bluuebunny/crossref_metadata_2025_split huggingface dataset:
Viral Respiratory Infections in the Institutionalized Elderly: Clinical and Epidemiologic Findings
Authors: Falsey Ann R. , Treanor John J. , Betts Robert F. , Walsh Edward E. 
Published: April 2015

ObjectiveTo prospectively evaluate the incidence and impact of viral respiratory infection in the institutionalized elderly during a winter season.DesignProspective descriptive study, without intervention.MethodPatients with respiratory illnesses were evaluated by a directed history and physical examination. Nasopharyngeal secretions for viral culture were obtained, and acute and convalescent serum samples were obtained for analysis. Serologic evidence of infection with respiratory syncytial virus (RSV) and parainfluenza were determined by enzyme immunoassay (EIA), and influenza by hemagglutination‐inhibition assay and EIA.SettingA 591‐bed nursing home.ParticipantsResidents with signs or symptoms of acute respiratory illness (nasal congestion, pharyngitis, cough, wheezing, or respiratory difficulty) were eligible for study.ResultsA viral etiology was documented in 62 out of 149 illnesses (42%). RSV was the most common virus associated with illness; it was documented in 27% of respiratory illnesses, followed by rhinovirus (9%), parainfluenza (6%), and influenza (1%). RSV was associated with significantly more severe disease when compared with rhinovirus. Clustering of specific viral infections occurred, suggesting nosocomial transmission.ConclusionsViruses are an important cause of acute respiratory infections in the institutionalized elderly during the winter months.
Study of Strategies for the Recuitment of Elders Including the Use of Community Volunteers
Authors: Cartmel B. , Moon T.E. 
Published: April 2015

ObjectivesThe primary objective was to compare study participation when first contact was made by telephone versus an unscheduled visit to the household. The secondary objective was to compare study participation when three differing modes of questionnaire presentation were used.DesignThe residents of 300 randomly selected households were contacted by community volunteers and asked to participate in a study of the etiology of cancer and other chronic diseases. Two methods of first contact were used, a telephone call to schedule a home visit and an unscheduled visit to the household. Three modes of questionnaire presentation were used.ParticipantsResidents of a retirement community in Arizona who were aged 50 or over.Main Outcome MeasuresAgreement to participate, defined as acceptance of and agreement to complete the study questionnaires. Participation in the study, defined as acceptance and completion of the study questionnaires.ResultsNo difference was observed in participation when first contact was made by telephone (46%) as compared with an unscheduled visit to the household (45%) (P = 0.83). Similarly, no difference in the participation was observed between three modes of presentation of the questionnaire to the householders (P = 0.13). Agreement to participate was, however, significantly higher when first contact was made by visiting the home (81% vs 55%) (P < 0.001).ConclusionsNeither the strategy used for first contact nor mode of questionnaire presentation affected participation.
The Impact of Falls in an Inner‐City Elderly African‐American Population
Authors: MD Jeane Ann Grisso , Schwarz Donald F. , Wolfson Virginia , Polansky Marcia , LaPann Karin 
Published: April 2015

ObjectiveTo describe the impact of falls in an elderly African‐American urban community and to identify predictors of poor recovery from falls.DesignProspective cohort study.SettingEmergency departments of 11 hospitals in western Philadelphia.SubjectsInterviews were conducted with 197 African‐American persons 65 years and older residing in West Philadelphia who were treated at an emergency department because of a fall. Second interviews were conducted a median of 7 months after the fall with a sample of 70 patients who had not recovered at the time of the first interview.Main Outcome MeasuresInformation abstracted from emergency department medical records and information on recovery obtained from two subsequent interviews.ResultsA median of 8 weeks after the fall occurred, 43% of persons reported continued pain or restriction in their usual activities as a result of the fall. Predictors of poor recovery included the presence of grandchildren in the household, hearing impairment, severity of the injury, and injury to the lower extremities. Having someone present at the time of the fall was associated with a lower risk of poor recovery. Forty‐one percent of the 70 persons interviewed a second time reported continued pain or restriction in usual activities a median of 7 months after the fall occurred. However, only 7% and 39% had received the services of a home health aide or physical therapist, respectively, and only 14% reported that a physician or other health professional had been particularly helpful since the fall had occurred.ConclusionsA large proportion of elderly African‐American persons treated at emergency departments for falls experience continued pain and restriction of activities after the fall. Many individuals have not recovered 7 months or longer after the fall and few persons report that a physician or other health professional has been particularly helpful since the fall occurred. We suggest that follow‐up programs be developed for elderly persons in minority communities who come to emergency departments after a fall.
Quantitative Assessment of Bed Rise Difficulty in Young and Elderly Women
Authors: Alexander Neil B. , Fry‐Welch Donna K. , Ward Michael E. , Folkmier Linda C. 
Published: April 2015

ObjectiveTo describe the motions which occur during rising from bed, specifically the motions that appeared to characterize difficulty in rising from a bed in older adults.DesignDevelopment of a Mobility assessment tool.SettingRetirement center and two university laboratories.ParticipantsThree groups of female volunteers: young controls (n = 17, mean age 24), community‐dwelling older adults (n = 12, mean age 71), and retirement center‐dwelling older adults who admitted to difficulty in rising from a bed (n = 15, mean age 86).InterventionVideotaping of motions occurring during controlled rises from a supine to sitting position.Main Outcome MeasuresThese motions were rated on the specially developed Bed Rise Difficulty (BRD) scale, a scale designed to measure movements that characterize difficulty in rising from a bed in older adults. Subject groups were compared in total BRD score, individual BRD item score, and total time to rise. Item relationships and scale reliability were also assessed.ResultsOlder adults with no apparent difficulty in rising based on total time to rise or on the BRD score nevertheless showed differences in upper extremity use when compared to young controls. Older adult subjects with difficulty in rising from a bed, when compared to other older adults with no apparent difficulty, differed more often in their upper extremity and leg use to facilitate the rise. Five BRD scale items, including use of extremity pushes, discontinuity of trunk and leg motion, multiple shoulder/pelvic adjustments, multiple leg adjustments, and poor vertical heel clearance may have best indicated true bed rise difficulty.ConclusionsThese data provide a reliable and valid method to characterize difficulty in rising from a bed and provide the basis for biomechanical analyses of the strength and joint ranges of motion required to rise from a bed.
Surgical Results and Complications in Elderly Patients with Benign Lesions of the Spinal Canal
Authors: Smith Edward B. , Hanigan William C. 
Published: April 2015

ObjectiveTo describe the long‐term outcome and complications of spinal surgery in a population of elderly patients.DesignRetrospective chart review and clinical follow‐up.SettingA 700‐bed tertiary care midwestern hospital.PatientsPatients 70 years of age or older who underwent elective surgical procedures for the treatment of benign lesions of the spinal canal.Main Outcome MeasuresData obtained from chart review included age, sex, nature and duration of neurological symptoms, activities of daily living (ADL), associated illnesses, length of hospitalization, type of surgery, and complications attributable to surgery. Outcome measurements included changes in neurological symptoms and ADL and a standardized scale obtained from consecutive outpatient visits, telephone interviews, or written responses.ResultsSeventy‐eight patients with lumbar canal stenosis or soft disc herniations underwent laminectomies, foraminotomies or discectomies. Eleven patients underwent cervical laminectomies for multilevel spondylitic myelopathy. Limb and spine pain were the most common neurological symptoms in patients with lumbar lesions; diminished ADLs were present in eight patients with cervical myelopathies. Six patients died of unrelated causes, and 78 were followed for an average of 27.1 months. Twenty‐three (85.2%) of 27 patients with lumbar disc herniations reported improvements or resolution of limb pain while 35 (81.4%) of 43 patients with lumbar canal stenosis reported fair or good results. Five of eight patients with multilevel cervical spondylosis reported improvements of myelopathic symptoms. Twenty‐six (28.6%) complications were attributable to 91 surgical procedures including five severe complications and one fatality. Patients with three or more associated illnesses demonstrated a significantly higher incidence of postoperative complications.ConclusionsElderly patients with benign lesions of the spinal canal may achieve significant reduction in limb pain and increases in ADL following appropriate surgery, with a tolerable rate of severe complications. The preoperative physical condition of the elderly patient served as an indicator for operative morbidity.
Joint Impairment and Hand Function in the Elderly
Authors: Hughes Susan L. , Gibbs James , Edelman Perry , Singer Ruth , Chang Rowland W. 
Published: April 2015

ObjectiveTo test the contribution of joint impairment to observed hand function (grip strength and Williams Test) in the elderly, using a multivariate model.DesignCross‐sectional observational data (baseline data from an ongoing longitudinal study).SubjectsFive hundred forty‐one persons over age 60, including continuing care retirement community (n = 222), homebound (n = 72), and ambulatory (n = 247) respondents. Mean age at assessment 76.7, (SD = 9.0).MeasurementIndependent variables included sociodemographics, physician measures of upper joint impairment, an index of comorbidities derived from physical examination or chart abstract, self‐assessed arthritis pain, depression, and anxiety. The dependent variables included grip strength and a modified Williams Test [Williams Test (M)].Main ResultsThe multiple regression explained 59% (Adjusted R2 = .59) of the variance in grip strength, with joint impairment accounting for a change in R2 of .07. Upper joint impairment and grip strength accounted for 3% and 5%, respectively, of the variance in the Williams Test (M) (total amount of explained variance = 45%).ConclusionsDemographics explain most of the variance in grip strength and performance on the Williams Test (M). Controlling for demographics, musculoskeletal disease represented by joint impairment is associated with diminished grip strength. Reduced grip strength is associated with poorer performance on the Williams Test (M).
Comorbid Mental and Substance Disorders among Older Psychiatric Patients
Authors: Speer David C. , Bates Kathie 
Published: April 2015

ObjectiveTo investigate the rate and configurations of current comorbid mental and substance disorders among older psychiatric patients.DesignA descriptive, retrospective study.SettingA non‐acute, public residential psychiatric treatment facility for adults 55 years of age and older (mean length of stay: 3 months).Patients128 patients discharged during a 2‐year period.MeasuresDSM‐III‐R diagnoses, demographic and history data.ResultsThe overall prevalence rate of concurrent mental and substance disorders during the present treatment episode was 21%. This is comparable to the 6‐month rate of 19.8% found in the Epidemiological Catchment Area Study among adults in treatment (all ages). Nearly 50% of the dually diagnosed subsample received more than two diagnoses, with 60% of the subsample receiving a personality disorder diagnosis. Concurrent affective, alcohol, and personality disorder diagnoses were common.ConclusionOlder patients with comorbid substance‐use and mental disorders may differ substantively from comorbid younger patients. Among older patients in an intermediate‐term psychiatric facility, the triple occurrence of alcoholism personality disorder and depression was common.
Modeling Recovery from Stumbles: Preliminary Data on Variable Selection and Classification Efficacy
Authors: Grabiner M. D. , Jahnigen D. W. 
Published: April 2015

ObjectiveThe primary purpose of this preliminary investigation was to determine the functional relationship between selected information processing time and response execution variables and measures of postural stability in elderly women. A secondary purpose was to explore the efficacy of a neuromotor model using selected variables to retrospectively identify subjects with a self‐reported history of falling.DesignDescriptive, retrospective, cohort.SettingGeneral community.SubjectsConvenience sample of 17 community‐dwelling females with a mean age of 72.2 years.Main Outcome MeasuresPostural stability variables included the amplitude and frequency of postural sway during static vision‐aided and no‐vision conditions. Information processing and response execution variables were collected using a simple‐choice reaction time paradigm for an isometric knee extension task.ResultsPostural stability and information processing variables were functionally independent. Based upon significant intergroup differences, simple and choice pre‐motor reaction time and non‐vision aided anterior posterior sway amplitude were selected for inclusion in a discriminant analysis. The resulting discriminant function was significant (P = 0.01), correctly categorizing all of the subjects with a self‐reported history of falling and identifying six out of seven of the non‐fallers.ConclusionsThese preliminary results suggest that it is feasible to identify a predisposition to falling by detecting an inability to respond successfully to a postural disturbance.
The Relationship of Patient's Age to the Perceptions of the Rehabilitation Environment
Authors: Strasser Dale C. , Falconer Judith F. , Martino‐Saltzman David 
Published: April 2015

ObjectiveTo compare the perceptions of the rehabilitation environment among staff, younger (<65), and older patients (>65).DesignThe Ward Atmosphere Scale (WAS) was administered to 55 patients and 108 staff members in a rehabilitation hospital.SettingA large university‐associated free‐standing rehabilitation hospital.SubjectsPatients and staff primarily associated with one of three treatment teams, each on a separate floor. The teams were selected to reflect a diversity of treatment styles and patients' diagnoses.Main Outcome MeasureThe WAS is a 100 true/false questionnaire with 10 subscales which combine to form three dimensions: relationship, program orientation, and system maintenance. These dimensions represent the principal constructs of the instrument.Main ResultsMultivariate analysis of variance was performed on three groups completing the WAS—staff, patients less than 65 years old, and patients 65 years and older. This analysis revealed significant differences among the three groups on the Relationship (F = 14.3; P <0.01) and Program Dimensions (F = 36.5; P < 0.01), and between staff and patients on the System Maintenance Dimension (F = 11.4; P < 0.01). Compared to younger patients and staff, older patients had lower perceptions in the combined areas of involvement, support, spontaneity, autonomy, practical orientation, personal problem orientation, and anger and aggression. Likewise, older patients perceived more staff control than staff and younger patients. Younger patients scored between older patients and staff.ConclusionsThis study suggests that there may be a mismatch between current rehabilitation environments and the needs of elderly individuals.
The Cost of Institutional Care in Alzheimer's Disease: Nursing Home and Hospital Use in a Prospective Cohort
Authors: Welch H. Gilbert , Walsh John S. , Larson Eric B. 
Published: April 2015

ObjectiveTo assess the nursing home and hospital use of patients with Alzheimer's Type Dementia.DesignA prospective cohort study of 126 patients entered into an Alzheimer's disease registry after diagnosis at a university hospital clinic between 1980 and 1982. Only four patients were in nursing homes at enrollment.Measurements and Main ResultsData regarding nursing home use came from the registry and the individual nursing homes themselves. Hospital‐use data were obtained using Medicare claims files. Follow‐up was obtained on 123 patients (98%). Eighty‐five (69%) had died by July 1, 1989. Three‐quarters of the cohort (92) eventually resided in nursing homes. The median nursing home length of stay was 2.75 years (mean 2.95, 95% CI = 2.5, 3.4), over 10 times the national median length of stay for all diagnoses. Based on prevailing rates in the region, nursing home charges for the cohort were estimated to be between $4.3 and $6.4 million ($35,000–$52,000 per patient). During the 5‐year period 1983–1988, 69 patients filed Part A (hospital) claims to Medicare for 76 admissions and 616 inpatient days. Part A Medicare reimbursement for the cohort totaled $460,000 over 5 years ($3,700 per patient), an expenditure comparable to what a random Medicare cohort might incur.ConclusionsThe combination of a high rate of nursing home entry and lengthy stays makes long‐term care the largest determinant of the cost of care in Alzheimer's disease. While Alzheimer's Type Dementia undoubtedly has profound indirect costs, this study demonstrates that the direct institutional costs alone are considerable.
Progressive Impairment of Left Ventricular Diastolic Filling with Advancing Age: A Doppler Echocardiography Study
Authors: Cacciapuoti Federico , D'Avino Maria , Lama Diana , Bianchi Ugo , Perrone Nicolò , Varricchio Michele 
Published: April 2015

ObjectiveTo identify the sequence and significance of left ventricular filling abnormalities associated with progressive aging in humans.DesignCross‐sectional study comparing three age groups. Setting: Department of Geriatrics at University of Naples.ParticipantsSeventy‐five healthy subjects in three age groups: 25 subjects from 25 to 45 years (Group I), 25 subjects from 46 to 65 years (Group II), and 25 subjects from 66 to 85 years (Group III).InterventionNone.Main Outcome MeasuresAll underwent pulsed‐doppler echocardiography under color guide to measure the following parameters: peak velocity flow for early (E wave) and late (A wave) mitral flow; A/E wave ratio; deceleration time of mitral flow (MDt); isovolumic relaxation time (IRT); ratio of velocity time integrals of the A wave to the velocity time integrals of the entire mitral spectrum (VTIA/VTIM).ResultsPeak velocity of the E wave was slightly lower in Group II and III compared to Group I; in contrast, peak velocity of the A wave was greater (P < 0.005) in aged individuals. Also A/E wave ratio, MDt, and IRT were significantly greater with advancing age (P < 0.01; P < 0.05 and P < 0.001, respectively). Finally, VTIA/VTIM tended to be greater in the oldest group, but not significantly so.ConclusionsLeft ventricular relaxation is progressively impaired in late middle age and old age, presumably an early marker of cardiac aging. Increased left atrial pressure is compromised only in the oldest group, presumably representing a compensation for impaired left ventricular relaxation.
Assessment of Cognitive, Psychiatric, and Behavioral Disturbances in Patients with Dementia: The Neurobehavioral Rating Scale
Authors: Sultzer David L. , Levin Harvey S. , Mahler Michael E. , High Walter M. , Cummings Jeffrey L. 
Published: April 2015

ObjectiveTo assess the validity of the Neurobehavioral Rating Scale (NRS) in patients with Alzheimer's disease (AD) or multi‐infarct dementia (MID) and to characterize the cognitive, psychiatric, and behavioral disturbances that occur in these patients.DesignCross‐sectional evaluation.SettingWest Los Angeles VAMC Geropsychiatry Inpatient Unit, Neurobehavior Inpatient Unit, and Dementia Clinic; UCLA Alzheimer's Disease Clinic.PatientsConvenience sample of 61 patients with AD and 22 patients with MID.Main Outcome MeasureThe NRS, a 27‐item observer‐rated instrument that measures cognitive, psychiatric, and behavioral disturbances.ResultsThe NRS demonstrated content and convergent validity in this patient group. Principal components analysis of the NRS ratings identified a six‐factor solution, and each factor contained clinically related symptoms. The factors were Cognition/Insight, Agitation/Disinhibition, Behavioral Retardation, Anxiety/Depression, Verbal Output Disturbance, and Psychosis. Among the patients with AD, agitation, disinhibition, hostility, poor insight, poor motivation, suspiciousness, and delusions were more severe in patients with more advanced dementia. Depressive symptoms occurred with equal severity in patients with mild and advanced dementia, but depressed mood was more severe in patients with earlier age of onset of AD.ConclusionThe NRS is a useful instrument for structured assessment of a broad range of cognitive, psychiatric, and behavioral disturbances in patients with dementia.
Psychiatric Status among the Homebound Elderly: An Epidemiologic Perspective
Authors: Bruce Martha Livingston , McNamara Robert 
Published: April 2015

ObjectiveTo compare the prevalence of specific psychiatric disorders in the homebound elderly to other elders, controlling for demographic, physical health, and socio‐economic factors.DesignSurvey.SettingEpidemiologic Catchment Area (ECA) project in New Haven, CT.Participants2,553 non‐institutionalized elders representing the total elderly population of the greater New Haven area.InterventionNoneMain MeasuresHomebound status determined by self‐report; psychiatric status according to DSM III by the Diagnostic Interview Schedule (DIS); cognitive status by Mini‐Mental Status Examination.ResultsCognitive impairment (21.8% vs 11.0%, P < 0.001), depression (2.3% vs 0.7%, P < 0.01), dysthymia (3.9% vs 1.7%, P < 0.01), and anxiety disorders (2.2% vs 0.4%, P < 0.001) were each at least twice as prevalent among elders confined to a bed or chair as among non‐homebound elders. Most of this increase was consistent with the poorer physical health status of the homebound; after controlling for health status, only dysthymia (Odds ratio = 2.1, P < 0.01) was significantly more prevalent among elders confined to a bed or chair.ConclusionsThe higher prevalence of disorders among the homebound support recommendations that psychiatric assessments become routine in primary care examinations of homebound elders and that the availability of preventive and therapeutic psychiatric services to the homebound increase.