katrina K. , Nelson Karen P. 
Published: April 2015

Objective: To determine the effects of resistance training on muscular strength, body composition (percent fat and lean tissue mass), and program adherence in active women over 60 years of age.Design: This study was designed as a stratified, randomized, non‐blinded trial. Subjects were stratified into rank‐ordered pairs by level of physical activity according to the Blair Seven‐Day Recall, then randomly assigned into either a weight‐training (WT, n = 18) or control (CON, n = 18) group.Participants and Setting: Thirty‐six women over the age of 60 (67.1 ± 1.5, x ± SE) were recruited from the San Diego community. All subjects had to be engaging in some form of aerobic exercise at least 3 days each week for a minimum of 6 months.Measurements and Intervention: Subjects engaged in isotonic training 3 days/week on Polaris machines at a target intensity of 80% of the 1 repetition maximum (1 RM) for three sets of seven exercises selected to train major muscle groups of the trunk and upper and lower body. The 1 RM was re‐tested every 6 weeks in WT and the workload adjusted to maintain target intensity. The 1 RM was tested at 0, 12, and 24 weeks in CON. Body fatness and lean tissue mass, excluding skeletal mass, were assessed at 0 and 24 weeks by dual energy radiography using a total body scan.Results: Increases in muscle strength of the weight trainers were significant for all seven exercises (5%–65%), with the greatest gains in the shoulder and trunk muscles. Percent body fat of weight trainers decreased significantly (from 38.8% to 37.9%, P < 0.05), while lean tissue mass increased by 1.5 kg (P < 0.01). No changes in body composition were observed in control subjects. Overall program adherence was 83% (15 weight trainers and 15 control women completed the study). Monthly attendance averaged 86.8 ± 3.3%, with no incidence of injury during the training sessions.Conclusions: These data indicate that heavy‐resistance weight training is safe and enjoyable for older women and that meaningful gains in muscular strength and body composition can be made even in women who are already highly active.
Survival of Elderly Patients with Transfusion‐Related Acquired Immunodeficiency Syndrome
Authors: Sutin David G. , Rose David N. , Mulvihill Michael , Taylor Brian 
Published: April 2015

Objective: To determine the influences of age and risk group on the survival of AIDS patients. We concentrated on transfusion because it is the commonest risk factor for AIDS in patients over 70 years of age.Design: Survival curve regression analysis.Participants: Patients aged 13 years and over with AIDS acquired through transfusion, and patients 65 years or older with AIDS as a result of intravenous drug use (IVDU). Data were obtained from the New York City Department of Health.Main Outcome: The patients were divided into four groups, ages 13–40 years, 41–64 years, and 65 years and over with AIDS as a result of transfusion, and 65 years and older with AIDS as a result of IVDU. The survivals of the three transfusion‐related AIDS groups were compared, as were the 65 years‐and‐over groups with AIDS as a result of transfusion or IVDU. AIDS‐defining diagnoses between those over and under 65 years with AIDS as a result of transfusion were also compared.Results: The median survival for the three transfusion‐related AIDS groups were 273 days, 58 days, and 60 days, respectively. There was a significant association between shorter survival and increasing age. This was largely due to the longer survival of the patients aged 13–40 years. There was no difference in AIDS‐defining diagnosis between those over and under 65 years with transfusion‐related AIDS. The survival curves of the elderly with AIDS as a result of transfusion or IVDU were not different.Conclusion: Age over 40 years is an independent risk factor for poor survival among transfusion‐related AIDS patients. Among the elderly, patients with transfusion‐related AIDS have similar survivals to patients with IVDU‐related AIDS.
Surface Area Measurement of Pressure Sores Using Wound Molds and Computerized Imaging
Authors: Hayward Peter G. , Hillman Gilbert R. , Quast Michael J. , Robson Martin C. 
Published: April 2015

Objective: To develop a method to measure wound surface area.Design: Validity study.Setting: Inpatient service.Participants: Four patients with decubitus ulcers.Measurements: A new imaging process estimating wound surface area and volume by NMR spectroscopy of a mold of the pressure ulcer and a comparison measurement of volume of the mold by water displacement. Measurements made serially totalled 17.Results: Measurement of the volume of the mold by the computer system correlated strongly with measurement of the volume by water displacement. Surface area of the pressure sore mold correlated strongly with volume of the mold raised to the two‐thirds power.Conclusions: It is possible for the first time to measure surface area of decubitus ulcers. This may provide a way of determining accurately the dose of newly proposed topical treatments.
Responsiveness of Health Status Measures to Change among Older Adults
Authors: Wagner Edward H. , LaCroix Andrea Z. , Grothaus Louis C. , Hecht Julia A. 
Published: April 2015

Objective: This study examines the ability of commonly used self‐reported health status measures to detect important changes in health (responsiveness) in older adults.Design: We compared changes in health status measures over the year among subgroups of a cohort of seniors: those who experienced an intervening illness, hospitalization or increase in drug regimen, and those who didn't. Differences between the two groups in changes in the measures were quantitated using Guyatt's responsiveness statistic and receiver operating characteristic curves (ROC).Setting: Staff model HMO.Participants: 1379 senior HMO enrollees who were participants in a health promotion trial and provided complete information at baseline and one year later.Measurements: The following self‐reported health status measures were evaluated: restricted activity days, bed disability days, the Medical Outcomes Study physical function scale, self‐evaluated health, and a positive affect scale.Main Results: All measures except the positive affect scale were able to discriminate significantly between seniors who were or were not hospitalized and/or reported a major illness in the intervening year. The two disability days measures showed the best responsiveness for all indicators of worsening health and included 70%‐80% of the area under the ROC curves for major illness defined by hospitalization or self‐report.Conclusions: Commonly used, brief self‐reported physical health status measures are responsive to intervening illness among relatively healthy seniors supporting their use in longitudinal geriatric research.
Effect of Education on the Clock‐Drawing Dementia Screen in Non‐Demented Elderly Persons
Authors: Ainslie Nina K. , Murden Robert A. 
Published: April 2015

Objective: To examine the effect of education on clock‐drawing ability in non‐demented elderly persons.Design, Setting, Participants: Descriptive study of 187 elderly persons, 77 demented, 110 non‐demented, 54 with 9+ years of education, 133 with 8 or fewer years of education, from three university medical center geriatric divisions.Measurements: Subjects took the Folstein Mini‐Mental State Exam and were asked to draw a clock showing a time of 3 o'clock. Clocks were scored using three previously described scoring scales (Shulman, Sunderland, and Wolf‐Klein). Mean scores and proportions of normal and abnormal clocks were compared for well and poorly educated non‐demented subjects. Sensitivities and specificities for detecting dementia were calculated.Results: Mean scores of the well educated non‐demented subjects were significantly better than mean scores of the poorly educated non‐demented subjects on all three scales. However, proportions of abnormal clocks were not significantly different between well and poorly educated on the Wolf‐Klein scale. For the poorly educated subgroup, sensitivity and specificity for detecting dementia by clock drawing were 90% and 42% by the Shulman scale, 74% and 44% by the Sunderland scale, and 48% and 90% by the Wolf‐Klein scale.Conclusions: Clock‐drawing ability is affected by education in non‐demented elderly persons. The scoring method of Wolf‐Klein is least educationally affected and maximizes specificity for detecting dementia but has low sensitivity. Educational effects make clock drawing a poor single screening test for dementia in a poorly educated population.
Iowa FICSIT Trial: The Feasibility of Elderly Wearing a Hip Joint Protective Garment to Reduce Hip Fractures
Authors: Wallace Robert B. , Ross Jo Ellen , Huston Jeffrey C. , Kundel Carolyn , Woodworth George 
Published: April 2015

Hip fractures exact a heavy toll in the elderly population. While intervention strategies are being investigated to reduce the numbers of geriatric falls and to improve the body's resiliency, the geriatric population remains at risk for the mortality and morbidity associated with fractures.The Iowa FICSIT site is investigating the feasibility of passive protection of the proximal femur through the use of hip pads. The pad is designed to disperse throughout the pad the energy created in a fall. The focus of the Iowa trial is to determine if elderly will wear hip pads for the majority of their waking hours. Thirty subjects are being recruited from each of six elderly populations who are at high risk to fall and at increased risk of injury.To facilitate compliance, the following strategies are utilized: run‐in period, graduated implementation, tailoring of wearing times, and self‐report of compliance. Outcome measures include compliance rates and injuries sustained during falls.
Dissociation between the Wishes of Terminally Ill Parents and Decisions by Their Offspring
Authors: Sonnenblick Moshe , Friedlander Yechiel , Steinberg Avraham 
Published: April 2015

Objective: To assess the attitude and factors affecting decision‐making by offspring for life‐sustaining measures toward their elderly terminally ill parents.Design: SurveySetting: Acute geriatric department of a university‐affiliated teaching hospital.Patients and Participants: 108 offspring of 48 terminally ill elderly patients were interviewed.Measurements: The attitude of offspring regarding life‐sustaining measures based on a comprehensive questionnaire, administered by face‐to‐face interview, that included clinical, social, and religious information for each patient and social, religious, demographic, and educational information for each family member.Results: A significant majority requested the continuation of fluid, nutrition, and medication (78%, 66%, 73%, respectively). A minority of 25%–29% requested the initiation of resuscitation, mechanical ventilation, and dialysis. Active euthanasia was requested by seven offspring. Factors that significantly affected offspring's decisions were the degree of religious observance and close relationship. Approximately 50% of offspring believed they knew their parents' wishes, but most of them did not comply with the parents' wishes. The offspring's preferences for themselves differed in important aspects from the requests for their parents. The great majority stated that a family member and/or the responsible physician should be involved in the decision‐making process (76% and 79%, respectively). Only 2.0% suggested the participation of an ethics committee, and the court was rejected by all.Conclusions: Basic life‐sustaining measures are requested for the terminally ill parents by most of the offspring. A significant minority even requested aggressive life‐sustaining measures. The degree of religiosity and closeness of relationship influenced offspring's request most strongly.