bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of Proxy Respondents in Studies of Older Adults: Lessons, Challenges, and Opportunities
Authors: Neumann Peter J. , Araki Sally S. , Gutterman Elane M. 
Published: April 2015

OBJECTIVE:Proxies play a critical role as sources of health information for older persons with cognitive impairment and other chronic debilitating conditions. This paper reviews the validity of proxy responses for people older than age 60 in the following areas: functioning, physical and mental health, cognition, medical care utilization, and preferences for types of care and health states.DESIGN:A Medline review identified 24 clinical studies from 1990 to 1999 that use proxy data as a source of information about older adults.RESULTS:In general, studies report fairly good agreement between subjects and proxies in assessments of functioning, physical health, and cognitive status, and fair‐to‐poor agreement in assessments of psychological well‐being. Proxies tend to describe more impairment in functioning and emotional well‐being, relative to subjects, a pattern that is particularly marked among persons with cognitive impairment. In addition, proxies who report more caregiver responsibilities and subjective stress from caregiver duties provide more negative assessments of subjects' health and well‐being.CONCLUSIONS:Findings tend to support the use of proxy ratings among older adults in many areas but not all when self‐reports are not feasible. There is a need for more evaluation of proxy data in relation to other measures, such as performance assessments, medical records, and claims data, which may be less subject to respondent biases.
The Relationship Between Cognitive/Neuropsychological Factors and Car Driving Performance in Older Adults
Authors: De Raedt Rudi , Ponjaert‐Kristoffersen Ingrid 
Published: April 2015

OBJECTIVES: Because demographic changes produce a society with a growing number of older people, seniors constitute the fastest growing segment of car drivers. The objective of this research project was to identify cognitive factors related to driving problems in older adults. A top‐down approach has been used, testing theory‐driven hypotheses.DESIGN: Correlational study.SETTING: Fitness‐to‐Drive Assessment Centre of the Belgian Road Safety Institute.PARTICIPANTS: The research sample consisted of 84 car drivers aged over 65 years, who were referred for a general fitness‐to‐drive evaluation.MEASUREMENTS: The relations between seven specific neuropsychological tests and self‐reported accidents were investigated. Furthermore, the relations between these same tests and a road test, independently assessed using a detailed evaluation grid, were analyzed in depth. These analyses were followed by stepwise multiple regression analyses.RESULTS: In a stepwise regression model, four neuropsychological tests could account for 64% of the variance of the score on the road test. Moreover, it could be demonstrated that specific cognitive subskills share common variance with specific real‐world situations. However, neuropsychological tests could explain only 19% of the variance of self‐reported at fault car accidents.CONCLUSIONS: The initial results of this study indicate the relevance of a cognitive/neuropsychological approach to the driving ability of older people. However, the link with accident risk seems more complex. Consequently, neuropsychological screening procedures are in need of a broader perspective to prevent an overemphasis on unidimensional screening procedures focusing mainly on deficit and less on capacities for safe behavior.
The Geriatric Pain Measure: Validity, Reliability and Factor Analysis
Authors: Ferrell Bruce A. , Stein Wendy M. , Beck John C. 
Published: April 2015

BACKGROUND: Pain is a multidimensional experience that should be evaluated beyond an estimate of intensity. A multidimensional pain measure has not been developed for older persons undergoing comprehensive geriatric assessment.OBJECTIVE: To develop and evaluate validity and reliability of a multidimensional pain assessment instrument for older persons.RESEARCH DESIGN: A series of steps in instrument development and evaluation.SUBJECTS: A total of 176 subjects (mean age 84 ± 6.0 years) in ambulatory geriatric clinics; 64% were women, and 73% had a history of chronic pain.MEASUREMENTS: Measurements included the Geriatric Pain Measure (GPM), the McGill Pain Questionnaire, Yesavage GDS, Katz ADLs, Lawton IADLs, Tinetti Gait and Balance, Folstein MMSE, and other demographic and clinical characteristics from interview and chart review.RESULTS: The GPM demonstrated a standardized alpha = 0.9445, homogeneity ratio =0.457, and average inter‐item correlation =0.415. A subgroup of 50 subjects demonstrated concurrent validity of the GPM in comparison with the McGill Pain Questionnaire (Pearson's r correlation 0.6269 (P < .0000). Test‐retest reliability was demonstrated in another subgroup of 50 subjects who repeated the GPM within 48 to 72 hours (Pearson's r = 0.9018; P < .0000). Factor analysis revealed five clusters of components: Pain Intensity, Disengagement, Pain with Ambulation, Pain with Strenuous Activities, and Pain with Other Activities.CONCLUSIONS: The GPM is a 24‐item questionnaire that is easy to administer and has significant validity and reliability in older persons with multiple medical problems. The GPM may be a useful addition to the multidimensional geriatric assessment process.
The Comorbidity Symptom Scale: A Combined Disease Inventory and Assessment of Symptom Severity
Authors: Crabtree H. L. , Gray C. S. , Hildreth A. J. , O'Connell J. E. , Brown J. 
Published: April 2015

OBJECTIVES: To develop and evaluate a scale to quantify the presence and severity of symptoms arising from comorbid diseases in older people.DESIGN: A validation cohort study of hospital inpatients and outpatients aged 65 years and older.SETTING: A Hospital and community in Northeast England.PARTICIPANTS: Development of the Comorbidity Symptom Scale ‐ Convenience sample of 50 hospital inpatients and outpatients aged 65 years and older. Evaluation of the Comorbidity Symptom Scale ‐ Convenience sample of 183 patients aged 65 years and older either awaiting cataract surgery or attending a geriatric day hospital.MEASUREMENTS: For development of the Comorbidity Symptom Scale, 22 comorbid conditions were identified and incorporated into a questionnaire (the CmSS). Evaluation of the Comorbidity Symptom Scale ‐ Assessments included the CmSS, activities of daily living, perceived health status, and anxiety and depression.RESULTS: A 23‐item scale was developed. Reliability of the CmSS was demonstrated by a test‐retest correlation coefficient for the total instrument score of r = 0. 87 (P < .001). The CmSS scores correlated with assessments of activities of daily living, perceived health status, and anxiety and depression.CONCLUSIONS: The CmSS is a simple interviewer‐administered tool for use in older people and provides an objective measure of the presence of comorbid disease and the patient's perception of severity of associated symptoms.
Do Hospital Fall Prevention Programs Work? A Systematic Review
Authors: Oliver David , Hopper Adrian , Seed Paul 
Published: April 2015

OBJECTIVES: To analyze published hospital fall prevention programs to determine whether there is any effect on fall rates. To review the methodological quality of those programs and the range of interventions used. To provide directions for further research.DESIGN: Systematic review of published hospital fall prevention programs. Meta‐analysis.METHODS: Keyword searches of Medline, CINAHL, monographs, and secondary references. All papers were included that described fall rates before and during intervention. Risk ratios and 95% Confidence Intervals (95% CI) were estimated and random effects meta‐analysis employed. Begg's test was applied to detect possible publication bias. Separate meta‐analysis regressions were performed to determine whether individual components of multifaceted interventions were effective.RESULTS: A total of 21 papers met the criteria (18 from North America), although only 10 contained sufficient data to allow calculation of confidence intervals. A rate ratio of <1 indicates a reduction in the fall rate, resulting from an intervention. Three were randomized controlled trials (pooled rate ratio 1.0 (CI 0.60, 1.68)), seven prospective studies with historical control (0.76 (CI 0.65, 0.88)). Pooled effect rate ratio from these 10 studies was 0.79 (CI 0.69, 0.89). The remaining 11 studies were prospective studies with historical control describing fall rates only. Individual components of interventions showed no significant benefit.DISCUSSION: The pooled effect of about 25% reduction in the fall rate may be a result of intervention but may also be biased by studies that used historical controls not allowing for historical trends in the fall rate before and during the intervention. The randomized controlled trials apparent lack of effect might be due to a change in practice when patients and controls were in the same unit at the same time during a study. Studies did not analyze compliance with the intervention or opportunity costs resulting from the intervention. Research and clinical programs in hospital fall prevention should pay more attention to study design and the nature of interventions.
MODELS OF GERIATRICS PRACTICE; The Hospital Elder Life Program: A Model of Care to Prevent Cognitive and Functional Decline in Older Hospitalized Patients
Authors: Reuben David B. , Inouye Sharon K. , Bogardus Sidney T. , Baker Dorothy I. , Leo‐Summers Linda , Cooney Leo M. 
Published: April 2015

OBJECTIVES: To describe the Hospital Elder Life Program, a new model of care designed to prevent functional and cognitive decline of older persons during hospitalization.PROGRAM STRUCTURE AND PROCESS: All patients aged ≥ 70 years on specified units are screened on admission for six risk factors (cognitive impairment, sleep deprivation, immobility, dehydration, vision or hearing impairment). Targeted interventions for these risk factors are implemented by an interdisciplinary team‐including a geriatric nurse specialist, Elder Life Specialists, trained volunteers, and geriatricians—who work closely with primary nurses. Other experts provide consultation at twice‐weekly interdisciplinary rounds.INTERVENTION: Adherence is carefully tracked. Quality assurance procedures and performance reviews are an integral part of the program.PROGRAM OUTCOMES: To date, 1507 patients have been enrolled during 1716 hospital admissions. The overall intervention adherence rate was 89% for at least partial adherence with all interventions during 37,131 patient‐days. Our results indicate that only 8% of admissions involved patients who declined by 2 or more points on MMSE and only 14% involved patients who declined by 2 or more points on ADL score. Comparative results for the control group from the clinical trial were 26% and 33%, and from previous studies 14 to 56% and 34 to 50% for cognitive and functional decline, respectively. Effectiveness of the program for delirium prevention and of the program's nonpharmacologic sleep protocol have been demonstrated previously.CONCLUSIONS: These results suggest that the Hospital Elder Life Program successfully prevents cognitive and functional decline in at‐risk older patients. The program is unique in its hospital‐wide focus; in providing skilled staff and volunteers to implement interventions; and in targeting practical interventions toward evidence‐based risk factors. Future studies are needed to evaluate cost‐effectiveness and long‐term outcomes of the program as well as its effectiveness in non‐hospital settings.
Delivery of Preventive Services to Older Black Patients Using Neighborhood Health Centers
Authors: Wright Paul J. , Fortinsky Richard H. , Covinsky Kenneth E. , Anderson Philip A. , Landefeld C. Seth 
Published: April 2015

OBJECTIVES: Older black patients are at risk for underutilization of preventive services. Our objectives were to assess the delivery of five preventive services in Title 330—funded health centers in low income neighborhoods in Cleveland, Ohio, and to determine the association of health system factors and health status with the delivery of these services.DESIGN: A cross‐sectional study.SETTING: Four neighborhood health centers in low income neighborhoods of Cleveland, Ohio.PARTICIPANTS: A total of 683 black men and women, aged 70 and older, who regarded the health center as their primary source of outpatient care.MEASUREMENTS: Demographic characteristics, independence in basic and instrumental activities of daily living, comorbidity scores, and perceived access were determined by telephone interview. We reviewed charts to determine whether each of five preventive service goals were obtained: influenza vaccination within 1 year; pneumococcal vaccination at any time; mammography within 2 years; Papanicolau screening within 1 year or twice at any time in the past with documentation of normal results; and fecal occult blood testing within 2 years.RESULTS: The defined goals for influenza vaccination, pneumococcal vaccination, mammography, Papanicolau screening, and fecal occult blood testing were achieved for 59%, 64%, 59%, 51%, and 17% of patients, respectively. Influenza and pneumococcal vaccines were obtained more often in persons with greater comorbidity. Mammography and Papanicolau smear were obtained more often in patients without of ADL or IADL impairments. The four clinical sites varied substantially in the delivery of each preventive service. More frequent office visits were associated with greater delivery of all five preventive services. This relationship persisted in multivariable analyses controlling for health status and clinical site.CONCLUSIONS: This study shows that Title 330 federally supported neighborhood health center sites providing primary care to older blacks in Cleveland achieved high rates of performance in four of the five recommended preventive services. In addition, preventive services practices were associated with prognostically relevant health status information. The frequency of office visits was related strongly and consistently to the performance of the various preventive services, indicating that more, not fewer, office visits may be necessary to achieve Healthy People 2000 targets. J Am Geriatr Soc 48: 124–130, 2000.
Determinants of Exercise Tolerance After Acute Myocardial Infarction in Older Persons
Authors: Marchionni Niccolò , Fattirolli Francesco , Fumagalli Stefano , Oldridge Neil B. , Del Lungo Francesco , Bonechi Francesco , Russo Laura , Cartei Alessandro , Mottino Giuseppe , Burgisser Costanza , Masotti Giulio 
Published: April 2015

OBJECTIVES: Exercise tolerance is reduced with advancing age. Identification of potentially reversible determinants of the age‐related decrement in exercise tolerance, which remain largely unexplored in older subjects and in patients recovering from a recent myocardial infarction (MI), may have useful therapeutic implications. The objective of this study was to identify the independent determinants of exercise tolerance in older patients with a recent MI.DESIGN, SETTING, AND PARTICIPANTS: Data is from baseline assessment of 265 post‐MI patients (age range 45–85 years) enrolled in the Cardiac Rehabilitation in Advanced Age randomized, controlled trial. Patients with major comorbidities or severe MI complications were excluded from the trial. Exercise tolerance was determined from symptom‐limited exercise testing and expressed as total work capacity (TWC, kg.m) or peak oxygen consumption (V̇o2peak, mL/kg/min). The associations between both TWC and V̇o2peak and baseline demographic, social, clinical, and neuropsychological variables and an index of health‐related quality of life were determined with univariate and multivariate analysis.RESULTS: With univariate analysis, TWC decreased by 1285 kg.m per decade of increasing age between 45 and 85 years of age. With multivariate analysis, TWC decreased by 922 kg.m per decade. Increasing age (P < .001), female gender (P < .001), a small body surface area (P < .001), a low level of usual physical exercise before MI (P < .002), and the presence of post‐MI depressive symptoms (P < .024) were independently associated with a lower TWC. The same factors, in addition to a small arm muscle area (P < .002), were also independently associated with a lower V̇o2PEAK.CONCLUSIONS: Age per se accounts for approximately 70% of the age‐related decay in TWC or V̇o2peak. However, the inclusion of modifiable factors such as physical exercise and depression in the prediction model reinforces the importance of a multidimensional approach to the evaluation and treatment of older patients with a recent MI. J Am Geriatr Soc 48: 146–153, 2000.
Modifiable Risk Factors Predict Functional Decline Among Older Women: A Prospectively Validated Clinical Prediction Tool
Authors: MD Catherine A. Sarkisian , Liu Honghu , Gutierrez Peter R. , Seeley Dana G. , Cummings Steven R. , MD Carol M. Mangione 
Published: April 2015

OBJECTIVE: To identify modifiable predictors of functional decline among community‐residing older women and to derive and validate a clinical prediction tool for functional decline based only on modifiable predictors.DESIGN: A prospective cohort study.SETTING: Four geographic areas of the United States.PARTICIPANTS: Community‐residing women older than age 65 recruited from population‐based listings between 1986 and 1988 (n = 6632).MEASUREMENTS: Modifiable predictors were considered to be those that a clinician seeing an older patient for the first time could reasonably expect to change over a 4‐year period: benzodiazepine use, depression, low exercise level, low social functioning, body‐mass index, poor visual acuity, low bone mineral density, slow gait, and weak grip. Known predictors of functional decline unlikely to be amenable to intervention included age, education, medical comorbidity, cognitive function, smoking history, and presence of previous spine fracture. All variables were measured at baseline; only modifiable predictors were candidates for the prediction tool. Functional decline was defined as loss of ability over the 4—year interval to perform one or more of five vigorous or eight basic daily activities.RESULTS: Slow gait, short‐acting benzodiazepine use, depression, low exercise level, and obesity were significant modifiable predictors of functional decline in both vigorous and basic activities. Weak grip predicted functional decline in vigorous activities, whereas long‐acting benzodiazepine use and poor visual acuity predicted functional decline in basic activities. A prediction rule based on these eight modifiable predictors classified women in the derivation set into three risk groups for decline in vigorous activities (12%, 25%, and 39% risk) and two risk groups for decline in basic activities (2% and 10% risk). In the validation set, the probabilities of functional decline were nearly identical.CONCLUSIONS: A substantial portion of the variation of functional decline can be attributed to risk factors amenable to intervention over the short term. Using eight modifiable predictors that can be identified in a single office visit, clinicians can identify older women at risk for functional decline. J Am Geriatr Soc 48: 170–178, 2000.
Decision‐Making Capacity to Execute A Health Care Proxy: Development and Testing of Guidelines
Authors: Mezey Mathy , Teresi Jeanne , Ramsey Gloria , Mitty Ethel , Bobrowitz Tracy 
Published: April 2015

OBJECTIVE: To evaluate the reliability and validity of guidelines to determine the capacity of nursing home residents to execute a health care proxy (HCP).DESIGN: A cross‐sectional study.SETTING: A 750‐bed not‐for‐profit nursing home located in New York City.PARTICIPANTS: A random sample of 200 nursing home residents: average age, 87; 99% white; 83% female; average length of stay, 3.05 years; mean Mini‐Mental State Exam (MMSE) score, 15.9.MEASUREMENTS: Demographic characteristics (Minimum Data Set (MDS)); function and cognitive status (Institutional Comprehensive Assessment and Referral Evaluation (INCARE)); Reisberg Dementia Staging; MMSE; Minimum Data Set‐Cognitive Performance Scale (MDS‐COGS)); an investigator‐developed measure of a nursing home resident's capacity to execute a health care proxy (Health Care Proxy (HCP) Guidelines.)RESULTS: The internal consistency of the decision‐making scales in the HCP Guidelines, paraphrased recall and recognition, reached acceptable levels, alphas of .85 and .73, respectively. Interrater reliability estimates were .92 and .94, respectively, for the recall and recognition scales; test‐retest reliability estimates were .83 and .90. The discriminant validity of these scales is promising. For example, the MMSE correlation was .51 with the Recall scale and .57 with the Recognition scale. Of residents with severe cognitive impairment (MMSE < 10), 71% completed 50% or more of the scaled items in the HCP guidelines and 95% consistently named a proxy.CONCLUSIONS: Seventy‐three percent of testable residents, approximately three‐quarters of whom were cognitively impaired, evidenced sufficient capacity to execute an HCP. Of residents with severe cognitive impairment, the HCP guidelines are potentially useful in identifying those with the capacity to execute a HCP. The guidelines are more predictive than the MMSE in identifying residents able to execute a HCP. J Am Geriatr Soc 48: 179–187, 2000.
The Effects of Childhood Residence in Japan and Testing Language on Cognitive Performance in Late Life Among Japanese American Men in Hawaii
Authors: Yano Katsuhiko , Grove John S , Masaki Kamal H , White Lon R , Petrovitch Helen , Chen Randi , Peng Evelyn L , Ross G Webster , Rodriguez Beatrix L , Curb J. David 
Published: April 2015

OBJECTIVES: To examine the association of years spent in Japan during childhood with cognitive test performance in late life among Japanese American men, and to assess the influence of the language used for testing on this association.DESIGN: A cross‐sectional study.SETTING/PARTICIPANTS: A total of 3734 Japanese American men, aged 71–93 years, who were first‐ or second‐generation migrants and living on Oahu Island, Hawaii.MEASUREMENTS: The outcome variable was cognitive test performance assessed using the Cognitive Abilities Screening Instrument (CASI), which was developed for cross‐cultural studies of cognitive impairment. The explanatory variable of main interest was the number of years spent in Japan during school‐age childhood years (ages 6–17). The associations of CASI scores with childhood years in Japan was evaluated using a stepwise multiple linear regression model in which a total of 40 potential confounders were included as covariates.RESULTS: In the total sample, there was an inverse association between CASI scores and middle childhood years in Japan. This association remained significant after controlling for age, education, socioeconomic status, traditional Japanese food consumption, pulmonary function, apolipoprotein E4, proficiency in speaking Japanese, and other possible confounders. When data were analyzed separately for subgroups according to the language preferred at testing (English or Japanese), associations between childhood years in Japan and CASI scores were in opposite directions negative for the group tested in English and positive for the group tested in Japanese. The interaction between the testing language and childhood years in Japan was statistically significant.CONCLUSIONS: There was an inverse association between years spent in Japan during school‐age years of childhood and cognitive test performance in late life. This association could not be accounted for by age, education, or other confounding factors. However, this finding was not observed in participants who preferred being tested in Japanese. To assess cognitive test performance in older people, it is of prime importance to use the most optimal language for testing, usually the subject's native language. J Am Geriatr Soc 48: 199–204, 2000.