bluuebunny/crossref_metadata_2025_split huggingface dataset:
Family Satisfaction with End‐of‐Life Care in Seriously Ill Hospitalized Adults
Authors: Baker Rose , Hyg MS , Wu Albert W. , Teno Joan M. , Kreling Barbara , Damiano Ann M. , Rubin Haya R. , Roach Mary J. , Wenger Neil S. , Phillips Russell S. , Desbiens Norman A. , Connors Albert F. , Knaus William , Lynn Joanne 
Published: April 2015

OBJECTIVE: To examine factors associated with family satisfaction with end‐of‐life care in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).DESIGN: A prospective cohort study with patients randomized to either usual care or an intervention that included clinical nurse specialists to assist in symptom control and facilitation of communication and decision‐making.SETTING: Five teaching hospitals in the United StatesPARTICIPANTS: Family members and other surrogate respondents for 767 seriously ill hospitalized adults who died.MEASUREMENTS: Eight questionnaire items regarding satisfaction with the patient's medical care expressed as two scores, one measuring satisfaction with patient comfort and the other measuring satisfaction with communication and decision‐making.RESULTS: Sixteen percent of respondents reported dissatisfaction with patient comfort and 30% reported dissatisfaction with communication and decision‐making. Factors found to be significantly associated with satisfaction with communication and decision‐making were hospital site, whether death occurred during the index hospitalization (adjusted odds ratio (AOR) 2.2, 95% CI, 1.3–3.9), and for patients who died following discharge, whether the patient received the SUPPORT intervention (AOR 2.0,1.2–3.2). For satisfaction with comfort, male surrogates reported less satisfaction (0.6, 0.4–1.0), surrogates who reported patients' preferences were followed moderately to not at all had less satisfaction (0.2, 0.1–0.4), and surrogates who reported the patient's illness had greater effect on family finances had less satisfaction (0.4, 0.2–0.8).CONCLUSIONS: Satisfaction scores suggest the need for improvement in end‐of‐life care, especially in communication and decision making. Further research is needed to understand how factors affect satisfaction with end‐of‐life care. An intervention like that used in SUPPORT may help family members.
Alternative Medicine Use in Older Americans
Authors: Foster David F. , Phillips Russell S. , Hamel Mary Beth , Eisenberg David M. 
Published: April 2015

OBJECTIVES: Because there are few data describing alternative medicine use in older populations, we analyzed a nationally representative survey to quantify and characterize the use of alternative medicine in people aged 65 and older.DESIGN: We utilized data collected in a nationally representative, random, telephone survey of adults, measuring use of conventional medical services and use of 20 alternative medicine therapies in the last 12 months.PARTICIPANTS: A total of 2055 adults, 311 of whom were aged 65 and older and who constituted our sample of older Americans.RESULTS: Overall, 30% of people aged 65 and older used at least one alternative medicine modality in the last year compared with 46% of those less than age 65 (P < .001), and 19% of older people saw a provider of alternative medicine within the past year compared with 26% of those less than age 65. The alternative medicine modalities used most commonly by those aged 65 and older were chiropractic (11%), herbal remedies (8%), relaxation techniques (5%), high dose or mega‐vitamins (5%), and religious or spiritual healing by others (4%). Older persons with a primary care provider used alternative medicine more frequently (34% vs 7% P < .05) than those with no primary care provider. Patients who saw their physician more frequently were more likely to use alternative medicine (0 visits 7%, 1–2 visits 22%, 3–6 visits 35%, 7 or more visits 44% P < .05). Six percent of older patients were taking both herbs and prescription drugs. Of older patients who used alternative medicine, 57% made no mention of their use of any alternative modality to their doctor.CONCLUSIONS: Thirty percent of Americans aged 65 and older reported using alternative medicine (amounting to 10 million Americans based on extrapolations to census data) and 19% visited an alternative medicine provider (making 63 million visits based on extrapolations to census data) within the past year. The two modalities used most commonly were chiropractic and herbs, both of which may be problematic in older patients. Physicians should ask all patients, including those aged 65 and older, about their use of alternative medicine, and in those aged 65 and older, physicians should ask specific questions about the user of chiropractic and herbal medicine.
Effects of a Multicomponent Intervention on Functional Outcomes and Process of Care in Hospitalized Older Patients: A Randomized Controlled Trial of Acute Care for Elders (ACE) in a Community Hospital
Authors: Counsell Steven R. , Holder Carolyn M. , Liebenauer Laura L. , Palmer Robert M. , Fortinsky Richard H. , Kresevic Denise M. , Quinn Linda M. , Allen Kyle R. , Covinsky Kenneth E. , Landefeld C. Seth 
Published: April 2015

BACKGROUND: Older persons frequently experience a decline in function following an acute medical illness and hospitalization.OBJECTIVE: To test the hypothesis that a multicomponent intervention, called Acute Care for Elders (ACE), will improve functional outcomes and the process of care in hospitalized older patients.DESIGN: Randomized controlled trial.SETTING: Community teaching hospital.PATIENTS: A total of 1531 community‐dwelling patients, aged 70 or older, admitted for an acute medical illness between November 1994 and May 1997.INTERVENTION: ACE includes a specially designed environment (with, for example, carpeting and uncluttered hallways); patient‐centered care, including nursing care plans for prevention of disability and rehabilitation; planning for patient discharge to home; and review of medical care to prevent iatrogenic illness.MEASUREMENTS: The main outcome was change in the number of independent activities of daily living (ADL) from 2 weeks before admission (baseline) to discharge. Secondary outcomes included resource use, implementation of orders to promote function, and patient and provider satisfaction.RESULTS: Self‐reported measures of function did not differ at discharge between the intervention and usual care groups by intention‐to‐treat analysis. The composite outcome of ADL decline from baseline or nursing home placement was less frequent in the intervention group at discharge (34% vs 40%; P = .027) and during the year following hospitalization (P = .022). There were no significant group differences in hospital length of stay and costs, home healthcare visits, or readmissions. Nursing care plans to promote independent function were more often implemented in the intervention group (79% vs 50%; P = .001), physical therapy consults were obtained more frequently (42% vs 36%; P = .027), and restraints were applied to fewer patients (2% vs 6%; P = .001). Satisfaction with care was higher for the intervention group than the usual care group among patients, caregivers, physicians, and nurses (P < .05).CONCLUSIONS: ACE in a community hospital improved the process of care and patient and provider satisfaction without increasing hospital length of stay or costs. A lower frequency of the composite outcome ADL decline or nursing home placement may indicate potentially beneficial effects on patient outcomes.
Assessment of Pain in Cognitively Impaired Older Adults: A Comparison of Pain Assessment Tools and Their Use by Nonprofessional Caregivers
Authors: Krulewitch Harry , London Maria R. , Skakel Victoria J. , Lundstedt Glenda J. , Thomason Heidi , Brummel‐Smith Kenneth 
Published: April 2015

OBJECTIVES:To compare self‐reporting of pain by cognitively impaired (CI) older adults living in the community with reports of their caregivers; to identify the factors associated with differences in agreement; and to identify those pain assessment tools that are most useful to nonprofessional caregivers.DESIGN:Prospective observational cohort of patients with dementia and their caregivers.SETTING:In‐home assessments of community‐dwelling CI older adults and family members, adult foster care providers, or aides in residential care facilities. All CI subjects were enrolled in a Program for All‐inclusive Care of the Elderly program (ElderPlace) in Portland, Oregon.PARTICIPANTS:A total of 156 CI adults and their caregivers.METHODS:Standardized pain assessment instruments were administered to the CI subjects and their caregivers in the subject's home by trained research assistants between June and October 1998. CI subjects were assessed with the Nonverbal Visual Analog scale (“line”), the Faces Pain Scale (“faces”), and the Philadelphia Pain Intensity Scale (PIS). Research assistants observed pain behaviors in the CI subjects using the Hospice Approach Discomfort Scale. The CI subject's caregivers completed the “line,” “faces,” PIS, and Cornell Scale for Depression in Dementia. A baseline Mini‐Mental State Exam, Functional Assessment Stage Test, and Geriatric Depression Scale were performed on all CI subjects by ElderPlace medical, nursing, or social work staff.RESULTS:The mean age of the CI subjects was 83, and 83% were women. The mean Mini‐Mental State Exam score was 15.7. One‐third of the CI subjects were unable to complete any of the three pain assessment tools. Of the 104 subjects completing at least one tool, 13 (12.5%) reported no pain and 91 (87.5%) reported some pain. Sixteen (10%) of the subjects were depressed as measured with the GDS or Cornell instrument. In 70 of the 104 subjects (67%) able to complete any tool, the caregiver and CI subject agreed as to the level of pain experienced by the CI subject. The number of tools completed by the CI subjects decreased with increased cognitive impairment. The Pain Intensity Scale was the tool most likely to be completed by both CI subjects and caregivers. The means of test scores were not significantly different for the paired groups of CI subject and caregiver, and the nonparametric correlation of each tool was significant: “faces” (Spearman's rho (ρ) = .417); “line” (ρ = .420); and PIS (ρ = .452). The Hospice Approach Discomfort Scale did not correlate well with other tools. The Pain Intensity Scale seems to be more useful than other pain assessment tools in assessing pain in cognitively impaired patients and can be used by nonprofessional caregivers in a community‐based care setting.
Long‐Term Exercise and its Effect on Balance in Older, Osteoarthritic Adults: Results from the Fitness, Arthritis, and Seniors Trial (FAST)
Authors: Messier Stephen P. , Royer Todd D. , Craven Timothy E. , O'Toole Mary L. , Burns Robert , Ettinger Walter H. 
Published: April 2015

OBJECTIVES: To examine the effects of 18‐month aerobic walking and strength training programs on static postural stability among older adults with knee osteoarthritis.DESIGN: Randomized, single‐blind, clinical trial of therapeutic exercise.SETTING: Both center‐based (university) and home‐based.PARTICIPANTS: A cohort of 103 older adults (age = 60 years) with knee osteoarthritis who were participants in a large (n = 439) clinical trial and who were randomly assigned to undergo biomechanical testing.INTERVENTION: An 18‐month center‐ (3 months) and home‐based (15 months) therapeutic exercise program. The subjects were randomized to one of three treatment arms: (1) aerobic walking; (2) health education control; or (3) weight training.MEASUREMENTS: Force platform static balance measures of average length (Rm) of the center of pressure (COP), average velocity (Vel) of the COP, elliptical area (Ae) of the COP, and balance time (T). Measures were made under four conditions: eyes open, double‐ and single‐leg stances and eyes closed, double‐ and single‐leg stances.RESULTS: In the eyes closed, double‐leg stance condition, both the aerobic and weight training groups demonstrated significantly better sway measures relative to the health education group. The aerobic group also demonstrated better balance in the eyes open, single‐leg stance condition.CONCLUSIONS: Our results suggest that long‐term weight training and aerobic walking programs significantly improve postural sway in older, osteoarthritic adults, thereby decreasing the likelihood of larger postural sway disturbances relative to a control group. J Am Geriatr Soc 48: 131–138, 2000.
Appropriateness of the Decision to Transfer Nursing Facility Residents to the Hospital
Authors: Saliba Debra , Kington Raynard , Buchanan Joan , Bell Robert , Wang Mingming , Lee Martin , Herbst Michael , Lee Daniel , Sur Denise , Rubenstein Lisa 
Published: April 2015

OBJECTIVES: To develop and test a standardized instrument, the purpose of which is to assess (1) whether skilled nursing facilities (SNFs) transfer residents to emergency departments (ED) inappropriately, (2) whether residents are admitted to hospitals inappropriately, (3) and factors associated with inappropriate transfers.DESIGN: A structured implicit review (SIR) of medical records.SETTING AND PARTICIPANTS: Using nested random sampling in eight community SNFs, we identified SNF and hospital records of 100 unscheduled transfers to one of 10 hospitals.MEASUREMENTS: Seven trained physician reviewers assessed appropriateness using a SIR form designed for this study (2 independent reviews per record, 200 total reviews). We measured interrater reliability with kappa statistics and used bivariate analysis to identify factors associated with assessment that transfer was inappropriate.RESULTS: In 36% of ED transfers and 40% of hospital admissions, both reviewers agreed that transfer/admit was inappropriate, meaning the resident could have been cared for safely at a lower level of care. Agreement was high for both ED (percent agreement 84%, kappa .678) and hospital (percent agreement 89%, kappa .779). When advance directives were considered, both reviewers rated 44% of ED transfers and 45% of admissions inappropriate. Factors associated with inappropriateness included the perceptions that: (1) poor quality of care contributed to transfer need, (2) needed services would typically be available in outpatient settings, and (3) the chief complaint did not warrant hospitalization.CONCLUSIONS: Inappropriate transfers are a potentially large problem. Some inappropriate transfers may be associated with poor quality of care in SNFs. This study demonstrates that structured implicit review meets criteria for reliable assessment of inappropriate transfer rates. Structured implicit review may be a valuable tool for identifying inappropriate transfers from SNFs to EDs and hospitals. J Am Geriatr Soc 48: 154–163, 2000.
Skeletal Muscle Mass and Muscle Strength in Relation to Lower‐Extremity Performance in Older Men and Women
Authors: Visser Marjolein , Deeg Dorly J.H. , Lips Paul , Harris Tamara B. , Bouter Lex M. 
Published: April 2015

OBJECTIVE: Low muscle strength is associated with poorer physical function, but limited empirical evidence is available to prove the relationship between muscle mass and physical function. We tested the hypothesis that persons with lower muscle mass or muscle strength have poorer lower‐extremity performance (LEP).DESIGN: A cross‐sectional, population‐based study.PARTICIPANTS: A cohort of 449 men and women aged 65 years and older living in Amsterdam and its surroundings participating in the second examination (1995–1996) of the Longitudinal Aging Study Amsterdam.MEASUREMENTS: Leg skeletal muscle mass was measured using dual‐energy X‐ray absorptiometry (DXA). Grip strength was used as an indicator of muscle strength. Timed functional performance tests, including walking and repeated chair stands, were used to assess LEP.RESULTS: After adjustment for body height and age, leg muscle mass was positively associated with LEP in men (regression coefficient 0.178 [95% confidence interval 0.013–0.343], P = .035). In women an inverse association was observed, which became positive after additional adjustment for body mass index (BMI) (0.202 [−0.001–0.405], P = .052). Grip strength was positively associated with LEP in men and women. After additional adjustment for behavioral, physiological, and psychological variables, the associations between leg muscle mass and LEP disappeared, whereas grip strength remained to be independently associated with LEP in men (0.079 [0.042–0.116], P = .0001), with a tendency in women (0.046 [−0.009–0.101], P = .11). Results were similar when quartiles of leg muscle mass or grip strength were used.CONCLUSIONS: These results suggest that low muscle strength, but not low muscle mass, is associated with poor physical function in older men and women. However, prospective studies are needed to investigate the association between loss of muscle mass and physical function. J Am Geriatr Soc 48: 381–386, 2000.
Benzodiazepines and the Risk of Falls in Nursing Home Residents
Authors: Ray Wayne A. , Thapa Purushottam B. , Gideon Patricia 
Published: April 2015

CONTEXT: For nursing home residents who require a benzodiazepine, short‐acting agents are recommended, primarily to avoid increased risk of falls and other injuries associated with the long‐acting agents. However, much of the data for the clinical outcomes of falls and injuries comes from community‐dwelling older people.OBJECTIVE: To quantify the rate of falls among nursing home residents taking benzodiazepines and how this varies with drug elimination half‐life.DESIGN: Historical cohort study.POPULATION: A total of 2510 residents of 53 Tennessee nursing homes, classified according to benzodiazepine use on each day of follow‐up.OUTCOME MEASURES: Falls occurring during study follow‐up.RESULTS: After adjustment for differences in resident characteristics, benzodiazepine users had a 44% increased rate of falls (adjusted rate ratio 1.44 [95% confidence interval, 1.33‐1.56]). The adjusted rate ratio increased from 1.30 (1.12‐1.52) for a dose equivalent to ≤2 mg of diazepam, to 2.21 (1.89‐2.60, P < .001) for a dose of > 8 mg. The rate of falls was greatest in the 7 days after the benzodiazepine was started (rate ratio of 2.96 [2.33‐3.75]) but remained elevated (1.30 [1.17‐1.44]) after the first 30 days of therapy. Drugs with elimination half‐lives of < 12, 12–23, and ≥24 hours had adjusted rate ratios of 1.15 (0.94‐1.40), 1.45 (1.33‐1.59), and 1.73 (1.40‐2.14), respectively. Users of hypnotics with elimination half‐lives < 12 hours had an increased rate of falls occurring during the night (adjusted rate ratio 2.82 [2.02–3.94]).CONCLUSIONS: Although the risk of falls among nursing home residents receiving short‐acting benzodiazepines is less than that for the long‐acting agents, these drugs are associated with a materially increased risk of nocturnal falls. J Am Geriatr Soc 48:682–685, 2000.
Racial Differences in Use of Cancer Prevention Services Among Older Americans
Authors: Hegarty Verona , Burchett Bruce M. , Gold Deborah T. , Cohen Harvey Jay 
Published: April 2015

CONTEXT: Racial differences in receipt of cancer prevention services may be related to poorer outcomes for minorities. Understanding reasons for such differences could help target appropriate interventions.OBJECTIVES: To determine if racial differences exist in the use of cancer prevention services among older blacks and whites and to explore explanatory factors.DESIGN: Sixth follow‐up survey of probability sample, four‐stage stratified household design with 4162 at baseline in 1986–1987 and 2846 surveyed in 1992–1993.SETTING: The Piedmont area of North Carolina.PARTICIPANTS: At time of follow‐up survey in 1992–1993 there were 1486 women and 726 men age >70 years, of whom 1246 were black and 966 were white.MEASUREMENTS: Self‐reported use of Papanicolou (pap) testing, clinical breast examination, mammography, rectal examination, and fecal occult blood testing on a regular basis within the last two years.RESULTS: Compared with older whites, older black persons are less likely to receive pap test (48.1% black vs 56.6% white, P < .001), clinical breast examination (64.6% black vs 69.2% white, P < .007), mammography (30.2% black vs 40.5% white, P < .001), rectal examination (50.2% black vs 62.4% white, P < .001), and fecal occult blood testing (37.5% black vs 46.2% white, P < .001). Effect of race on receipt of cancer prevention services was not significant when levels of education, income, and insurance coverage were considered.CONCLUSION: Racial differences exist in the use of cancer prevention services among older Americans. However, these differences are related to educational, income, and insurance differences between blacks and whites. J Am Geriatr Soc 48:735–740, 2000.
Association Between Medication Supplies and Healthcare Costs in Older Adults from an Urban Healthcare System
Authors: Stroupe Kevin T. , Murray Michael D. , Stump Timothy E. , Callahan Christopher M. 
Published: April 2015

OBJECTIVES: The amount of medication dispensed to older adults for the treatment of chronic disease must be balanced carefully. Insufficient medication supplies lead to inadequate treatment of chronic disease, whereas excessive supplies represent wasted resources and the potential for toxicity. We used an electronic medical record system to determine the distribution of medications supplied to older urban adults and to examine the correlations of these distributions with healthcare costs and use.DESIGN: A cross‐sectional study using data acquired over 3 years (1994–1996).SETTING: A tax‐supported urban public healthcare system consisting of a 300‐bed hospital, an emergency department, and a network of community‐based ambulatory care centers.PATIENTS: Patients were >60 years of age and had at least one prescription refill and at least two ambulatory visits or one hospitalization during the 3‐year period.MEASUREMENTS: Focusing on 12 major categories of drugs used to treat chronic diseases, we determined the amounts and direct costs of these medications dispensed to older adult patients. Amounts of medications that were needed by patients to medicate themselves adequately were compared with the medication supply actually dispensed considering all sources of care (primary, emergency, and inpatient). We calculated the excess drug costs attributable to oversupply of medication (>120% of the amount needed) and the drug cost reduction caused by undersupply of medication (<80% of the amount needed). We also compared total healthcare use and costs for patients who had an over‐supply, an undersupply, or an appropriate supply of their medications.RESULTS: The cohort comprised 4164 patients with a mean age of 71 ± 7 (SD) who received a mean of 3 ± 2 (SD) drugs for chronic conditions. There were 668 patients (16%) who received <80% of the supply needed, 1556 patients (37%) who received between 80 and 120% of the supply needed, and 1940 patients (47%) who received >120% of the supply needed. The total direct cost of targeted medications for 3 years was $1.96 million or, on average, $654,000 annually. During the 3‐year period, patients receiving >120% of their needed medications had excess direct medication costs of $279,084 or $144 per patient, whereas patients receiving <80% of drugs needed had reduced medication costs of $423,438 or $634 per patient. Multivariable analyses revealed that both under‐ and over‐supplies of medication were associated with a greater likelihood of emergency department visits and hospital admissions.CONCLUSIONS: More than one‐half of the older adults in our study have under‐ or over‐supplies of medications for the treatment of their chronic diseases. Such inappropriate supplies of medications are associated with healthcare utilization and costs. J Am Geriatr Soc 48:760–768, 2000.