bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting Bacteremia in Older Patients
Authors: Pfitzenmeyer P. , Decrey H. , Auckenthaler R. , Michel J. P. 
Published: April 2015

Predicting Bacteremia in Older PatientsOBJECTIVE: To evaluate potential clinical predictors of bacteremia in hospitalized geriatric patients and to propose an individual risk score as an alternative to “subjective” clinical judgment for a more efficient approach in early recognition and treatment of bacteremia.DESIGN: A 16‐month prospective study.SETTING: The University Geriatric Hospital of Geneva, Switzerland.PATIENTS: Four hundred thirty‐eight patients aged 62 years or older in whom 558 episodes of bacteremia were suspected.MEASUREMENTS: The unit of evaluation was the blood culture episode, which was defined as a 48‐hour period beginning with the drawing of the first blood for culture. An extensive precoded protocol, including clinical and biological data, was completed by the resident who requested the blood cultures. For each episode, the resident also provided a subjective assessment of the probability of bacteremia. Odds ratios and their variances were used to estimate the relative risks of potential predictors of bacteremia. The performance of a predictive clinical model based on risk score threshold was evaluated by means of a receiver‐operating characteristic analysis.RESULTS: Of the 558 potentially bacteremic episodes investigated, 46 (8.2%) yielded positive blood cultures. The bacteremia rate was strongly associated with the type of episode: it reached 15.6% among the community‐acquired (CA) episodes (those occurring within 48 hours of hospital admission) and 6.0% only among the hospital‐acquired (HA) episodes (those occurring after the first two days of hospitalization). Predictors of bacteremia with highest relative risks included: bladder catheter removal, fever (≥38.5°C), rigors, shock, total band count ≥ 1500/mm3, and lymphocyte count ≤ 1000/mm3. When assessed by episode type, it appeared that bladder catheter removal and rigors were good predictors of bacteremia in HA episodes only, whereas fever (≥38.5°C) had a good predictive value in CA episodes only. The performance of the clinical model was two times better than the physician's subjective ability to predict bacteremia when the threshold of the risk score was fixed at two or more predictors per episode.CONCLUSIONS: These findings provide means to identify older hospitalized patients at high risk of bacteremia. Although the proposed predictive model will need further validation and more precise evaluation of the potential benefits, it may nevertheless be of some help in early recognition and treatment of bacteremia. J Am Geriatr Soc 43: 230–235, 1995.
Elevated Plasma Levels of Interleukin‐6 in Postmenopausal Women Do Not Correlate with Bone Density
Authors: Kania D. M. , Binkley N. , Checovich M. , Havighurst T. , Schilling M. , Ershler W. B. 
Published: April 2015

Elevated Plasma Levels of Interleukin‐6 in Postmenopausal Women Do Not Correlate with Bone DensityOBJECTIVE: To determine if plasma levels of Interleukin‐6 (IL‐6) across the lifespan correlate with bone density or plasma osteocalcin.DESIGN: Cross‐sectional study.PARTICIPANTS: Forty‐five healthy community‐dwelling volunteers aged 25–74 years. Exclusion criteria were smoking, use of medications known to affect bone metabolism (corticosteroids, heparin, thyroxine, thiazides, and anticonvulsants), and presence of chronic inflammatory disease.MEASUREMENTS: Bone density was measured by dual‐energy X‐ray absorptiometry at the femoral neck and lumbar spine. Plasma levels of IL‐6 and osteocalcin were determined by ELISA and RIA, respectively.RESULTS: Plasma levels of IL‐6 increased with advancing age (P <.0001) and correlated with postmenopausal status (P < .0001). No correlation was observed between plasma IL‐6 level and bone mineral density at either the lumbar spine or femoral neck, and none was observed with plasma osteocalcin.CONCLUSIONS: The elevation of plasma IL‐6 observed following menopause is consistent with the proposed importance of estrogen in the regulation of IL‐6. These findings do not provide support for a role of IL‐6 in determination of peak bone density or subsequent development of osteoporosis. However, it is possible that plasma levels of IL‐6 differ from those in the bone microenvironment. J Am Geriatr Soc 43: 236–239, 1995.
Clinical Spectrum of Tuberculosis in Older Patients
Authors: Liaw Yuang‐Shuang , Yang Pan‐Chyr , Yu Chong‐Jen , Wu Zen‐Guang , Chang Dun‐Bing , Lee Li‐Na , Kuo Sow‐Hsong , Luh Kwen‐Tay 
Published: April 2015

Clinical Spectrum of Tuberculosis in Older PatientsOBJECTIVE: To investigate the clinical differences between old and young patients infected with Mycobacterium tuberculosis in a developing country.DESIGN: Retrospective chart and chest radiograph review.SETTING: A university‐affiliated teaching hospital.PATIENTS: The medical records of patients with documented tuberculosis (TB) from January 1990 through December 1991 were analyzed. Clinical assessment included sex, age, diagnosis at first visit, past history, symptoms and signs, laboratory data, X‐ray findings, bacteriological examinations, outcome, time elapsed from first visit to initiation of anti‐TB therapy and the major determinants for starting anti‐TB therapy. Statistical significances were analyzed by Student's t test and χ2 tests.RESULTS: Among 205 patients with culture‐proven TB, 57 were 65 years of age and older (range, 65 to 91; mean, 73) and 148 under 65 years of age (range, 16 to 64; mean, 41). There was a higher incidence of previous TB (26.3% vs. 16.2%) and diabetes mellitus (24.5% vs. 14.3%) in the elderly patients. Initial diagnosis of TB at first visit was less frequent in the elderly than in the young group (38.6% vs. 47.3%), although symptoms and signs at first visit were similar in each of the age groups. Radiographic presentation with mass lesions was more frequently encountered in elderly patients (10.5% vs. 2.1%, P <.05). Elapsed time from the first visit to suspicion of TB and the initiation of anti‐TB therapy was frequently delayed in elderly patients (22 ± 23 vs. 13 ± 20 days, P <.05). The incidence of drug‐resistance (39% vs. 16%, P <.05) and unfavorable response to anti‐TB therapy (17.5% vs. 3.4%, P <.05) were significantly higher in the older patients.CONCLUSIONS: Although clinical presentation of TB in the elderly did not differ significantly from that in younger patients, this study showed that diagnosis and treatment were more often delayed in the elderly, and there was a higher incidence of treatment failure. J Am Geriatr Soc 43: 256–260, 1995.
Predictors of Pap Smear Screening in Socioeconomically Disadvantaged Elderly Women
Authors: Weinrich Sally , Coker Ann L. , Weinrich Martin , Eleazer G. Paul , Greene Frederick L. 
Published: April 2015

Predictors of Pap Smear Screening in Socioeconomically Disadvantaged Elderly WomenOBJECTIVE: The objective for this study was to identify predictors for participation in Pap smear screening in a socioeconomically disadvantaged older population.DESIGN AND SAMPLE: A cross‐sectional survey design was used to examine data from 238 southern women 50 years of age and older who were recruited from 24 randomly selected congregate meal sites of the Council on Aging.MEASUREMENTS: The 45‐item questionnaire covered demographics, Pap smear screening history, and colorectal cancer screening history.RESULTS: Among this older, very low income population, women who had never had Pap smears (17.2%) were significantly more likely to have no phone or to be unable to use a phone (adjusted odds ratio (aOR) = 4.1; 95% confidence interval (CI) 1.6–10.6), to have annual incomes of less than $5,800 (aOR = 3.1; 95% CI 1.1–9.0), to be widowed (aOR = 2.8; 95% CI 1.1–7.3), to have no family history of cancer (aOR = 3.3, 95% CI 1.3–10.0), to report having never had a rectal examination (aOR = 5.4, 95% CI 1.8–16.0), and not to have participated in a free fecal occult blood testing program (aOR = 5.0, 95% CI 2.0–10.0).CONCLUSIONS: These data, unique in including very low income (<$10,000) and older women (65 and over), found that income and access to a phone were strongly correlated with cervical cancer screening participation. Women who lacked external incentives for screening (being widowed and not having a family history of cancer) were less likely to obtain screening. This study's finding that “not having a phone” was a strong predictor for nonparticipation in cervical cancer screening has implications for national telephone‐derived estimates of cervical cancer screening. J Am Geriatr Soc 43: 267–270, 1995.
The Contribution of Predisposing and Situational Risk Factors to Serious Fall Injuries
Authors: Tinetti Mary E. , Doucette John T. , Claus Elizabeth B. 
Published: April 2015

OBJECTIVES: The objectives were to identify situational risk factors associated with suffering a serious fall injury and to determine whether, and to what extent, predisposing and situational risk factors contributed independently to risk of suffering a serious fall injury.DESIGN: Nested cohort study.SETTING: General community.PARTICIPANTS: 568 members of a representative sample of community‐living persons 72 years of age or older who fell during a median follow‐up of 36 months.MEASUREMENTS: Candidate predisposing factors, identified during a baseline face‐to‐face home assessment, were the demographic, cognitive, medical, and physical performance measures associated with an increased risk of serious injury among fallers in a previous analysis of the cohort. Acute host, behavioral, and environmental factors present at the time of the participants' first reported fall constituted potential situational risk factors. The primary outcome was occurrence of a serious fall injury, defined as a fracture, joint dislocation, or head injury resulting in loss of consciousness and hospitalization, during the first fall recorded during follow‐up.RESULTS: Sixty‐nine subjects (12%) suffered a serious injury during their first reported fall. No acute host factor was associated with increased risk of injury. The environmental and activity factors associated independently with serious injury in multivariate analysis included falling on stairs (adjusted relative risk 2.0; 95% confidence intervals 1.1 – 3.5), during displacing activity (1.8; 1.0 – 3.0), and from at least body height (2.1; 1.0 – 4.7). The independent predisposing factors included female gender (2.1; 1.0 – 4.4), low body mass index (1.8; 1.2 – 2.9), and cognitive impairment (2.8; 1.7 –4.7). Although 12% of first falls resulted in a serious injury overall, this percentage ranged from 0% to 36% as the number of predisposing risk factors increased from zero to three and from 5% to 40% as the number of situational risk factors increased from zero to three. Further, for any given number of predisposing risk factors, the percentage of fallers suffering a serious injury increased with the number of situational risk factorsCONCLUSIONS: Several environmental and behavioral factors contributed to the risk of serious fall injury; this contribution was independent of the effect of chronic predisposing risk factors. Preventive programs that address both predisposing and situational risk factors may result in the greatest injury reduction. These findings support previously recommended multicomponent intervention programs that combine medical, rehabilitative, and environmental components. J Am Geriatr Soc 43:1207–1213,1995.
The Event‐Related P300 Potential Approach to Cognitive Functions of Nondemented Patients with Cerebral and Peripheral Arteriosclerosis
Authors: Kiigler Christian F.A. , Vlajic Predrag , Funk Harald , Raithel Dieter , Platt Dieter 
Published: April 2015

OBJECTIVES: To detect subtle cognitive dysfunction in non‐demented patients with either cerebral (cAD) or peripheral (pAD) arteriosclerotic disease, and to evaluate in these patients the effects on cognitive functions of carotid endarterec to my and bypass surgery, respectively.DESIGN: Case‐control study.SETTING: Tertiary care referral center.PARTICIPANTS: Eighty consecutive patients with moderate to high‐grade stenosis of the internal carotid artery (ICA) (mean age plusmn SD, 62plusmn 8 years), 53 patients with stenoses of the peripheral arteries (60plusmn10 years), and 80 healthy volunteers (58plusmn15 years) enrolled in a study on healthy aging. Cerebral and peripheral arteriosclerotic disease was verified by digital subtraction angiography, and all patients were screened for confounding effects of concomitant diseases.MAIN OUTCOME MEASURES: Cognitive functions by event‐related visual P300 potentials.RESULTS: Patients with cAD showed prolonged P300 latencies and reduced P300 amplitudes, whereas pAD patients had reduced P300 amplitudes only. On an individual scale, 25% of cAD patients, but only 6% of pAD patients, revealed P300 abnormalities. In the cAD, but not in the pAD patients, the P300 latencies were especially prolonged in the older patients, but other factors such as sex, cerebral symptoms, degree of ICA stenosis, and premorbid intelligence did not play any role in either group. Within 1 to 2 weeks of surgery, the P300 latencies shortened in both cAD and pAD patients with high initial values.CONCLUSIONS: As demonstrated by P300 potentials, even nondemented arteriosclerotic patients reveal signs of subtle cognitive dysfunction affecting especially the older cAD patient. In the short‐term, carotid endarterectomy presumably improves cognitive functions unspecifically in nondemented patients with a higher initial degree of P300 abnormality.
Measuring the Psychosocial Impact of Urinary Incontinence: The York Incontinence Perceptions Scale (YIPS)
Authors: Lee Paul S. , Reid David W. , Saltmarche Anita , Linton Lyn 
Published: April 2015

OBJECTIVE: The York Incontinence Perceptions Scale (YIPS) was developed to measure the psychosocial aspects of urinary incontinence and its management.DESIGN: Testing of internal consistency and validity of the YIPS.SETTING AND PARTICIPANTS: Subjects were 101 female rural community residents (mean age = 67.4 years) diagnosed with urinary incontinence and participating in a 25‐week longitudinal randomized control study testing the efficacy of treating incontinence with a behavioral/educational intervention.MEASUREMENTS: Participants completed the YIPS, a bladder chart monitoring daily incontinence episodes, the Aids to Living Scale, the Incontinence Impact Questionnaire, and single‐item ratings of self‐perceptions of amount of leakage, continence status, and overall health status.MAIN RESULTS: The YIPS had high internal consistency (a = .78). Positive adjustment on the YIPS was correlated with lower frequency of incontinence (r = ‐.44), and self‐ratings of improvement in amount of leakage (r = .60), improved continence status (r = .38), and overall health status (r = .32). At the end of the 25‐week treatment period, the participants in the treatment group reported a more positive adjustment on the YIPS than did participants in the control group (t[99] = 4.78, P < .001), which was concordant with a reduction in the incidence of incontinence in the treatment group (F [l, 91] = 6.95, P<.01).CONCLUSIONS: The YIPS is a brief, yet reliable, instrument that addresses such psychosocial issues as coping, control, and acceptance of incontinence.
Causes of Increasing Mortality in a Nursing Home Population
Authors: Holtzman Jeremy , Lurie Nicole 
Published: April 2015

OBJECTIVE: To examine the roles played by changes in case‐mix, quality of care, and aggressiveness of care in explaining the 42% increase in mortality of the Medicaid nursing home population of Hennepin County, Minnesota, between 1984 and 1988.DESIGN: Retrospective chart review.SETTING: All nursing homes in Hennepin County, MN, that care for Medicaid patients.PATIENTS: A random sample of 1605 Medicaid nursing home residents from 1984 and 1988 stratified by year and by whether the resident died in that year. Sampling was disproportionate to allow approximately 400 individuals per stratum. A total of 1405 charts (87%) were reviewed; the remainder were either lost or destroyed.MAIN OUTCOME MEASURES: Measures included case‐mix (Charlson index, functional status, implicit reviewer assigned severity [range 1–4]), aggressiveness of care (orders limiting care), quality of care (process of care for tracer conditions [range 1–5], falls), and resident death.RESULTS: Implicitly rated severity of illness worsened between 1984 and 1988 (2.77 vs 2.91; P = .009), but other measures of case‐mix were unchanged. A greater percentage of residents had a DNR order in 1988 (12% in 1984 vs 37% in 1988; P < .001), and more received less aggressive care (31% vs 40%; P = .006). Overall process of care improved between 1984 and 1988 (2.88 vs 3.01; P < .05). With adjustment of the mortality rates and with logistic regression controlling for age and gender, changes in quality of care alone accounted for less than 5% of the mortality rate change between 1984 and 1988, case‐mix alone accounted for 49%, and aggressiveness of care alone accounted for nearly 100%.CONCLUSIONS: The nursing home population became sicker between 1984 and 1988, but process of care improved. These changes had a modest effect on the mortality rate. The increase in less aggressive care between 1984 and 1988 accounts for nearly all of the increase in mortality. J Am Geriatr Soc 44:258–264, 1996.
Focused Assessment of Foot Care in Older Adults
Authors: Plummer E. Sharon , Albert Stewart G. 
Published: April 2015

OBJECTIVES: The purpose of this study was to investigate the prevalence and characteristics of foot problems in non‐diabetic individuals compared with those in a diabetic population in order to develop recommendations for preventive foot care in older people.DESIGN: Retrospective review of a convenience sample of all patients referred to a Foot Care Service during a 24‐month period.SETTING: University Health Sciences Center.PARTICIPANTS: A total of 308 patients aged 33 to 95 years (176 women and 132 men), of whom 183 had diabetes mellitus (DM) and 125 were without DM.INTERVENTION: Each subject had a detailed history of foot care behavior and a thorough foot examination for peripheral neuropathy (PN), peripheral vascular disease (PVD), and foot deformities. PN was evaluated using the Semmes‐Weinstein monofilament test. PVD was graded by clinical measures and Doppler examination (ankle: brachial index < 0.8).MEASUREMENTS: Forty‐three percent of subjects with diabetes had PN, 32% had PVD, and 19% had both conditions. Eighteen percent of subjects without diabetes had PN, 21% had PVD, and 6% had both. The risk of foot abnormalities in those without DM increased with age (r = .99, P = .0002). Thirty‐eight percent of non‐diabetic patients older than age 60 had one or more of these major risk factors and would be considered at high risk for the development of foot ulcers or amputation. Ninety percent of the subjects reported inappropriate foot care practices. Forty‐seven percent of non‐diabetic individuals with PN or PVD wore inappropriate shoes.CONCLUSION: Older individuals without DM are at high risk for foot‐related disease and should receive the same foot care screening, education, and follow‐up as those with DM. Older people who have PN, PVD, or physical and psychosocial limitations, may require referral to foot care specialists. J Am Geriatr Soc 44:310–313, 1996.
The Relationship Between Alcohol Consumption, Cognitive Performance, and Daily Functioning in an Urban Sample of Older Black Americans
Authors: Hendrie Hugh C. , Gao Sujuan , Hall Kathleen S. , Hui Siu L. , Unverzagt Frederick W. 
Published: April 2015

OBJECTIVE: To report on moderate alcohol consumption and measurements of cognitive function and activities of daily living in an older, urban, community‐dwelling sample of black Americans.DESIGN: As part of a community prevalence study of dementia, information on alcohol consumption and cognitive performance was collected on 2040 randomly selected black subjects living in Indianapolis.MEASUREMENTS: From questions in the screening interview, alcohol consumption was grouped into four categories: lifetime abstainers, regular drinkers less than 4 drinks per week, 4 to 10 drinks per week, and more than 10 drinks per week. Current and past drinkers were analyzed separately. Three measurements were used: (1) a total cognitive score; (2) the delayed recall score from the East Boston Memory Test; (3) a score for daily functioning based upon information from the informant. Multiple regression models were fitted with drinking variables as the major predictor, including covariates of age, gender, education, history of stroke, hypertension, being treated for depression, and a family history of dementia.MAIN RESULTS: In all analyses, there was a very consistent pattern for both current and past drinkers. There was a small but significant dose effect of drinking for the drinkers, with subjects in the heaviest drinking category scoring poorest, i.e., lowest scores in cognitive tests and highest scores in scales of daily functioning indicating more impairment. The scores of abstainers were worse than those of subjects in the lightest drinking category. The pattern of scores for cognitive performance and daily functioning was similar between current and past drinkers. These patterns remained the same even after potential confounders were included.CONCLUSIONS: Previous research on effects of alcohol on health indices have suggested a J‐shaped relationship between amounts of alcohol consumption and measurements of heart disease, stroke, and mortality rates. Our study provides some support for the concept of a similar J‐shaped relationship between cognitive performance and alcohol consumption, but the differences between drinking categories were modest and the clinical significance of these findings uncertain.
No Evidence for a Higher Resting Metabolic Rate in Noninstitutionalized Alzheimer's Disease Patients
Authors: Donaldson Kendall E , Carpenter William H , Toth Michael J. , Goran Michael I. , Newhouse Paul , Poehlman Eric T. 
Published: April 2015

OBJECTIVE: It has previously been suggested that Alzheimer's disease patients have higher resting energy requirements than healthy individuals, which may contribute to their unexplained weight loss. We examined whether resting metabolic rate, the largest component of daily energy expenditure, is elevated in Alzheimer's patients compared with healthy older controls.DESIGN: Cross‐sectionalSETTING: General Clinical Research Center and Baltimore VA Medical CenterPATIENTS: Twenty‐five noninstitutionalized demented patients (74 ± 8 years; mean ± SD) with a wide range of Mini‐Mental Examination scores (1 to 20) and 73 healthy older individuals (69 ± 7 years).MEASUREMENTS: Resting metabolic rate was measured by indirect calorimetry, fat‐free mass and fat mass by dual energy X‐ray absorptiometry, and daily energy intake by food diaries.RESULTS: No differences in fat‐free mass and fat mass were noted between Alzheimer's disease patients and healthy older controls. Resting metabolic rate was similar in Alzheimer's disease patients (5446 ± 962 kJ/day) and healthy older individuals (5647 ± 887 kJ/day). These results persisted when resting metabolic rate was statistically adjusted for differences in body composition and age.CONCLUSION: These results provide no evidence for an elevation in resting energy requirements in noninstitutionalized demented patients.