bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Validation of a Clinical Prediction Rule for Prolonged Nursing Home Residence After Hip Fracture
Authors: Steiner John F. , Kramer Andrew M. , Eilensen Theresa B. , Kowalsky Jacqueline C. 
Published: April 2015

OBJECTIVES: To develop and validate a clinical prediction rule for nursing home residence 6 months after a hip fracture.DESIGN: Two prospective cohort studies, a development study (DS) and a validation study (VS).SETTING: The DS included hip fracture patients admitted to 92 rehabilitation units or skilled nursing facilities; the VS included hip fracture patients from 11 integrated healthcare systems.PARTICIPANTS: A total of 344 community‐dwelling hip fracture patients aged 65 and older participated in the DS; 239 similar patients were enrolled in the VS.INTERVENTION: None.MEASUREMENTS: The acute hospital record, nursing evaluations, and patient questionnaires provided information about demographics, physical and neuropsychological function, and comorbidity. Residence 6 months after fracture was determined by phone interview. Multivariate analysis identified predictors for a risk score to assess the likelihood of nursing home residence.RESULTS: 18.7% of patients in the DS resided in nursing homes 6 months after hip fracture. The four independent risk factors for institutionalization were (1) being unmarried (OR = 6.7 [95% CI 2.4 to 19]), (2) incontinence (OR = 2.3 [CI 1.2 to 4.7]), (3) dependence in ambulation (OR = 5.0 [CI 2.1 to 12.3]), and (4) cognitive impairment (OR = 6.6 [CI 3.3 to 13.2]). Of patients with all four risk factors, 73.2% were institutionalized at 6 months, compared with 0% of patients with no risk factors. In the VS, 6.1% of patients resided in nursing homes after 6 months, with a range from 50.0% of patients with four risk factors to 0% of those with no risk factors. Areas under receiver‐operating characteristic curves for the prediction rule were 0.84 ± .03 in the DS, and 0.81 ± .06 in the VS.CONCLUSION: A clinical prediction rule using four easily measurable characteristics can identify individuals at high or low risk of nursing home residence 6 months after hip fracture. J Am Geriatr Soc 45:1510–1514, 1997.
Longitudinal Weight Changes, Length of Survival, and Energy Requirements of Long Term Care Residents with Dementia
Authors: Wang San Y. , Fukagawa Naomi , Hossain Monir , Ooi Wee L. 
Published: April 2015

OBJECTIVE: We hypothesized that institutionalized patients with dementia, who frequently have feeding problems and require supervised and assisted feeding, would lose more weight during their residency than nondemented, independently functioning residents and have compromised survival. To test this hypothesis, we examined the survival and longitudinal changes in weight of two cohorts of institutionalized residents with dementia and compared these cohorts with a cohort of nondemented residents. We also measured the resting energy expenditures of a subset of the subjects with dementia as an indicator of their energy needs.DESIGN: A longitudinal cohort study with retrospective baseline chart review and subsequent follow‐up of monthly weights and mortality over 4 years.SETTING: A 725‐bed long‐term care institution with specified levels of care.SUBJECTS: Two cohorts of residents with dementia, one consisting of subjects who required total care throughout their institutional stay (n = 31) and another group who did not initially require total care (n = 48); these were compared with a cohort with normal mentation who were functionally independent in their daily activities (n = 26). The total number of subjects was 105.MEASUREMENTS: Demographics, medical problems, and medications by chart review; functional and mental status evaluations; longitudinal monthly weights and mortality for the 48‐month study period; and resting energy expenditures by indirect calorimetry.MAIN RESULTS: Residents with dementia had lower weights on admission and throughout their stay than nondemented, independently functioning residents, and they were more likely to have a weight loss of 10 lbs or more at some point during the 4‐year study period. However, their mean weights did not change during the study period. The mean survival from admission of those demented residents who died was more than 3 years. Resting energy expenditures of women residents with advanced dementia were 12% lower than predicted from the Harris Benedict equations.CONCLUSION: Dementia is not necessarily associated with unremitting weight loss during institutionalization despite the frequent occurrence of feeding difficulties and temporary weight loss. This may be caused partly by the lower than expected resting energy expenditures and, hence, energy needs of affected residents as their dementia progresses. Demented residents weighed significantly less than nondemented, independently functioning residents throughout their institutional stay. Nevertheless, nursing staff are able to maintain weight and survival for extended periods even in very impaired residents. J Am Geriatr Soc 45:1189–1195, 1997.
Active Voluntary Euthanasia or Physician‐Assisted Suicide?
Authors: Onwuteaka‐Philipsen Bregje D. , Muller Martien T. , van der Wal Gerrit , van Eijk Jacques Th. M. , Ribbe Miel W. 
Published: April 2015

OBJECTIVE: To find out why Dutch general practitioners (GPs) and nursing home physicians (NHPs), and patients (according to their physician) opt for active voluntary euthanasia rather than for physician‐assisted suicide, or vice‐versa.DEFINITIONS: The following definitions were used in the study: Euthanasia is the intentional termination of life, by someone other than the patient, at the patient's request; physician‐assisted suicide is intentionally helping a patient to terminate his or her life at his or her request.DESIGN: Two descriptive, retrospective studies.SETTING: The Netherlands.METHOD: Data were collected by means of anonymous questionnaires sent to a random sample of 521 GPs from the province of North Holland, 521 GPs from the rest of the Netherlands, and all 713 NHPs who were members of the Dutch Association of Nursing Home Physicians. Data were collected over the period 1986–1989 (inclusive) for GPs and the period 1986‐June 1990 (inclusive) for NHPs.RESULTS: Forty‐eight percent of the Gps, 78% of the NHPs, and about half of the patients who opted for euthanasia did so because of the physical condition of the patient. The reason GPs, NHPs, and patients gave most often for opting for physician‐assisted suicide was that they wanted ‘as far as possible to let the patient bear the responsibility.’CONCLUSION: In 38% of all cases for GPs and 57% of all cases for NHPs, only active voluntary euthanasia could be performed because of the patient's condition. In the other cases, where there was a choice, most GPs performed euthanasia, while most NHPs assisted in suicide. Active voluntary euthanasia was chosen primarily for medico‐technical reasons, whereas physician‐assisted suicide was selected primarily for moral reasons.
Driving Patterns and Medical Conditions in Older Women
Authors: Forrest Kimberly Y.‐Z. , Bunker Clareann H. , Songer Thomas J. , Coben Jeffrey H. , Cauley Jane A. 
Published: April 2015

OBJECTIVES: To describe driving patterns (e.g., driving frequency) in older women drivers and to evaluate the impact of medical conditions and comorbidity on driving patterns.DESIGN: Cross‐sectional examination of the association between medical conditions and driving patterns.SETTING: Population‐based cohort from the Pittsburgh Center of the Study of Osteoporotic Fractures (SOF).PARTICIPANTS: A total of 1768 women aged 71 years or older.MAIN MEASUREMENTS: Driving information was obtained through a driving questionnaire, including driving status, weekly mileage, longest trip in the past year, etc. Data for demographics, lifestyle behavior, and medical conditions were collected through the SOF study.RESULTS: Among the participants, 1103 (62.3%) were current drivers, 337 (19.1%) had stopped driving, and 329 (18.6%) had never driven in their lifetime. The proportion reporting driving cessation and decline in driving amount increased with age. The prevalence of most medical conditions was higher among former drivers than in current or never drivers. Even after controlling for age and other demographic variables, fractures, heart disease, diabetes, self‐ reported poor vision or hearing, as well as comorbidity were found to be associated independently with decreased driving amount, including driving cessation, decline in mileage, and avoiding long trips.CONCLUSION: Both individual medical conditions and comorbidity influence driving patterns in older drivers. Because it is common for older people to have several medical conditions simultaneously, comorbidity might be a more comprehensive measure of medical impact on driving.
Association of Insulin‐Like Growth Factor‐I with Body Composition, Weight History, and Past Health Behaviors in the Very Old: The Framingham Heart Study
Authors: Harris Tamara B. , Kiel Douglas , Roubenoff Ronenn , Langlois Jean , Hannan Marian , Havlik Richard , Wilson Peter 
Published: April 2015

OBJECTIVES: We examined correlates of insulin‐like growth factor‐I (IGF‐I), an indicator of growth hormone levels, to identify factors associated with higher levels of IGF‐I in old age.DESIGN: Nested study of cross‐sectional correlates and early‐life predictors of IGF‐I level.SETTING: A longitudinal cohort study, the Framingham Heart Study.PARTICIPANTS: A total of 790 men and women (mean age 78.5, range 72–94), who had weight, waist and hip circumferences measured at the time of IGF‐I measurement.MEASUREMENTS: Association of IGF‐I with weight, fat distribution, functional status, nutritional indicators, and past health behaviors was assessed. We also examined IGF‐I in relation to body composition derived from dual energy X‐ray absorptiometry.RESULTS: IGF‐I levels declined with age in both men and women. However, low IGF‐I did not show expected associations with low lean mass and increased body fat. Current functional status and grip strength were not associated with IGF‐I. Low IGF‐I was associated with weight loss in men; the strongest associations were with indicators of poorer nutritional status in both men and women. Levels of IGF‐I in old age did not vary by past health behaviors.CONCLUSION: Although IGF‐I declined with age, these data from the Framingham Heart Study did not show expected cross‐sectional associations of weight, body fat, and lean mass. The strongest associations were between IGF‐I and nutritional indicators. These results suggest caution may be warranted with regard to use of IGF‐I as an indicator of growth hormone.
Financial Performance Among Adult Day Centers: Results of a National Demonstration Program
Authors: Reifler Burton V. , Henry Rona Smyth , Rushing Julia , Yates Kim , Cox Nancy J. , Bradham Douglas D. , McFarlane Mary 
Published: April 2015

OBJECTIVES: This paper describes the financial performance (defined as percent of total expenses covered by net operating revenue) of 16 adult day centers participating in a national demonstration program on day services for people with dementia, including examination of possible predictors of financial performance.METHODS: Participating sites submitted quarterly financial and utilization reports to the National Program Office. Descriptive statistics summarize the factors believed to influence financial performance.RESULTS: Sites averaged meeting 35% of expenses from self‐pay and 29% from government (mainly Medicaid) revenue, totaling 64% of all (cash plus in‐kind) expenses met by operating revenue. Examination of center characteristics suggests that factors related to meeting consumer needs, such as being open a full day (i.e., 7:30 am to 6:00 pm) rather than shorter hours, and providing transportation, may be related to improved utilization and, thus, improved financial performance. Higher fees were not related to lower enrollment, census, or revenue.CONCLUSIONS: Adult day centers are able to achieve financial viability through a combination of operating (i.e., fee‐for‐service) and non‐operating revenue. Operating revenue is enhanced by placing emphasis on consumer responsiveness, such as being open a full day. Because higher fees were not related to lower utilization, centers should set fees to reflect actual costs. The figure of 64% of expenses met by operating revenue is conservative inasmuch as sites included in‐kind revenue as expenses in their budgeting calculations, and percent of cash expenses met by operating revenue would be higher (approximately 75% for this group of centers).
Health Status Gender Differences of Newly Admitted Black Nursing Home Residents
Authors: Martin Judy C. , Engle Veronica F. , Graney Marshall J. 
Published: April 2015

OBJECTIVES: To investigate gender differences in health status of newly admitted black nursing home residents on the day following admission.DESIGN: Descriptive and comparative cross‐sectional study of black residents drawn from a larger prospective longitudinal study on health and functional status of new nursing home residents interviewed on the first full day after admission.SETTING: Eight southern nursing homes: three not‐for‐profit, three for‐profit, one county government‐operated, and one federal government‐operated. Homes ranged in size from 110 to 575 beds and were licensed for skilled and intermediate care.PARTICIPANTS: Black nursing home residents (N = 224) aged 60 years and older as admitted sequentially to nursing homes.MEASUREMENTS: Health status was assessed by the Short Portable Mental Status Questionnaire, as a measure of mental status, and the Scaled Outcome Criteria, as a measure of ability to perform activities of daily living (ADLs). Morbidity was assessed by the number of medical diagnoses, number of prescribed medications, and the medical diagnoses of hip fracture, dementia, and cancer. Resident classification data assessed the source of entry to the nursing home, payer source, and level of care required. Demographic data assessed included age, education, marital status, and number of living children.RESULTS: Both black men (n = 126) and women (n = 98) newly admitted to the nursing home had health and social deficits. Moreover, women, although not significantly different from men in average age, were more impaired in six of eight ADLs, including grooming, dressing, feeding, ambulating, transferring, and defecating. Women were also less likely to be married. No gender differences were found for five other health status variables, four other demographic variables, five resident classification variables, or five measures of morbidity.CONCLUSION: These data on southern black nursing home residents provide evidence that among older black nursing home residents, women have greater care needs than men. Findings illustrate the need to consider gender in planning nursing home care of black older residents. black women may be at greater risk for health status alterations and require more frequent health status monitoring and intervention.
The Prognostic Significance of Delirium in Older Hospital Patients
Authors: O'Keeffe Shaun , Lavan John 
Published: April 2015

OBJECTIVES: To determine whether delirium is an independent predictor of adverse outcomes of hospitalization in older patients.DESIGN: Cohort studyPATIENTS: A total of 225 people admitted as an emergency to an acute geriatric unit in a university teaching hospitalMETHODS: Subjects were screened for delirium, defined by Diagnostic and Statistical Manual, 3rd Edition criteria, every 48 hours. Outcome measures included mortality, duration of hospital stay, hospital‐acquired complications, and institutional placement. The influence of delirium on these outcomes was calculated after adjusting for age, illness severity on admission, burden of comorbidity, prior cognitive impairment, and level of disability.RESULTS: Delirium was present on admission in 41 patients (18%) and developed after admission in a further 53 patients (24%). Patients with delirium were more likely than non‐delirious patients to have chronic cognitive impairment, severe acute illness, multiple comorbid conditions, and functional disability. Nevertheless, in multivariate analyses adjusting for these factors, delirium was independently associated with prolonged hospital stay, functional decline during hospitalization, increased risk of developing a hospital‐acquired complication, and with increased admission to long‐term care.CONCLUSION: Delirium is an independent predictor of adverse outcomes in older hospital patients.
Recruitment in the Trial of Nonpharmacologic Intervention in the Elderly (TONE)
Authors: Whelton Paul K. , Bahnson Judy , Appel Lawrence J. , Charleston Jeanne , Cosgrove Nora , Espeland Mark A. , Folmar Steve , Hoagland Donna , Krieger Susan , Lacy Clifton , Lichtermann Lynne , Oates‐Williams Floria , Tayback Matthew , Wilson Alan C. 
Published: April 2015

OBJECTIVE: To compare the effectiveness of different approaches to participant enrollment in a behavior modification trial.DESIGN: Concurrent, prospective evaluation performed in context of recruitment for a randomized, controlled trial.SETTING: Four study centers located in Baltimore, Maryland, Memphis, Tennessee New Brunswick, New Jersey, and Winston‐Salem, North Carolina.PARTICIPANTS: Men and women aged 60 to 80 years who were being treated with a prescription medication for control of hypertension.MAIN OUTCOME MEASURES: Visit counts and percent yields were assessed at each stage of the screening and randomization process. Logistic regression was used to contrast the randomization yields for different recruitment strategies and to explore the impact of sociodemographic characteristics and geographic location on recruitment yieldsRESULTS: The overall randomization yields from a pre‐screen contact and a first screening visit to enrollment in the trial were 11% and 31%, respectively. Randomization yields varied significantly by participant age, education, and marital status.CONCLUSIONS: Our results demonstrate the feasibility of recruitment for trials of nonpharmacologic interventions in older people and suggest that mass mailing and mass media advertising campaigns provide an effective means of enrolling in such studies participants with a broad range of personal characteristics.
Driving Cessation and Increased Depressive Symptoms: Prospective Evidence from the New Haven EPESE
Authors: Marottoli Richard A. , de Leon Carlos F. Mendes , Glass Thomas A. , Williams Christianna S. , Cooney Leo M. , Berkman Lisa F. , Tinetti Mary E. 
Published: April 2015

OBJECTIVES: The purpose of this study was to determine the association between driving cessation and depressive symptoms among older drivers. Previous efforts in this area have focused on the factors associated with cessation, not the consequences of having stopped.DESIGN: Cohort studySETTING: Urban communityPARTICIPANTS: A driving survey was administered in 1989 to surviving noninstitutionalized members of the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) cohort. Of 1316 respondents, 502 were active drivers as of 1988, 92 had stopped driving between 1982 and 1987, and the remainder had either never driven or had stopped before 1982.MEASUREMENTS: Information about independent and dependent variables other than driving status came from the in‐person EPESE interviews in 1982, 1985, and 1988, except for medical conditions, which were updated yearly. Depressive symptoms were assessed by the Centers for Epidemiologic Studies ‐ Depression (CES‐D) scale. Analyses focused on the changes in depressive symptoms before and after driving cessation. Repeated measures multivariable analysis accounted for the effect of cessation on the outcome adjusting for the potential confounding due to sociodemographic and health‐related factors.RESULTS: Individuals who stopped driving exhibited substantial increases in depressive symptoms during the 6‐year interval. Driving cessation was among the strongest predictors of increased depressive symptoms (Coefficient 2.464, SE 0.758, P = .001) even when adjusting for sociodemographic and health‐related factors.CONCLUSIONS: Driving cessation was associated with an increase in depressive symptoms even when accounting for sociodemographic and health‐related factors. These consequences need to be taken into account when advising older drivers and when developing alternative transportation strategies.
Predictors of Antipsychotic Withdrawal or Dose Reduction in a Randomized Controlled Trial of Provider Education
Authors: Meador Keith G. , Taylor Jo A. , Thapa Purushottam B. , Fought Randy L. , Ray Wayne A. 
Published: April 2015

OBJECTIVES: To evaluate the effects of an educational program to reduce antipsychotic use in nursing homes that had high use rates post‐OBRA‐87 and to identify factors that predicted antipsychotic withdrawal or 50% or greater dose reduction.DESIGN/SETTING: A randomized controlled trial (RCT) of the educational program (nursing home the unit of randomization and analysis) was conducted in 12 Tennessee nursing homes (6 education/6 control). Cohort analysis in baseline antipsychotic users identified factors predicting withdrawal or dose reduction.SUBJECTS: The RCT analysis included 1152 patients in the homes at baseline and 6 months. The cohort analysis included 133 baseline antipsychotic users in the five education homes able to implement the recommendations of the educational program.OUTCOME MEASURES: Change in days of antipsychotic use per 100 days of nursing home residence, withdrawal from antipsychotics, reduction in antipsychotic dose by 50% or more.RESULTS: Following the educational intervention, use of antipsychotics in the six education homes decreased from 25.3 days per 100 at baseline to 19.7 days per 100 by month 6, a 23% reduction relative to control homes (P = .014). In the withdrawal analysis, 44 (33%) of 133 baseline antipsychotic users were withdrawn. Factors at baseline predicting successful withdrawal were low antipsychotic dose, no use of benzodiazepines or antidepressants, and behavioral symptoms score below the median. However, although an additional 22 patients had dose reductions 50%, none of the predictors of withdrawal were associated with dose reductions.CONCLUSION: Focused provider education programs may facilitate antipsychotic reduction above and beyond that attributable to regulatory changes. Patients who are poor candidates for total antipsychotic withdrawal may tolerate substantial dose reductions, which should reduce their risk of adverse antipsychotic effects.
The Benefits of In‐Home Pharmacy Evaluation for Older Persons
Authors: Der Elaine Hsia , Rubenstein Laurence Z. , Choy Gavin S. 
Published: April 2015

OBJECTIVE: To assess the potential benefit of a pharmacist performing in‐home medication evaluations on frail older people.DESIGN: Prospective analysis with pre‐post comparison.SETTING: A hospital‐based home care program at the Sepulveda Veterans Affairs Medical Center.PARTICIPANTS: Male veterans in a home care program who live within 15 miles of the medical center and take three or more prescription medications (N = 20, mean age: 75.1 years).MEASURES: Prescribed medications were documented from the medical records and compared with regimens actually being followed in the home. In addition, the home was inspected, patients were educated, and recommendations were made to the prescribing physicians when necessary.RESULTS: At first visit, patients had a mean of 6.0 prescribed daily medications but were only taking 4.7 of these regularly. Also noted were many potentially unnecessary medications (70% of subjects) and multiple problems with the medication regimen (e.g., incorrect drug frequency or dosage, expired medications, medication omission). Follow‐up visit revealed a significant decrease in medication discrepancies and problems (P ≤ .05).CONCLUSION: An in‐home pharmacy assessment reveals many problems with drug administration not otherwise detected easily. These assessments can lead to potentially useful interventions that can improve medication regimens and compliance. Determination of long‐term effects must await controlled trials.