bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alterations in Glucose Metabolism in Patients with Alzheimer's Disease
Authors: Meneilly Graydon S. , Hill Amanda 
Published: April 2015

Objective: To determine the alterations in glucose metabolism that occur in patients with Alzheimer's Disease (AD).Design: Cross‐sectional comparison of AD and healthy controls.Setting: A University teaching hospital.Patients: Healthy controls (n = 14, BMI: 24.9 ± 0.5 kg/M2, age 73 ± 1 years) and patients with AD (n = 12, BMI: 23.9 ± 1.0 kg/M2, age 72 ± 1 years). All controls and patients with AD had a normal history and physical examination, a negative family history of diabetes, and took no medications.Measurements: All patients and controls underwent an assessment of their dietary intake and physical activity, a 3‐hour oral glucose tolerance test (OGTT), and a 2‐hour hyperglycemic glucose clamp study.Results: Total caloric intake (AD: 27.1 ± 1.3 kcal/kg/day; Control: 23.6 ± 1.6 kcal/kg/day; P = ns) and intake of complex carbohydrates (AD: 5.9 ± 0.4 kcal/kg/day; Control: 6.5 ± 0.3 kcal/kg/day; P = ns) were not different between groups. Leisure time physical activity was greater in controls (AD: 2970 ± 411 kcal/week; Control: 5229 ± 864 kcal/week; P < 0.05). Patients with AD had higher fasting glucose (AD: 5.9 ± 0.2 mmol/L; Control: 5.1 ± 0.1 mmol/L; P < 0.01) and insulin (AD: 144 ± 20 pmol/L; Control: 100 ± 6 pmol/L; P < 0.05) values. In response to the OGTT, the area under the curve for glucose and insulin was similar in both groups. During the hyperglycemic clamp, steady‐state glucose values were higher in the Alzheimer's patients (AD: 11.5 ± 0.2 mmol/L; Control: 10.9 ± 0.1 mmol/L, P < 0.01). First‐ and second‐phase insulin responses were similar in each group. The insulin sensitivity index (units: mL/kg.min per pmol/L × 100), a measure of tissue sensitivity to insulin, was reduced in the patients with AD (AD: 0.59 ± 0.06; Control: 0.79 ± 0.07; P < 0.05).Conclusions: We conclude that early AD is characterized by alterations in peripheral glucose metabolism, which may relate, in part, to alterations in physical activity.
Measured versus Estimated Creatinine Clearance in a High‐Functioning Elderly Sample: MacArthur Foundation Study of Successful Aging
Authors: Malmrose Lynda C. , Gray Shelly L. , Pieper Carl F. , Blazer Dan G. , Rowe John W. , Seeman Teresa E. , Albert Marilyn S. 
Published: April 2015

Objective: To assess the validity of several equations for estimating creatinine clearance in a large sample of high‐functioning, community‐dwelling elderly.Design: Serum and 12‐hour urine samples were collected and assayed for creatinine using the Jaffe total chromagen method. Fifteen clearance‐estimating equations were evaluated for bias, accuracy, correlation with measured clearance values, and frequency of erroneous placement into renal function categories. Stepwise regression modeling and reliability testing were performed on a split sample to construct and assess a novel creatinine‐clearance‐estimating equation.Setting: New Haven, Connecticut, East Boston, Massachusetts, and a five‐county region in and around Durham, North Carolina.Participants: A subsample of community‐dwelling men and women (age range 70–79 years) from the Established Populations for Epidemiological Studies of the Elderly was screened for physical and cognitive functioning and placed into high‐, medium‐, and low‐functioning groups (n = 1354). High‐functioning respondents who provided blood and complete urine samples (n = 762) were included in the present study.Results: In general, estimated creatinine clearance was more closely correlated to measured values in males than in females. Most equations underestimated creatinine clearance, with average bias ranging from—33.1 mL/min to +19.6 mL/min. Predictive accuracy ranged from 18.2 mL/min to 38.0 mL/min. Equations were variable in their erroneous placement of individuals into renal function categories. Regression modeling yielded an equation which contained novel components but failed to provide better estimates of creatinine clearance than those already available.Conclusions: The equations evaluated here provide unacceptable predictions of creatinine clearance in normally aging individuals. We advocate the use of serum drug concentration measurements when available and encourage investigation into timed urine collections of short duration as alternatives to clearance‐estimating equations in the elderly.
Relationship between Cognitive Status and Behavioral Symptoms in Alzheimer's Disease and Mixed Dementia
Authors: Kurita Akira , Blass John P. , Nolan Karen A. , Black Ronald S. , Thaler Howard T. 
Published: April 2015

Objective: To investigate the relationship between cognitive and behavioral impairments in Alzheimer's disease (AD) and to examine whether the addition of cerebrovascular disease modifies that relationship.Design: Correlational analysis.Setting: An outpatient dementia clinic.Patients: An autopsy‐confirmed series of 28 patients with AD and 16 patients with mixed Alzheimer and vascular dementia (MIX).Measurements: Neuropsychological and behavioral tests during life: Mini‐Mental State (MMS), Blessed Dementia Scale (BDS), Haycox Dementia Behavior Scale (HDBS), and two non‐cognitive functional scales derived from the BDS and HDBS.Results: In the AD group, MMS scores correlated significantly with scores on the BDS, HDBS, and two non‐cognitive functional scales. In the MIX group, however, no significant relationship was observed between MMS scores and scores on any of the behavioral measures.Conclusions: These observations suggest that in AD, cognitive and behavioral impairments progress simultaneously. However, with the addition of a vascular component to the dementing process, cognitive and behavioral impairments may progress more independently.
Changes in Orders Limiting Care and the Use of Less Aggressive Care in a Nursing Home Population
Authors: Holtzman Jeremy , Pheley Alfred M. , Lurie Nicole 
Published: April 2015

ObjectiveTo examine changes in the aggressiveness of care of the nursing home population and to determine the factors that predict whether care is limited.DesignRetrospective chart review.SettingAll nursing homes in Hennepin County, Minnesota that care for Medicaid patients.PatientsA random sample of 1605 residents of Hennepin County, MN nursing homes from 1984 and 1988 who were also Medicaid beneficiaries. The sample was stratified by year and by whether the resident died in that year. The residents were sampled disproportionately to allow approximately 400 individuals in each stratum. A total of 1405 charts (87%) was reviewed; the remainder had either been lost or destroyed.Main Outcome MeasureOrders limiting care (do not resuscitate, supportive care only, etc.), care that was less aggressive than care usually given to a person of that age (eg, not using antibiotics for a clear infection or not sending a resident to the hospital for an illness for which someone would “usually” be sent to the hospital), determined implicitly through chart review.ResultsThe demographic characteristics of the nursing home population did not change between 1984 and 1988, but the population had significantly greater severity of illness in 1988. The percentage of residents with 'sdo not resuscitate's orders (DNR) increased from 12% to 37% (P < 0.0001), and the use of other orders to limit care (do not hospitalize, supportive care only, etc.) increased from 12% to 17% (P < 0.05). The use of CPR did not change between the two years but the percentage of residents who were found to receive less aggressive care through implicit chart review increased from 31% to 40% (P < 0.01). The year the resident was in the nursing home, the severity of illness, functional status, and dementia were significant predictors of DNR status. Factors that predict receipt of less aggressive care were similar except that age was also a significant predictor.ConclusionsThe nursing home population received less aggressive care in 1988 than in 1984. Further, there was a discrepancy between what was ordered and what was delivered in the nursing home in that residents with DNR orders had care limited beyond the withholding of CPR.
Relationship of Age with Eligibility for Thrombolytic Therapy and Mortality Among Patients with Suspected Acute Myocardial Infarction
Authors: Krumholz Harlan M. , Friesinger Gottlieb C. , Cook E. Francis , Lee Thomas H. , Rouan Gregory W. , Goldman Lee 
Published: April 2015

Objective: To determine the relationship of age and the percentage of patients presenting to the emergency department with myocardial infarction who meet conventional electrocardiographic and time‐to‐presentation criteria for thrombolytic therapy.Design: Prospective cohort study.Setting: Emergency departments of three university hospitals and four community hospitals.Patients: Patients enrolled in the Multicenter Chest Pain Study, an investigation of patients aged 30 years or older presenting to the emergency department with the chief complaint of anterior, precordial, or left lateral chest pain unexplained by obvious local trauma or abnormalities on the chest radiograph.Interventions: None.Measurements: The frequency of patients who presented with conventional electrocardiographic and time‐to‐presentation criteria for thrombolysis.Main Results: Of a total of 12,140 patients who were enrolled in the Multicenter Chest Pain Study, 10,850 had information about their electrocardiogram and their time‐to‐presentation. Acute myocardial infarction occurred in 1,584 patients, 746 of whom were over age 65. Among patients presenting to the emergency department with acute myocardial infarction, the proportion who arrived within 6 hours of the onset of pain and had ST‐segment elevation or pathologic Q‐waves not known to be old decreased significantly with increasing age, from 34% in patients under 65 years to 18% for those 75 years and older. In addition, comorbidities that would have contraindicated thrombolytic therapy were present in an additional 12% of myocardial infarction patients who were older than 65 years.Conclusion: Although other analyses have shown that thrombolytic therapy is cost‐effective for eligible elderly patients with acute myocardial infarction, only a small percentage of very elderly patients who present to the emergency department with acute myocardial infarctions meet current eligibility criteria to receive it, so thrombolysis is unlikely to narrow the difference in mortality rates for young as compared with elderly patients with acute infarctions.
A Prospective Community‐Based Pilot Study of Risk Factors for the Investigation of Elder Mistreatment
Authors: Lachs Mark S. , Berkman Lisa , Fulmer Terry , Horwitz Ralph I. 
Published: April 2015

Purpose: To identify risk factors for the investigation of elder abuse, neglect, self‐neglect, exploitation, and abandonment in a population‐based observational cohort of community living elders.Study Population: Population‐based sample of 2,812 community‐living men and women in New Haven, Connecticut who were over age 65 in 1982.Methods: Matching process whereby cohort members who were investigated by Connecticut's State Ombudsman on Aging in 1985 or 1986 were identified.Analysis: Relative risks for ombudsman investigation in 1985 or 1986 were calculated based on risk factors status at baseline interview in 1982.Results: Sixty‐eight (2.4%) members of the cohort received investigation. Features at cohort entry significantly associated with investigation in multiple logistic regression included: requiring assistance with feeding (Adjusted OR 3.5, 95% CI 1.2, 11.7), being a minority elder (Adj. OR 2.3, 95% CI 1.4, 2.8), over age 75 at cohort inception (Adj. OR 1.9, 95% CI 1.1, 3.1), and having a poor social network as defined by a social network index (Adj. OR 1.7, 95% CI 1.0, 2.7). When stratified by race, requiring assistance with feeding was associated with ombudsman investigation in minority elders (Adj. OR 10.8, 95% CI 2.8, 40.5) but not non‐minority elders (Adj. OR 1.1, 95% CI 0.5, 7.5).Conclusion: Functional disability, minority status, older age, and poor social networks were associated with investigation for elder mistreatment in this prospective, community‐based population of men and women over the age of 65.
The Epidemiology of Adverse and Unexpected Events in the Long‐Term Care Setting
Authors: Gurwitz Jerry H. , Sanchez‐Cross Maria T. , Eckler Marie A. , Matulis John 
Published: April 2015

Objective: To describe the adverse and unexpected events reported by staff over a 1‐year period in a large, long‐term care institution.Design: A retrospective review of resident incident reports.Setting: A 703‐bed, academically oriented, long‐term care facility.Patients: Residents of the facility have a mean age of 88.5 years, are 76% female, and have an average length of stay of 4.3 years.Measurements and Main Results: Of the 3,390 adverse and unexpected events reports over the 1‐year study period, falls (with and without associated injury) were the most frequently reported incidents, followed by non‐fall‐related injuries, medication‐related events, and wandering episodes. While a large proportion of falls occurred in ambulating residents (47%), the majority occurred under different circumstances including falls from bed, wheelchair, and commode/toilet. Bruises and skin tears were the most frequently reported fall‐and non‐fall‐related injuries. The annual incidence rates for falls, fall‐related injuries, and non‐fall‐related injuries varied according to resident care unit level, with semi‐dependent residents experiencing the highest rates of falls and dependent residents experiencing the highest rates of non‐fall‐related injuries. Circadian patterns in the incidence of these events varied according to resident care level.Conclusions: Information regarding adverse and unexpected events in the long‐term care setting can be organized into databases that allow analysis of patterns and trends. The results of these analyses may be helpful in targeting limited resources to areas of greatest need within an individual institution and for comparing quality of care across different long‐term care facilities. J Am Geriatr Soc 42:33–38, 1994
Self‐Reported Causes of Physical Disability in Older People: The Cardiovascular Health Study
Authors: Ettinger Walter H. , Fried Linda P. , Harris Tamara , Shemanski Lynn , Schulz Richard , Robbins John , Group CHS Collaborative Research 
Published: April 2015

OBJECTIVE: To determine the major conditions and symptoms reported to cause difficulty in 17 physical tasks of daily life and the criterion validity of self‐report of diseases given as the causes of the difficulty in functioning, in community‐dwelling older people.DESIGN: Cross sectional analyses of data obtained in an observational cohort study.SETTING: Research clinics in four US communities: Winston‐Salem, NC, Hagerstown, MD, Pittsburgh, PA, and Sacramento, CA.PARTICIPANTS: 5201 community‐dwelling people ≥ 65 years old.RESULTS: Arthritis and other musculoskeletal diseases were given as the primary causes of difficulty in performing physical tasks by 49.0% of the participants reporting difficulty in any task, followed by heart disease (13.7%), injury (12.0%), old age (11.7%), lung disease (6.0%), and stroke (2.9%). The self‐reports of diseases that caused disability varied by task. Whereas arthritis was given as a cause of difficulty in most of the 17 different tasks, heart and lung disease were more likely to be reported as causing difficulty with activities requiring high aerobic work capacity such as walking one‐half mile or doing heavy housework. Stroke was more likely to be reported as causing difficulty with use of the upper extremities and in performing basic activities of daily living.There was a high degree of consistency (91%) between the diseases and symptoms reported to cause disabilities. The percentage of people who reported a disease as the cause of their difficulty performing a task and had independent confirmation of the diagnosis was 85% in men and 71% in women, and varied according to type of disease and the individual's cognitive status and health status.CONCLUSION: These data suggest that age‐related chronic diseases are important causes of disability in older people but that the type of disability is dependent on the underlying disease that causes the disability. Also, self‐report of the cause of disability appears to be generally accurate but is influenced by gender, health status, and type of disease.
Pharmacokinetics of Methylprednisolone in Elderly and Young Healthy Males
Authors: Tornatore Kathleen M. , Logue Gerald , Venuto Rocco C. , Davis Paul J. 
Published: April 2015

OBJECTIVE: To characterize and compare the pharmacokinetics of a single intravenous dose of methylprednisolone in elderly and young healthy males.DESIGN: A randomized, parallel pharmacokinetic trial.SETTING: A public university‐affiliated hospital.SUBJECTS: Seven healthy, elderly white males (aged 69 to 82 years) and five healthy, young white males (aged 24 to 37 years) who gave informed consent and fulfilled all screening criteria.MEASUREMENTS: Serial blood samples were obtained over a 24‐hour study period after intravenous administration of a 10‐mg dose of methylprednisolone. Serum methylprednisolone concentrations were determined by high performance liquid chromatography and utilized to determine the pharmacokinetic parameters.RESULTS: Methylprednisolone serum concentrations declined in a linear manner in both groups. However, 4 hours after the dose, the mean serum concentration of methylprednisolone was 50.9 ± 15.1 ng/mL in the elderly group and 37.6 ± 7.5 (P = 0.07) ng/mL in the young group. The clearance of methylprednisolone was 237 ± 62 mL/h/kg, with a volume of distribution of 1.10 ± 0.07 L/kg, for the elderly group, whereas the young males had a mean drug clearance of 359 ± 90 mL/h/kg (P < 0.05) and a mean volume of distribution of 1.28 ± 0.34 L/kg. The half‐life of methylprednisolone ranged from 1.90 to 5.40 hours in the elderly group; the range was 1.99 to 3.31 hour (P = 0.16) in the young group.CONCLUSION: A slower methylprednisolone clearance was noted in the elderly group compared with the young counterparts. This pharmacokinetic alteration seen in healthy elderly subjects may contribute to the increased incidence of adverse effects from chronic glucocorticoid therapy that has been observed among elderly patients.
Risk Factors for Non‐Insulin‐Dependent Diabetes Mellitus Requiring Treatment in the Elderly
Authors: Gurwitz Jerry H. , Field Terry S. , Glynn Robert J. , Manson JoAnn E. , Avorn Jerry , Taylor James O. , Hennekens Charles H. 
Published: April 2015

OBJECTIVE: To examine the relationship of possible modifiable risk factors, including obesity, physical activity level, alcohol consumption, blood pressure, and thiazide diuretic use with the development of non‐insulin‐dependent diabetes mellitus (NIDDM) requiring treatment among a large cohort of community‐dwelling elderly.SETTING: The East Boston Senior Health Project, one of four components of the National Institute on Aging‐sponsored Established Populations for the Epidemiologic Study of the Elderly (EPESE).PARTICIPANTS: Residents of East Boston who were 65 years of age or older.MEASUREMENTS: We performed a prospective cohort study with follow‐up over two consecutive 3‐year time periods beginning in 1982–1983. The main outcome measure was the occurrence of NIDDM, defined as new treatment with a hypoglycemic agent. A total of 2737 study participants contributed 4682 3‐year intervals for analysis.MAIN RESULTS: NIDDM requiring hypoglycemic therapy occurred in 185 participants over the duration of the study. High body mass index (>26 kg/m22) (adjusted odds ratio 2.4, 95% confidence interval 1.3–4.4) and low physical activity level (adjusted odds ratio 1.5, 95% confidence interval 1.0–2.1) were significant predictors of NIDDM in a multiple logistic regression model adjusting for age, sex, blood pressure, and self‐report of “high blood sugar”; moderate alcohol consumption (0.5‐< l ounce per day) had an inverse relation to NIDDM of borderline significance (adjusted odds ratio 0.4, 95% confidence interval 0.2–1.0). Those receiving one or more non‐thiazide antihypertensive agents had a higher risk of developing NIDDM in a model including age, sex, body mass index, various antihypertensive regimens, physical activity level, alcohol consumption, blood pressure, and self‐report of “high blood sugar.” Thiazide diuretic therapy alone or in combination with another antihypertensive was not associated with NIDDM.CONCLUSIONS: Our findings suggest a positive relationship of obesity and low physical activity level with the development of NIDDM requiring treatment in elderly persons. The inverse association of borderline significance between moderate alcohol use and NIDDM deserves further study. Thiazide diuretic therapy conferred no excess risk for developing NIDDM in this older population although selection factors in the choice of antihypertensive therapy may partially explain the absence of a thiazide effect.
Appropriateness of Medication Prescribing in Ambulatory Elderly Patients
Authors: MD Kenneth Schmader , Hanlon Joseph T. , Weinberger Morris , Landsman Pamela B. , Samsa Gregory P. , Lewis Ingrid , Uttech Kay , Cohen Harvey J. , Feussner John R. 
Published: April 2015

OBJECTIVE: To assess the quality of medication prescribing in ambulatory elderly patients on multiple medications using the Medication Appropriateness Index (MAI).DESIGN: Cross‐sectional study.SETTING: General Medical Clinic of the Durham VA Medical Center.PATIENTS: 208 elderly outpatients on five or more regularly scheduled medications.MEASUREMENTS: Medication prescribing appropriateness was measured with the MAI, a reliable method that employs 10 implicit criteria. A weighted MAI score (range 0–18 per drug) served as a summary measure of appropriateness.RESULTS: There were 1644 medications evaluated; 26% received no inappropriate ratings, 37% had one, 19% had two, and 18% had three or more. Of 16,440 ratings, 2295 (14%) were evaluated as inappropriate. The percentage of inappropriate ratings varied across prescribing dimensions: drug‐drug interactions, 0%; drug‐disease interactions, 1.4%; medication effectiveness, 4.7%; therapeutic duplication, 5.7%; indication, 11.5%; duration of treatment, 16.5%; dosage, 17.3%; practical directions, 20.3%; cost, 29.7%; and correct directions, 32.4%. The mean MAI score for all medications was 2.2 ± 2.1 (range 0–10) and varied by therapeutic class. MAI scores were significantly lower for medications with a high potential for adverse effects compared with those with a low potential (MAI score of 1.8 vs 2.9, P < 0.001). Regression analysis revealed that no patient characteristics were associated with a higher likelihood of inappropriate prescribing.CONCLUSIONS: Medication prescribing for elderly outpatients taking multiple medications was substantially appropriate. Prescribing dimensions with the most room for improvement were more exact directions, less expensive drugs, and practical directions. Drugs at high risk for adverse effects were prescribed more appropriately than those at low risk.