bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Advancing Age on the Efficacy and Side Effects of Antiarrhythmic Drugs in Post‐Myocardial Infarction Patients with Ventricular Arrhythmias
Authors: Akiyama Toshio , Pawitan Yudi , Campbell W. Barton , Papa Louis , Barker Allan H. , Rubbert Pat , Friedman Lawrence , Keller Marcia , Josephson Richard A. ,   the CAST Investigators
Published: April 2015

ObjectiveTo determine the effect of age on the response to anti‐arrhythmic drugs.DesignRandomized controlled trial comparing particular drugs.SettingMulti‐institutional (The Cardiac Arrhythmia Suppression Trial, CAST).Participants2,371 patients, age <80, with ventricular arrhythmias after a recent myocardial infarction. Subjects classified by age as ≤55, 56–65, and 66–79 years.InterventionUpwardly titrated doses of encainide, flecainide or moricizine. After identification of a tolerated and effective dose of one of the drugs, participants were randomized to that drug and dose versus its placebo for up to 10 months.Main Outcome MeasuresEfficacy of drug (suppression of ventricular premature depolarizations and/or non‐sustained ventricular tachycardia), side effects and mortality.ResultsOlder patients had more previous MIs, congestive heart failure (CHF), hypertension, NSVT, repolarization abnormalities, digitalis use, and diuretic use. They had less pathologic Q‐waves or electrocardiographic injury pattern, and their left ventricular ejection fraction (LVEF) was lower. First dose VPD suppression with the first drug averaged 53% and is not associated with age (P = 0.29). Adverse events including death are more frequent in older patients taking study drugs (P < 0.001). This trend is consistent in all three study drugs and at varying LVEFs. History of prior MI, low LVEF, VPD (in log scale), and digitalis therapy also correlates with adverse events (all P < 0.05). Following adjustment for these factors, older age is an independent predictor of adverse events (relative risk 1.30 per decade of age, P < 0.001).ConclusionsOlder age increases the susceptibility to adverse cardiac events from a class of relatively toxic antiarrhythmic agents.
Predictors of Advance Directive Restrictiveness and Compliance with Institutional Policy in a Long‐Term‐Care Facility
Authors: Batchelor Allison J. , Winsemius David , O'Connor Patrick J. , Wetle Terrie 
Published: April 2015

ObjectiveTo ascertain factors influencing the level of advance directives selected by nursing home residents or surrogates and the time delay to documentation of these choices in the medical record after implementation of a facility‐wide policy.DesignLongitudinal cohort study of nursing home residents followed from date of advance directive policy initiation or time of admission for a maximum of 21 months from study commencement.SettingA 315‐bed multilevel nursing home.ParticipantsFour hundred twenty‐four nursing home residents (mean age 85, 74.9% female, 96.1% white).Outcome MeasuresLevel of advance directive status chosen—full code, do not resuscitate (DNR) or palliative care only—and date documented in the medical record.ResultsFactors predictive of restricted advance directives (DNR or palliative care) included age >85 years (P = 0.025), documented use of a surrogate decision maker (P = 0.001), low physical function (P < 0.001), low cognitive function (P < 0.001), and having a nursing home‐employed physician (P = 0.001). These results were confirmed using logistic regression models. Median time to directive documentation decreased from 54 days for residents admitted in the first quarter to 1 day for residents admitted in the fourth quarter of the year following initiation of an advance directive policy.ConclusionIn logistic models, nursing home‐employed physicians were more likely to write restricted advance directive orders than community‐based physicians even after controlling for resident age, cognitive status, and physical function. In addition, implementation of a formal nursing home advance directive policy can shorten time to physician documentation of resident advance directive status.
Validation of a Telephone Version of the Mini‐Mental State Examination
Authors: Roccaforte William H. , Burke William J. , Bayer Barbara L. , Wengel Steven P. 
Published: April 2015

ObjectiveTo assess the construct validity of a telephone‐administered version of the Mini‐Mental State Examination (MMSE).DesignValidity testing by comparing a telephone version of the MMSE administered first to a face‐to‐face evaluation done several days later.SettingOutpatient geriatric assessment center.Subjects100 of 175 consecutive referrals.Main Outcome MeasuresMMSE and a brief neuropsychological screening test (BNPS) face‐to‐face and a telephone version of the MMSE as part of the Adult Lifestyles and Function Interview (ALFI‐MMSE).ResultsTest scores of the two MMSE versions correlated strongly for all subjects (Pearson's r = 0.85, P = 0.001) and remained significant for the cognitively intact (P = 0.02) and questionably (P = 0.002), mildly (P = 0.0001), and moderately (P = 0.003) demented. Comparison of the two versions' equivalent 22 items revealed no significant difference for scores of all subjects (P = 0.07) but with a trend toward higher scores in the original version. Diminished hearing, reported either by the subject (P = 0.003) or by the collateral source (P = 0.02) was associated with lower scores on the telephone version. Five individual test items were biased by the route of test administration. Sensitivity and specificity relative to the BNPS were 67% and 100% for the ALFI‐MMSE and 68% and 100% for the MMSE, respectively.ConclusionThe scores on the ALFI‐MMSE correlated strongly with the scores of the original version given face‐to‐face in subjects undergoing geriatric assessment. The results indicate that the ALFI‐MMSE could be a useful and economical tool to screen for cognitive impairment.
Decline in Physical Function following Hip Fracture
Authors: Marottoli Richard A. , Berkman Lisa F. , Cooney Leo M. 
Published: April 2015

ObjectiveThe main objective of the study was to determine the change in physical function following hip fractures in a community‐living elderly population. A secondary objective was the determination of baseline factors predictive of altered function following hip fracture.DesignProspective, cohort study.SettingUrban, community‐living elders.Participants120 members of a cohort of 2806 individuals age 65 and older in New Haven, CT who sustained a hip fracture from 1982 to 1988 and were treated in the two New Haven hospitals.Outcome MeasureSelf‐reported performance of dressing, transferring, walking across a room, climbing stairs, and walking one‐half mile before the fracture occurred and 6 weeks and 6 months post‐fracture. Baseline factors were assessed before the hip fracture occurred.ResultsOf the 120 cohort members who sustained a hip fracture in the 6‐year study period, 22 died within 6 months of the fracture. Among survivors there was a sustained decline in function at 6 weeks after the fracture with little improvement by 6 months. At baseline, 86% could dress independently versus 49% at 6 months; 90% could transfer independently versus 32% at 6 months; 75% could walk across a room independently versus 15% at 6 months; 63% could climb a flight of stairs versus 8% at 6 months; and 41% could walk one‐half mile versus 6% at 6 months. Physical function and mental status were the only baseline factors significantly associated with physical function at 6 months after the fracture in bivariate analysis, while physical function and depression were associated in multivariate analysis.ConclusionWe found a substantial decline in physical function following hip fracture in a prospectively followed community‐living elderly population. Only pre‐morbid physical and mental function predicted this decline.
Geriatric Education Part II: The Effect of a Well Elderly Program on Medical Student Attitudes toward Geriatric Patients
Authors: Adelman Ronald D. , Fields Suzanne D. , Jutagir Rajendra 
Published: April 2015

ObjectiveTo assess impact of exposure to healthy elderly on medical students' attitudes toward the elderly.DesignProspective, randomized, controlled intervention trial.SettingCommunity‐based Well Elderly Program.ParticipantsNinety‐three fourth year medical students on a required Geriatric Medicine clerkship who were assigned to either a tertiary care university medical center or a teaching nursing home.InterventionThirty‐five students were randomly assigned to participate in a Well Elderly Program and were compared to a control group of 58 students at equivalent sites who did not participate.MeasurementsPre‐ and post‐rotation, students were given the Aging Semantic Differential (ASD), a validated geriatric attitudinal scale.Main ResultsBy repeated measures analysis of variance, the difference between pre‐ and post‐rotation ASD scores were most significant for students who participated in the Well Elderly Program; site did not exert a significant interaction effect.ConclusionThese results underscore the importance of exposure to healthy older people on effecting positive attitude changes among medical students on geriatrics rotations.
Sensitivity and Specificity of Death Certificate Diagnoses for Dementing Illnesses, 1988–1990
Authors: Macera Caroline A. , Sun Richard K. P. , Yeager Kimberly K. , Brandes Debra A. 
Published: April 2015

ObjectiveTo evaluate the extent to which mortality data, which is often used to track secular trends for specific diseases, underestimates the prevalence of dementia.DesignRetrospective analysis of existing data.SettingDepartment of Mental Health inpatient facilities in South Carolina.SubjectsInpatients at Department of Mental Health facilities who were listed in the South Carolina Statewide Alzheimer's Disease and Related Disorders Registry and who died between 1988 and 1990 (n = 450).Main Outcome MeasuresSensitivity and specificity of dementia diagnoses on death certificates compared to medical record diagnoses for inpatients with a pre‐mortem dementia diagnosis.ResultsTwenty‐three percent of death certificates contained any dementia diagnosis (104/450). The sensitivity of death certificates varied by type of dementia (28 percent for Alzheimer's disease; 8 percent for multi‐infarct dementia) as well as by race, sex, and age.ConclusionsMortality statistics substantially underestimate the prevalence of dementing illnesses and do not fully represent the public health burden of dementia.
The Use of Targeting Criteria in Hospitalized HMO Patients: Results from the Demonstration Phase of the Hospitalized Older Persons Evaluation (HOPE) Study
Authors: Reuben David B. , Wolde‐Tsadik Girma , Pardamean Bens , Hammond Betty , Borok Gerald M. , Rubenstein Laurence Z. , Beck John C. 
Published: April 2015

ObjectiveTo determine the yield of standardized targeting criteria for identifying hospitalized HMO patients who are at high risk for mortality and nursing home placement and, therefore, may be appropriate for comprehensive geriatric assessment.DesignProspective cohort study.SettingFour HMO (Southern California Kaiser‐Permanente) hospitals.Subjects3,697 patients 65 years of age or older admitted to any inpatient service from July 1 through September 30, 1990.Main Outcome MeasuresScreening measures for standardized targeting criteria, administered 24–48 hours after admission.ResultsOverall, 35.1% of patients screened met at least one inclusionary criterion, which is considerably higher than other published reports. The most commonly met criteria were incontinence, impairment in performing activities of daily living, malnutrition, and immobility. The percentage of patients meeting at least one criterion and meeting each criterion varied considerably among hospitals. The vast majority of patients (83%) who were judged appropriate for assessment met at least three criteria.ConclusionsThe yield of standardized criteria differs when applied to patients in different health care systems and to patients at different hospitals within a health care system, which may reflect differences in the populations being served and the practice styles of physicians and the delivery system. Because no single criterion identified more than approximately half of patients who were judged appropriate for assessment, it is likely that a battery of criteria will be necessary to identify these patients.
Anemia and Hemoglobin Levels in Older Persons: Relationship with Age, Gender, and Health Status
Authors: Salive Marcel E. , Cornoni‐Huntley Joan , Guralnik Jack M. , Phillips Caroline L. , Wallace Robert B. , Ostfeld Adrian M. , Cohen Harvey J. 
Published: April 2015

ObjectiveTo determine the relationship of hemoglobin levels and anemia with age and health status in older adults.DesignSurvey.SettingCommunity.Participants and MethodsHematologic tests were obtained from 3,946 adults aged ≥71 years in three communities (East Boston, MA; Iowa and Washington counties, IA; and New Haven, CT).ResultsHemoglobin level was inversely associated with age, although this was more pronounced in men than in women. The proportion anemic was equal for men and women aged 71–74 years (8.6%) and increased differentially with age, reaching 41% and 21% for men and women aged ≥90 years, respectively. Hemoglobin and anemia were independently associated with age, race, body‐mass index, smoking, cancer, hospitalization, renal insufficiency, and hypoalbuminemia. The adjusted relative odds of anemia for a 5‐year increase in age was 1.5 (95% confidence interval [CI] 1.3–1.8) for men and 1.2 (95% CI 1.1–1.4) for women.ConclusionsAge is significantly associated with both hemoglobin levels and anemia, with a stronger effect in men compared with women, even after simultaneously adjusting for demographic characteristics and health status. The decline of hemoglobin and concomitant increased anemia with age is not necessarily a result of “normal aging” so the detection of anemia in an older person should prompt appropriate clinical attention.
Multidimensional Risk Assessment versus Age as Criterion for Retirement of Airline Pilots
Authors: Stuck Andreas E. , van Gorp Wilfred G. , Josephson Karen R. , Morgenstern Hal , Beck John C. 
Published: April 2015

ObjectiveTo determine whether airline pilots over the age of 60 pose a hazard to aviation safety and whether risk assessment could replace age‐based retirement.Data SourcesA computer‐assisted literature search (MEDLINE), expert consultation, and government reports.Study SelectionOriginal studies on flight performance and pilot age; sudden incapacitation, neuropsychological testing, and/or medication use in pilots; and/or non‐invasive testing for predicting sudden death or stroke in asymptomatic subjects.Data ExtractionPertinent results and methods data were abstracted from the 49 included studies.Data SynthesisNo study on aircraft accidents or pilot performance has shown an increased accident risk for over‐60‐year‐old pilots. Normal age‐related cognitive changes probably have minimal impact on aviation safety up to age 70, given above average health, education, and experience in airline pilots. Cognitive tests have not been validated for predicting flight performance safety, but they can detect early stages of cognitive disease. Cardiovascular incapacitation risk increases with age, but risk factor profiles and non‐invasive tests could identify pilots with non‐acceptable risk.ConclusionsAn improved medical certification test could identify those pathologic conditions that might occur more frequently in older subjects. If pilots also underwent adequate performance testing, a gradual increase of the retirement age to approximately age 70 would seem justified. In the future, a longitudinal database should be established to validate medical tests for their ability to predict a pilot's accident risk. Using individual pilots as their own controls might be more sensitive than using population‐based norm values. Progress in this field would advance medical assessment for other groups such as air traffic controllers or automobile drivers.
Prevalence and Predictors of Regularly Scheduled Prescription Medications of Newly Admitted Nursing Home Residents
Authors: Renner Elizabeth A. , Engle Veronica F. , Graney Marshall J. 
Published: April 2015

ObjectiveThe purpose of this study was to identify the prevalence and predictors of commonly prescribed regularly scheduled medications.DesignData were collected on the first day following nursing home admission in this non‐experimental study.SettingA stratified, proportional probability sample of eight nursing homes in a large Mid‐South city participated in this study.ParticipantsA consecutive sample of 574 new and readmitted nursing home residents who did not refuse participation.InterventionsNone.Main Outcome Measure(s)Data were collected on regularly scheduled prescription medications and resident and nursing home characteristics.ResultsResidents without a diagnosis of dementia were more likely to receive cardiovascular medications (Odds Ratio = 2.34; 95% CI = 1.56–3.49), and white residents were more likely to receive cardiovascular medications (Odds Ratio = 1.74; 95% CI = 1.19–2.53) or central nervous system medications (Odds Ratio = 1.72; 95% CI = 1.18–2.51). Older residents were less likely to receive central nervous system medications (Odds Ratio = 0.97 per year; 95% CI = 0.96–0.99), and females were more likely to receive cardiovascular medications (Odds Ratio = 1.89; 95% CI = 1.30–2.75).ConclusionsResident characteristics were the most important predictors for cardiovascular and central nervous system medication prescriptions of new and readmitted nursing home residents.
Somatic Complaints and the CES‐D
Authors: Foelker George A. , Shewchuk Richard M. 
Published: April 2015

ObjectiveTo evaluate the Center for Epidemiology Surveys‐Depression (CES‐D) scale for inordinate false positives, due to measurement of non‐depression‐related somatic complaints.DesignCross‐sectional correlation of analysis of random multi‐cluster samples.SettingThirteen counties considered representative of the community‐dwelling elderly population of Alabama.ParticipantsOne‐thousand‐sixty persons aged 55 and older.InterventionNone.Main Outcome MeasuresStudy evaluated the relationship of somatic symptomatology, as measured by the Multi‐Level Assessment Instrument's Physical Health Domain Index (PHDI) composite score and its three component indices, with the CES‐D and its four component scales, particularly the Somatic scale.ResultsThe CES‐D total score and the Somatic scale were not related to: age increases in the sample; PHDI composite score or the three index scores; or to subgroups of high and low PHDI composite scores. Among those screened as depressed, the PHDI and the three indices were not related to the CES‐D total score or three of the four subscales. The CES‐D Somatic scale was positively related to those depressed persons with the highest number of total PHDI somatic complaints. However, among the depressed group there were more persons scoring greater than 1.5 standard deviations above the mean on the CES‐D Depressive Affect scale (n = 81) than on the Somatic scale (n = 65).ConclusionsThe CES‐D and its Somatic scale were relatively unbiased by the respondent's somatic complaints. The CES‐D can continue to be considered valid under these circumstances.
Role of the Opioid System in the Hypodipsia Associated with Aging
Authors: Silver Andrew Jay , Morley John E. 
Published: April 2015

ObjectiveTo compare the effects of the opioid antagonist, naloxone, on fluid ingestion in young and older males, in order to estimate the role of the opioid system in hypodipsia of older men.DesignSingle‐blinded, randomized, cross‐over, placebo‐controlled study.SettingOutpatient Department of Veterans Affairs.Study ParticipantsSixteen young subjects (aged 23 to 39) and eight older subjects (aged 69 to 75). All subjects were healthy, community‐dwelling, non‐smoking men, on no medications.InterventionSubjects were randomized to receive either placebo or naloxone on day one. Whichever substance the subject did not receive was given on day two with days one and two separated by at least a 2‐week washout period.Main Outcome MeasuresFluid intake after overnight food and fluid deprivation, with placebo or naloxone injected in the morning.ResultsAfter overnight fluid deprivation, older individuals consumed 29% less fluid in 2 hours compared with younger individuals (ns). After overnight fluid deprivation and injection with naloxone 100 μg/kg, fluid intake was diminished by 42% (P < 0.05) in young subjects compared with placebo, but only by 7% (ns) in older subjects. Subjective ratings did not differ significantly between young and old subjects.ConclusionsThese preliminary data suggest that the opioid system plays a role in the drinking response in young subjects while failing to alter fluid intake in older subjects. Hypodipsia in older individuals may be due to a deficit in the opioid drinking drive.
Association between Stimulated Plasma C‐peptide and Age: The Wadena City Health Study
Authors: French L. Ronald , Goetz Frederick C. , Martinez Anita M. , Boen James R. , Bushhouse Sally A. , Sprafka J. Michael 
Published: April 2015

ObjectiveTo assess age‐related changes in stimulated plasma C‐peptide in a population‐based sample of adults.DesignCross‐sectional study.SettingWadena, Minnesota, a city of 4,699 residents (1980 census) in west central Minnesota, approximately 150 miles from Minneapolis/St. Paul.Study Subjects344 non‐diabetic subjects (NDDG standards) from a stratified random sample of the total adult population of Wadena, MN. The six‐study strata were men and women from three age groups: young, 20–39 years of age; middle‐aged, 40–59; and older, >60 years of age.MeasurementsDuring a liquid meal of Ensure‐Plus (Ensure‐Plus® challenge test; EPCT; Ross Laboratories), blood samples were taken for glucose, free fatty acids, creatinine, and C‐peptide. Plasma C‐peptide taken 90 minutes after the EPCT was used as a surrogate measure for insulin. Clinical tests included one‐time samples for hemoglobin, glycosylated hemoglobin, plasma cholesterol, triglycerides, and lipoproteins. Physical measurements included height, weight, and blood pressure. Urine was assayed for C‐peptide and creatinine. Assays of urine and plasma C‐peptide used antibody M1221 (from Novo; Copenhagen, Denmark).Main ResultsNo differences were observed for the relationship between age and C‐peptide within each of the three age groups for men and the three age groups for women. However, the levels of plasma C‐peptide for older men or women were statistically significantly higher than levels for the young age groups of the same sex; fasting plasma glucose also was higher for older groups of both sexes, and postmeal glucose was significantly higher for older women. There were decreases with age in urine C‐peptide clearance for women and men; the decline for women was statistically significant. In multiple regression models for men alone and women alone, that controlled for age, post‐meal plasma glucose best explained plasma C‐peptide levels. For young men, plasma glucose alone provided the best prediction of plasma C‐peptide levels; body mass index (BMI) and plasma glucose provided the best prediction for young women. For older men and both middle‐aged and older women, a combination of urine C‐peptide clearance and plasma glucose best predicted plasma C‐peptide levels; for middle‐aged men, BMI also contributed to the prediction.ConclusionsSecretion of insulin in response to an orally administered mixed meal is undiminished with age in non‐diabetic adults.