bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age‐Related Changes in Facial Skin Contours and Rheology
Authors: Henry Frédérique , Piérard‐Franchimont Claudine , Cauwenbergh Geert , Piérard Gérald E. 
Published: April 2015

OBJECTIVES: To evaluate the age effect on both the mechanical properties and wrinkling of facial skin. This topic has not previously been addressed in the literature.DESIGN: A total of 180 white women aged 18 to 67 years participated in the study. Each of the 5 decades of age was represented by 30 subjects, with the exception of menopausal women aged 48 to 57 years who were allocated to two groups of 30 according to the use or non‐use of hormone replacement therapy (HRT).SETTING: A University medical center, Belgian SSTC Research Unit 5596.MEASUREMENTS: Mechanical properties of the skin were measured on the face using a computerized suction device. Skin contours were assessed using optical profilometry and computerized image analysis.RESULTS: Skin aging of the face is characterized by a progressive increase in extensibility associated with a decreased elasticity. The loss of tonicity is accompanied by a progressive deepening of facial creases. HRT appears to limit the age‐related rheological changes without showing a preventive effect on wrinkling of facial skin.CONCLUSION: Aging of facial skin resembles, in some ways, the features previously reported on sun‐protected areas of the forearms. HRT has a beneficial effect that may slow the overall process of aging without, however, limiting the number and depth of wrinkles.
Effect of a Single Dose of Diazepam on Balance Measures in Older People
Authors: Cutson Toni M. , Gray Shelly L. , Hughes Michael A. , Carson Stanley W. , Hanlon Joseph T. 
Published: April 2015

OBJECTIVE: This study examines the effect of a single dose of diazepam on a spectrum of balance measures in healthy older subjects. The measures include static (postural sway), dynamic (anterior tibialis muscle activation latency), and a complex self‐initiated task of balance (functional reach) in addition to neuropsychological tests of attention.DESIGN: A double‐blind, two‐period, cross‐over trial.SETTING: The community surrounding a university hospital.PARTICIPANTS: Community‐dwelling, nonsmoking volunteers 65 years of age and older
MEASUREMENTS: Measures included response to unexpected perturbation (platform/EMG muscle latency), self‐initiated perturbation (functional reach), and a static measure of balance (postural sway). Neurocognitive tests (digital symbol substitution test, card sorting) were included to document the cognitive effect.RESULTS: Twelve nonsmoking healthy subjects (average age = 70.4 years (66–76 years)) participated. The anterior tibialis muscle latency increased in response to a sudden perturbation with diazepam compared with placebo (TA latency 149 ms vs 142 ms, P < .001). Neurocognitive tests were adversely affected for 90 minutes after diazepam administration compared with placebo (P < .05). Other measures did not demonstrate significant effect of diazepam.CONCLUSIONS: This is among the first reports showing that benzodiazepines affect neuromuscular processing related to balance control. Increased muscle latency to sudden perturbations may represent an effect of diazepam upon the oligosynaptic spinal reflex distinct from the sedation. Surface electromyography may be a valuable noninvasive tool for future studies of drug effect on balance and falls risk among older people.
Consistency of Physician Judgments of Capacity to Consent in Mild Alzheimer's Disease
Authors: Marson Daniel C. , McInturff Bronwyn , Hawkins Lauren , Bartolucci Alfred , Harrell Lindy E. 
Published: April 2015

OBJECTIVE: To investigate the agreement of physician judgments of capacity to consent to treatment for normal and demented older adults.DESIGN: Subjects were individually administered a standardized consent capacity interview. Physicians viewed videotapes of these interviews and made judgments of capacity to consent to treatment.SETTING: University medical center.PARTICIPANTS: Subjects assessed for competency (N = 45) were 16 normal older controls and 29 patients with mild Alzheimer's disease (AD). Five medical center physicians with experience assessing the competency of dementia patients were recruited from the specialties of geriatric psychiatry, geriatric medicine, and neurology.MEASUREMENTS: Subjects were videotaped responding to a standardized consent capacity interview (SCCI) designed to evaluate capacity to consent to treatment. Study physicians blinded to subject diagnosis individually viewed each SCCI videotape and made a judgment of competent or incompetent to consent. Agreement of physician judgments was evaluated using percentage agreement, kappa, and logistic regression.RESULTS: Competency judgments of physicians showed high agreement for controls but low agreement for AD patients. Physicians as a group achieved 98% judgment agreement for the controls but only 56% judgment agreement for the mild AD patients. The physician group kappa for controls was 1.00 (P < .0001) and differed significantly (P < .0001) from the physician group kappa of .14 (P = .44) for AD patients, indicative of a real difference in the ability of the study physicians to judge consistently competency across the two groups. Similarly, logistic regression analysis showed significant variability in physician judgments for the AD group (χ2 = 63.8, P < .0001) but not for the control group (χ2 = 4.1, P = 1.00). Within the AD group, pairwise analyses revealed significant judgment disagreement (P < .01) for seven of the 10 physician pairs.CONCLUSIONS: Experienced physicians demonstrated significant agreement judging the competency of older controls, but significant disagreement judging the competency of mild AD patients. Physician judgment currently does not represent a gold standard for determining consent capacity of dementia patients. Standardized assessment instruments and clinical training may improve the agreement and accuracy of physician competency judgments.
Cognitive Models That Predict Physician Judgments of Capacity to Consent in Mild Alzheimer's Disease
Authors: Marson Daniel C. , Hawkins Lauren , McInturff Bronwyn , Harrell Lindy E. 
Published: April 2015

OBJECTIVE: To identify cognitive measures that predict consent capacity of normal and demented older adults as judged by experienced physicians. This study is a companion to the physician competency judgment research reported in this issue.DESIGN: Predictor models for competency judgments of individual physicians were developed using independent patient neuropsychological test measures and discriminant function analyses (DFA).SETTING: University medical center.PARTICIPANTS: Subjects were 16 normal older controls and 29 patients with mild AD (MMSE ≥ 20). Five experienced medical center physicians were recruited as competency decision‐makers.MEASUREMENTS: Subjects were videotaped responding to a standardized consent capacity interview (SCCI) designed to evaluate capacity to consent to treatment. Interview subjects were also independently administered (off videotape) a battery of neuropsychological measures theoretically and empirically linked to competency function. Study physicians blinded to subject diagnosis and neuropsychological test performance individually viewed each SCCI videotape and made a judgment of competent or incompetent to consent to treatment. Stepwise DFA identified neuropsychological predictors of each physician's competency judgments for the full sample (N = 45). Classification DFAs determined how accurately these predictor models classified competency outcomes assigned by the individual physician.RESULTS: Cognitive models differed across individual physicians and were related to stringency of judgments for AD patients. Under stepwise DFA, delayed verbal recall (R2 = .57, P < .0001) predicted judgments of Physician 1 (incompetency rate of 90% for AD patients), short term verbal recall (R2 = .43, P < .0001) predicted judgments of Physician 2 (incompetency rate of 52%), phonemic word fluency (R2 = .27, P < .001) predicted judgments of Physician 3 (incompetency rate of 24%), and visuomotor tracking/sequencing (R2 = .31, P < .001) predicted judgments of Physician 4 (incompetency rate of 14%). (No predictor model was available for Physician 5 as this physician found all subjects to be competent). These single predictor solutions correctly classified 93%, 87%, 87%, and 96% of cases for Physicians 1–4, respectively. Use of two predictor solutions achieved successful classification rates between 98% and 100%.CONCLUSIONS: We identified two cognitive models of consent capacity as judged by physicians: (1) verbal recall and (2) simple executive function. The verbal recall model predicted judgments of physicians likely to find mild AD patients incompetent, whereas the executive function model predicted judgments of physicians likely to find mild AD patients competent. Assessment of verbal recall and simple executive functions may provide important information in the clinical evaluation of capacity to consent to treatment.
Assessing Attentiveness in Older Hospital Patients: Global Assessment Versus Tests of Attention
Authors: O'Keeffe Shaun T. , Gosney Margot A. 
Published: April 2015

OBJECTIVES: Impairment of attentiveness is a cardinal symptom of delirium. We examined the relationship between bedside tests of attention and a global rating of attentiveness in older hospital patients and sought to identify cut‐off points on the tests of attention that might be helpful in the diagnosis of delirium.SETTING AND PARTICIPANTS: Subjects were 110 patients admitted to an acute geriatric unit.MEASUREMENTS: Subjects were assessed by two physicians. One physician rated global attentiveness on a 10‐cm visual analog scale following general conversation with the patient. The second physician determined whether patients met DSM‐3 criteria for delirium or dementia and administered four tests of attentiveness: Digit Span Forwards (DSF), Digit Span Backwards (DSB), Vigilance ‘A’ test (VAT), and a timed Digit Cancellation Test (DCT).MAIN RESULTS: Of the 87 patients who completed the study, 18 were delirious and 17 demented. There was no difference between demented and delirious patients on the VAT, DSF, or MMSE tests; other comparisons between demented and delirious patients and between delirious patients and those with neither delirium nor dementia were significant. All tests of attention except DSF were significantly correlated with the global rating.CONCLUSION: Simple bedside tests of attention can aid identification of delirium.
Criteria for Enrolling Dementia Patients in Hospice
Authors: Luchins Daniel J. , Hanrahan Patricia , Murphy Kathleen 
Published: April 2015

OBJECTIVE: Because survival time varies greatly, it is difficult for dementia patients to meet a key criterion for eligibility for the Medicare hospice benefit: a 6‐month survival time. We have developed criteria for the Medicare hospice benefit that include the characteristics of advanced dementia and related medical complications. The purpose of the study was to determine survival time among dementia patients who met these criteria. Additionally, because the National Hospice Organization (NHO) developed its own guidelines while the study was in progress, we retrospectively examined the application of these guidelines to our sample.DESIGN: Two cohorts of hospice patients were studied longitudinally, each for 2 years.SETTING: Nine Midwestern hospice programs. PARTICIPANTS: Forty‐seven patients were enrolled in home hospice and institutional hospice settings.MEASUREMENTS: Survival time consisted of the number of days between enrollment in the hospice program and death or the end of the study. Other measures included Activities of Daily Living, ratings of Appetite, Nourishment, and Mobility, Functional Assessment Staging (FAST), a Medical Complications Checklist, and a care plan concerning the use of medications for acute illness.RESULTS: Our hospice enrollment criteria predicted a median survival time of 4 months and a mean survival time of 6.9 months; 38% of patients survived for more than 6 months. FAST scores and Mobility ratings were significantly related to survival time. However, 41% could not be scored on the FAST as their disease progression was not ordinal. Among patients who could be scored on the FAST and who had reached Stage Seven C, their mean survival time was 3.2 months compared with 18 months among those who could be scored and had not reached this stage and 8.6 months among patients whose disease progression was not ordinal, .001. When the palliative care plans were examined, less aggressive care plans resulted in shorter survival times, P <.01.CONCLUSION: Our hospice enrollment criteria identified a group with a median survival time of 4 months and a mean survival time of 6.9 months. Using NHO criteria relying on the FAST allows the identification of a subgroup with very high mortality and a short time until death. Although the FAST can identify a subgroup of appropriate candidates for hospice, sole reliance on this measure might decrease access to hospice care for many dementia patients. J Am Geriatr Soc 45: 1054–1059, 1997.
Baseline Correlates with Quality of Life Among Men and Women with Medication‐Controlled Hypertension. The Trial of Nonpharmacologic Interventions in the Elderly (TONE)
Authors: Anderson Roger T. , Hogan Patricia , Appel Lawrence , Rosen Raymond , Shumaker Sally A. 
Published: April 2015

OBJECTIVES: To examine Quality of Life (QOL) and its correlates among older adults with medication‐controlled hypertension.DESIGN: Baseline data from the TONE clinical trial. MEASUREMENTS: Demographic variables (age, race, income), hypertension treatment (medication class, years treated), health status (obesity, physical symptoms), and QOL status (MOS‐Short‐Form 36, Jenkins Sleep Disturbance, and CES‐D Depression).PARTICIPANTS: A total of 975 men and women, aged 60 to 81 years and free of major diseases and disability, with a screening blood pressure (BP) of < 145/85 mm Hg, treated medically for hypertension with antihypertensive medication.RESULTS: On average, TONE participants reported a QOL level on the SF‐36 that was similar to or better than that reported by older adults in the general population. However, there was a strikingly high prevalence of physical complaints or symptoms: 90.3% of men and 93.3% of women experienced one or more physical symptoms or complaints, and nearly 50% reported that such symptoms had disrupted their daily functioning. Among variables considered, only the physical symptoms index score, number of severe symptoms, and obesity status were correlated consistently with QOL among TONE men and women. Lower QOL scores were associated with higher symptom scores and with obesity. Neither medication class nor age were appreciably associated with QOL status.CONCLUSIONS: Physical symptoms, rather than medication class and age, were the strongest correlates of QOL in TONE. This underscores the importance of identifying the etiology of symptoms as a means to improve the QOL of older hypertensive persons rather than substituting medication. The association of poorer physical well‐being with obesity suggests that weight reduction to manage BP may also improve QOL for some individuals.
Circumstances of Falls Resulting in Hip Fractures Among Older People
Authors: Norton Robyn , Campbell A. John , Lee‐Joe Trevor , Robinson Elizabeth , Butler Meg 
Published: April 2015

OBJECTIVES: To describe the circumstances of falls resulting in hip fractures among older people and to determine whether the circumstances differ by gender, age, and residential status.DESIGN: Cross‐sectional study.SETTING: Two hospitals in Auckland, New Zealand, in which all individuals aged 60 years or older with a fracture of the proximal femur are hospitalized. PARTICIPANTS: A total of 911 individuals (97% response rate) were hospitalized with fractures of the proximal femur; 77% were women, 66% were aged 80 years or older, and 58% were living in private homes at the time of fracture. MEASUREMENTS: Data were collected face‐to‐face by a trained interviewer using a standardized questionnaire.RESULTS: Ninety‐six percent of the fractures were associated with a fall, with fewer that 2% of subjects reporting that their fractures occurred spontaneously before a fall. Sixteen percent of fractures were associated with an acute medical or physical condition. Although 85% of the fractures involving a fall occurred at home, only about 25% of these were associated with an environmental hazard, and only a proportion of these were likely to have been amenable to modification. The circumstances of falls differed significantly by age and residential status.CONCLUSION: Strategies aimed at preventing fall‐related hip fractures among the old old and among institutionalized individuals should focus primarily on the modification of intrinsic factors. Modification of environmental hazards has the greatest potential for prevention among the young old and those living in private homes. J Am Geriatr Soc 45:1108–1112,1997.
Characteristics of Patients Receiving or Forgoing Resuscitation at the Time of Cardiopulmonary Arrest
Authors: Ghusn Husam F. , Teasdale Thomas A. , Boyer Kathryn 
Published: April 2015

OBJECTIVE: To compare clinical, functional and social characteristics of DNR patients at the time of their cardiopulmonary arrest with characteristics of patients who receive cardiopulmonary resuscitation.DESIGN: Retrospective chart review of all 261 patients who had a cardiopulmonary arrest during a 6‐month period in an academic institution.SETTING: Teaching Veterans Affairs Medical Center serving a large metropolitan area.MEASUREMENTS: Demographic characteristics, medical diagnoses, and measures of functional status were collected when DNR orders were initiated and at the time of cardiopulmonary arrest.RESULTS: The mean age of the studied group was 62 years. Ninety‐nine percent were males, and the majority were non‐ Hispanic white men. One hundred ninety‐eight (76%) patients/proxies elected for limiting treatment. Most (85%) elected a DNR order only. Patients were the most frequently documented participants in advance directive decisions in the DNR group. At the time of cardiopulmonary arrest, a higher proportion of the CPR group had coronary artery disease or chronic renal failure, and a higher proportion of the DNR group had cancer or AIDS. The functional status of the DNR group deteriorated from the time of DNR order to death. At the time of cardiopulmonary arrest, the majority of both groups were dependent in all functional domains, and 70% of the DNR group were stuporous or comatose compared with 47% of the CPR group (P =.05). DNR patients were hospitalized for an average of 13.7 ± 29.5 days after a DNR order was initiated. Six of the 81 patients who received CPR (7.4%) were alive at discharge.CONCLUSIONS: Patients and physicians deciding to implement a DNR order may be overly focused on medical diagnoses and less so on functional status. A significant proportion of patients with clinical characteristics associated with poor CPR outcome are electing for CPR.
Visual Impairment and Falls in Older Adults: The Blue Mountains Eye Study
Authors: BOptom Rebecca Q. Ivers , Cumming Robert G. , Mitchell Paul , Attebo Karin 
Published: April 2015

OBJECTIVES: To examine the association between visual impairment and falls in older people.DESIGN: Cross‐sectional survey of eye disease with retrospective collection of falls data.SETTING: Two postcode areas in the Blue Mountains west of Sydney, Australia.PARTICIPANTS: All people 49 years of age and older were invited to participate, 3654 (82.4%) of 4433 eligible residents took part, and 3299 answered questions about falls.MEASUREMENTS: Subjects had a detailed eye examination and answered questions about health and vision status, use of medication, and number of falls in the previous 12 months.RESULTS: Tests of visual function that had a statistically significant association with two or more falls after adjustment for confounders were visual acuity (prevalence ratio (PR) 1.9 for visual acuity worse than 20/30), contrast sensitivity (PR 1.2 for a 1‐unit decrease at 6 cycles per degree), and suprathreshold visual field screening (PR 1.5 for 5 or more points missing). However, only visual acuity and contrast sensitivity were significantly associated with two or more falls per 1 standard deviation decrease. The presence of posterior subcapsular cataract (PR 2.1) and use of nonmiotic glaucoma medication (PR 2.0) had a statistically significant association with two or more falls; presence of age‐related macular degeneration, diabetic retinopathy, and cortical or nuclear cataract did not.CONCLUSION: Visual impairment is strongly associated with two or more falls in older adults. In addition to poor visual acuity, visual factors such as reduced visual field, impaired contrast sensitivity, and the presence of cataract may explain this association.
Pemphigus Vulgaris in Older Adults
Authors: Tehranchi‐Nia Zohreh , Qureshi Tabarak A. , Ahmed A. Razzaque 
Published: April 2015

OBJECTIVE: Pemphigus vulgaris (PV) affects primarily middle‐aged persons in North America. Conventional therapy suggests use of high doses of systemic corticosteroids and immunosuppressive agents. We have observed a group of older patients with PV and determined their clinical characteristics, treatment, and clinical course.DESIGN, SETTING, AND PARTICIPANTS: Eighteen patients with PV, in whom the onset of the disease was at age 65 or older, were observed and followed at the New England Baptist Hospital in Boston, Massachusetts, between 1985 and 1992. We determined sex and race distribution, disease severity, clinical presentation, autoantibody levels, treatment, response to treatment, and clinical course in these patients.RESULTS: Men and women were affected equally. All the patients were white, and 50% were Jewish. Extensive disease was observed in only 27.8%. The disease was localized in 44.4%; in eight patients (44.4%), the use of sublesional corticosteroid (SLS) injection alone produced satisfactory clinical response. In patients with severe disease, the maximum dose of 60 mg/day of prednisone was sufficient. Patients with moderate disease responded to 20 to 40 mg/day of prednisone. Immunosuppressive agents were used in only four patients. The patients were followed for 3 to 15 years (mean 5.2 years). None of them died of the disease or the complications of therapy. At the time we reported this experience, most of the patients were in clinical remission without any therapy.CONCLUSIONS: Our observations suggest that prognosis for older patients with PV is favorable. In several older patients, PV was controlled by SLS or lower doses of systemic corticosteroids. Systemic agents should be used cautiously and judiciously, and supportive measures should be offered frequently and aggressively.