bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Clinical Indicators in Two Nursing Homes
Authors: Rudman Daniel , Mattson Dale E. , Alverno Luca , Richardson Timothy J. , Rudman Inge W. 
Published: April 2015

Objective: Pressure ulcer prevalences in 30 VA nursing homes in 1986 ranged from 0% to 15%. The institutions with lowest (“A”) and highest (“B”) prevalence were selected for further examination.Design: Analysis of nursing home files for five study periods, each lasting 6 months.Setting: A and B were 60‐bed rural and 280‐bed urban facilities, respectively.Measurements: Eleven outcome indicators were calculated for each study period: prevalences and incidences of pressure ulcer, aggressive behavior and disruptive behavior, 6‐month declines in each of the four activities of daily living (ADLs), and prevalence of underweight.Results: Populations in A and B were similar with regard to age, sex, length of stay, degree of dependency, and level of nursing care. All indicators for the first study period were more favorable in A than in B. In addition, underweight (body mass index <22 kg/M2) was significantly less prevalent in A than in B. The differences between the two institutions in the indicators were persistent over the five study periods from 1988 to 1991.Conclusions: The populations of A and B were similar in the available measures of severity of illness. Nevertheless, the residents in nursing home A were significantly less likely to experience adverse outcomes than were the residents in nursing home B. The virtual absence of pressure ulcers, physical aggression, and verbal disruption in nursing home A, despite the presence of many immobile and demented residents, suggested that these complications can mostly be prevented.
Effect of Aging on Body Fat
Authors: Silver Andrew Jay , Guillen Clarita P. , Kahl Mary Jo , Morley John E. 
Published: April 2015

Objective: To examine the effects of aging on body fat.Design: Cross‐sectional comparison by age and gender.Setting: Community health fairs, medical school, and a Department of Veterans Affairs Nursing Home Care Unit.Participants: Five hundred and fourteen individuals between the ages of 29–96 attending three different community health fairs; 62 first year medical students; and 121 male residents of a nursing home.Intervention: NoneMeasurements: All underwent measurements of weight, height, and percentage body fat using the RJL Spectrum Bodycomp II Bioelectrical Impedance machine.Results: Percentage body fat increased slightly between ages 20 to 39 years and 40 to 84 years. There were no significant differences noted in percentage body fat among the age groups 40–64, 65–74 and 75–84 in either males or females. There were also no significant differences noted in percentage body fat between any age groups when age‐matched for body mass index. Patients over the age of 85 had significantly lower percentage body fat compared with all other age groups. Finally, nursing home patients were more likely to have a lower percentage body fat compared with the ambulatory population.Conclusions: The percentage body fat does not appear to increase significantly after the age of 40 years. In addition, the major reason for the increase in body fat in older persons appears to be weight gain rather than a true age‐related increase in percentage body fat. Previous studies suggesting a marked increase in percentage body fat with advancing age have failed to correct for the presence of an increased body mass index that commonly occurs at middle age.
How the Manner of Presentation of Data Influences Older Patients in Determining Their Treatment Preferences
Authors: Mazur Dennis J. , Merz Jon F. 
Published: April 2015

Objective: To assess how the manner of presentation of graphic data to older patients influences their treatment preferences.Design: Cross‐sectional structured interviews with patients.Setting: A university‐based Department of Veterans Affairs Medical Center.Patients: One hundred sixty‐six consecutive patients (mean age = 64.8 years, range of ages 29–82) seen in a Department of Veterans Affairs general medicine clinic.Measurements: Five pairs of 5‐year survival curves were presented to patients. Each pair was composed of two survival curves for alternative unidentified treatments for an unidentified medical condition. Curve A (LT = better long‐term, worse short‐term survival) was fixed throughout all curve pairs. Curve B (ST = better short‐term, worse long‐term survival) changed in each curve pair, showing incrementally better chances of short‐term survival across the five curve pairs. Patients were randomly assigned to view the curve pairs in forward (increasing short‐term survival) or backward (decreasing short‐term survival) order.Results: Order is a significant predictor of patients' initial preferences for the short‐term survival curve (P = 0.0004) as well as their willingness to shift preferences during presentation of the five curve pairs. Patients ≥65 were more likely to initially choose the ST curve in forward order presentation than patients <65. More educated patients generally were less likely to prefer the ST curve under both elicitation orders.Conclusions: The data indicate that the method of eliciting patients' preferences strongly influenced their expressed preferences, and that these preferences may have predictable relationships with demographic characteristics such as age.
Hospital Outcomes Project for the Elderly (HOPE): Rationale and Design for a Prospective Pooled Analysis
Authors: Margitić Susan E. , Inouye Sharon K. , Thomas Julia L. , Cassel Christine K. , Regenstreif Donna I. , Kowal Jerome ,   HOPE Group
Published: April 2015

Objective: To describe a collaborative investigation that is based on a series of six clinical studies aimed at reducing functional decline in the acutely‐ill hospitalized elderly.Design: A prospective, multicenter pooled analysis project involving collection of a common set of data from a group of related but distinct intervention trials with similar objectives.Setting: Five university‐affiliated hospitals and one community hospital.Participants: Elderly patients (age minimums from 65 to 75 years) admitted for a range of acute illnesses.Interventions: Site‐specific interventions include exercise and physical therapy; developing and implementing methods to improve detection and evaluation of delirious patients; a multidisciplinary geriatric care unit; a multidisciplinary intervention implemented in‐hospital that includes some postdischarge care; and a nursing‐centered geriatric care program.Main outcome measure: Functional status.Conclusion: The prospective, multicenter design of the Hospital Outcomes Project for the Elderly (HOPE) provides an innovative approach for analysis of hospital outcomes in the elderly. Although differences in study populations and interventions exist, qualitative comparisons across sites will enhance generalizability and will provide a great opportunity to examine consistency among the sites. The HOPE pooled analysis project will impart greater statistical power to detect the primary and secondary outcomes compared with previous single‐center trials that have assessed interventions related to functional decline in the hospitalized elderly.
Prevalence and Significance of Electroencephalographic Abnormalities in Patients with Suspected Organic Mental Syndromes
Authors: Leuchter Andrew F. , Daly Kathleen A. , Rosenberg‐Thompson Susan , Abrams Michelle 
Published: April 2015

Objective: To determine the prevalence of electroencephalogram (EEG) abnormalities at different levels of cognitive impairment and to assess the possible diagnostic usefulness of the test.Design: Combined prospective assessment of subjects receiving EEGs and retrospective chart review of symptoms and medications.Setting: Academic geriatric psychiatry service.Patients: 350 adults age 50 and above; 312 were patients being evaluated for possible organic mental syndrome and 38 were normal controls.Measurements: All subjects had EEGs and Mini‐Mental State Examinations (MMSE) performed at the time of the EEG. EEGs were rated for the presence and type of abnormality, and subjects were stratified according to the severity of impairment. Charts were reviewed by a person blinded to EEG results to determine clinical diagnosis and medications received.Main Results: Abnormal EEGs were significantly more common among all patients (67%) in the study than among controls (11%), and the prevalence of abnormality increased with increasing impairment. Many demented patients with equivocal impairment (42%), and most with mild‐to‐moderate impairment (65%) had abnormal EEGs. An abnormal EEG was not indicative of dementia even when clear cognitive impairment was present, since patients with depression frequently also had abnormal EEG results.Conclusions: These findings suggest that the EEG is a moderately sensitive but non‐specific indicator of brain dysfunction in the elderly. The significance of abnormalities among patients with equivocal impairment should be more fully assessed by longitudinal follow‐up to determine if greater cognitive impairment develops.
Do Family Caregivers Recognize Malnutrition in the Frail Elderly?
Authors: Albert Steven M. 
Published: April 2015

Objective: To determine if family caregivers are aware of the severely underweight elder's risk of malnutrition and accordingly increase nutritional care efforts.Design: Case‐control study.Participants: Familial caregivers to community‐dwelling elders.Measurements: Risk of malnutrition as defined by body mass index ≤ 5th percentile of the national average for elders aged 65–90.Results: Compared with caregivers of elders without risk for malnutrition, caregivers to undernourished elders are significantly more likely to give elders protein supplements, to make foods accessible to elders, and to encourage and pressure the elder to eat.Conclusions: Caregivers recognize gross signs of malnutrition in elders, increase nutritional care in response, and deserve some measure of support for their claims of health expertise.
Effects of Age, Gender and Education on Selected Neuropsychological Tests in an Elderly Community Cohort
Authors: Wiederholt W. C. , Cahn Deborah , Butters Nelson M. , Salmon David P. , Kritz‐Silverstein Donna , Barrett‐Connor Elizabeth 
Published: April 2015

Objective: To establish population‐based data, with special emphasis on the effects of age, gender, and education, for eight, widely used neuropsychological tests in a community‐dwelling cohort of normal and cognitively impaired older adults.Design: A population‐based observational study.Setting: Examinations were performed in a research clinic by specially trained staff during a 1988–1992 evaluation for osteoporosis.Participants: 1,692 community‐dwelling subjects, aged 55 to 94 years, who were members of the Rancho Bernardo Heart and Chronic Disease Study initiated in 1972. The mean age for men was 73.9 years (SD 9.3) and for women, 73.5 (SD 9.1).Outcome measures: Eight neuropsychological tests were used to measure cognitive functions. Analysis of variance and post hoc contrasts were performed to determine the effects of age, gender, education, and their interactions on performance on these tests.Results: Performance on all tests decreased progressively, without leveling off, from the youngest, age 55, to the oldest, age 94. Women performed better on verbal tasks and men on tests of visuospatial, visuoconceptual, and mental control functions. Performances of men on several tests declined more rapidly with advancing age than those of women. Both men and women with some college education performed better on most tests than men and women with high school educations, and the rate of decline with age was sometimes slower in the college‐educated group. Only the savings score from the Visual Reproduction Test, which is a measure of rate of forgetting, and the scores of short‐term recall derived from the Selective Reminding Test (Buschke‐Fuld) were unaffected by educational attainment.Conclusions: In a community‐dwelling cohort, including normal and cognitively impaired elderly men and women, advancing age is accompanied by decline in cognitive functions as measured by neuropsychological tests. This decline is slower in women and in college‐educated subjects. Two cognitive indices were unaffected by education, and these may be especially useful in cross‐cultural studies.
Functional Decline in Alzheimer's Disease: A Longitudinal Study
Authors: Green Cynthia R. , Mohs Richard C. , Schmeidler James , Aryan Moshen , Davis Kenneth L. 
Published: April 2015

Objective: To assess the reliability of activities of daily living (ADL) measures and determine the rate and pattern of longitudinal ADL change in patients with Alzheimer's disease (AD).Design: Longitudinal study with evaluations every 6 months.Setting: Alzheimer's Disease Research Center Clinics at Mount Sinai Medical Center, New York, and the Veterans Affairs Medical Center, Bronx, New York.Patients: 104 patients meeting NINCDS‐ADRDA criteria for probable AD were followed an average of 31 months.Measurements: Physical Self‐Maintenance Scale (PSMS) and Instrumental Activities of Daily Living Scale (IADLS) of Lawton and Brody and the Blessed Test of Information, Memory, and Concentration.Results: For men there was inconsistency over time in the decision about whether or not some IADLS items such as “Laundry” were appropriate for a given patient. Test‐retest and inter‐rater reliabilities were high for all PSMS items and for IADLS items that were judged to be appropriate. IADLS scores changed an average of 2.06 (±3.27) points annually, and change scores were smaller for patients with severe dementia. PSMS scores changed an average of 2.44 (±3.87) points annually with virtually all change occurring in severely demented patients. There was a marked ceiling effect for the IADLS and a curvilinear relationship of PSMS annual change with PSMS baseline.Conclusions: Both PSMS and IADLS measures can be reliable in AD patients, but better IADLS items for males need to be developed. IADLS scores are sensitive to change in mild and moderately demented AD patients, while PSMS scores are sensitive to change in more severely demented patients.
The Importance of Dietary Protein in Healing Pressure Ulcers
Authors: Breslow Rosalind A. , Hallfrisch Judith , Guy David G. , Crawley Barbara , Goldberg Andrew P. 
Published: April 2015

Objective: To determine the effect of dietary protein on healing of pressure ulcers in malnourished patients.Design: Nutritional intervention trial with the non‐randomized assignment of patients by pressure ulcer stage and bed type.Setting: Long‐term care facility.Patients: Twenty‐eight malnourished patients (age = 72 ± 18 years, mean ± SD) with a total of 33 truncal pressure ulcers. Nine patients had stage II ulcers, eight had stage III ulcers, and 16 had stage IV ulcers.Methods: Patients received liquid nutritional formulas as tubefeedings or meal supplements containing either 24% protein (61 g protein/L; n = 15) or 14% protein (37 g protein/L; n = 13) for 8 weeks.Results: There was a significant decrease in total truncal pressure ulcer surface area of the 15 patients in the 24% protein group (‐4.2 ±7.1 cm2, P < 0.02), but not in the 13 patients in the 14% protein group (‐2.1 ±11.5 cm2, P = NS). The change in total ulcer area correlated with both dietary protein intake per kg body weight (rs = −0.50, P < 0.01) and caloric intake per kg body weight (rs = −0.41, P < 0.03). The decrease in stage IV ulcer area in eight patients in the 24% protein group (‐7.6 ± 5.8 cm2, P < 0.02) was significantly greater (P < 0.05) than in eight patients in the 14% protein group (‐3.2 ± 16.4, P = NS). In these 16 patients, the decrease in ulcer size also correlated with dietary protein intake per kg body weight (rs = −0.63, P < 0.01).Conclusion: High protein diets may improve the healing of pressure ulcers in malnourished nursing home patients.
L‐Deprenyl in the Treatment of Mild Dementia of the Alzheimer Type: Preliminary Results
Authors: Burke William J. , Ranno Anthony E. , Roccaforte William H. , Wengel Steven P. , Bayer Barbara L. , Willcockson Nancy K. 
Published: April 2015

Objective: To examine the short‐term cognitive and behavioral effects of L‐deprenyl in persons with mild dementia of the Alzheimer type (DAT) over a 2‐month period.Design: A 15‐month randomized, double‐blind, placebo‐controlled trial using a parallel‐group design. This report deals with the first 2 months of the trial.Participants: 39 subjects with mild DAT (CDR 1) selected using NINCDS‐ADRDA criteria.Measures: A battery of neuropsychological tests and clinical rating scales.Results: The placebo and L‐deprenyl subjects were similar at baseline on the clinical and neuropsychological tests. There was no evidence of a L‐deprenyl effect on any clinical or neuropsychological measures after 2 months.Conclusion: L‐deprenyl did not have a measurable impact on behavior or cognitive function over a 2‐month period in this group of subjects with mild DAT.
The Role of Prognostic Scores in Targeting Stroke Rehabilitation in Elderly Patients
Authors: Kalra L. , Crome P. 
Published: April 2015

Objective: To determine the validity of clinically derived prognostic scores in targeting stroke rehabilitation in elderly patients.Design, Setting and Participants: One‐year prospective cohort study in 96 hospitalized stroke patients over 75 years of age from a well defined geographical area.Measurements: Edinburgh prognostic score (incorporating measures of motor deficit, proprioception, and power), Orpington prognostic score (Edinburgh score modified to include a measure of cognition), and Barthel ADL scores were measured at 1, 2, and 4 weeks after stroke. These scores were correlated with outcome and patients' Barthel ADL score at discharge or at 16 weeks if still in hospital.Results: Edinburgh prognostic score measured at 2 weeks correlated significantly with Barthel ADL score at discharge or at 16 weeks (r2 = 0.57, P < 0.001), and Orpington prognostic scores showed greater correlation (r2 = 0.89 vs 0.57), especially in patients with dementia (r2 = 0.81 vs 0.39). Barthel ADL scores at 2 weeks showed a weak correlation with Barthel ADL scores at discharge or 16 weeks (r2 = 0.58). Patients with Orpington Score <3.2 were discharged within 3 weeks of stroke, whereas those scoring <5.2 required long‐term care. Most patients (90%) with Orpington Score of 3–5 were eventually discharged home although this was not always apparent on initial clinical assessment at the time of admission.Conclusions: The Orpington score when assessed at 2‐weeks post‐stroke is a useful prognostic indicator with special suitability for the elderly and may help to select patients most likely to benefit from stroke unit rehabilitation.
The Menopause: Health Implications and Clinical Management
Authors: Greendale Gail A. , Judd Howard L. 
Published: April 2015

Objective: To review the anatomy, physiology, clinical symptoms, long‐term health effects, and treatment of the menopause and climacteric syndrome, with a special emphasis on features, such as incontinence, particularly relevant to geriatric medicine.Data sources: English‐language publications on menopause and the climacteric.Study selection: Articles and books containing recent information pertinent to the topics covered. Studies in human subjects were given priority, but primate studies that amplify physiologic concepts are included.Data synthesis: Due to increased longevity, the average US woman will spend one‐third of her life as a postmenopausal individual. Anatomic and physiologic changes associated with the peri‐ and postmenopausal state include hot flushes, genitourinary atrophy, and bone loss. Possible correlates of the menopausal transition and postmenopause include affective changes and unfavorable alterations in lipoproteins and other cardiac risk factors. Clinical correlates of these changes can include incontinence, sexual dysfunction, increased risk of fracture, dysphoric mood, and increased risk of cardiovascular disease. Formal indications for estrogen therapy are hot flushes, genital atrophy, and osteoporosis prevention; other common clinical uses are reviewed. Non‐contraceptive estrogens can be administered orally, transdermally, vaginally, or by injection. Each route and preparation has some unique features with respect to actions and side effects. Progestins, in adequate doses, protect against the unwanted side effect of endometrial hyperplasia; alternatives to progestin use are presented. Non‐hormonal alternatives for some peri‐ and postmenopausal symptoms are described.Conclusions: A discussion of the menopause and the benefits and risks of hormone therapy should be part of the routine health care of older women. Since the use of hormone therapy is elective, health care providers must elicit the goals, needs, and preferences of each patient, supply her with relevant information, and serve as a facilitator of her individual decision.
Functional Status Care Categories and National Health Policy
Authors: Thomasma David C. 
Published: April 2015

Our society clearly needs to set limits on health care. The United States health care delivery system is the fourth largest economy in the world, yet its inflation continues to grow at twice the normal rate of other products and services. The inefficiencies are built in in such a way that while intensive care beds are plentiful, and very expensive, 37 million Americans cannot gain access to health care because they are either uninsured or underinsured. It is estimated that this figure will approach 39 million by the end of the decade.1 Since many of these individuals are young, the problem, it is said, has no real practical consequences because the young are relatively healthy. Yet evidence exists that the uninsured and underinsured receive poorer care than covered individuals.2 This and other inequities in the system have led many thinkers like Leonard Heck to ask how just we must be in society.3 The answer to this question would presumably help us determine the lengths we must go in correcting the inequities.Even if the peace‐dividend emerges from the new political events around the world, and we are able to spend more of our money on health care, our resources are not a bottomless pit. If need alone drives the system, just performing open‐heart surgery on everyone who needs it would cost more than the annual budget itself. Virtually everyone agrees, then, that escalating health care costs are a moral problem because justice is involved, a political problem because public interest is involved, and that limits must be set that are moral and public.4