bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Practice with Nursing Home Residents: Results from the National Physician Professional Activities Census
Authors: Katz Paul R. , Karuza Jurgis , Kolassa John , Hutson Alan 
Published: April 2015

OBJECTIVE: The study describes the prevalence of medical nursing home practice. Further, it examines the extent to which physician characteristics and local county health care resources predict nursing home involvement. This information is relevant to evaluating and devising strategies that address the future provision of medical care in institutionalized long‐term care.DESIGN: A cross‐sectional survey.SETTING: A national sample of all licensed practicing physicians was obtained from a special Professional Activities (PPA) survey conducted by the American Medical Association (AMA) in 1991.PARTICIPANTS: Respondents were 21,578 physicians involved in direct patient care.MEASURES: The typical number of hours spent weekly caring for nursing home patients was obtained from the PPA survey, and physician demographics were obtained from the AMA Masterfile. County health care resources were obtained from the National Institutes of Health Area Resources File.RESULTS: Most (77%) physicians reported spending no measurable time caring for nursing home patients. In all disciplines, a majority of physicians with a nursing home practice spent less than 2 hours per week with patients. Logistic regressions indicted that family practitioners and internists were most likely to have a nursing home practice, but general practitioners were most likely to spend more time in practice. Only 15% of specialists reported having a nursing home practice. Prevalence of practice was greatest among solo practitioners and physicians in partnerships and least among academic and hospital‐based physicians and physicians in group practice or employed by the government. Most county of practice resources were not associated or were modestly associated with nursing home practice, but having a nursing home practice became much more likely as the number of nursing home residents increased and hospital beds decreased. A pattern was found for nursing home practice to be slightly less likely as the county's per capita income and the proportion of proprietary nursing facilities increased.CONCLUSIONS: With increasing numbers of older and frailer residents, nursing homes will continue to be integral components of the future healthcare system. However, physicians currently spend minimal time caring for nursing home patients, with physician characteristics best predicting involvement. Questions remain about the future of nursing home medical practice and how to best recruit, staff, and train future cadres of physicians to provide sufficient quality care for nursing home patients in an evolving health care system.
Changes in Hospitalization Associated with Introducing the Resident Assessment Instrument
Authors: Mor Vincent , Intrator Orna , Fries Brant E. , Phillips Charles , Teno Joan , Hiris Jeffrey , Hawes Catherine , Morris John 
Published: April 2015

OBJECTIVE: To compare the rates of hospitalization among cohorts of nursing home residents assembled before and after the implementation of the federally mandated Resident Assessment Instrument (RAI).SAMPLE: Subjects were nursing home residents chosen from 268 facilities in major Metropolitan Statistics Areas in 10 states and representing more than 1500 facilities and 60,000 residents. Two resident cohorts (1990 and 1993) were sampled (8 to 16 residents per facility, depending upon facility size) as part of an evaluation of the impact of implementing the RAI.METHODS: Research nurses reviewed records, interviewed staff, observed patients, and completed an RAI at baseline and 6 months later. All transitions during this interval (hospital admissions, nursing home transfers, returns home, death, etc.) were tracked. Using polytomous logistic regression, we tested the effect of cohort on the probability of being hospitalized in light of the competing risks of dying or remaining in the home, controlling for demographic and case‐mix variables, and having a DNR order in the chart.RESULTS: A total of 4196 residents were studied, 2118 in 1990 (age 81.3, female 77.7%, LOS 6+ months 49.8%) and 2078 in 1993 (age 81.7, females 75.5%, LOS 6+ months 50.2%). The unadjusted probability of hospitalization dropped from .205 to .151. Multivariate analyses revealed a significant adjusted odds of hospitalization of .74 (95% CI .60‐.91) and no cohort effect on home discharge or death. Among severely cognitively impaired residents, the adjusted odds of hospitalization in 1993 compared with the 1990 cohort was 0.74 (.53–1.03). Finally, among survivors in both cohorts who had a follow‐up MDS performed, and whose ADL remained stable, 15.9% were hospitalized in 1990, whereas only 10.9% were hospitalized in 1993. On the other hand, ADL decliners were more likely to have been hospitalized in 1993 than in 1990 (40.6% vs 25.2%).CONCLUSIONS: Although other changes in the industry, clinical practice, and health care policy may have influenced hospitalization of nursing home residents, the substantial reductions observed among the cognitively impaired and those with stable ADL suggest superior and uniform assessment information in the form of the RAI contributed significantly to this decline.
A Randomized Trial of Group Outpatient Visits for Chronically Ill Older HMO Members: The Cooperative Health Care Clinic
Authors: Beck Arne , Scott John , Williams Patrick , Robertson Barbara , Jackson Deborrah , Gade Glenn , Cowan Pamela 
Published: April 2015

OBJECTIVE: To compare the impact of group outpatient visits to traditional “physician‐patient dyad” care among older chronically ill HMO members on health services utilization and cost, self‐reported health status, and patient and physician satisfaction.DESIGN: A 1‐year randomized trial.SETTING: A group model HMO in the Denver Metropolitan area.PARTICIPANTS: Three hundred twenty‐one members aged 65 and older, randomized to a group visit intervention (n = 160) or to usual care (n = 161).INTERVENTION: Patients with high health services utilization and one or more chronic conditions had monthly group visits with their primary care physician and nurse. Visits included health education, prevention measures, opportunities for socialization, mutual support, and for one‐to‐one consultations with their physician, where necessary.MEASUREMENTS: Health services utilization and associated cost, health status, and patient and physician satisfaction.RESULTS: Outcome measures obtained after a 1‐year follow‐up period showed that group participants had fewer emergency room visits (P = .009), visits to subspecialists (P = .028), and repeat hospital admissions per patient (P = .051). Group participants made more visits (P = .021) and calls (P = .038) to nurses than control group patients and fewer calls to physicians (P = .019). In addition, a greater percentage of group participants received influenza and pneumonia vaccinations (P < .001). Group participants had greater overall satisfaction with care (P = .019), and participating physicians reported higher levels of satisfaction with the groups than with individual care. No differences were observed between groups on self‐reported health and functional status. Cost of care per member per month was $14.79 less for the group participants.CONCLUSIONS: Group visits for chronically ill patients reduce repeat hospital admissions and emergency care use, reduce cost of care, deliver certain preventive services more effectively, and increase patient and physician satisfaction.
Rising from the Floor in Older Adults
Authors: Alexander Neil B. , Ulbrich Jessica , Raheja Aarti , Channer Dwigbt 
Published: April 2015

OBJECTIVE: The primary goal was to determine the ability of older adults to rise from the floor. A secondary goal was to explore how rise ability might differ based on initial body positions and with or without the use of an assistive device.DESIGN: Cross‐sectional analysis of young, healthy older, and congregate housing older adults.SETTING: University‐based laboratory and congregate housing facility.PARTICIPANTS: Young adult controls (12 men and 12 women, mean age 23 years), healthy older adults (12 men and 12 women, mean age 73 years), and congregate housing older adults (32 women and 6 men, mean age 80 years). The healthy older adult women (n = 12, mean age 75 years) and a subset of the congregate housing women (n = 27, mean age 81 years) were identified for further analyses.INTERVENTION: Videotaping and timing of rising from the floor from controlled initial body positions (supine, on side, prone, all fours, and sitting) and with or without the use of a furniture support.MAIN OUTCOME MEASURES: Whether subjects were successful in rising, and if they were, the time taken to rise. Subjects also rated their perceived difficulty of the task as compared to the reference task, rising from a supine position.RESULTS: Older adults have more difficulty rising from the floor than younger adults. The healthy old took twice as long as the young to rise, whereas the congregate old took two to three times as long as the healthy old to rise. Although all young and healthy old rose from every position, a subset of the congregate housing residents was unable to rise from any position, 24% when attempting to rise without a support and 13% when attempting to rise with a support. Congregate old were most likely to be successful when rising from a side‐lying position while using the furniture for support. The more able congregate old, as well as the young and healthy old, rose more quickly and admitted to the least difficulty when rising from the all fours position.CONCLUSIONS: The inability to rise from the floor is relatively common in congregate housing older adults. Based on the differences between groups in time to complete the rise, determining the differences in rise strategies, and the underlying biomechanical requirements of rising from different positions with or without a support would appear to be useful. These data may serve as the foundation for future interventions to improve the ability to rise from the floor.
Does Aging Mean A Better Life for Women?
Authors: Eronen Minna K. , Rankinen Tuomo , Rauramaa Rainer , Sulkava Raimo , Nissinen Aulikki 
Published: April 2015

OBJECTIVE: To study 10‐year changes in selected quality of life dimensions in a cohort of aging Eastern Finnish women.DESIGN: Ten‐year follow‐up of a representative population sample.SETTING: The county of Kuopio in Eastern Finland.PARTICIPANTS: In 1982, a representative sample (n = 296) of 50 to 60‐year‐old women was examined in the FIN‐MONICA study. Ten years later, 241 of the participants were re‐examined.MEASUREMENTS: Self‐administered questionnaires were used to collect the data. Self‐rated health, self‐rated physical fitness, frequency of leisure time physical activity, functional capacity, reported symptoms, occurrence of diseases, and satisfaction with family life and economic situation were measured. In 1992, total life satisfaction at that moment and 5 years earlier were also assessed.RESULTS: The self‐rated health assessment remained unchanged. During the 10 years from 1982 to 1992, the proportion of women who reported diagnosed cardiopulmonary diseases increased; angina pectoris, in particular, increased from 6% to 20%. However, even though their running ability had decreased, the number of women rating their physical fitness as good or fairly good increased from 23% to 32%. The participants reported significantly less headache and feelings of exhaustion than they had 10 years earlier. Average satisfaction with their economic situation increased, and satisfaction with family life remained the same. Thirty‐seven percent of the women rated their current life situation as better than 5 years previously, 29% felt that it had remained the same, and 34% indicated that it had become worse during the past 5 years.CONCLUSION: These data suggest that some quality of life dimensions may improve during aging in postmenopausal women.
Seasonal Prevalence of Vitamin D Deficiency in Institutionalized Older Adults
Authors: Liu Barbara A. , Gordon Michael , Labranche Jean M. , Murray Tim M. , Vieth Reinhold , Shear Neil H. 
Published: April 2015

OBJECTIVE: To determine the prevalence and seasonal variation of vitamin D deficiency among older residents of long‐term care facilities.DESIGN: Cross‐sectional survey with 6‐month follow‐up.SETTING: Three long‐term care facilities in Toronto.PATIENTS: Persons more than 65 years old, medically stable, who had resided in the facility for at least 6 months and had no conditions known to interfere with vitamin D metabolism.MEASUREMENTS: Information regarding demographics, past health, and medication use was collected. Mental and functional status were assessed by questionnaire. Venous blood samples were analyzed for alkaline phosphatase, calcium profile, albumin, intact parathyroid hormone, 25 hydroxyvitamin D (25OHD), and vitamin D binding protein in September 1994 and March 1995. In a subgroup of patients, bone specific alkaline phosphatase was measured, and dietary intake of vitamin D was assessed.RESULTS: A total of 155 subjects completed the study. The mean age of the subjects was 83.2 years (SD 7.1), and 47% were female. The mean 25OHD level in the March sample (39.9 nmol/L, SD 19.7) was significantly lower than the mean 25OHD level in the September sample (44.9 nmol/L, SD 16.9) (P = .001). The prevalence of vitamin D deficiency in the osteomalacic range (25OHD < 25 nmol/L) increased from 9% in the fall sample to 18% after the winter (χ2 = 4.65, P = .03). The prevalence of borderline deficiency or hypovitaminosis D (25OHD < 40 nmol/L) increased from 38% in the fall sample to 60% in the spring sample (χ2 = 14.9, P < .001).Dependence in transfers was associated with an increased risk of hypovitaminosis D, odds ratio 2.08 (95% confidence interval 1.08–4.01), dependence in ambulation 2.57 (1.26–5.23), and regular use of a wheelchair 2.17 (1.09–4.31). When entered into a forward conditional logistic regression model, only dependence in ambulation remained significant, with an adjusted odds ratio of 2.57 (95% CI: 1.26–5.18).CONCLUSIONS: Vitamin D deficiency and borderline vitamin D status are common among older residents of long‐term care facilities in Canada. Even though this population has limited outdoor exposure, seasonal variation in the prevalence of deficiency remains significant. Evaluation of interventions to improve the status of vitamin D nutrition in this population is needed.
The Effect of Specific Medical Conditions on Functional Decline
Authors: Kiely Dan K. , Morris John N. , Morris Shirley A. , Cupples L. Adrienne , Ooi Wee Lock , Sherwood Sylvia 
Published: April 2015

OBJECTIVES: To examine how functional status among older community‐dwelling residents differs over time between those with and those without specific medical conditions.DESIGN: Prospective cohort study.PARTICIPANTS: A total of 1060 community‐dwelling Massachusetts residents aged 65 or older who were not totally functionally dependent at baseline assessment.MEASUREMENTS: Functional status, five medical conditions (heart problem, arthritis, diabetes, cancer, and stroke), and the total number of these five medical conditions. Assessments were done at baseline and at two annual follow‐ups. RESULTS: Adjusted repeated measures analysis of covariance revealed a time difference (P < .001) for all five medical conditions and group differences for diabetes (P = .006) and stroke (P < .001). Functional abilities declined over time and those with specific medical conditions were more impaired initially, but the rate of decline did not significantly differ from those free of the condition. The presence of each additional medical condition resulted in additional impairment (P < .001), but the rate of decline over time did not differ by number of medical conditions.CONCLUSIONS: Efforts to reduce or prevent the development of specific medical conditions are essential to maintaining functional independence of older people as well as to reducing use of supportive services and admission rates to nursing homes. Particular attention should be directed toward preventing stroke since its consequences are the most functionally disabling. J Am Geriatr Soc 45:1459–1463, 1997.
Mortality over Four Years in SHEP Participants with a Low Ankle‐Arm Index
Authors: Newman Anne B. , Tyrrell Kim Sutton , Kuller Lewis H. 
Published: April 2015

OBJECTIVES: To assess the risk of total and cardiovascular mortality in older adults with systolic hypertension and with a low ankle‐arm index (AAI) as a marker of subclinical peripheral arterial disease (PAD).DESIGN: Prospective observational studyPARTICIPANTS: A subgroup of 1537 participants in the Systolic Hypertension in the Elderly Program (SHEP) were screened for lower extremity arterial disease using the AAI. Participants were evaluated at 4 years to determine vital status and cause of death. Total and cardiovascular disease (CVD) mortality rates were assessed in relationship to clinical CVD at baseline, cardiovascular risk factors and the presence of a low AAI (subclinical PAD).RESULTS: Total mortality rates increased as the AAI decreased in those with and without clinical CVD at baseline. In those without clinical CVD at baseline, the presence of an AAI ≤ .9 was associated with an age‐adjusted relative risk (RR) of 3.00 for total mortality in men and 2.67 in women. Results were similar for CVD mortality and persisted after adjustment for cardiovascular risk factors including the presence of an abnormal electrocardiogram.CONCLUSIONS: A low ankle arm‐index predicted a two to three‐fold increase in total and cardiovascular mortality in older adults with systolic hypertension of risk for incident cardiovascular disease. In this study of older adults with systolic hypertension, 19.7% of the participants had subclinical PAD. Risk factor modification could be targeted to older adults based on markers of asymptomatic atherosclerosis. J Am Geriatr Soc 45:1472–1478, 1997.
The Impact of Kyphosis on Daily Functioning
Authors: Ryan Stephen D. , Fried Linda P. 
Published: April 2015

OBJECTIVES: To determine whether moderate or severe kyphosis is associated with decrements in physical function, especially mobility.DESIGN: Cross‐sectional analysis of a cohort study.SETTING: The Johns Hopkins Functional Status Laboratory, a multidisciplinary, standardized, quantitative assessment center.PARTICIPANTS: A total of 231 community‐dwelling volunteers aged 59 and older who participated in a 1‐day evaluation.MEASUREMENTS: Age, gender, self report of physical function, standardized measurement of: kyphosis (both qualitatively clinical criteria and quantitative assessment), time to walk 5 meters (0.1 seconds), and time to climb a flight of stairs (0.1 seconds) at usual pace.RESULTS: Using multivariate step‐wise regression analysis, the presence and severity of kyphosis, measured qualitatively, was independently associated with time to walk 5 meters and to climb a flight of stairs (P = .015, P < .001, respectively), adjusting for moderate‐severe scoliosis, heart rate response to exercise, arthritis, vertigo, age, and gender. Similarly, quantitative kyphosis was associated independently with stair climb time (P = .005). Qualitative kyphosis was also associated with difficulty reaching (OR = 2.21 (95%CI: 1.14 to 4.29)) and difficulty performing heavy housework (OR = 1.64 (95%CI: 1.03 to 2.61)), adjusting for prior diagnosis of moderate‐severe scoliosis, prior diagnosis of arthritis, age, and gender.CONCLUSION: Kyphosis, by both clinical and quantitative assessment, is associated with diminished function, especially performance of mobility tasks. This association should be verified prospectively. If predictive, the impact of kyphosis on physical function should be considered in osteoporosis prevention and treatment counseling. J Am Geriatr Soc 45:1479–1486, 1997.
Antidepressant Use Over Time in a Rural Older Adult Population: The MoVIES Project
Authors: Ganguli Mary , Mulsant Benoit , Richards Stephanie , Stoehr Gary , Mendelsohn Aaron 
Published: April 2015

OBJECTIVE: To examine the use of antidepressant drugs over time among community‐based older persons.DESIGN: A longitudinal community study with four approximately biennial data collection waves (1987 ‐ 1996).SETTING: A low‐socioeconomic status rural older community‐based population in Southwestern Pennsylvania.PARTICIPANTS: A total of 1681 individuals with a mean age of 72.9 years at study entry,MEASUREMENTS: Antidepressant drug use, demographics, and health services utilization by self‐report.RESULTS: Antidepressant use was reported by less than 5% of the population during all four waves. It was associated with female gender, use of mental health services, presence of five or more depressive symptoms, and use of five or more prescription drugs, but not with age. During the four waves, tricyclics accounted for 84.6%, 85.3%, 78.4%, and 45.5% of total antidepressants used, whereas selective serotonin reuptake inhibitors (SSRIs) accounted for 2.6%, 11.8%, 8.1%, and 36.4%.CONCLUSIONS: Overall, our data on antidepressant use in this rural older population mirror national trends away from tricyclics and towards SSRIs. Our findings also suggest underutilization of mental health services and antidepressant drugs in this population. J Am Geriatr Soc 45:1501–1503, 1997.
Preserved Antilipolytic Insulin Action Is Associated with a Less Atherogenic Plasma Lipid Profile in Healthy Centenarians
Authors: Paolisso Giuseppe , Gambardella Antonio , Ammendola Stefania , Tagliamonte Maria Rosaria , Rizzo Maria Rosaria , Capurso Antonio , Varricchio Michele 
Published: April 2015

OBJECTIVE: Recent studies have demonstrated that centenarians have a preserved glucose tolerance and insulin action and a more favorable body composition and fat distribution than aged subjects. The strong relationship among glucose tolerance, insulin action, plasma lipid concentration, and lipoprotein metabolism would lead to the hypothesis that healthy centenarians may also have a less atherogenic profile than aged subjects less than 100 years old.DESIGN: Investigation of the relationship between insulin action and lipid metabolism in healthy centenarians.PARTICIPANTS: Fifty‐six subjects were categorized into three groups: Adults (≤ 50 years old; n = 20); Aged (≥ 75 years old; n = 22); Centenarians (≥100 years old; n = 14). The latter represented a select group of individuals free of major age‐related diseases.MEASUREMENTS: Anthropometric measurements were made in all subjects, fasting blood samples were drawn for metabolite determinations, and an euglycemic glucose clamp was performed.RESULTS: Compared with aged subjects, healthy centenarians appeared to have a less atherogenic plasma lipid profile. Fasting plasma LDL cholesterol (2.4 ± 0.6 vs 3.7 ± .6 mmol/L P < .010) was significantly higher in aged subjects than in centenarians, whereas fasting plasma HDL cholesterol (1.0 ± 0.4 vs 1.7 ± .4 mmol/L P < .005) had an opposite trend. In centenarians, insulin‐mediated glucose uptake was greater (34.6 ± 0.5 vs 23.3 ± .05 μmol/Kg FFM × min P < .010) than in aged subjects and correlated with fasting plasma triglycerides, FFA, LDL, and HDL cholesterol, Apo B, and Apo A1 concentrations. Finally, insulin infusion suppressed plasma FFA concentration in similar ways in adults and centenarians.CONCLUSION: Our study demonstrates that centenarians have a less atherogenic plasma lipid and lipoprotein profile than aged subjects J Am Geriatr Soc 45:1504–1509, 1997.