bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial Natriuretic Peptide and the Development of Congestive Heart Failure in the Oldest Old: A Seven‐Year Prospective Study
Authors: Knight Eric L. , Fish Loretta C. , Kiely Dan K. , Marcantonio Edward R. , Davis Kenneth M. , Minaker Kenneth L 
Published: April 2015

BACKGROUND: Atrial natriuretic peptide (ANP) levels are elevated in symptomatic heart failure and correlate with invasively measured left heart pressures.OBJECTIVE: To examine the association between plasma ANP level and the subsequent development of congestive heart failure (CHF) in older subjects with no history of CHF.DESIGN: A 7‐year, prospective, blinded, cohort study.SETTING: A life care facility in Boston, Massachusetts.PARTICIPANTS: Two hundred fifty‐six frail older subjects (mean age 88 ± 7) with no history of CHF at study entry.MAIN OUTCOME MEASURE: Clinical episodes of CHF with confirmatory chest roentgenogram findings. Cox proportional hazard analyses were performed to examine the relationship between ANP levels and the development of CHF while controlling for 19 clinical, physical, and laboratory parameters. A Kaplan‐Meier estimator (log‐rank test) was used to determine if the development of CHF differed by tertile of ANP.RESULTS: During the follow‐up period, 32% of the cohort developed CHF. The mean ANP level in the CHF group was 95 pmol/L ±11 pmol/L versus 60 pmol/L ± 5 pmol/L in the no CHF group (two tailed t test P = .005). On multivariate analysis, a high ANP level was found to be associated significantly (P =. 01) with the development of CHF.CONCLUSIONS: There is a statistically significant association between ANP level and the subsequent development of CHF in frail older individuals with no history of CHF.;
Diabetes and Dementia in Long‐Term Care
Authors: Tariot Pierre N. , Ogden M. Allison , Cox Christopher , Williams T. Franklin 
Published: April 2015

OBJECTIVES: To examine the presence or absence of dementia, and the prevalence rates for different dementias, in patients with and without adult onset diabetes (AODM).DESIGN: Chart survey.SETTING: A public long‐term care facility in Rochester, New York, chosen to provide an enriched sample with respect to the diseases and demographic variables of interest.PARTICIPANTS: All long‐term care residents in the facility aged 50 years or older (n = 476), mean age 74.8 years. Thirty‐six (7.6%) had probable Alzheimer's disease (AD), 49 (10.3%) had possible AD, 38 (8.0%) had clinically diagnosed vascular dementia, 84 (17.6%) had unspecified dementias, and 269 (56.5%) were not demented.MEASUREMENTS: Demographic data, dementia and diabetes determined on the basis of extraction of chart data, and hypertension, myocardial infarction, congestive heart failure, and hypercholesterolemia determined on the basis of chart diagnoses.RESULTS: There were 99 residents with AODM in the sample, a prevalence rate of about 21%. The rates of both dementia and AODM were as expected for this age group and setting. Patients with probable or possible AD had the lowest rates of AODM (0 and 6.1%, respectively), and patients with vascular dementia had the highest rates of AODM (47.4%). Age, sex, and race influenced both the risk of having a dementia and the type of dementia. When these variables were adjusted for in multiple logistic regression, however, AODM remained a robust predictive factor because of its significant negative association with AD. Patients with unspecified dementias and no dementia showed rates of AODM (about 20%) that were roughly comparable and intermediate between vascular dementia and AD.CONCLUSIONS: In our study, AD diagnosed clinically and AODM did not co‐occur, whereas AODM was associated with vascular dementia diagnosed clinically. Conversely, in non‐Alzheimer, nonvascular dementias diagnosed clinically, the rates of AODM were equivalent to those in nondemented patients. These findings are in agreement with some, but not all, previous studies.
The General Medical Health Rating: A Bedside Global Rating of Medical Comorbidity in Patients with Dementia
Authors: Lyketsos Constantine G. , Galik Elizabeth , Steele Cynthia , Steinberg Martin , Rosenblatt Adam , Warren Andrew , Sheppard Jeannie‐Marie , Baker Alva , Brandt Jason 
Published: April 2015

OBJECTIVE: Dementia is a serious public health problem. General medical comorbidity is common in dementia patients and critical to their care. However, little is known about medical comorbidity in these patients, and there are no straightforward bedside global rating scales for the seriousness of comorbid medical illness. This paper describes the development and measurement properties of the General Medical Health Rating (GHMR), a rapid global rating scale of medical comorbidity in dementia patients.DESIGN: Interrater reliability, concurrent validity, and predictive validity of the GMHR are reported.SETTING: An outpatient dementia clinic, assisted living, and nursing home.PARTICIPANTS: A total of 819 consecutive dementia clinic outpatients and 180 consecutive admissions to Copper Ridge, a long‐term care residence for people with dementia, were included in the study.RESULTS: GMHR was found to be highly reliable (weighted kappa =. 91). Across all stages and types of dementia, GMHR ratings were correlated with number of comorbid medical conditions, number of medications being taken for comorbid conditions, and with activity of daily living impairment, even after adjustment for severity of dementia. GMHR ratings were also a strong predictor of falls and of mortality in long‐term care residents after adjustment for age and severity of dementia.CONCLUSION: GMHR is a reliable, valid, global bedside measure of severity of general medical comorbidity for patients with dementia that can be used for clinical and research purposes.
Clinical Profile of Delirium in Older Patients
Authors: Sandberg Olov , Gustafson Yngve , Brannstrom Benny , Bucht Gosta 
Published: April 2015

OBJECTIVE: To examine the prevalence, psychiatric and behavior symptoms, differing symptom profiles, and diurnal variations of delirium in older patients.DESIGN: A descriptive, point prevalence study with a cross‐sectional design,.SETTING: One ordinary county hospital (n = 148), three nursing homes (n = 202), five old people's homes (n = 196), and home medical care patients (n = 171) in parts of a hospital catchment area in Mid‐Sweden.PARTICIPANTS: A total of 717 patients 75 years of age and older were observed and assessed for the prevalence of delirium. Women accounted for 66.4% of the studied population, and the mean age for both sexes was 83.7 years.MEASUREMENTS: All patients were examined using the OBS (Organic Brain Syndrome) scale, and delirium was diagnosed according to DSM‐III‐R.RESULTS: Delirium was diagnosed in 315 of 717 (43.9%) patients, and 135 of 315 (42.9%) of the delirious patients had dementia. Thirty‐seven percent of the patients with delirium were delirious in the afternoon, evening, or at night, and 47% of the delirious patients had morning delirium. The delirious patients presented a wide variety of psychiatric symptoms. More than half the patients xhibiting anxiety, psychomotor slowing, depressed mood, and irritability. Nearly 26% were classified as having hypoactive, 22% as having hyperactive, and 42% as having mixed delirium, whereas 11% had neither hypo‐ nor hyperactive delirium. Seventy‐seven percent were classified as having delirium with pronounced emotional and 43% with pronounced psychotic symptomsCONCLUSIONS: This study shows that patients with delirium have very different clinical profiles. This might indicate a need for different treatment strategies for patients with different types of delirium. J Am Geriatr Soc 47:1300–1306, 1999.
Preventing the Spread of Vancomycin‐Resistant Enterococci in a Long‐Term Care Facility
Authors: Silverblatt Fredric J. , Tibert Cynthia , Mikolich Dennis , Blazek‐D'Arezzo Julia , Alves Josephine , Tack Marc , Agatiello Paul 
Published: April 2015

OBJECTIVES: To test the hypothesis that infection control practices can prevent the spread of vancomycin‐resistant enterococci (VRE) to residents of a long‐term care facility (LCF) from an affiliated acute care facility with a high endemic rate of colonization.DESIGN: Point prevalence study of the rate of rectal colonization.SETTING: A state‐supported veterans nursing home and an acute care veterans hospital.PARTICIPANTS: Residents in a state veterans home.INTERVENTIONS: Identification of patients with rectal colonization by VRE before transfer to the state veterans home, contact isolation for colonized veterans, use of oral bacitracin to eliminate colonization.MEASUREMENTS: Rectal swab and culture for VRE, review of clinical records and recording of presumptive risk factors for VRE colonization. The risk factors were age, gender, length of stay at nursing home, treatment with vancomycin or oral antibiotics, prior hospitalization at the acute care facility during the prior year, use of indwelling urethral catheters, presence of diarrhea, and fecal or urinary incontinence.RESULTS: Sixty‐nine of 200 residents were cultured in the first study (1996) and 130 of 230 residents were cultured in the second study (1998). Residents who consented to culture differed from those who did not only with regards to gender (2 vs 7, P = .012). In neither study were any residents found to be colonized with VRE who had not already been identified as positive on admission.CONCLUSIONS: Adherence to infection control practices by the patient care staff of the LTCF was associated with the absence of transmission of VRE colonization among its residents. The presence of rectal colonization with VRE in an acute care patient should not be a barrier to acceptance in a nursing home.
A Serious Outbreak of Parainfluenza Type 3 On a Nursing Unit
Authors: Faulks J. Todd , Pharm R. , Drinka Paul J. , Shult Peter 
Published: April 2015

OBJECTIVE: To report a serious outbreak of respiratory illness in a nursing home, with isolation of parainfluenza type 3 in four cases.DESIGN: Viral respiratory cultures from a sample of symptomatic residents, and retrospective chart review.SETTING: A 50‐bed nursing unit/floor in a skilled nursing facility.PARTICIPANTS: All residents of the nursing unit.MEASUREMENTS: Respiratory viral cultures and clinical chart review.RESULTS: Twenty‐five of 49 residents developed new respiratory symptoms between September 2 and September 25, 1999. Ten cases (40%) had a tympanic temperature of 100°F or greater. Eighteen (72%) had a chest X‐ray with 11 (44%) new infiltrates. Sixteen (64%) were treated with antibiotics. Three cases were hospitalized and four died (16%) within 1 to 9 days after onset of symptoms. Four of 10 viral cultures yielded parainfluenza type 3.CONCLUSIONS: Parainfluenza type 3 may cause outbreaks complicated by pneumonia and fatal outcome. Clinicians should consider uniform secretion precautions to contain all viral URIs in nursing homes.
Mammography Use, Breast Cancer Stage at Diagnosis, and Survival Among Older Women
Authors: McCarthy Ellen P. , Burns Risa B. , Freund Karen M. , Ash Arlene S. , Shwartz Michael , Marwill Sandra L. , Moskowitz Mark A. 
Published: April 2015

BACKGROUND: Women age 65 years and older account for most newly diagnosed breast cancers and deaths from breast cancer. Yet, older women are least likely to undergo mammography, perhaps because mammography's value is less well demonstrated in older women.OBJECTIVE: To investigate the relationship between prior mammography use, cancer stage at diagnosis, and breast cancer mortality among older women with breast cancer.DESIGN: Retrospective cohort study using the Linked Medicare‐Tumor Registry Database.SETTING: Population‐based data from three geographic areas included in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.PARTICIPANTS: Women aged 67 and older diagnosed with a first primary breast cancer, from 1987 to 1993, residing in Connecticut, metropolitan Atlanta, Georgia, or Seattle‐Puget Sound, Washington.MEASUREMENTS: Medicare claims were reviewed and women were classified according to their mammography use during the 2 years before diagnosis: nonusers (no prior mammograms), regular users (at least two mammograms at least 10 months apart), or peri‐diagnosis users (only mammogram(s) within 3 months before diagnosis). Mammography utilization was linked with SEER data to determine stage at diagnosis and cause of death. Our main outcome variables were (1) stage at diagnosis, classified as early (in situ/Stage I) or late (Stage II or greater), and (2) breast cancer mortality, measured from diagnosis until death from breast cancer or end of the follow‐up period (December 31, 1994).RESULTS: Older women who were nonusers of mammography were diagnosed with breast cancer at Stage II or greater more often than regular users (adjusted odds ratio (OR), 3.12; 95% confidence interval (CI), 2.74–3.58). This association was present within each age group studied. Nonusers of mammography were at significantly greater risk of dying from their breast cancer than regular users for all women (adjusted hazard ratio (HR), 3.38; 95% CI, 2.65–4.32) and for women within each age group. Even assuming a lead time of 1.25 years, nonusers of mammography continued to be at increased risk of dying from breast cancer. Our findings remained significant for all women and for the two youngest age groups (67–74 years, 75–85 years), although the benefit was no longer statistically significant for the oldest women (85 years and older).CONCLUSIONS: Older women who undergo regular mammography are diagnosed with an earlier stage of disease and are less likely to die from their disease. These data support the use of regular mammography in older women and suggest that mammography can reduce breast cancer mortality in older women, even for women age 85 and older.
GERIATRICS IN MANAGED CARE
Authors: Brummel‐Smith Kenneth , Phillips V. L. , Paul Wendy , Becker Edmund R. , Osterweil Dan , Ouslander Joseph G. 
Published: April 2015

OBJECTIVE: To describe the healthcare utilization of a long‐term care population receiving primary and specialty care in a closed system and to compare Medicare fee‐for‐service (FFS) reimbursement with the amount that would have been paid under capitation for these services.SETTING: A life care community in California composed of two facilities, both having residential care and nursing facility (NF) beds.PARTICIPANTS: Residents (n = 700) living in the community between September 1995 and February 1996.METHODS: Data on Medicare Part A and Part B reimbursements were gathered from billing records for hospitalizations, based on diagnostic related group payments, primary and specialty care visits, various procedures, diagnostic tests, and therapeutic services. These data were compared with what the facility, in collaboration with the providers and an affiliated hospital, would have received under Medicare capitated rates at that time.RESULTS: Annually, residents averaged 16.3 primary care visits, 7.7 specialist visits, and 3453 hospital days per thousand. Nursing facility residents received significantly more primary care than did those in residential care. Total Medicare Part A and B payments per resident per month averaged $558. The monthly capitation rate in effect at the time for this population was substantially higher at $1085, generating an annual “risk pool” of $9.1 million.Care provided in the two facilities varied greatly. Hospitalization rates, clinic‐based primary care and specialist visits, and therapy sessions were greater in facility one. Overall expenditures were lower for residents at facility two, where the majority of care was provided by trained geriatricians in collaboration with physician extenders and without sophisticated clinical pathways and utilization controls.CONCLUSIONS: Our data support other studies that suggest that teams of geriatricians and physician extenders can reduce hospitalization rates and overall expenditures. Capitated rates for the frail, geriatric population warrant careful study. These rates must balance fiscal responsibility with the need for adequate, risk‐adjusted payments that create incentivesfor providers to produce high quality as well as cost‐effective care.
Midazolam Sedation for Upper Gastrointestinal Endoscopy in Older Persons: A Randomized, Double‐Blind, Placebo‐Controlled Study
Authors: Christe C. , Janssens J.P. , Armenian B. , Herrmann F. , Vogt N. 
Published: April 2015

OBJECTIVES: To investigate the benefits and risks of using midazolam for sedation during upper gastrointestinal endoscopic procedures in older persons.DESIGN: Randomized, double‐blind, placebo‐controlled study.SETTING: A 304‐bed geriatric university hospital.PATIENTS: Sixty‐five geriatric inpatients (mean age 84 ± 7) undergoing gastroscopy.INTERVENTION: Sedation with either midazolam (30 μg/kg IV) or saline (placebo). All patients received supplemental oxygen during the procedure (2 L/minute).MEASUREMENTS AND RESULTS: Patients' recall of their tolerance to the exam (categorical scale) and pain score were significantly in favor of midazolam at 2 and 24 hours. Multivariate analysis at 2 hours showed that midazolam increased the probability of good tolerance (odds ratio (OR) = 19.3; 95% confidence interval (CI) 2.2–170.4, P = .008). Circumstantial amnesia occurred at 24 hours in 84% (midazolam) versus 27% (placebo) (P < .001). With midazolam, mean sedation time was 83 ± 13 minutes and mean arterial pressure (MAP) was about 10 mm Hg lower without clinically significant hypotension. Hypoxemia (SaO2 < 92%) was more frequent in the midazolam group after endoscopy (44% vs. 18%, P = .033), but no major desaturation was observed. Cognitive function (Mini‐Mental State Exam, MMSE) was similar before and 2 and 24 hours after the exam in both groups. Acute confusion was observed in two patients (1 midazolam, 1 placebo). In multivariate analysis, midazolam was associated with a higher risk of hypoxemia after endoscopy (OR = 3.5; 95% CI 1.1–10.8, P = .029) but not of confusion.CONCLUSIONS: Under adequate surveillance, the benefits in terms of tolerance to the procedure of low‐dose midazolam for upper gastrointestinal endoscopic sedation outweigh the risks in older people.
Undetected Dementia in Community‐Dwelling Older People: The Canadian Study of Health and Aging
Authors: Sternberg Shelley A. , Wolfson Christina , Baumgarten Mona 
Published: April 2015

OBJECTIVE: To estimate the frequency and correlates of undetected dementia in community‐dwelling older people.DESIGN: Secondary analysis of data from the Canadian Study of Health and Aging (CSHA) prevalence survey of dementia.SETTING: All 10 provinces of Canada excluding Indian reserves and military units.PARTICIPANTS: A total of 252 community‐dwelling older adults diagnosed with dementia in the CSHA survey.MAIN OUTCOME MEASURE: Undetected dementia, defined as occurring in persons who meet standard diagnostic criteria for dementia but who report never having seen a doctor for memory problems.RESULTS: Of the 252 subjects, 64% had undetected dementia. Subjects with mild functional impairment were significantly more likely to have undetected dementia (odds ratio = 2.4, 95% confidence interval 1.2, 5.0). Older subjects and those with mild cognitive impairment showed a trend toward undetected dementia, although the results did not achieve statistical significance. Educational level, number of comorbid conditions, and degree of social support were not significantly associated with undetected dementia.CONCLUSIONS: A large number of older persons are living in the community with undetected dementia. These older people may be at significant risk for delirium, motor vehicle accidents, medication errors, and financial difficulties. As preventive strategies are developed and new cognitive enhancing therapies emerge, we need to reexamine our current guidelines about screening for cognitive impairment in older adults.
Glycemic Control in Older Subjects with Type 2 Diabetes Mellitus in the Fremantle Diabetes Study
Authors: Bruce D. G. , Davis W. A. , Davis T. M. E. 
Published: April 2015

OBJECTIVES: We investigated whether there were differences in glycemic control in older compared with younger subjects with type 2 diabetes mellitus enrolled in the Fremantle Diabetes Study, a prospective study of diabetes care, control, and complications in an urban setting.DESIGN: Cross‐sectional observational study.SETTING: University teaching hospital clinical research center.PARTICIPANTS: A total of 1205 patients with type 2 diabetes mellitus, 404 (33.3%) of whom were aged over 70 years and 83 (6.9%) aged over 80 years.MEASUREMENTS: Fasting plasma glucose, HbA1c, body mass index, and waist/hip ratio.RESULTS: In multiple linear regression analysis, age was inversely associated with glycemic control whereas duration of diabetes and treatment with either oral hypoglycemic agents or insulin were positively associated with glycemic control. For most age groups there was a significant worsening of glycemic control with duration of diabetes. Octogenarians differed significantly from younger age groups in that those with longer diabetes duration did not demonstrate the increase in hyperglycemia seen in other age groups. As a result, significantly greater proportions of these oldest diabetic subjects had satisfactory glycosylated hemoglobin levels compared with younger subjects.CONCLUSIONS: Octogenarians do not demonstrate the usual progressive deterioration of glycemic control with diabetes duration seen in type 2 diabetes mellitus. The reasons for this difference are unknown but are likely to have clinical significance with regard to therapy and the development of diabetic complications.