bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time and Cost for Recruiting Older Adults
Authors: Taylor‐Davis Stephanie , Smiciklas‐Wright Helen , Davis Andrew C. , Jensen Gordon L. , Mitchell Diane C. 
Published: April 2015

OBJECTIVES: The purpose of this study was to examine the time requirements and costs of recruiting older adults for participation in a medical center‐/university‐sponsored, home‐based nutrition education study. A two‐step recruitment strategy consisting of an introductory letter followed by a telephone call was used.DESIGN: A random selection of 1300 individuals aged 60 to 74 years was drawn from a patient database of a large, rural, tertiary care hospital to receive introductory letters and recruitment telephone calls. One week after the mailing, potential subjects were contacted by trained interviewers and asked to participate in a home‐based nutrition education study.PARTICIPANTS: Men and women, aged 60 to 74 years, whose names appeared in a rural, tertiary care hospital database.MEASUREMENTS: Recruitment rate, time required for recruitment by telephone, and cost of the combined mailing and telephone recruitment effort.RESULTS: Of the 1300 individuals selected, 1077 (83%) people were contacted by phone and 223 (17%) people were unable to be reached. A total of 2895 calling attempts were required to determine the recruitment status of those identified as potential participants. Of those reached by phone, the recruitment rate was 45%. The total cost (mailing, telephone, and database management) per recruited subject was $8.56.CONCLUSION: This study has helped to establish the costs of recruitment for home‐based education interventions using a two‐step strategy of an introductory mailing and follow‐up telephone interview.
Attention, Frailty, and Falls: The Effect of a Manual Task on Basic Mobility
Authors: Lundin‐Olsson Lillemor , Nyberg Lars , Gustafson Yngve 
Published: April 2015

OBJECTIVE: To investigate the effect of a second task on balance and gait maneuvers used in everyday life. Our hypothesis was that those who were more distracted by a familiar manual task performed concurrently with functional maneuvers were more frail and more prone to falls.DESIGN: A cross‐sectional design with prospective follow‐up for falls.SETTING: Sheltered accommodation in Umeå, Sweden.PARTICIPANTS: Forty‐two residents (30 women, 12 men; mean age ± SD = 79.7 ± 6.1 years), ambulant with or without a walking aid, able to follow simple instructions and able to carry a tumbler.MEASUREMENTS: Timed Up & Go (TUG), i.e., the time taken to rise from an armchair, walk 3 meters, turn round, and sit down again. TUG was repeated with an added manual task (TUGmanual), which was to carry a glass of water while walking. The Montgomery‐Åsberg Depression Rating Scale, Barthel Index, Functional Reach, Mini‐Mental State Examination, and Line Bisection test were used to assess for frailty. The subjects were followed‐up prospectively regarding falls indoors for a period of 6‐months.RESULTS: Subjects with a time difference (diffTUG) between TUGmanual and TUG of ≥ 4.5 seconds were considered to be distracted by the second task. Ten subjects had a difference in time of ≥ 4.5 seconds. These subjects were more frail, and seven of them fell indoors during the follow‐up period (odds ratio 4.7, 95% Confidence Interval (CI) 1.5–14.2).CONCLUSION: The time difference between the TUGmanual and the TUG appears to be a valid marker of frailty and a useful tool for identifying older persons prone to falling.
Correlates of Prescription and Over‐the‐Counter Medication Usage Among Older Mexican Americans: The Hispanic EPESE Study
Authors: Espino David V. , Lichtenstein Michael J. , Hazuda Helen P. , Fabrizio Dennis , Wood Robert C. , Goodwin James , Stroup‐Benham Christine A. , Markides Kyriakos S. 
Published: April 2015

OBJECTIVES: To determine the prevalence rates of prescription and over‐the‐counter (OTC) medication usage among community‐dwelling older Mexican Americans.DESIGN: Cross‐sectional survey of a regional probability sample of older Mexican Americans.SETTING: The 1992–1997 Hispanic Established Population for the Epidemiologic Study of the Elderly (H‐EPESE), a probability sample of noninstitutionalized Mexican Americans, age 65 and over, living in the five Southwestern states of Texas, New Mexico, Colorado, Arizona, and California.PARTICIPANTS: 2899 persons, age 65 and over, considered Mexican American, using appropriate weighting procedures to produce regional estimates.OUTCOME MEASURES: Use of prescription and OTC medication within the last 2 weeks before the survey confirmed by in‐home review of medication containers.RESULTS: Medication users consumed a mean of 2.9 prescription and 1.3 OTC medications. Over half (58.9%, n = 1,798) of the participants used at least one prescribed medication, and 31.3% (n = 847) used at least one OTC medication within the 2 weeks before their participation in the study. Factors associated with both prescription and OTC medication usage were self‐perceived health and number of co‐morbid conditions. Factors associated only with prescription medication usage included female gender, alcohol usage, ADL dependency, and presence of additional insurance. Structural assimilation was associated only with OTC medication usage.CONCLUSIONS: These data show lower prevalence rates of prescription medication usage among Mexican American older men and lower rates of OTC medication usage in older Mexican Americans of both genders than previously reported in other ethnic groups. This may reflect differences in time and geographic location of the Hispanic EPESE relative to other EPESE studies, ethnic differences in access to care as reflected by insurance in addition to Medicare, ethnic differences in survival, especially among males, or ethnic differences in medication preferences.
Beliefs Concerning Death, Dying, and Hastening Death Among Older, Functionally Impaired Dutch Adults: A One‐Year Longitudinal Study
Authors: Sullivan Mark , Ormel Johan , Kempen G.I.J.M. , Tymstra Tj. 
Published: April 2015

OBJECTIVES: Population surveys have documented increasing public support for euthanasia and assisted suicide but have not focused on the population of chronically ill older persons, obtained detailed sociocultural or health status information, or performed repeat assessments. This study seeks to describe the views of functionally‐impaired Dutch elders on death, dying, and hastened death and to relate these to sociocultural and health status.DESIGN: One‐year prospective epidemiologic survey.SETTING AND PARTICIPANTS: Community‐dwelling participants in the longitudinal component of the Groningen Longitudinal Aging Study were assessed at home by interview and questionnaire in 1994 (n=632) and again in 1995 (n=575).MEASUREMENTS: Independent variables were sociocultural characteristics (eg, age, sex, income, education, religious affiliation, strength of religious belief), physical health status (number of chronic medical conditions, functional impairments), and mental health status (life satisfaction, self‐efficacy, anxiety, depression, and neuroticism). Dependent variables were preoccupation with and fear of death, fears of the dying process, and attitudes toward hastened death.RESULTS: Low and stable rates of preoccupation with death and fear of death were found. Occasional but not persistent fears about the dying process were common. Fears of death and dying were most closely related to health status, especially mental health status. Views concerning hastening death were most strongly related to sociocultural variables, especially religious belief and affiliation. There was little change over the 1‐year follow‐up, with a trend toward less fears of death and dying and less support for hastened death. Significant changes in fears of death and dying and attitudes toward hastened death were not seen even in the 25% of subjects with the greatest deterioration in activities of daily living or greatest increase in anxiety and depression during the 1‐year follow‐up.CONCLUSION: Beliefs about death, dying, and hastened death are stable over 1‐year follow‐up. Fears of death and dying are most strongly related to mental health in this community sample. Attitudes about hastening death are primarily related to religious belief and secondarily to mental health. Mental health factors may determine the distress associated with the prospect of death and dying, whereas religion may dictate the actions considered proper when dying.
An Operation Under General Anesthesia as a Risk Factor for Age‐Related Cognitive Decline: Results from a Large Cross‐Sectional Population Study
Authors: Dijkstra Jeanette B. , Van Boxtel Martin P.J. , Houx Peter J. , Jolles Jellemer 
Published: April 2015

OBJECTIVE: To evaluate the factor ‘operation under general anesthesia’ as a possible risk factor for age‐related cognitive decline.DESIGN: A retrospective, population‐based, cross‐sectional study.SETTING: Maastricht Aging Study (MAAS), Maastricht, The Netherlands.PARTICIPANTS: 1257 normal healthy subjects aged 24 to 86 years. Of the 1257 healthy subjects, 946 subjects appeared to have undergone at least one operation under general anesthesia.MEASUREMENTS: The history of an operation under general anesthesia, number of operations, duration of anesthesia, cognitive performance, subjective health, and subjective memory were measured.RESULTS: A history of an operation under general anesthesia, the number of operations, and the total duration of anesthesia significantly contributed to the number of subjective health‐related complaints but did not predict cognitive performance or memory complaints. Subjects with a history of an operation under general anesthesia felt less healthy than subjects who had never undergone an operation under general anesthesia. No interactions with age were found.CONCLUSION: The present study found no support for the notion that a history of an operation under general anesthesia is a determinant or risk factor for accelerated age‐related cognitive decline.
The Relationship Between Insomnia and Mortality Among Community‐Dwelling Older Women
Authors: Althuis Michelle D. , Fredman Lisa , Langenberg Patricia W. , Magaziner Jay 
Published: April 2015

OBJECTIVES: To investigate the relationship between insomnia and 6‐year survival among older, community‐dwelling, white women.DESIGN: Longitudinal study.SETTING: The sample was selected randomly from a 20‐census tract area of Baltimore, Maryland.PARTICIPANTS: In 1984, 778 women aged 65 years and older participated in the baseline survey; 613 were re‐interviewed in 1985; 596 were reinterviewed in 1986.MEASUREMENTS: Insomnia was measured as self‐report of at least one of three sleep complaints: trouble initiating sleep, waking at night and trouble falling back to sleep, and waking too early. Cox proportional hazards models were used to assess the relationship between insomnia, as reported at the most recent of three interviews, and mortality.RESULTS: Twenty‐nine percent of the sample reported trouble initiating sleep, 22.4% reported waking at night and having trouble falling back to sleep, and 26.6% reported waking too early. Of the sample, 43.2% had insomnia at the baseline interview; 23.2% percent of respondents with insomnia at baseline died during the follow‐up period compared with 22.0% of those without insomnia at baseline. Recent insomnia was not associated significantly with mortality in either crude analyses (Hazards Ratio (HR)=1.11, 95% CI, 0.78–1.60) or analyses adjusted for age, prescription medication use, functional limitations, self‐rated health, and number of chronic conditions (HR=0.74, 95% CI, 0.50–1.09).CONCLUSION: Our results, combined with the results from previous studies, suggest strongly that insomnia is not an indicator of approaching mortality in older community‐dwelling populations.
Arginine Vasopressin Levels in Nursing Home Residents with Nighttime Urinary Incontinence
Authors: Ouslander Joseph G. , Nasr Samer Z. , Miller Myron , Withington Wendy , Lee Carol S. , Wiltshire‐Clement Michelle , Cruise Patrice , Schnelle John F. 
Published: April 2015

OBJECTIVES: To examine the relationship between diurnal urine volume and plasma arginine vasopressin levels (AVP) in nursing home residents with nighttime urinary incontinence and a comparison group of frail but nondemented, continent geriatric board and care residents.DESIGN: Case series.SETTING: Four nursing homes and two board and care facilities.PARTICIPANTS: Sixty‐two nursing home residents and 27 board and care residents.MEASUREMENTS: Daytime (7:00 a.m. to 7:00 p.m.) and nighttime (7:00 p.m. to 7:00 a.m.) urine volumes of incontinent nursing home residents were measured over 3 days and 3 nights by reweighing preweighed adults diapers and toileting inserts emptied by research staff for the comparison group. AVP levels were drawn in the early morning (5:00 a.m. to 7:00 a.m.) before subjects arose and in the evening after an hour of lying in bed (8:00 p.m. to 11:00 p.m.), and plasma levels were determined by radioimmunoassay.RESULTS: Half of the nursing home residents and 82% of the comparison group had night/total urine volume ratios ± 50%. Forty‐nine percent of the total of 89 subjects had undetectable morning AVP levels, 61% had undetectable evening AVP levels, and 42% had undetectable AVP levels in both morning and evening. There were no significant differences in AVP levels between those with night/total urine volume ratios ± 50% and < 50% in either the nursing home or comparison groups though the small number of comparison group subjects with ratios < 50% may have limited our statistical power to detect differences.CONCLUSION: Our data suggest that a substantial proportion of both nursing home residents with nighttime incontinence and frail geriatric patients with a reversal of the normal diurnal pattern of urine excretion have an accompanying deficiency in AVP production and/or secretion. More detailed physiologic studies are needed to understand better the pathophysiology of geriatric nocturia and nighttime incontinence and the role that AVP deficiency may play in these conditions. Until such studies are carried out, we do not recommend the routine use of exogenous AVP for geriatric patients with unexplained nocturnal polyuria.
Congestive Heart Failure and Cognitive Impairment in an Older Population
Authors: Cacciatore Francesco , Abete Pasquale , Ferrara Nicola , Calabrese Claudio , Napoli Claudio , Maggi Stefania , Varricchio Michele , Rengo Franco ,   Osservatorio Geriatrico Campano Study Group
Published: April 2015

OBJECTIVE: Congestive heart failure (CHF) is potentially preventable, and the identification of modifiable risk factors for cognitive impairment (CI) for older persons is a very important issue. We examined the cross‐sectional relationship between CHF and CI in an older population.DESIGN: A cross‐sectional survey.SETTING AND PARTICIPANTS: A total of 1339 subjects aged 65 and older were selected from the electoral rolls of Campania, a region of southern Italy.MEASUREMENTS: Sociodemographic characteristics were recorded, as was the presence of cardiovascular diseases, including CHF classified according to the New York Heart Association (NYHA) guidelines for disease severity; CI evaluated by means of the Mini‐Mental State Examination (MMSE), with a score of <24 indicating impairment; geriatric depression scale (GDS) rating; blood pressure (BP); and heart rate (HR).RESULTS: The final sample numbered 1075; 172 subjects were excluded because of neurological disorders and psychotropic therapy, and 92 were excluded because their BP, HR, or cognitive examination was not recorded. Prevalence of CHF was 8.2%, and 23.0% of subjects scored <24 on the MMSE. The prevalence of CHF in subjects with an MMSE score of <24 and ≥24 was 20.2% and 4.6%, respectively (P < .001). Logistic regression analysis showed that CHF was associated independently with CI by sex, age, educational level, GDS, diabetes, hypertension, alcohol consumption, smoking, atrial fibrillation, systolic and diastolic BP, and HR. The risk of CI was 1.96‐fold greater in subjects with CHF (odds ratio: 1.96; 95% confidence interval: 1.07–3.58; P < .028). Systolic BP decrease was correlated negatively with NYHA classes only in subjects with CI (r = −0.981; P < .020), whereas HR increase was correlated positively with NYHA classes only in subjects without CI (r = 0.985; P < .015).CONCLUSIONS: In our population, CHF is associated with CI in subjects aged 65 years and older. Systolic BP reduction and the lack of HR increase, related to NYHA classes, might characterize cognitively impaired subjects with CHF.
Improving Balance
Authors: Robbins Steven , Waked Edward , Krouglicof Nicholas 
Published: April 2015

OBJECTIVE: To test the hypothesis that shoes made with a sole material that retains compressed thickness between steps (low resiliency) provide balance better than and comfort equal to shoes composed of high resiliency sole material.SETTING: Older subjects were recruited from a medical clinic population, and younger subjects came from a recreational sports population.DESIGN: A randomized‐order, cross‐over, controlled comparison design.PARTICIPANTS: Groups comprised random samples of 30 older (mean age 66 years, SD ± 3.0), and 30 younger (mean age 34 years, SD ± 6.0) healthy men who met age selection criteria.MEASUREMENTS: Stability was inferred by sway measures: sway velocity (cms−1), X‐Y area (cm2), and radial area (cm2). Comfort was measured by direct scaling and magnitude estimation using an 11‐point ratio scale.RESULTS: Stability inferred by sway velocity was 311% (P < .001) and 31 % (P < .001) poorer for younger and older groups, respectively, for high and low resiliency interfaces. Sway velocity with low resiliency interface was lower than bare platform, the lowest ever recorded under equivalent conditions (P < .001). All interfaces were equally comfortable.CONCLUSIONS: Stability rises with low resiliency interfaces and declines with high resiliency interfaces: sway velocity in older people wearing hard‐soled footwear incorporating low resiliency technology would be 20% lower than in younger people wearing most current athletic and walking shoes. Inasmuch as existing theory can not account for improved balance with interfaces, we propose that when humans are supported by rigid support surfaces, elastic biologic tissues store energy from postural adjustments and locomotion, which is returned as a reaction force causing overshoot. This amplifies frontal plane foot movement and attenuates foot position awareness, causing less precise postural adjustments and instability. Low resiliency interfaces dissipate energy and thereby moderate overshoot. Low resiliency interface technology is capable of improving stability, which portends improved health for unstable older people in particular.
Cost of Health Care for a Community of Older Adults in an Urban Academic Healthcare System
Authors: Callahan Christopher M. , Stump Timothy E. , Stroupe Kevin T. , Tierney William M. 
Published: April 2015

BACKGROUND: Urban academic medical centers provide care for large populations of vulnerable older adults. These patients often suffer a disproportionate share of chronic illnesses, disabilities, and social stressors that may increase health care costs.OBJECTIVE: To describe the distribution and content of total healthcare costs accrued over a 4‐year period by a community of older adults cared for in an urban academic healthcare system and to describe high‐cost patients and utilization patterns.DESIGN: A cohort study.SETTING: A tax‐supported public healthcare system consisting of a 450‐bed hospital and seven community‐based ambulatory care centers.PATIENTS: 12,581 patients aged 60 years and older who had at least two ambulatory visits and/or one hospitalization within the healthcare system from 1993 through 1995.MEASUREMENTS: Patient demographic and clinical characteristics, hospital and ambulatory utilization rates, and all healthcare costs accrued from 1993 through 1996 were determined. Costs were estimated from the perspective of the healthcare system using cost to charge ratios.MAIN RESULTS: The mean patient age was 70 years, 60% were women, 44% were Black, and 83% were covered by Medicare and/or Medicaid. Nearly 25% of patients were obese, 15.8% had a history of smoking, and 15.5% had evidence of malnutrition. The mean number of ambulatory visits per year was 4.3 (± 7.2), and 38.1% of patients had been hospitalized one or more times. Within the 4‐year window, 24.1% of patients had missed five or more appointments with their primary care physicians, 32.7% of patients had five or more unscheduled clinic visits, and 12.5% had five or more emergency room visits. Total health care costs for 4 years for this cohort of older adults was $125.2 million dollars, with per capita annual mean costs of $3893. Expenditures associated with hospitalizations accounted for 63.6% of healthcare costs. Total inpatient and outpatient costs for the 38% of patients hospitalized at least once accounted for 85.3% of all health care expenditures. Patients who died in the hospital did not accrue significantly greater costs than patients who died out of the hospital. Simulations of a random 5% adverse selection of high‐cost patients among two capitated systems resulted in cost shifts of $11.1 million. Recorded smoking history, obesity, and low serum albumin were significantly associated with excess costs.CONCLUSIONS: Healthcare costs are concentrated in a significant minority of older adults. Costs accrued in conjunction with hospital stays dominate healthcare expenditures for this cohort of older adults. However, most older adults (83%) have one or fewer hospital episodes in a 4‐year period. Although patients who died accrued greater healthcare costs, these costs were not higher when the death occurred in the hospital. Self‐care behaviors are an important target for interventions to reduce costs.