bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flexible Bronchoscopy as a Diagnostic Tool in the Evaluation of Pulmonary Tuberculosis in an Elderly Population
Authors: Patel Yogesh R. , Mehta Jay B. , Harvill Leo , Gateley Kerry 
Published: April 2015

Objective: This study intends to determine what role fiberoptic bronchoscopy (FOB) plays in the diagnosis of tuberculosis (TB), particularly in a geriatric population.Design: Cases of tuberculosis reported to the Tennessee Department of Health during the years 1989 and 1990 were divided into two age groups: Group A (<65 years) and Group B (≥65 years). Natural sputum smears and cultures positive for M, tuberculosis (M. TB) in each group were compared with FOB specimens, acid‐fast bacilli (AFB) smears and cultures. Data were analyzed by chi‐square tests of independence for each year, then compared to determine statistical significance.Setting and Patients: Of the 601 TB cases reported to the State of Tennessee in 1989, 285 patients were in Group A and 316 in Group B. For 1990, 525 cases were reported, 269 in Group A and 256 in Group B. All cases met CDC‐approved criteria for diagnosis of tuberculosis.Measurements: The number of positive AFB smears and M. TB cultures were compared in each group. In cases with sputum negative but FOB specimens positive for TB, identification was made by FOB only.Main Results: In Group A, 26 (9.1%) were diagnosed by FOB; only eight of these had positive sputum cultures. In Group B, 77 (24.4%) were diagnosed by FOB. Of these, 23 had positive sputum cultures; the remaining 54 patients (17.1%) had diagnoses based on FOB alone. In 1990, 269 cases of TB were reported in Group A. Of these, 38 (14.1%) were diagnosed by FOB. There were 256 TB cases reported among Group B, 83 (32.4%) of which were diagnosed by FOB. Of these 83 cases, 60 (23.4%) were diagnosed by FOB only. While no statistically significant difference was seen between the 1989 and 1990 rates of TB diagnosis by FOB for those in Group A (age <65), the difference in rates for those in Group B (age ≥65) was statistically significant (P < 0.05).Conclusions: A steady increase in the use of FOB as a diagnostic tool was noted, suggesting that a significant number (19.9%) of geriatric TB cases might have been missed without the aid of FOB. While the exact reason for its increased utilization is not known, this study indicates that FOB has become a more important source of diagnosis in pulmonary TB, particularly among the elderly.
Urinary Retention in the Elderly: A Study of 100 Hospitalized Patients
Authors: Grosshans Cl. , Passadori Y. , Peter B. 
Published: April 2015

Objective: To estimate the prevalence of incomplete bladder emptying by the elderly and to determine its significance and its relationship to overflow incontinence.Design: Survey comparing groups with and without incomplete bladder emptying.Setting: A geriatric hospital ward.Patients: One hundred patients who were consecutively admitted, with an average age of 82.6 years.Measurements: A physical examination, perineal examination, micturition assessment, and evaluation of the postvoiding residual urine volume (PRUV) by ultrasonography at day 1 and day 8 following admission. One‐channel cystometry and urine cultures were also done. Between‐group comparison was performed between groups R (ie, PRUV greater than 50 mL) and C (ie, PRUV less than 50 mL).Main Results: The prevalence of PRUV greater than 50 mL was 34%. Group R patients presented with greater dependency; death was the final outcome of hospitalization in 36% of these cases (vs only 9% in group C). A high PRUV was not correlated with urinary tract infection or renal failure, but there was a strong, almost significant trend toward incontinence being more prevalent in R (57%) than in C (38%) (P = 0.06). Group R presented a hypotonic bladder in 45% of cases, evidenced by cystometry, versus 6% in group C.Conclusions: In cases with a high PRUV, the utmost caution is necessary both in the diagnosis of overflow incontinence and in establishing a therapeutic approach. Incomplete bladder emptying is associated with a poor prognosis.
Falls: An Examination of Three Reporting Methods in Nursing Homes
Authors: Kanten Deanna N. , Mulrow Cynthia D. , Gerety Meghan B. , Lichtenstein Michael J. , Aguilar Christine , Cornell John E. 
Published: April 2015

Objective: To examine the concordance of various fall reporting methods and to use the results to recommend a preferred method of ascertaining fall frequency for residents of nursing homes, both for research and in the collection of federally mandated nursing home data.Design: A cohort study followed for 858 patient months, with a mean individual follow‐up of 6.6 months.Measurements: Falls were independently ascertained monthly by three methods: review of administrative incident reports, nursing home chart abstraction, and structured interview of subjects. Concordance of events was assessed using measures of simple agreement and Kendall's Tau‐b. Simple correlation and multiple regression were used to evaluate the relation of age, sex, gender, depression, mental status, and functional status with degree of concordance between self‐reported falls and chart‐recorded falls.Setting: One academic and six community nursing homes in San Antonio, Texas.Participants: 131 long‐stay nursing home residents, greater than 60 years of age, dependent in at least two activities of daily living, and mildly cognitively impaired.Results: Falls were ascertained in 74 of the 131 individuals; 53 subjects fell 124 times by incident report, 58 had 140 falls according to chart review, and 66 subjects self‐reported 232 falls. Greatest agreement between reporting methods was shown for incident report and chart review, with a Kendall's Tau‐b of 0.88; self‐report and chart‐review agreement was 0.56; and self‐report and incident agreement was 0.53. Estimated total fall events were more often (P = 0.001) identified by chart review (92%) than incident report (82%). Although concordance was higher for non‐fallers, no significant relationships were observed between concordance and age, sex, race, depression, mental status, and functional status. Also, there was no systematic relationship between length of follow‐up and degree of concordance.Conclusions: Fall frequency varies by ascertainment method, with chart review reflecting a greater number of fall events than the traditionally counted incident reports.
Nighttime Sleep and Bed Mobility among Incontinent Nursing Home Residents
Authors: Schnelle John F. , Ouslander Joseph G. , Simmons Sandra F. , Alessi Cathy A. , Gravel Michele D. 
Published: April 2015

Objective: To describe sleep and body movement patterns in incontinent nursing home residents for the purpose of determining if the residents require nighttime changing and body repositioning on a 2‐hour schedule.Design: Cross‐sectional survey.Setting: Four nursing homes.Participants: 118 nursing home residents.Measurements: Over two nights, bedside monitoring equipment recorded wrist activity (as a proxy measure for sleep) and body movements of both the shoulder and hip areas in consecutive 2‐minute intervals. Specific outcome measures were: (1) Average duration of a sleep episode, peak duration of a sleep episode, and percent of time in bed asleep. (2) The number of 2‐minute intervals in which a large movement (45 degree turn) at the shoulder and hip was noted per hour of recording for each resident. (3) The number of resident‐initiated, rather than staff‐initiated, large movements at the shoulder and hip that occurred within the same 2‐minute intervals.Results: There was large variability in all sleep measures; however, on average, residents slept 66% of the time they were in bed. The distribution of these measures suggests that sleep was punctuated with frequent mighttime awakenings. Thirty‐three percent of the incontinent residents demonstrated very low levels of resident‐initiated movement at the shoulder and hip. Sixty‐six percent demonstrated at least one large movement at the shoulder and hip per hour during periods of sleep as well as during periods of wake.Conclusion: The majority of incontinent nursing home residents self‐initiate sufficiently frequent movements at both the shoulder and hip so as not to be in need of frequent repositioning by nursing staff. Since the sleep of many of these residents is also characterized by frequent awakenings, incontinent nursing home residents may benefit from a schedule of nursing care at night that considers sleep of equal importance to incontinence care and body repositioning.
The Nighttime Environment, Incontinence Care, and Sleep Disruption in Nursing Homes
Authors: Schnelle John F. , Ouslander Joseph G. , Simmons Sandra F. , Alessi Cathy A. , Gravel Michele D. 
Published: April 2015

Objective: To evaluate the association between noise, light, nursing care practices, and nighttime awakenings in incontinent nursing home residents.Design: Cross‐sectional survey.Setting: Four long‐term care nursing facilities.Participants: One hundred eighteen incontinent nursing home residents.Measurements: Over two nights, bedside monitoring equipment recorded wrist activity, resident bed movements, and environmental noise and light changes in consecutive 2‐minute intervals. Changes in sleep and bed movement were compared with changes in noise and light that occurred within the same or proximal 2‐minute intervals. Noise and light changes in combination with large resident movement at the hip and shoulder were interpreted as related to incontinence care based on observational measures. Specific outcome measures were: (1) the number of noise and light changes as well as staff care practices that did not wake the resident during periods of consecutive sleep, ie, sleep lasting a minimum of 10 minutes; (2) the number of noise and light changes as well as staff care practices that occurred immediately before or during the 2‐minute intervals during which a resident woke from a period of consecutive sleep; and (3) the number of such staff care practices that were related to incontinence care.Results: Noise and light changes associated with both general environmental events and more specific nurse care practices were associated with 50% of all waking episodes of 4 minutes or longer and 35% of all waking episodes of 2 minutes or shorter. The major sources of all noise were traced to nursing staff. Eighty‐seven percent of all incontinence care practices were associated with episodes of waking.Conclusion: The data reported in this paper document that general environmental noise and incidents of nursing care practices, particularly those related to incontinence care, are responsible for a substantial amount of the sleep fragmentation that is common among nursing home residents.
A Practical Equation to Predict Resting Metabolic Rate in Older Females
Authors: Arciero Paul J. , Goran Michael I. , Gardner Andrew M. , Ades Philip A. , Tyzbir Robert S. , Poehlman Eric T. 
Published: April 2015

Objective: To develop a practical and accurate age‐specific equation for predicting resting metabolic rate (RMR) in older women and, thereafter, to cross‐validate existing equations for predicting RMR in older females.Design: Cross‐sectional validation study.Setting: General Clinical Research Center.Participants: A convenience sample of 75 healthy older women (age 50–81) free of significant cardiovascular or any other non‐cardiac disease that may affect cardiovascular function or metabolic rate.Measurements: All 75 volunteers were characterized for resting metabolic rate (RMR), body composition, anthropometrics, physical activity, and energy intake.Results: A practical equation for predicting RMR in older women using easily measured variables was: [RMR (kcal/d) = 7.8 (weight, kg) + 4.7 (standing height, cm) − 39.5 (menopausal status; 1–3) + 143.5]. These variables accounted for 59% (R2) of the variation in RMR and predicted RMR within ±66 kcal/d. When five previously published equations were applied to our sample of older women to predict RMR, individual predicted values deviated by −31% to 20% from the measured value.Conclusion: We offer a practical equation to predict RMR in healthy older women based on a measure of body weight, standing height, and menopausal status.
Drug Use Patterns of Persons with Alzheimer's Disease and Related Disorders Living in the Community
Authors: Semla Todd P. , Cohen Donna , Paveza Gregory , Eisdorfer Carl , Gorelick Philip , Luchins Daniel , Hirschman Robert , Freels Sally , Levy Paul , Ashford J. Wesson , Shaw Helen 
Published: April 2015

Objective: To describe drug use patterns by persons with Alzheimer's disease, multi‐infarct dementia, and mixed Alzheimer's disease and multi‐infarct dementia.Design: Multicenter, patient registry.Setting: Community‐living persons evaluated in primary care, geriatric, and Alzheimer ambulatory settings.Participants: Of the 930 persons in three diagnostic categories, there were 671 with probable or possible Alzheimer's disease by NINCDS/ADRDA criteria or Alzheimer's disease by DSM‐III‐R criteria, 162 multi‐infarct cases by DSM‐III‐R criteria, and 97 mixed cases by DSM‐III‐R criteria. In each diagnostic category, 65% were women, and the majority were 70 years or older.Measurements: The average number of all prescription and non‐prescription drugs and selected therapeutic categories by age, sex, diagnosis, and mini‐mental status score at the time of diagnosis or evaluation.Results: Alzheimer patients average 2.3 drugs compared with multi‐infarct (4.3; P < 0.0001) and mixed (3.7; P = 0.002) patients, and their pattern of drug use was different when stratified by therapeutic categories and drug classes. Drug use increased with age, and women used significantly more drugs than men in all three diagnostic categories. Women with Alzheimer's disease used significantly more cardiovascular drugs than men with Alzheimer's disease (P < 0.05). The lower the mini‐mental status score in patients with any dementia, the greater the mean number of central nervous system agents used. The higher the mini‐mental status score in a patient with multi‐infarct or mixed dementia, the greater the use of cardiovascular drugs.Conclusion: Drug use by Alzheimer patients was lower than in multi‐infarct and mixed patients, primarily due to a lower prevalence of cardiovascular drugs.
How Many Physicians Will Be Needed to Provide Medical Care for Older Persons? Physician Manpower Needs for the Twenty‐First Century
Authors: Reuben David B. , Zwanziger Jack , Bradley Thomas B. , Fink Arlene , Hirsch Susan H. , Williams Albert P. , Solomon David H. , Beck John C. 
Published: April 2015

To estimate the number of full‐time‐equivalent (FTE) physicians and geriatricians needed to provide medical care in the years 2000 to 2030, we developed utilization‐based models of need for non‐surgical physicians and need for geriatricians.Based on projected utilization, the number of FTE physicians required to care for the elderly will increase two‐ or threefold over the next 40 years. Alternate economic scenarios have very little effect on estimates of FTE physicians needed but exert large effects on the projected number of FTE geriatricians needed.We conclude that during the years 2000 to 2030, population growth will be the major factor determining the number of physicians needed to provide medicare care; economic forces will have a greater influence on the number of geriatricians needed.
Type of Fall and Risk of Hip and Wrist Fractures: The Study of Osteoporotic Fractures
Authors: Nevitt Michael C. , Cummings Steven R. ,   Study of Osteoporotic Fractures Research Group
Published: April 2015

Objective: To determine the causes of hip or wrist fractures.Design: Case‐control analysis nested in a prospective cohort study.Setting: Four clinical centers in Baltimore, Maryland, Minneapolis Minnesota, Portland, Oregon, and Monessen, Pennsylvania.Participants: Non‐black women age 65 and older living in the community.Measurements: We measured bone density, arm strength, and anthropometric characteristics at a baseline examination. Those who subsequently suffered hip (n = 130) or wrist (n = 294) fractures as a result of a fall and a consecutive sample of those who fell without a fracture (n = 467) were interviewed about their falls.Results: In multivariate analyses, those who suffered hip fractures were more likely to have fallen sideways or straight down (odds ratio 3.3; 95% confidence interval 2.0 to 5.6) and to have landed on or near the hip (32.5; 9.9, 107.1) than women who fell without a fracture. Among women who fell on the hip, those with hip fractures were taller (1.5; 1.2, 2.2 per SD increase), less likely to have landed on a hand (0.3; 0.1 to 0.6) or to break the fall by grabbing or hitting an object (0.4; 0.2, 0.9), had weaker triceps (1.7; 1.2, 2.5 per SD decrease), and were more likely to land on a hard surface (2.8; 1.4, 5.5) than those without fractures. Women with wrist fractures were more likely to have fallen backward (2.2; 1.3, 3.8) and to have landed on a hand (20.4; 11.5, 36.0) than those who fell without a fracture. Among women who fell on the hand, those with wrist fractures were taller (1.4; 1.1, 1.8 per SD increase) and less likely to break the fall by grabbing or hitting an object (0.4; 0.2, 0.7). Among women who fell on their hip or hand, the risk of fracturing that site more than doubled for each standard deviation decrease in bone density at the site of fracture.Conclusions: The nature of the fall determines the type of fracture, while bone density and factors that increase or attenuate the force of impact of the fall determine whether a fracture will occur when a faller lands on a particular bone. These findings have important implications for prevention of fractures in older women.
Medical Decision‐Making in the Last Six Months of Life: Choices about Limitation of Care
Authors: Fried Terri R. , Gillick Muriel R. 
Published: April 2015

ObjectiveTo characterize the limitation of care in routine geriatric practice in advance of and at the time of a patient's final episode of illness.DesignA descriptive study performed by retrospective chart review.SettingAn outpatient geriatric practice affiliated with a community teaching hospital.PatientsFifty‐nine recipients of primary care who were community‐dwelling and older than 65, died in the years 1988–1991, and were enrolled in the practice for at least 6 months prior to death.MeasurementsWe recorded the type(s) of care patients (or, in the case of incompetence, their families) and their physicians chose to limit during the last episode of illness preceding death and during previous episodes of illness by examining those instances when therapy other than that considered “standard” was given. We also examined whether the presence of dementia, functional impairment, chronic disease, terminal illness, site of routine care (home vs hospital), and location of death were associated with the limitation of care.ResultsA choice to limit diagnostic tests or treatment was made by the patient or surrogate in 40% of the 59 patients during the 6 months before the patient's final episode of illness. Most frequently limited were diagnostic tests, surgery, and hospitalization for purposes other than surgery. Terminal illness and location of death were associated with the limitation of care, but dementia, functional impairment, chronic illness, and location of care were not. By comparison, 89% of the patients had limitation of care during the final episode of illness, and more aggressive therapies such as cardiopulmonary resuscitation and intubation constituted the majority of therapies withheld.ConclusionsIn one geriatric practice, care is frequently limited before a patient's final illness in the course of routine practice. In contrast to recent discussion focusing on limitation of end‐of‐life interventions or interventions in the severely impaired, these results suggest that there are multiple points in the course of a community‐dwelling elderly patient's illness at which choices about level of care can be made. Given this opportunity, a significant number of elderly patients or their surrogates will choose less intensive therapy.
Individualized Care Alternatives Used in the Process of Removing Physical Restraints in the Nursing Home
Authors: Werner Perla , Koroknay Vivian , Braun Judith , Cohen‐Mansfield Jiska 
Published: April 2015

ObjectiveTo describe the individualized care alternatives used during the process of removing physical restraints in a nursing home.DesignDescriptive survey.SettingA non‐profit geriatric long‐term care facilitySubjectsSixty‐three physically restrained residents (mean age = 85.3 years).MeasuresInformation regarding the different care alternatives used to replace physical restraints was obtained from the Gerontological Clinical Nurse Specialist implementing the process of removing restraints.ResultsThe physical restraints of six of the 63 participants were removed without implementing any care alternative. With the remaining 57 participants, an average of 3.3 different care alternatives were used (range 1–7 care alternatives). Environmental alternatives (such as wheelchair adaptations and alternative seating) were used with 86% of the restrained residents; alterations in nursing care (such as additional supervision and toileting schedules) were used with 77% of the participants. Psychosocial and physiological alternatives, as well as the use of structured activities, were used less frequently. At the end of the study period, five residents remained restrained.ConclusionsThis papers shows the complexity of the process of removing physical restraints in the nursing home. The need of an individualized approach is stressed.
Depression, Cognition, and Functional Ability in Patients with Alzheimer's Disease
Authors: Fitz Allan G. , Teri Linda 
Published: April 2015

Objective: To investigate the relationship of depression to functional and cognitive impairment in patients with Alzheimer's disease (AD).Design: Clinic‐based study comparing AD patients with and without depression.Setting: Geriatric outpatient clinic at the University of Washington Medical Center, Seattle, WA.Participants: Ninety‐one AD patients, 46 with major depression and 45 without.Measurements: The relationship of the Mattis Dementia Rating Scale (mDRS), DSM‐III‐R diagnosis of depression, and Hamilton Depression Rating Scale (HDRS) to daily functioning as measured by the Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), and Communication subscales of the Record of Independent Living (RIL) was examined.Main Results: Both depression and mDRS related significantly to functional impairment, but the amount of variance contributed differed by level of cognitive impairment and functional area investigated. In mildly cognitively impaired subjects, diagnosis and severity of depression (combined) was significantly related to IADL and Communication subscales, after controlling for age and mDRS. No predictor was significantly related to ADL functioning. In contrast, for moderately cognitively impaired subjects, depression diagnosis was significantly related to ADL and Communication performance, but not to IADL functioning. mDRS also significantly predicted ADL, IADL, and Communication subscales. Severity of depression was not significant.Conclusions: These findings, that the presence (diagnosis) and severity (HDRS score) of depression significantly predicted functional status, but that the degree of association varied by level of cognitive severity, has important diagnostic and treatment implications. In particular, the importance of examining whether functional impairment in depressed AD patients can be modified by depression treatment is discussed.