bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing Frailty and Falls in Older Persons: An Investigation of Tai Chi and Computerized Balance Training
Authors: Wolf Steven L. , Barnhart Huiman X. , Kutner Nancy G. , McNeely Elizabeth , Coogler Carol , Xu Tingsen ,   Atlanta FICSIT Group
Published: April 2015

OBJECTIVE: To evaluate the effects of two exercise approaches, Tai Chi (TC) and computerized balance training (BT), on specified primary outcomes (biomedical, functional, and psychosocial indicators of frailty) and secondary outcomes (occurrence of falls).DESIGN: The Atlanta FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques), a prospective, randomized, controlled clinical trial with three arms (TC, BT, and education [ED]). Intervention length was 15 weeks, with primary outcomes measured before and after intervention and at 4‐month follow‐up. Falls were monitored continuously throughout the study.SETTING: Persons aged 70 and older living in the community.PARTICIPANTS: A total of 200 participants, 162 women and 38 men; mean age was 76.2.MEASUREMENTS: Biomedical (strength, flexibility, cardiovascular endurance, body composition), functional (IADL), and psychosocial well‐being (CES‐D scale, fear of falling questionnaire, self‐perception of present and future health, mastery index, perceived quality of sleep, and intrusiveness) variables.RESULTS: Grip strength declined in all groups, and lower extremity range of motion showed limited but statistically significant changes. Lowered blood pressure before and after a 12‐minute walk was seen following TC participation. Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group (P = .046 and P = .058, respectively). After adjusting for fall risk factors, TC was found to reduce the risk of multiple falls by 47.5%.CONCLUSIONS: A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty. This intervention can also have favorable effects upon the occurrence of falls. Tai Chi warrants further study as an exercise treatment to improve the health of older people.
A Randomized Trial of Dementia Care in Nursing Homes
Authors: Rovner Barry W. , Steele Cynthia D. , Shmuely Yochi , Folstein Marshal F. 
Published: April 2015

OBJECTIVE: To evaluate the efficacy of a dementia care program to reduce behavior disorders in nursing home patients with dementia.DESIGN: Randomized controlled clinical trial with 6‐month follow‐up.SETTING: A 250‐bed community nursing home.PATIENTS: The nursing home was screened to identify patients with dementia and behavior disorders. A total of 118 patients were eligible for randomization. Of these, 89 (75.4%) were randomized, and 81 of these (91.0%) completed the trial.INTERVENTION: The A.G.E. dementia care program consisted of Activities, Guidelines for psychotropic medications, and Educational rounds. The control treatment was usual nursing home care.MEASUREMENTS: Behavior disorders, antipsychotic drug and physical restraint use, patient activity levels, and cognitive and functional status.RESULTS: After 6 months, 12 of 42 (28.6%) intervention patients exhibited behavior disorders compared with 20 of 39 (51.3%) controls (OR = 0.38; 95% CI [0.15, 0.95]; P = .037). Controls were more than twice as likely to receive antipsychotics (OR = 2.55, 95% CI [0.96,6.76]; P < .056), to be restrained during activity times (OR = 2.98, 95% CI [1.10, 8.04]; P < .028), and to be restrained on nursing units (OR = 2.14, 95% CI [0.9,5.3]; P < .10). Intervention patients were much more likely to participate in activities (OR = 13.71; 95% CI [4.51,41.73]; P = .001).CONCLUSIONS: The A.G.E. program reduces the prevalence of behavior disorders and the use of antipsychotic drugs and restraints. It is practical, feasible, and appears to improve the lives of patients with dementia in nursing homes. J Am Geriatr Soc 44:7–13, 1996.
Multi‐site Study of Incidence of Pressure Ulcers and the Relationship Between Risk Level, Demographic Characteristics, Diagnoses, and Prescription of Preventive Interventions
Authors: Bergstrom Nancy , Braden Barbara , Kemp Mildred , Champagne Mary , Ruby Elizabeth 
Published: April 2015

OBJECTIVE: To determine the incidence of pressure ulcers in varied populations, and whether demographic characteristics (age, gender, race) and primary diagnosis are factors in pressure ulcer development when the level of risk for developing ulcers is considered. To determine if there is a difference in the type of preventive services prescribed for persons who do or do not develop pressure ulcers when risk is controlled and whether differences can be related to demographic characteristics.DESIGN: Cohort study.SETTING: Two skilled nursing homes, two university operated tertiary care hospitals, and two Veteran's Administration Medical Centers (VAMCs) in Omaha, NE, Durham, NC, and Chicago, IL.PATIENTS: A total of 843 randomly selected patients more than 19 years of age who did not have pressure ulcers on admission to their place of care. Subjects were 63% male, 79% white, and had a mean age of 63 (± 16) years.MEASURES: A head‐to‐toe skin assessment for pressure ulcers recording site and stage of ulcers, scores for the Braden Scale for Predicting Pressure Sore Risk, demographic characteristics (age, sex, race), and primary diagnosis and preventive interventions (turning or repositioning orders and pressure reduction surface) were documented on the patient record. Observations were made every 48 to 72 hours for a minimum of 1 to a maximum of 4 weeks.MAIN OUTCOME MEASURES: Presence/absence and stage of pressure ulcers.MAIN RESULTS: One hundred eight of 843 (12.8%) subjects developed pressure ulcers. The incidence was 8.5%, 7.4%, and 23.9% in tertiary care, VAMCs, and nursing homes, respectively. Logistic regression demonstrated that lower Braden Scale scores, older age and white race predicted pressure ulcers; gender was not predictive. Primary diagnoses were not significant predictors of pressure ulcer risk when the Braden Scale score was entered into the regression. Prescription of turning was predicted by Braden Scale scores and by white race, whereas prescription of pressure reduction was predicted by Braden Scale scores, white race, and female sex.CONCLUSIONS: Risk assessment, rather than diagnoses or demographic characteristics, is recommended as the basis for prescriptive decisions. Risk assessment should cue health care providers to make more judicious use of turning and support surfaces to prevent pressure ulcers. Persons who are at risk for pressure ulcers should have turning and pressure reduction surfaces consistently prescribed and implemented. The costs and goals of preventive prescription for those not at risk for pressure ulcers should be considered. J Am Gcriatr Soc 44:22–30, 1996.
Use of Cardiovascular Drugs in an Older Swedish Population
Authors: Wills Phillippa , Fastbom Johan , Claesson Cecilia B. , Cornelius Christel , Thorslund Mats , Winblad Bengt 
Published: April 2015

OBJECTIVE: To describe the use of cardiovascular drugs in an older population with respect to age, sex, housing type, and creatinine clearance.DESIGN: A cross‐sectional survey.PARTICIPANTS: All residents of a district of Stockholm (Kungsholmen), Sweden, aged 75 and older, living in institutions or at home.MEASUREMENTS: Cardiovascular drug use, serum creatinine, electrolytes, height, weight, and symptoms.RESULTS: A total of 43 cardiovascular (CV) drugs were used. The most common drugs were digoxin (used by 18.2%), furosemide (16.4%), and glyceryl trinitrate (12.4%). Drugs with an antihypertensive effect accounted for 61% of all CV drugs. CV drug use increased with age for cardiac glycosides and diuretics, but decreased with age for calcium antagonists and β‐blockers. Drug doses tended to be less than the recommended daily dose except for a few drugs, e.g., furosemide. There was a trend toward decreasing dose with increasing age, but this was not significant. Diuretics were the only CV drugs used more often in women. People living in institutional care used the least amount of CV drugs. The dose of drugs taken did not appear to be related to estimated creatinine clearance. Comparisons between drug use and complaint of symptoms showed a strong correlation between the use of cardiac glycosides and anorexia, calcium antagonists and constipation, and nitrates and vertigo. There were weaker correlations with cardiac glycosides and visual disturbances and with potassium sparing diuretics and a high potassium.CONCLUSIONS: CV drugs are used commonly in older people. We suggest that the symptoms correlating with cardiac glycoside use may be signs of unrecognized toxicity, and this may relate to our finding that drug use is often not tailored to renal function as measured by creatinine clearance. J Am Geriatr Soc 44:54–60, 1996.
Outcomes for Older Men and Women with Congestive Heart Failure
Authors: Burns Risa B. , McCarthy Ellen P. , Moskowitz Mark A. , Ash Arlene , Kane Robert L. , Finch Michael 
Published: April 2015

OBJECTIVES: To describe and compare outcomes for men and women discharged alive following a hospitalization for congestive heart failure (CHF).DESIGN: Prospective cohort studyPARTICIPANTS: A total of 519 patients, aged ≥ 65, who were discharged alive after a hospitalization for CHF (DRG = 127).MEASUREMENTS: Outcomes (Activities of Daily Living (ADLs), shortness of breath when walking, perceived health, living situation, rehospitalization, and mortality) were measured at 3 times (6 weeks, 6 months, and 1 year) post‐discharge.RESULTS: The 205 men were, on average, younger (77 ± 7 vs 80 ± 8, P < .001), wealthier (46% vs 21% earned ≥ $10,000, P < .001), and more often married (50% vs 19%, P < .001). Men were more likely than women to have a previous history of CHF (71% vs 63%, P = .052). Men also had higher 1‐year mortality than women (48% vs 35%, P = .009), even after adjusting for age, comorbidity, physiological severity (APACHE II APS and RAND discharge instability), radiological evidence of CHF, prior ADLs, walking ability, living situation, and perceived health. Men and women survivors at 1‐year had similar and substantial impairment for all non‐fatal outcomes considered (all P values ≥ .489). Their adjusted mean ADL scores were consistent with complete dependence on one essential activity (range 0–6 dependencies); 35% were short of breath walking less than 1 block; 62% had fair or poor perceived health; 32% received some formal care; and 46% were rehospitalized within 1 year of discharge.CONCLUSIONS: Men with CHF have a higher mortality than women with CHF. Men and women who survive have similar and substantial impairment for all non‐fatal outcomes (ADLs, shortness of breath upon walking, perceived health, living situation, and rehospitalization).
The Economic Cost of Hip Fractures in Community‐Dwelling Older Adults: A Prospective Study
Authors: Brainsky Ada , Glick Henry , Lydick Eva , MD Robert Epstein , Fox Kathleen M. , Hawkes William , Kashner T. Michael , Zimmerman Sheryl Itkin , Magaziner Jay 
Published: April 2015

OBJECTIVES: To evaluate the incremental cost in the year after hip fracture.DESIGN: Prospective cohort studySETTING: Baltimore, MarylandPARTICIPANTS: 759 community dwelling older patients who sustained a hip fracture and participated in the Baltimore Hip Fracture Study.MEASUREMENTS: Resource use for direct medical care, formal nonmedical care, and informal care in the 6 months before and the year after fracture was estimated from interviews with patients or proxy respondents. Costs in 1993 dollars were estimated by multiplying resources times national unit cost estimates.RESULTS:: The annualized costs in the year before the fracture ranged between $18,523 and $20,928. The costs in the year after the fracture equaled $37,250. The incremental costs in the year after the fracture, compared with the costs in the year before the fracture, ranged between $16,322 and $18,727. The largest cost differences were attributable to hospitalizations, nursing home stays, and rehabilitation services.CONCLUSIONS: Because we compared the costs after a fracture with costs before, our estimates of the incremental cost of a hip fracture are lower than others in the literature. These results, obtained from interviews with patients enrolled in a cohort study, or their proxies, provide the best data available to date on the economic cost of hip fractures among community‐dwelling older persons.
A Longitudinal Examination of Functional Recovery Among Older People with Subcapital Hip Fractures
Authors: Young Yuchi , Brant Larry , German Pearl , Kenzora John , Magaziner Jay 
Published: April 2015

OBJECTIVE: Few studies have examined the time‐dependent change in functional recovery along with the factors that affect the change among older hip fracture patients. The focus of this study is to examine the predictors of functional recovery in community‐dwelling older people with subcapital fractures using longitudinal data analysis methods.DESIGN: A 1‐year prospective study. Information was obtained through structured interviews following surgery and at 2, 6, and 12 months after hospital discharge and from medical chart review.SETTING AND PATIENTS: The sample consisted of 312 community‐dwelling older adults, admitted to one of the seven Baltimore area hospitals with a subcapital fracture, who received either internal fixation or hemiarthroplasty.RESULTS: The longitudinal data analysis using mixed‐effects regression indicates that time and prefracture physical activities of daily living (PADL) had a significant association with PADL functional recovery over the course of 1 year. Among those 85 years and older, those who were disoriented after surgery had poorer PADL functional recovery over time than those who were not disoriented. Also, recovery in instrumental activities of daily living (IADL) was associated significantly with time, prefracture IADL function, unsteady gait prefracture, hospital length of stay, and discharge to an institution. The type of surgical procedure performed was not associated significantly with either PADL or IADL functional recovery.CONCLUSIONS: The factors that are related to functional recovery in this study shed light on the complexity of the recovery process in hip fracture patients. The rate of recovery in postsurgical PADL and IADL function is not constant over time; postsurgical IADL function among disoriented patients (without dementia) continues to deteriorate over time compared with the nondisoriented group; this difference in trends of deterioration on IADL function is most profound in the oldest‐old aged group, those 85 and older. The types of surgical procedure performed was not significantly associated with postsurgical functional recovery.
Prevalence of Diabetes and Effect on Quality of Life in Older French Living in the Community: The PAQUID Epidemiological Survey
Authors: Bourdel‐Marchasson Isabelle , Dubroca Bénédicte , Manciet Gérard , Decamps Arnaud , Emeriau Jean‐Paul , Dartigues Jean‐François 
Published: April 2015

OBJECTIVES: To evaluate the prevalence of diabetes mellitus in older French subjects and to examine the different aspects of quality of life in an older diabetic population.DESIGN: From a random sample of 2792 people older than age 65 living in the community, a diabetic sample was selected using three items from a questionnaire: Are you diabetic? Are you on a diabetic diet? What kind of medications do you take daily? Validation of the questionnaire was carried out previously to correct the observed prevalence.MEASUREMENTS: The questionnaire assessed social and demographic aspects, physical, mental, and subjective health, and functional disabilities. Because quality of life assessment was mainly subjective, demented subjects were excluded.RESULTS: The diabetic group consisted of 237 subjects from the older sample of 2792 (8.5%). No age difference was demonstrated between the two groups (mean, distribution), but the male/female ratio was significantly higher in those with diabetes (49.4% vs 39.3%, P = .003). Corrected prevalence of diabetes was 10.3%. After exclusion of demented subjects, 230/2726 people were investigated. Diabetic subjects were heavier (P < .001), had higher systolic blood pressure (P < .001), and had more frequent symptoms of ischemic heart disease (P < .001) and painful peripheral arterial disease (P < .001) and dyspnea (P < .001), but antecedents of stroke were similar in both groups. Diabetics were more often lacking in autonomy according to the IADL Lawton scale (P < .001), Rosow and Breslow scale (P < .001), and Mobility scale (P = .043), but not according to the Katz ADL scale. They more often exhibited symptoms of depression on the CES‐D self‐rating scale (21.3% vs 12.7%, P < .001), but evaluation of cognitive function was similar in both groups.Thirteen percent of diabetics, compared with 7.6% of non‐diabetics, were unsatisfied with their own situation (P = .002). Health was rated as fair, bad, or very bad by 67.8% of diabetics compared with 49% of non‐diabetics (P < .001). Diabetics rated themselves as feeling worse than others (15.3% vs 9.2%, P << .001) and worried more about their health status (78% vs 63%, P << .001).CONCLUSION: The observed prevalence of diabetes in older French people living in the community was 8.5%. Quality of life in older diabetics was poorer than that of other people of the same age.
MODELS OF GERIATRICS PRACTICE: A University‐Affiliated Community Hospital Inpatient Geriatrics Program Functioning in an Administrative and Educational Capacity*
Authors: Cefalu Charles A. , Colbourne George , Duffy Maureen , Johnson Ernest , Lestter Mary , Wright Jeff 
Published: April 2015

OBJECTIVE: To demonstrate an unusual form of inpatient geriatric assessment with unique outcomes.DESIGN: A prospective evaluation of patients admitted to a community hospital‐based inpatient geriatrics unit utilizing traditional members of the assessment team along with educational assessment of nurses and satisfaction profiles of patients and/or families.SETTING: A non‐profit community hospital in Northeast Washington, DC.PARTICIPANTS: All patients older than age 62 admitted to the 42‐ bed Geriatric Unit during a 4 1/2 year time period.MEASUREMENTS: Number of total and category recommendations taken by attending physicians from the Inpatient Geriatric Assessment Team, periodic evaluation of unit nurses' geriatric knowledge base and certification, and patient satisfaction through periodic surveys.RESULTS: More than 4500 patients have been evaluated during the past 4 1/2 years. The number of recommendations taken by attending physicians has averaged 31.3 to 50.7% during four consecutive chart reviews involving the first 25 consecutive patients for the month each performed every six months (n = 100). The average age of patients evaluated was 77.2 (minimum of 62 and maximum of 97); 67% were females and 33% males. The average number of recommendations communicated per patient was 4.1, and the average number adhered to 1.6/patient. The overall knowledge base and certification in geriatric nursing has increased significantly over a 2.5‐year period. Composite monthly unit patient satisfaction survey scores increased as well.CONCLUSIONS: The program is unique in its development, limitations, and outcomes. Other than the cost of limited geriatric nurse practitioner and faculty salary support, the program has been implemented using only current hospital department personnel. The role of the assessment team is to educate attending nurses and staff physicians. It has not yet been possible to measure objective outcomes. However, the current program also serves the purpose of introducing a new medical program to a community hospital in a nonthreatening way and offers opportunities for research. In addition, the program offers further opportunity for expansion and change.
Postural Balance and Self‐Reported Functional Ability in 75‐Year‐Old Men and Women: A Cross‐National Comparative Study
Authors: Era P. , Avlund K. , Jokela J. , Gause‐Nilsson I. , Heikkinen E. , Steen B. , Schroll M. 
Published: April 2015

OBJECTIVE: To study postural balance in relation to selfreported functional ability (mobility and ADL) and general physical activity in elderly men and women living in three different Nordic environments.PARTICIPANTS: A random sample of 448 men and 556 women from among the 75‐year‐old residents in Glostrup, Denmark, and Göteborg, Sweden, and all the residents of relevant age (127 men and 261 women) in Jyväskylä, Finland.MEASUREMENTS: Assessment of postural balance with eyes open and closed using a piezoelectric force platform. A structured interview on self‐reported functional ability and physical activity. An in‐laboratory medical examination.RESULTS: In spite of some differences in balance between the groups studied (better results in women compared with men and, to some extent, better results in the participants from Denmark and Finland than in those from Sweden), the performance in the balance tests was similarly associated with functional ability within all groups. The subjects reporting no need of help in performing the ADL and mobility functions performed significantly better in the balance tests. These differences were seen more clearly in the control of anteroposterior movement of center of forces than in the mediolateral direction. The performance in the balance tests was also significantly better among the subjects reporting a higher level of general physical activity than in their less active counterparts. Physical activity and certain long standing illnesses modified significantly the relationship between postural balance and ADL‐performance. When these factors were analyzed simultaneously, the role of balance as a predictor of ADL‐performance largely disappeared.CONCLUSIONS: The results suggest that good balance is one of the prerequisites of performance without difficulty in mobility and ADL functions. Physical exercise may help to maintain balancing abilities in old age; good balance, in turn, may also enable a physically active way of life. The associations of balance with functional ability and physical activity were independent of sex and locality. The results also support the validity of static stabilometry as a tool for evaluating threats to functional limitations in older subjects.