bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Characteristics of Antibiotic Use in Aged Nursing Home Patients
Authors: Warren John W. , Palumbo Francis B. , Fitterman Leslye , Speedie Stuart M. 
Published: April 2015

Objective. To measure the prevalence, incidence, types, and certain characteristics of antibiotics prescribed in nursing homes.Design and Setting. Periodic survey over 1 year of patient charts in 53 stratified, randomly selected nursing homes in the state of Maryland.Patients. All patients 65 years of age or more residing in these nursing homes on the first day of study.Results. Of 4,165 patients in 53 nursing homes, records over the year were satisfactory in 3,899 patients in 52 nursing homes. The prevalence of antibiotic use on the first day of the study was 8%. Over the next 12 months, observations of more than one million patient‐days revealed an incidence of 0.46 antibiotic courses/100 patient‐days; 54% of the 3,899 patients received at least one antibiotic course.For presumed active infections, beta lactam antibiotics were the most commonly used, 54% of antibiotic orders. For all antibiotics, urinary tract infection was the most common indication, eliciting 36% of orders including 9% for asymptomatic bacteriuria. Skin, lower respiratory, and upper respiratory infections comprised 14%–17% each. Physicians prescribed 94% of courses but documented examinations of only 44% of patients at the outset of these courses. Consensus criteria for minimal diagnostic evaluation of four selected infections were met in only 11% of episodes of infection. Although the most serious infections tended to be better evaluated than others, 31% of the former were not noted to have been examined by a physician. Three percent of orders were for prophylaxis and two‐thirds of these antibiotics were administered for more than 2 days.Conclusions. Antibiotics are frequently prescribed for aged nursing home patients, often in the absence of a physician's examination and other features commonly performed in evaluation of specific infectious diseases. More than one‐fifth of antibiotics prescribed by presumed active infections were for two infections usually thought not to require antibiotic therapy, “viral” upper respiratory infection (13%) and asymptomatic bacteriuria (9%). To optimize antibiotic use in nursing homes, greater attention should be directed to appropriate durations of prophylaxis for urologic, dental, and minor surgical procedures; to standards for diagnostic evaluations of common infections; and to the roles of antibiotics in upper respiratory infections and in asymptomatic bacteriuria.
Fever Response in Elderly Nursing Home Residents: Are the Older Truly Colder?
Authors: Castle Steven C. , Norman Dean C. , Yeh Michael , Miller Denver , Yoshikawa Thomas T. 
Published: April 2015

Objective To test the hypothesis that many nursing home residents with an apparently blunted fever response (maximum temperature <101°F) may actually have a significant change in temperature (ΔT ≥ 2.4°F) which is not recognized because of a low baseline temperature.Design: Retrospective chart review for cases of infection that met specific criteria and for chart‐recorded baseline and infection temperatures. Chart‐recorded baseline temperatures were prospectively compared with re‐measurement of morning temperatures.Setting: Nursing Home Care Unit of the VAMC West Los Angeles.Patients: Random review of 40 residents' charts resulted in the detection of 69 infections among 26 residents over a 20‐month period. Fifty randomly selected residents prospectively underwent comparison of chart‐determined and actual re‐measurement of baseline temperatures.Results: In 50 randomly selected residents, the mean oral baseline temperature of 97.4 ± 0.2 (°F ± SEM) closely approximated the mean nurse‐recorded measures in the charts (97.6 ± 0.1). Chart review detected 69 infections among 26 residents, with 53 episodes having a temperature recorded during the infection. The mean maximum temperature (Tmax) during an infection was 101.3 ± 0.3 (°F ± SEM) but 47% (25/53) of the episodes had a “blunted” fever response (Tmax < 101°F). Of the 25 “blunted” fevers (Tmax < 101°F), about one‐fourth demonstrated an adequate change in temperature from baseline (ΔT ≥ 2.4°F) but failed to reach 101°F because of a low baseline. Most infections (89%) had a Tmax > 99°F.Conclusion: Establishing a nursing home patient's basal temperature and monitoring for changes in temperature (AT > 2.4°F) and/or lowering the threshold for recognition of fevers (to 99° or 100°F) in nursing home residents with a change in function should assist in early recognition of infections.
Detectable Serum Levels of Tumor Necrosis Factor Alpha May Predict Early Mortality in Elderly Institutionalized Patients
Authors: Mooradian Arshag D. , Reed Richard L. , Osterweil Dan , Scuderi Philip 
Published: April 2015

Objective: To determine if detectable serum tumor necrosis factor alpha (TNF) levels are associated with higher mortality in nursing home residents.Subjects and methods: The basal serum concentrations of TNF and interleukin‐1 alpha (IL‐1) were measured in 129 elderly nursing home patients (mean age of 89 years), and survival in the cohort was monitored over a 13‐month period.Results: At 4 months follow‐up, seven out of 33 patients with detectable serum TNF levels had died (21.2%), and only three out of 96 patients with undetectable serum TNF levels had died (3.1%) (P<0.001). The difference in mortality remained significant up to 13 months of follow‐up (P<0.05). Those with detectable serum TNF levels and those with undetectable levels were comparable in age, body mass index, hematocrit, lymphocyte counts, and serum level of albumin, prealbumin, and retinol‐binding protein. When patients with detectable serum IL‐1 levels were compared to those with undetectable levels, there were no significant differences in mortality over a 13‐month period.Conclusion: Detectable serum TNF levels in elderly nursing home patients may be a predictor of early mortality.
Medicare Reimbursement for Geriatric Assessment: Report of the American Geriatrics Society Ad Hoc Committee on Geriatrics Assessment
Authors: Rubenstein Laurence Z. , Applegate William B. , Burton John R. , Hyer Kathryn , Pawlson L. Gregory , Winograd Carol H. 
Published: April 2015

This ad hoc committee report from the American Geriatrics Society proposes the prompt initiation of Medicare reimbursement for geriatric assessment (GA) services (also termed comprehensive geriatric assessment or geriatric evaluation and management services). Despite an extensive body of literature documenting the effectiveness of GA for improving health care outcomes in many settings for identifiable groups of frail elderly patients, no explicit Medicare reimbursement mechanisms currently exist to cover GA services provided by either hospital or physician. We believe that new physician reimbursement codes specific for geriatric assessment should be established in the Current Procedural Technology (CPT‐4) manual and that reimbursement for GA should be specifically provided under Part B of Medicare. Further, we believe that hospital reimbursement within the Medicare prospective payment system should be modified to encourage GA during inpatient stays for appropriate patients.This paper summarizes the background for these recommendations. It defines the major content of GA at three levels of intensity—screening, intermediate, and comprehensive. It describes the major sites for conducting GA—hospital, office, home, nursing home. Finally, it proposes criteria for targeting patients most likely to benefit from GA.
Low to Moderate Intensity Endurance Training in Healthy Older Adults: Physiological Responses after Four Months
Authors: Posner Joel D. , Gorman Kevin M. , Windsor‐Landsberg Lisa , Larsen James , Bleiman Michael , Shaw Carl , Rosenberg Beth , Knebl Janice 
Published: April 2015

ObjectiveTo determine the physiological adaptations in previously sedentary healthy older men and women (mean age = 68) to a 16‐week low‐to‐moderate‐intensity exercise program.DesignRandomized, controlled trial.SettingAn exercise facility and testing laboratory in a gerontological research institute.ParticipantsTwo‐hundred forty‐seven community‐dwelling older persons free of significant cardiovascular, pulmonary, or uncontrolled metabolic disease, anemia, electrolyte abnormality, resting BP of 165/90 or greater, or chronic disease affecting the ability to exercise on a bicycle.InterventionSubjects were randomly assigned to either an exercise (n = 166) or attention control group (n = 81). Exercisers trained thrice weekly for 40 minutes on a cycle ergometer (5‐minute warm up, 30 minutes at training heart rate (THR), 5‐minute cool down). THR was set at 70% of peak heart rate attained on a maximal exercise test (mean = 115 ± 15). Control subjects attended weekly group talks. Testing took place before and after the program.ResultsPeak attained oxygen uptake (VO2max) increased 8.5% in exercisers and decreased slightly in controls (p < .001) and oxygen uptake at ventilatory threshold (VeT VO2) increased by 3.5% in exercisers and decreased by 3% in controls (p < .001). This pattern of a greater increase in VO2max than VeT VO2 is different from that seen in young and middle‐aged subjects.ConclusionThis study demonstrated that a large scale training program is feasible for healthy older people, that physiologic improvements can be measured after 16 weeks of low‐to‐moderate‐intensity training, and that mechanisms of adaptation to exercise may be different in elderly subjects from those in younger ones.
Use of a Vacuum Tumescence Device in the Management of Impotence in Men with a History of Penile Implant or Severe Pelvic Disease
Authors: Korenman Stanley G. , Viosca Sharon P. 
Published: April 2015

PurposeTo evaluate the use of a vacuum tumescence device in the treatment of impotence in couples wishing to restore coital function, whose male partners had unsatisfactory results from penile implants or in whom the man was impotent following treatment for prostate or colon carcinoma.SubjectsConvenience sample of seventeen couples seeking treatment of male factor sexual dysfunction.MethodsAfter completion of a comprehensive diagnostic evaluation of the male partner, couples who expressed a wish to restore coital function were instructed in the use of the vacuum tumescence device. Partners each filled out and initialled a daily diary of sexual activity and returned to clinic for followup at 3 and 6 months.ResultsSixteen patients were able to obtain firm to hard erections lasting an average of 14.9 minutes and had satisfactory coitus with vaginal ejaculation an average of 3.9 times per month. There were no significant complications.ConclusionThe vacuum tumescence device can be effective in the treatment of impotence after penile prosthesis explantation, in enhancement of inadequate erections with a prosthesis in place, and after surgical or radiation therapy for prostate or colon carcinoma.
Ethics Rounds at the Nursing Home: An Alternative to an Ethics Committee
Authors: Libow Leslie S. , Olson Ellen , Neufeld Richard R. , Martico‐Greenfield Theresa , Meyers Helene , Gordon Natalie , Barnett Peggy 
Published: April 2015

The increased attention in US medicine to medical ethics reflects in large part the “new” demography of a growing elderly population and the conflict of whether decisions regarding medical care should be based on cost‐effectiveness or “human‐effectiveness.” Currently, about 40 percent of the nation's elderly end up in nursing homes where they confront ethical and legal dilemmas that would not arise in their own homes. In the nursing home, difficult medical‐ethical decisions generally rely on two approaches: the often used but frequently invalid concept of informed consent and little used ethics committees.At The Jewish Home and Hospital for Aged in New York City we have developed a program of “ethics rounds” as an alternative to ethics committees. We conduct the rounds in the open style of a forum or clinical conference rather than with the aura of a decision‐making group. We encourage the participation of patients and family and seek to educate the staff, any one of whom may choose to attend. The rounds consist of a multidisciplinary case presentation, an interview of patient and/or family, a discussion by the staff, and an overview by an ethicist.Staff response to the educational and interdisciplinary aspects of the rounds has been remarkably positive.
The Risk Factors of Age and Family History and Their Relationship to Screening Mammography Utilization
Authors: Costanza Mary E. , Stoddard Anne , Victoria P. , Zapka Jane G. 
Published: April 2015

ObjectiveTo study the association of two well known risk factors for breast cancer and the association of knowledge of those risk factors with mammography utilization.DesignCross sectional: two independent random telephone surveys.SettingTwo Northeastern metropolitan communities surveyed in 1987 and in 1989.ParticipantsWomen without breast cancer who spoke English and who were between 45 and 75 years of age.Main Outcome MeasuresThe two risk factors measured were a family history of breast cancer and being 65 or older. Participants were surveyed about their knowledge of risk factors, presence of risk factors, selected beliefs, attitudes, reinforcing factors and mammography use. Results were analyzed for women 50–75.ResultsThere was a substantial increase in mammography use over the 2‐year period. Having a positive family history or being older is not associated with increased mammography utilization. Knowledge that family history and/or age are risks is associated with increased utilization. However, knowledge of risk factors is not associated with having those risks. Older women have lower utilization than younger women regardless of their knowledge of age as a risk. Increased physician recommendation is associated with increased utilization.ConclusionSince knowing that a factor is a risk and having a physician recommend mammography are each associated with increased use, we conclude that the primary care physicians' role in increasing mammography utilization is critical.
Hypnotics, Sleep, and Mortality in Elderly People
Authors: Morgan Kevin 
Published: April 2015

ObjectiveTo re‐assess relationships between mortality, hypnotic use, subjective insomnia, and sleep duration.DesignA prospective study examining 5‐year mortality among hypnotic drug users and respondents with subjective insomnia identified in a longitudinal study of health, activity, and lifestyle (Nottingham Longitudinal Study of Activity and Ageing).SettingGeneral community.Participants1042 survey respondents, aged over 65 years, randomly selected from the community and stratified at age 75 years.Main Outcome MeasureRecorded mortality.ResultsDuring the 5‐year period, 352 respondents died. The mortality rate was significantly greater among those taking some form of medication for sleep (n = 208) than for those not taking sleep medication (n = 812; chi‐square = 4.91, df = 1, P = 0.027). When sleep medication users were categorized as either “hypnotic users” (ie, users of medication with recognized hypnotic or sedative actions) or “other users” (including analgesics and other over‐the‐counter medicines), only “other users” showed significant excess mortality (chi‐square = 7.27, df = 1, P = 0.007). Logistic regression showed that “other users” were 2.5 times more likely to die than “non‐users” even when gender, health risk, and usual sleep duration were controlled. There were no significant relationships between mortality and subjective insomnia or reported duration of sleep.ConclusionsEarlier reported relationships between excess mortality and use of medication for sleep are replicated in this study. Among elderly people, however, this relationship does not derive from the pharmacological characteristics of prescription hypnotics. Rather, it appears that reported self‐medication to promote sleep, using a variety of non‐sedative products, provides an epidemiological “marker” for a group within which levels of morbidity and mortality are particularly high. Excess mortality associated with very short or long sleep duration was not replicated in this study. Overall, these findings provide little epidemiological support for a widespread interaction between benzodiazepine hypnotic use and sleep disordered breathing in old age.
Risk Factors for Early Hospital Readmission in a Select Population of Geriatric Rehabilitation Patients: The Significance of Nutritional Status
Authors: Sullivan Dennis H. 
Published: April 2015

ObjectiveTo test the strength of the evidence in favor of the hypothesis that protein‐energy undernutrition is an independent risk factor for non‐elective hospital readmission within 3 months of discharge in a population of elderly hospitalized patients.DesignRetrospective analysis of data from prospective observational study.MethodsAll 110 elderly patients admitted to a geriatric recuperative care and rehabilitation unit during a 6‐month period completed a comprehensive in‐patient evaluation. Ninety‐eight of these patients were subsequently discharged alive and followed prospectively for 3 months. All hospital readmissions during the observation period were identified by patient interview and, within the VA hospital system, computer tracking of admissions. Based on the discharge assessment, the strongest predictors of non‐elective readmission were identified using univariate and multivariate statistical procedures.ResultsTwenty‐eight of the 98 patients discharged alive and completing the 3‐month follow‐up (29%) had at least one non‐elective readmission. The patients discharged home were non‐electively readmitted more frequently than were the patients discharged to a nursing home (32% vs 11%, P = 0.05). Of the 109 discharge assessment variables analyzed, the best predictor of which patients would have at least one non‐elective hospital readmission was the discharge serum albumin, followed by a diagnosis of dementia, discharge gamma globulin, the subscapular skinfold thickness, home ownership, and the discharge Katz Index of ADL score. Discharge serum albumin concentration, subscapular skinfold thickness, and discharge serum gamma globulin concentration were all negatively correlated with risk of non‐elective readmission. The presence of functional debilitation or dementia was associated with a lower likelihood of non‐elective readmission compared with the absence of these conditions.ConclusionsProtein‐energy undernutrition appears to be a strong independent risk factor for non‐elective hospital readmission especially among the highest risk patients, those who are functionally independent and cognitively intact.
Urinary Tract Infections and Estrogen Use in Older Women
Authors: Orlander Jay D. , Jick Susan S. , Dean Alan D. , Jick Hershel 
Published: April 2015

ObjectiveTo examine the relationship between exogenous estrogen use and risk of clinically diagnosed urinary tract infection (UTI) in older women.DesignA case‐control study.SettingTwo hundred seventy‐six general practices.PatientsCases (n = 3,616) were women, age 50–69 years, with a first recorded UTI in the calendar years 1989 or 1990. Controls (n = 19,162) were matched for age and practice.Main Outcome MeasureClinical diagnosis of UTI.ResultsWomen using estrogens for ≥1 year had an increased risk of being diagnosed with a UTI compared to non‐users, crude odds ratio (OR) 1.9 (95% CI 1.5–2.2). All of this excess risk was observed in women with intact uteri, OR 2.1 (CI 1.7–2.7). Hysterectomized women had no increased risk, OR 1.1 (CI 0.8–1.5). Controlling for diabetes, neurologic deficit, atrophic vaginitis, incontinence, and age did not affect the observed associations.ConclusionEstrogen use is associated with an increased risk of UTI in older women with intact uteri but not in hysterectomized women. This observed differential effect on women with or without uteri may be explained by prescribing biases between these two groups of women, but we lack any evidence to support this conclusion over several alternative possibilities.
Diabetes Support Groups Improve Health Care of Older Diabetic Patients
Authors: Gilden Janice L. , Hendryx Michael S. , Clar Steven , Casia Carla , Singh Sant P. 
Published: April 2015

ObjectiveTo assess whether knowledge or psychosocial and glycemic benefits of a diabetes education program are enhanced by a support group for older patients.DesignA partially randomized controlled trial involving two groups of patients: Group A, subjects who received an education program followed by 18 months of support group sessions; Group B, only the diabetes education program. A third convenience sample, Group C, received neither intervention. Groups A and B were assessed before and immediately after the education program, and all groups were assessed 2 years after the education program.SettingDiabetes clinic at a Veterans Affairs Medical Center. Patients: All subjects were male (mean age = 68 ± 1.3 years, range = 57–82 years; duration of diabetes = 10 ± 2 years, range 3–16). Sample sizes were 11 in Group A, 13 in Group B, and 8 in Group C.InterventionThe education program consisted of six weekly sessions covering aspects of diabetes self‐care. The support group consisted of 18 monthly sessions for continuing education, discussion, and structured social activities.Outcome MeasuresDiabetes knowledge, psychosocial factors (self‐care‐related quality of life, stress, family involvement in care, and social involvement), depression, and glycemic control.ResultsGroup A scored better (at least P < 0.05) on knowledge, quality of life, and depression than the other groups. Groups A and B showed less stress, greater family involvement, better glycemic control, but less involvement in social activities than Group C.ConclusionDiabetes education programs can have long term benefits on knowledge, psychosocial functioning, and glycemic control for older diabetic patients. The addition of support groups enhances diabetes knowledge and psychosocial functioning.
Alcohol as a Risk Factor for Fall Injury Events among Elderly Persons Living in the Community
Authors: Nelson David E. , Sattin Richard W. , Langlois Jean A. , DeVito Carolee A. , Stevens Judy A. 
Published: April 2015

ObjectiveTo determine if alcohol use is a risk factor for fall injury events among community‐dwelling older persons.DesignCase‐control study.SettingSouth Miami Beach, Florida.Participants320 persons 65 or older who sought treatment at six area hospitals for injuries resulting from falls; 609 controls, matched for sex and age, selected randomly from Health Care Financing Administration (Medicare) files.Main Independent VariablesSelf‐reported current alcohol use.ResultsNo association was found between fall injury events and average weekly alcohol use.ConclusionsFurther efforts at reducing injuries to older persons from falls should concentrate on other modifiable risk factors, including adequate treatment of underlying medical conditions, reducing inappropriate psychotropic medication use, and installing safety devices in the home.