bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancement of Proxy Appointment for Older Persons: Physician Counselling in the Ambulatory Setting
Authors: Meier Diane E. , Gold Gabriel , Mertz Kristan , Taylor Brian , Cammer‐Paris Barbara E. , Seckler Allison , Mulvihill Michael 
Published: April 2015

OBJECTIVE: To determine the effectiveness of physician‐initiated counselling on the rate of health care proxy appointment.DESIGN: Observational study of an intervention in a convenience sample.SETTING: A geriatric outpatient clinic in a tertiary care teaching hospital, New York, New YorkPARTICIPANTS: A total of 687 patients enrolled in the geriatric clinic during the study period March 1991 through June 1993.INTERVENTION: Physician counselling about the New York State Health Care Proxy Law, distribution of educational materials and healthcare proxy forms, and reminders in 331 of 466 eligible patients.MEASUREMENTS: Rate of healthcare proxy appointment in eligible and counselled groups; predictors of appointment and non‐appointment; time elapsed from counselling to appointment; reasons for non‐appointment; characteristics of the proxy appointment process.RESULTS: A healthcare proxy was appointed for 31.5% of patients eligible for counselling and for 44% of patients who actually received the intervention, compared with a 2.3% proxy appointment rate at baseline. Eighty‐one percent of the patients completing the proxy appointment process did so at or before their third clinic return visit after the counselling intervention. Of the counselled patients who did not appoint a proxy, 25% explicitly declined, and 75% had not come to a decision by the end of the study period. Proxy completion was associated with ethnicity, education, and more frequent clinic visits. Of those who appointed a proxy, 97% had good or fair comprehension of the procedure, 92% discussed the appointment with their designees, 63% appointed a daughter or son, and 80% discussed their wishes for care at the end of life with their proxy.CONCLUSIONS: Physician counselling of older outpatients is an effective means of increasing healthcare proxy appointments. J Am Geriatr Soc 44:37–43, 1996.
Occurrence of Fibroadenomas in Postmenopausal Women Referred for Breast Biopsy
Authors: Hunter Tim B. , Roberts Catherine C. , Hunt K. Rebecca , Fajardo Laurie L. 
Published: April 2015

OBJECTIVE: To examine the occurrence of breast fibroadenomas in postmenopausal patients referred for breast biopsy.DESIGN: A retrospective review of breast biopsy outcome and of patient demographics, including menstrual and hormonal status.SETTING: The Tucson Breast Center, a large outpatient breast cancer detection clinic affiliated with the University of Arizona Health Sciences Center in Tucson, Arizona.PARTICIPANTS: All women seen at the Tucson Breast Center between 1985 and 1990 who were referred for breast biopsy.RESULTS: A total of 100 fibroadenomas were found in 709 breast biopsies whose results were known. Fifty‐two of these were in premenopausal women and 44 in postmenopausal women; the menopausal status of four women was unknown. In postmenopausal women, 11 of the 44 patients reported hormone use. Fibroadenomas constituted 20% (39 of 195) of the benign masses and 12% (39 of 339) of all breast masses in postmenopausal women. Fibroadenomas constituted 10% (44 of 447) of all biopsies in postmenopausal women, including those with breast masses, abnormal calcifications, or other lesions.CONCLUSION: Noncalcified fibroadenomas of the breast are not confined to young women and may constitute a small but noteworthy proportion of lesions coming to breast biopsy in postmenopausal women. J Am Geriatr Soc 44:61–64, 1996.
Evaluation of Four Methods for the Diagnosis of Respiratory Syncytial Virus Infection in Older Adults
Authors: Falsey Ann R. , McCann Robert M. , Hall William J. , Criddle Mary M. 
Published: April 2015

OBJECTIVE: To evaluate four methods of rapid diagnosis of respiratory syncytial virus (RSV) infection in older adults and to compare sensitivities with serologic analysis.DESIGN: Prospective comparative analysis.SETTING: Two adult daycenters.PATIENTS: Frail older persons attending the daycenter who developed signs or symptoms of acute respiratory illness between the months of December and February.MEASUREMENTS: Viral cultures performed by standard technique and bedside inoculation: antigen detection by indirect immunofluorescence assay (IFA) and Directigen enzyme immunoassay (EIA) on nasal brush samples; serologic analysis of acute and convalescent sera using EIA.RESULTS: RSV infection was documented by serology in 11 of 54 (20%) subjects during the study period. Bedside viral cultures were the most sensitive assay and were positive in 6/9 infections. Standard viral culture detected 5/11 cases. Both methods of rapid antigen detection were found to be insensitive, with 1/11 detected by IFA and 0/11 detected by EIA.CONCLUSION: Rapid antigen tests for the diagnosis of RSV in older persons should be used with caution. J Am Geriatr Soc 44:71–73, 1996.
Approach to Fever and Infection in the Nursing Home
Authors: Yoshikawa Thomas T. , Norman Dean C. 
Published: April 2015

OBJECTIVE: To summarize current information on the scope, epidemiology, clinical manifestations, diagnostic approach, and general management of infectious diseases in nursing home residents, as well as the specific treatment of common infections occurring in the nursing home setting.DESIGN: Survey and literature review of the diagnostic and therapeutic problems of nursing home residents with infections.CONCLUSIONS: Older persons residing in nursing homes as well as other types of long‐term care facilities are at increased risk for infections. Moreover, infection is the most frequent reason for patients to be transferred from nursing homes to an acute‐care facility. The most common infections that are acquired in nursing homes are urinary tract infection (cystitis pyelonephritis), respiratory infections (pneumonia, bronchitis), and skin/soft tissue infections (infected pressure ulcers, cellulitis). Most serious infections in this setting are caused by bacteria; however, influenza and other respiratory viruses as well as herpes zoster may cause significant morbidity in older nursing home residents. Mycobacterium tuberculosis infects nursing home residents at a higher rate than it infects older community dwellers. Infections in older nursing home residents may manifest clinically, with atypical symptoms and signs, including the absence of fever. Rapid diagnostic evaluation and early therapeutic intervention are essential for minimizing the high mortality and morbidity associated with infections in this older population; most nursing home residents with serious infections should be considered for hospitalization. J Am Geriatr Soc 44:74–82, 1996.
Short‐Term Functional Outcomes of Long‐Term Care Residents with Pneumonia Treated with and without Hospital Transfer
Authors: Fried Terri R. , Gillick Muriel R. , Lipsitz Lewis A. 
Published: April 2015

OBJECTIVE: To determine 2‐month mortality and functional status outcomes after resolution of pneumonia in older long‐term care facility (LTCF) patients treated with and without hospital transfer.DESIGN: Retrospective cohort study.SETTING: Hebrew Rehabilitation Center for Aged, a 725‐bed LTCF affiliated with an academic medical center, whose residents are cared for by staff physicians and geriatric fellows.PATIENTS: LTCF residents with an acute episode of pneumonia, defined as a new respiratory sign or symptom and a new infiltrate on chest radiograph.MEASUREMENTS: Functional decline or death in the 2 months after the resolution of pneumonia.RESULTS: Of 312 cases of pneumonia, 246 (79%) were treated in the LTCF and 66 (21%) were treated in the hospital. Equal proportions of patients died of their pneumonia (13% vs 12%), but a larger proportion of those hospitalized had either worsening in their functional status or had died at 2 months (P = .005, Mantel‐Haenszel trend test). In a logistic regression model controlling for differences between patients treated at the two sites, hospital treatment remained associated with poorer 2‐month outcome (AOR 3.02, 95% CI 1.32, 7.22), with a significant interaction between respiratory rate and treatment site. LTCF treatment was associated with better 2‐month outcomes only among patients with a lower respiratory rate. For these patients, the difference in outcome between LTCF treatment and hospital treatment was greatest for patients who were independent or mildly dependent at baseline.CONCLUSIONS: In this academic LTCF, treatment for pneumonia without hospital transfer resulted in better 2‐month outcomes compared with hospital treatment. Although the difference in outcome may be explained in part by differences between patients treated with and without hospital transfer, it persisted after correcting for these differences. The benefits of LTCF treatment appear to be greatest for those with less severe pneumonia and more independent functional status.
Gait Changes in Older Adults: Predictors of Falls or Indicators of Fear?
Authors: Maki Brian E. 
Published: April 2015

OBJECTIVE: To determine, in a cohort of ambulatory older adults, whether spatial‐temporal measures of foot placement during gait can predict the likelihood of future falls or whether these measures are more likely to be indicative of adaptations associated with pre‐existing fear of falling.DESIGN: Prospective cohort study.SETTING: Baseline gait measurements were performed in a gait and balance laboratory; subsequent history of falling was monitored prospectively for 1 year in two self‐care facilities.PARTICIPANTS: Fourteen male and 61 female consecutive volunteers (mean age = 82, SD = 6) who were independent in activities of daily living and able to walk 10 m unaided.MEASUREMENTS: Spatial gait parameters were derived from digitized “footprints”; temporal parameters were derived using footswitches. A clinical activity‐based gait assessment was also performed. The dependent variables were pre‐existing fear of falling (reported at baseline) and future falling (experiencing one or more falls during the 1‐year follow‐up).MAIN RESULTS: Reduced stride length, reduced speed, increased double‐support time, and poorer clinical gait scores were associated with fear but showed little evidence of an independent association with falling. Conversely, increased stride‐to‐stride variability in stride length, speed, and double‐support was associated independently with falling but showed little evidence of relationship to fear. Increased stride width showed some evidence of association with both falling and fear. Stride‐to‐stride variability in speed was the single best independent predictor of falling.CONCLUSIONS: Changes in gait cited previously as risk factors for falling, i.e., decreased stride length and speed and prolonged double support, may in fact be stabilizing adaptations related to fear of falling. Stride‐to‐stride variability in the control of gait is an independent predictor of falling and may be a useful measure for identifying high‐risk individuals and evaluating preventive interventions. Stride width may also be a useful outcome measure. Contrary to common expectation, a wider stride does not necessarily increase stability but instead seems to predict an increased likelihood of experiencing falls.
Sleep Disturbance, Psychosocial Correlates, and Cardiovascular Disease in 5201 Older Adults: The Cardiovascular Health Study
Authors: Newman Anne B. , Enright Paul L. , Manolio Teri A. , Haponik Edward F. , Wahl Patricia W. ,   On behalf of the Cardiovascular Health Study Research Group
Published: April 2015

OBJECTIVES: To describe the prevalence of self reported sleep disturbances in older men and women and to describe their relationships with health status and cardiovascular diseases (CVD).DESIGN: Cross‐sectional study of sleep disturbance, CVD, general health, psychosocial factors, physical function, and use of psychotropic medications.SETTING: Participants of the Cardiovascular Health Study, 5201 adults aged 65 and older recruited from a random sample of noninstitutionalized Medicare enrollees in four US communities.MEASURES: Self‐reported sleep disturbances and standardized questionnaires for cardiopulmonary symptoms and diseases, depression, social support, activities of daily living, physical activity, cognitive function, and current medications, spirometry, ECG, echocardiography, and carotid ultrasound.RESULTS: Women were twice as likely as men to report difficulty falling asleep (30% vs 14%). Daytime sleepiness, difficulty falling asleep, and frequent awakenings increased in prevalence with age. All symptoms were related strongly to depression. Symptoms of daytime sleepiness were also related strongly to poor health and limitations in activities of daily living in men and women. In multivariate analysis, men taking benzodiazepines were likely to report difficulty falling asleep and daytime sleepiness, whereas women taking benzodiazepines reported difficulty falling asleep and waking up too early. After accounting for these factors, the only cardiovascular disease independently associated with sleep disturbances was angina. Men and women with confirmed angina were 1.6 times more likely to report trouble falling asleep. Independent relationships between sleep disturbances and cardiovascular risk factors such as obesity, hypertension, smoking, and diabetes were relatively weak and inconsistent, though smokers were less likely to report frequent awakenings.CONCLUSIONS: Sleep disturbances are relatively common in older men and women and are associated with poor health, depression, angina, limitations in activities of daily living, and the use of benzodiazepines.
The Association Between Human Leucocyte Antigens (HLA) and Mortality in Community Residents Aged 85 and Older
Authors: Izaks Gerbrand J. , van Houwelingen Hans C. , Schreuder Geziena MT , Ligthart Gerard J. 
Published: April 2015

OBJECTIVE: The association between Human Leucocyte Antigens (HLA) and aging was investigated. It is possible that HLA antigens are associated with longevity, either indirectly through disease associations or directly through involvement in the aging mechanism.DESIGN: Community‐based follow‐up study.SETTING: Leiden, the Netherlands.PARTICIPANTS: A total of 919 subjects were HLA typed in this community‐based study. All subjects were aged 85 and older and were white. Seventy‐two percent of the cohort was female.MEASUREMENTS: Age‐ and sex‐adjusted Mortality Rate Ratios (MRR) were estimated for 79 antigens by the subject‐years method. HLA‐A, ‐B and ‐C typing was performed with the standard NIH lymphocytotoxicity test, HLA‐DR and ‐DQ typing was performed with the two‐color fluorescence test. Homozygosity for HLA‐A, ‐B, and ‐DR was defined as only one detectable antigen at a locus.RESULTS: The mean follow‐up period (SD) was 5.0 (0.6) years. At the end of the follow‐up, 70% of the subjects had died. The MRR (95%CI) for B60 was 0.96 (0.75‐1.23), and for DR11 it was 0.82 (0.66‐1.01). For A2 and A26 only, the MRR (95%CI) was significantly different from 1:0.85 (0.73‐0.99), P = .04 and 1.45 (1.06‐1.99), P = .02, respectively (P values not corrected for the number of antigens tested). Homozygosity was not associated with mortality.CONCLUSIONS: HLA was not associated with mortality after the age of 85. Therefore, direct involvement of HLA in aging is unlikely. We suggest that the findings of previous studies are attributable to methodological shortcomings such as small sample size and differences in genetic background of the subjects.
A Survey of Habitual Snoring in Centenarians
Authors: Shiomi Tshiaki , Guilleminault Christian , Kayukawa Yuhei , Wakida Yasushi , Okamoto Yasuyoshi , Kobayashi Tadashi 
Published: April 2015

OBJECTIVE: To ascertain whether centenarians in the surveyed group would be nonhabitual snorers.DESIGN AND SETTING: A cross‐sectional survey of centenarians residing in the Aichi Prefecture of Japan.PARTICIPANTS: A total of 103 centenarians (21 men and 82 women).MEASUREMENTS: Questionnaire on sleep habits, breathing, and snoring.RESULTS: Nineteen centenarians (18.4%; 5 men and 14 women) were habitual snorers and two (1.9%) were suspected of having sleep apnea syndrome because of the presence of heavy snoring and nocturnal respiratory arrest.CONCLUSION: Most centenarian subjects were non‐snorers and without breathing pauses during sleep; their snoring rates were no different from those of younger aged older adults in the same population.
The Impact of Aging and Chronic Disease on Use of Hospital and Outpatient Services in a Large HMO: 1971–1991
Authors: Haan Mary N. , Selby Joe V. , Quesenberry Charles P. , Schmittdiel Julie A. , Fireman Bruce H. , Rice Dorothy P. 
Published: April 2015

OBJECTIVES: To examine overall and diagnosis‐specific trends in the use of inpatient and outpatient medical services (1970–1988) among older members of a large HMO.DESIGN: Two cohorts of approximately 3000 persons aged 65 or older in 1971 and 1980 were compared for hospital and outpatient utilization during 9‐year follow‐up periods (1971–79 and 1980–88). All subjects were evaluated for vital status throughout the follow up period as well.PARTICIPANTS: All 6057 subjects were members of the Northern California Kaiser Permanente Medical Care Program in 1971 or 1980. The study sample was sex‐age stratified (65–69, 70–79, 80+) at baseline.MEASUREMENTS: Data on demographics, outpatient health services utilization, categories of outpatient utilization and disease diagnoses were obtained from membership lists or medical chart review; inpatient utilization, including admitting and discharge diagnosis, length of stay, and number of hospital days was assessed from computerized hospitalization records.RESULTS: Hospital discharge rates (sex‐age adjusted) increased by 12% between cohorts, with the largest increases at the oldest ages. There was a 25% increase among women and a 9% increase among men. Length of stay decreased by 20%. Hospitalization for ischemic heart disease decreased by 17%. Congestive heart failure (CHF) discharge rates (sex‐age adjusted) were 92% higher in the 1980–88 cohort. For diagnoses related to nursing home institutionalization and frailty, discharge rates were significantly higher in the 1980–88 cohort: pneumonia (+ 34%), urinary tract infections (+ 104%), dehydration (+ 110%), osteoarthritis (+ 64%), syncope (+ 246%), leg cellulitis (+ 70%). In‐hospital survival improved, but overall percent of readmissions also increased by 4%; readmissions for CHF increased by 13% and those for conditions of frailty by 120%. Overall outpatient visits increased by 17%. Use of laboratory tests (+ 57%) and outpatient surgeries (+ 99%) increased for all age strata in 1980–88 compared with 1971–79.CONCLUSIONS: While overall outpatient and inpatient utilization has largely decreased over the past 30 years, as a result of economic factors and improved treatments for some major diseases, there has been an increase in utilization among older people. Hospitalization for diagnoses associated with end‐stage cardiovascular disease (CHF), musculoskeletal disease, frailty and iatrogenic aspects of institutionalization are clearly increasing substantially. The largest impact of aging on health care may be the result of institutionalization and its sequelae. Improved treatment for cardiovascular disease may also be leading to increased utilization at later stages in the disease process.
Blood Pressure Reduction and Tolerability of Felodipine ER in Older and Younger Hypertensive Patients
Authors: Fagan Timothy C. ,   Felodipine ER in the Elderly versus Young Working Group
Published: April 2015

OBJECTIVE: To evaluate and compare blood pressure reduction and tolerability of felodipine ER (extended‐release), in younger and older patients.DESIGN: A multicenter, double‐blind, placebo‐controlled, parallel group study.SETTING: Nineteen study sites; approximately half of the sites were at academic medical centers and half were in private primary care practices. Patients were non‐hospitalized and free‐living.PATIENTS: There were 243 younger (≤61 years) and older (≥64 years) patients, age range 26 to 83, with sitting diastolic blood pressure (SDBP) of 95–115 mm Hg (higher stage 1 to lower stage 3) on placebo. Patients volunteered for the study.INTERVENTIONS: After a 2 to 4 week, single‐blind, placebo baseline period, patients with SDBP of 95–115 mm Hg were randomized to treatment with felodipine ER 2.5 mg qd or placebo at a ratio of 3:1, felodipine:placebo. The dose of felodipine ER was increased to 5 mg qd after 3 weeks and to 10 mg qd after 6 weeks if the SDBP was greater than 90 mm Hg.MEASUREMENTS: The main outcome measure was change in SDBP. Secondary Outcome measures were change in sitting systolic blood pressure (SSBP) and percent of responders, defined as SDBP less than 90 mm Hg or a ≥ 10 mm Hg reduction. Other measurements included heart rate, weight, routine laboratory values, and self‐reported adverse events.RESULTS: By Week 9, felodipine ER reduced blood pressure in the older subjects (n = 77) by 13/12 mm Hg; in the younger patients, (n = 102), the reduction was 12/8 mm Hg. All reductions were significantly different from placebo (P ≤ .003). The reduction in diastolic, but not systolic, blood pressure was significantly greater in the older than in the younger patients (P = .004 and P = .188, respectively). The percentage of patients reporting a clinical adverse experience was similar for felodipine ER and placebo treatment groups. The incidence of side effects was similar between old and young patients. Discontinuation occurred in 9% of the felodipine‐treated patients and 19% of the placebo‐treated patients. Older patients required lower doses of felodipine ER to achieve equivalent blood pressure control.CONCLUSIONS: Felodipine ER is effective in lowering blood pressure and is well tolerated in both young and old people.
Abnormal Exercise Electrocardiograms in Master Athletes After Three Months of Deconditioning
Authors: Katzel Leslie I. , Busby‐Whitehead M. Janette , Hagberg James M. , Fleg Jerome L. 
Published: April 2015

OBJECTIVE: To determine the effects of 3 months of voluntary deconditioning on cardiac function in master athletes.DESIGN: A prospective study.SETTING: Research participants at the University of Maryland School of Medicine and Johns Hopkins Bayview Medical CenterPARTICIPANTS: Ten older (59 ± 8 years, mean ± SD), highly conditioned (maximal aerobic capacity V̇O2 max 50 ± 5 mL/kg/min), aerobically trained athletesMEASUREMENTS AND RESULTS: Three months after the cessation of training, three of the 10 athletes had unexpected, new, markedly asymptomatic, ischemic‐appearing, exercise‐induced ST‐segment depression on their maximal exercise tests. After retraining, the ST‐segment changes disappeared in two of the subjects, but it persisted, although at a higher work load, in one of the athletes.CONCLUSION: In three master athletes, voluntary cardiopulmonary deconditioning was associated with the development of new, asymptomatic, exercise‐induced ST‐segment depression on exercise ECG. The mechanisms underlying these new ischemic‐appearing ST‐segment changes accompanying detraining and their clinical significance are not known and warrant further investigation.