bluuebunny/crossref_metadata_2025_split huggingface dataset:
Absence of Significant Bacteremia During Urinary Catheter Manipulation in Patients With Chronic Indwelling Catheters
Authors: Polastri François , Auckenthaler Raymond , Loew François , Michel Jean‐Pierre , Lew Daniel P. 
Published: April 2015

The objective of this study was to quantify the microorganisms present in blood at urinary catheter removal and at reinsertion in patients with chronic indwelling urinary catheters. This was a prospective study during a 4‐month period at a university‐affiliated geriatric medical center. Our subjects were 33 patients with chronic indwelling urinary catheters and positive urinary cultures; the urinary catheter was usually changed once a month. A peripheral vein line was used for blood withdrawal and urinary cultures and quantitative blood cultures (Isolator) were performed during and shortly after urinary catheter removal and insertion. All patients had significant bacteriuria (> 105 cfu/mL) with an average of 2.3 microorganisms. Among the 46 sequential quantitative blood cultures performed, only two patients had bacteremia from the urinary source and at a very low concentration; one patient had 0.13 cfu/mL Str. faecalis in blood 5 minutes after removal of the urinary catheter, and the other 0.1 cfu/mL Proteus mirabilis 5 minutes after reinsertion of a new urinary catheter. None of the patients had any subjective or objective clinical problem during the 36 hours after the urinary manipulation.Clinical symptoms and bacteremia are rare events, and prophylactic antibiotics do not appear necessary during urinary catheter removal and reinsertion in elderly institutionalized patients. Further studies are necessary to identify risk factors in the rare instances of patients with bacteremia.
The Dieulafoy Gastric Erosion
Authors: Polit Stanley A. 
Published: April 2015

Definitive treatment of the Dieulafoy erosion—once recognized—has generally been surgery. Numerous surgical approaches have been suggested, including: simple oversewing of the lesion,11 wedge restriction,12 and gastrectomy with and without vagotomy and pyloroplasty.8,12 Attempts at endoscopic electrocoagulation and angiographic embolization have generally been disappointing; however, Pointer el al have recently reported satisfactory control of hemorrhage from Dieulafoy lesions with bipolar electrocoagulation and endoscopic injection sclerotherapy, either independently or in combination.13These case reports describe two elderly patients with massive upper gastrointestinal tract bleeding from Dieulafoy's gastric erosion; it is hoped the geriatrician will be alerted to an often unrecognized source of hemorrhage.
Survival in Acute Leukemia in Elderly Patients
Authors: Whitely Randolph , Hannah Phyllis , Holmes Frederick 
Published: April 2015

Acute leukemia is more common in older people than in the young or middle‐aged. However, the possibilities of achieving remission or prolonging survival are both inversely correlated with increasing age. We studied survival in 118 acute leukemia patients over the age of 64 seen at a university hospital from 1970 to 1987. Seventy percent had myeloid morphology. Median survival times were 106 days in those diagnosed in the 1970s and 71 days for those diagnosed in the 1980s. This was little changed from an earlier series from the same hospital extending back to the 1940s in which median survival was 69 days.Considering the two decades separately, age at diagnosis, sex, race, type of leukemia, and whether or not disease‐specific treatment was applied had no significant effect on survival duration. Acute leukemia in the older patient demands difficult medical and ethical choices. Supportive therapy provides immediate comfort and relatively limited morbidity with certainty of death within a few months. Disease‐specific therapy causes immediate morbidity for all, shortened life for the majority, and extended life for the minority.
Do‐Not‐Resuscitate Orders in an Extended‐Care Study Group
Authors: Meyers Roberta M. , Lurie Nicole , Breitenbucher Robert B. , Waring Christine J. 
Published: April 2015

We examined the charts of 911 nursing home patients in Hennepin County, Minnesota, to determine the prevalence of written do‐not‐resuscitate (DNR) orders. Information regarding demographic characteristics, and whether a surrogate decisionmaker was available and participated in the decision, was also collected.Twenty‐seven percent of patients had DNR orders. Ninety percent of all patients had potentially available surrogate decisionmakers. However, for 31% of patients with DNR orders, there was no documentation of patient or surrogate participation in the DNR decision. Univariate analysis identified female sex, increased age, level of care (skilled versus intermediate), presence of a potential surrogate decisionmaker, and increasing length of time since nursing home admission as factors associated with presence of DNR orders. When a logistic regression model was used, increased age, increased length of time since nursing home admission, skilled versus intermediate level of care, and presence of a surrogate decisionmaker were independently associated with presence of DNR status.Several variables are independently associated with written DNR orders; their relationship to the factors physicians use in decision making requires further study.
The Effect of Recombinant Human Growth Hormone on Malnourished Older Individuals
Authors: Kaiser Fran E. , Silver Andrew J. , Morley John E. 
Published: April 2015

Malnutrition in the elderly is often unrecognized and untreated. Reduced secretion of growth hormone (GH) has been suggested as a cause of decreased muscle and bone mass with aging. This pilot study characterized the nutritional response of elderly malnourished subjects to recombinant human GH (rhGH). Subjects were included if they were over 60 years of age, if weight was more than 20% below average body weight (ABW), and if serum albumin concentration was less than 3.8 g/dL. Subjects were divided into two groups: one received 100 Hg/kg rhGH (Protropin®, Genentech) intramuscularly (IM) daily for 21 days; the other received a daily control injection of normal saline (Controls ‐ C) (0.1 mL/kg IM) for the same period of time.During the 3‐week period, mid‐arm muscle circumference (MAMC) increased an average of 0.6 cm in GH patients but fell in C subjects. There was a non‐significant trend to a decreased caloric intake in the control group. Weight increased an average of 4.95 lbs (2.2 kg) in the GH treated group, and decreased an average of 4.9 lbs (2.2 kg) in C subjects (P < 0.05). Urinary nitrogen retention occurred only in the growth hormone treated subjects (P < 0.05). Somatomedin C (IGF‐1) rose significantly in those treated with GH (P < 0.05), while there was no change in the control group. There was a significant assocition between weight change and IGF 1 concentration (r = 0.837, P < 0.05). Neither clinical edema nor hyperglycemia was noted. These findings suggest that GH may be an effective way of maintaining and enhancing weight in malnourished older individuals.
Abnormal Eating Attitudes and Body Image in Older Undernourished Individuals
Authors: Miller Douglas K. , Morley John E. , Rubenstein Laurence Z. , Pietruszka Fern M. 
Published: April 2015

An anorexia nervosa‐like syndrome has been reported in older persons. To gain additional insight into this condition, a questionnaire designed to assess the severity of eating disorders (the EAT‐26) was administered to 183 male outpatients. Thirty‐four subjects were found to be undernourished by midarm circumference measurement and 21 by weight adjusted for age‐sex‐height. Approximately 60% of malnourished subjects acknowledged inappropriate self‐control around food, up to 26% described other unsuitable eating attitudes, and 3% to 52% evidenced various forms of distorted body image. They scored high on EAT‐26 Oral Control subscale but low to normal on Dieting and Bulimia and Food Preoccupation subscales.These results indicate that abnormal eating attitudes and body image occur in an important minority of undernourished elderly males, but the pattern of abnormalities differs from that seen in classical anorexia nervosa. This association deserves additional investigation, with special attention to the psychopathology producing high Oral Control responses and to females as well as males. In the meantime, clinicians need to consider anorexialike attitudes when caring for malnourished seniors.
Are There Clinical and Epidemiological Differences between Familial and Non‐familial Alzheimer's Disease?
Authors: Edwards Jeffrey K. , Larson Eric B. , Hughes James P. , Kukull Walter A. 
Published: April 2015

To determine whether there are clinical and epidemiological differences between familial and non‐familial Alzheimer's disease, we studied 151 patients with the clinical diagnosis of Dementia of the Alzheimer Type (DAT).Eighty‐four index patients (56%) had at least one relative with reported DAT‐type memory loss; the remaining 67 did not. For comparison, patients with a positive family history were grouped into a suspected familial DAT (FDAT), and those with a negative family history were grouped into a suspected non‐familial DAT (NFDAT). There were no significant differences between FDAT and NFDAT patients with respect to age of symptom onset, survival time, rate of cognitive decline, motor function, behavioral signs or symptoms, head trauma, thyroid dysfunction, maternal age, or birth order. There were no significant differences between pedigrees of FDAT and NFDAT patients in respect to the prevalence of Down's syndrome or age of mortality.To examine a more “familial” set of FDAT patients, an FDAT subgroup (F2DAT) consisting of 33 index patients with two or more affected relatives with DAT‐type memory loss was compared to the 67 NFDAT patients in a similar analysis. No significant differences were found. However, NFDAT index patients had a higher reported prevalence of head trauma than those patients in the F2DAT subgroup (NFDAT 22%, F2DAT 7%, OR = 4.2, CI = 0.9–20.0, P = 0.08). Thus severe head trauma may be a more important etiological factor in the non‐familial form of DAT. To better examine this tendency, future studies should be conducted utilizing a larger number of pedigrees and familial criteria which account for the number of persons at risk and the age at onset of disease.
Rationale for a Primary Prevention Study Using Low‐Dose Aspirin To Prevent Coronary and Cerebrovascular Disease in the Elderly
Authors: Silagy Christopher A. , McNeil John J. , Bulpitt Christopher J. , Donnan Geoffrey A. , Tonkin Andrew M. , Worsam Bernard 
Published: April 2015

The benefits of prophylactic aspirin therapy to prevent cardiovascular and cerebrovascular disease in asymptomatic individuals remains unclear. The rationale for developing a multicentered, double‐blind, placebo‐controlled clinical trial to determine whether low‐dose aspirin (100 mg daily) prevents cardiovascular and cerebrovascular morbidity and mortality in persons aged 70 years and over with no evidence of pre‐existing cardiovascular or cerebrovascular disease is described.Sample size calculations have indicated that 15,000 subjects would be required over a 4‐year follow‐up period in order to demonstrate a 20% reduction in overall cardiovascular mortality at the 0.01 level with a power of 0.8. Such a large‐scale community‐based clinical trial has never been conducted in Australia in this age group. Therefore the PACE (prevention by low‐dose aspirin of cardiovascular disease in the elderly) pilot study has been developed to test recruitment strategies and methods and ascertaining disease end‐points.
Screening for Frailty: Criteria and Predictors of Outcomes
Authors: Winograd Carol Hutner , Gerety Meghan B. , Chung Maria , Goldstein Mary K. , Dominguez Frank , Vallone Robert 
Published: April 2015

ObjectiveTo determine the reliability of rapid screening by clinically derived geriatric criteria in predicting outcomes of elderly hospitalized patients.DesignProspective cohort study of 985 patients screened at the time of hospital admission and followed for 1 year with respect to the outcomes of mortality, hospital readmission, and nursing home utilization.SettingPalo Alto Veterans Affairs Medical Center, a tertiary care teaching hospital.SubjectsMale patients 65 years of age and older admitted to the Medical and Surgical services during the period from October 1, 1985 through September 30, 1986.ResultsPatients were grouped by specific screening criteria into three groups of increasing frailty: Independent, Frail, and Severely Impaired. Each criterion focused on a geriatric condition and was designed to serve as a marker for frailty. Increasing frailty was significantly correlated with increasing length of hospital stay (P < 0.0001), nursing home utilization (P < 0.0001), and mortality (P < 0.0001). Multivariate analyses revealed that the clinical groups were more predictive of mortality and nursing home utilization than were age or Diagnosis‐Related Groups (DRGs). Rehospitalization was unrelated to age, clinical group, or DRG, suggesting that utilization may not be driven by the clinical factors measured in this study.ConclusionsRapid clinical screening using specific geriatric criteria is effective in identifying frail older subjects at risk for mortality and nursing home utilization. Our findings suggest that geriatric syndromes are more predictive of adverse outcomes than diagnosis per se. This well operationalized screening process is inexpensive as well as effective and could easily be introduced into other hospital settings.
Comparing Sources of Drug Data about the Elderly
Authors: Johnson Richard E. , Vollmer William M. 
Published: April 2015

Objective: This project assessed the extent of agreement between drug‐taking data obtained from an in‐home assessment and that obtained from an automated outpatient pharmacy system and from a mail questionnaire.Design: The underlying assumption is that an in‐home assessment provides the most complete information (criterion standard) about the prescription medications being taken. The drug data from the mail questionnaire and automated outpatient pharmacies were compared with that from the in‐home assessment by use of t tests and measures of sensitivity, specificity, and positive predictive value.Setting: Kaiser Permanente, Northwest Region, a prepaid group practice HMO.Participants: All elderly HMO members enrolled in the Social HMO demonstration project who had a comprehensive assessment within 30 days of returning a mail questionnaire between March 1986 and March 1988 (n = 83 frail elderly).Main Outcome Measures: The number of medications currently being taken and the number of different therapeutic classes of drugs being taken per elderly HMO member.Main Results: The in‐home assessment and the automated prescription system closely agreed on the number of different medications and the different therapeutic classes of prescription drugs being taken. The in‐home assessment and mail questionnaire were in less agreement. Agreement was less for non‐prescription drugs.Conclusions: An automated prescription system is an adequate source of information about the prescription drugs currently being taken by frail elderly HMO enrollees with a prepaid prescription drug benefit.
Refusal of Tube Feeding as Seen from a Patient Advocacy Organization: A Comparison with Landmark Court Cases
Authors: Ahronheim Judith C. , Mulvihill Michael 
Published: April 2015

Objective: To determine how closely high court decisions regarding tube feeding are a reflection of the situations that occur in the general population.Design: A retrospective review was conducted of memos recording inquiries made to the Society for the Right to Die (SRD), a patient advocacy organization. Characteristics of clients were compared to characteristics of individuals considered in landmark “right‐to‐die” tube feeding cases during the same period of time.Results: Information from 116 memos of inquiries made from 1985 through mid‐1990 was compared to 20 court cases, and significant differences were identified. The average age of the SRD clients was 77.6 (±18.4) years compared to 55.1 (±22.8) years for the court cases (P < 0.001). Of the clients, 79% were 70 years of age or older and 28% were 90 or older; in contrast, 7 (35%) of subjects in the court cases were 70 years of age or older, and none was over 90 (P < 0.001). In addition, whereas 14 (70%) of the court cases dealt with individuals in a persistent vegetative state, only 17 (15%) of SRD clients carried that diagnosis (P < 0.001), with the remainder suffering from dementia, various stages of coma, or a variety of other debilitating disorders. The sex distribution, year of inquiry or year of court decision, and geographic distribution were similar. Some states were overrepresented in both groups.Conclusion: High court cases may inadequately reflect the majority of situations that arise on a day‐to‐day basis. Elderly individuals, in particular those who are not in a persistent vegetative state, are significantly underrepresented.
Appropriateness of Patient Transfer from a Nursing Home to an Acute‐Care Hospital: A Study of Emergency Room Visits and Hospital Admissions
Authors: Bergman Howard , Carfield A. Mark 
Published: April 2015

Objective: To determine the appropriateness of transfers to acute care hospitals from a nursing home.Design: Nursing home and hospital records of all the nursing home residents during the 3‐year study period were reviewed retrospectively to determine: number and type of transfers; problems identified in the nursing home justifying the transfers; diagnoses made at the hospitals; length of hospital stays; outcome of hospital visits.Setting: An 80‐bed public nursing home.Subjects: 112 residents in the nursing home over the 3‐year study period.Main Outcome Measures: Based on the decision of the hospital physician, those transfers resulting in hospital admissions were considered appropriate. As well, transfers to the emergency room with return to the nursing home without hospital admission were also judged to be appropriate if the problems required diagnostic and therapeutic procedures not available in the nursing home.Results: During the 3‐year study period, 55 residents (49%) were transferred a total of 102 times. An average of 26% of patients were transferred each year. Direct admissions to acute hospitals accounted for 17% of the transfers, transfers to the emergency room with subsequent admission for 34%, and transfers to the emergency room with subsequent return to the nursing home without admission for 45%. Four percent of patients transferred died in the emergency room. On the basis of the outcome measure, 7% of all transfers could have been diagnosed and treated in the nursing home and were considered inappropriate.Conclusions: The majority of transfers from this nursing home to acute‐care hospitals were appropriate.
The Management of Geriatric Hypertension in Health Maintenance Organizations
Authors: Preston Jeanette A. , Retchin Sheldon M. 
Published: April 2015

Objective: To evaluate the quality of medical care received by Medicare enrollees with hypertension in health maintenance organizations (HMOs) compared to that received by a similar group of elderly hypertensives in a fee‐for‐service (FFS) setting.Design: A quasi‐experimental design was used to study an historical cohort of newly evaluated hypertensive patients over a 2‐year period.Setting: Medicare HMO and FFS practice settings.Participants: Eight Medicare HMOs and 87 FFS primary care physicians in the same communities were selected. A sample of 685 elderly hypertensive patients was studied, 336 in FFS settings and 349 in HMOs.Measurements and Main Results: An expert panel of physicians selected standards of care for the management of geriatric hypertension, and medical records were reviewed. The results showed significant differences (P < 0.01) in recording medications (94.5% HMO versus 88% FFS) and smoking histories (75.8% HMO versus 64.7% FFS), checking orthostatic blood pressures (9.5% HMO versus 3.3% FFS), performing funduscopy (44.4% HMO versus 27% FFS), completing cardiac examinations (90.8% HMO versus 79.8% FFS), and obtaining chest x‐rays (72.8% HMO versus 64.3% FFS, P < 0.05). Treatment and follow‐up were similar between the two groups, except that FFS hypertensives were more likely to have medications adjusted and electrolytes ordered.Conclusions: The results suggest that elderly hypertensives in HMOs receive equal or better quality of care for most criteria compared to elderly hypertensives in FFS settings.
An Evaluation of a Brief Health Status Measure in Elderly Veterans
Authors: Weinberger Morris , Samsa Gregory P. , Hanlon Joseph T. , Schmader Kenneth , Doyle Marti E. , Cowper Patricia A. , Uttech Kay M. , Cohen Harvey J. , Feussner John R. 
Published: April 2015

Objective: To examine the feasibility of a brief 36–item health status measure in elderly male veterans, by comparing it with the 136–item Sickness Impact Profile.Design: Cross‐sectional study in which all subjects completed both measures in a random order.Setting: Durham VAMC General Medicine and Geriatrics Clinics.Patients: Convenience sample of 25 male veterans aged 65 and older (mean age = 73.5 years; 68% white; 68% currently married; mean annual income = $7,000).Main Outcome Measures: Two well‐validated health status measures, the Sickness Impact Profile and the SF‐36.Results: The SF‐36 took less time to administer than the Sickness Impact Profile in both the Geriatrics Clinic (mean: 15 vs 33 minutes) and General Medicine Clinic (mean: 14 vs 21 minutes). Although SIP scores consistently displayed a more optimistic picture of respondents' health compared with the SF‐36, the two instruments were highly correlated: overall functioning (r = 0.73), physical functioning (r = 0.78), and social functioning (r = 0.67).Conclusions: These two measures provide a similar ranking of elderly male veterans' health status. The significantly shorter administration time of the SF‐36 is an attractive feature for both researchers and clinicians interested in assessing health status.