bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tube Feeding in Nursing Home Residents with Severe and Irreversible Cognitive Impairment
Authors: Gessert Charles E. , Mosier Michael C. , Brown Edward F. , Frey Bruce 
Published: April 2015

OBJECTIVES: This study was undertaken to determine the degree to which selected demographic and clinical variables are associated with the use of feeding tubes in older nursing home residents with very severe and irreversible cognitive impairment.DESIGN: Descriptive, cross‐sectional, population‐based study.SETTING: Kansas nursing homes from January 1, 1994, through June 30, 1998.PARTICIPANTS: A total of 4997 nursing home residents with very severe and irreversible cognitive impairment comprised the study population. Subjects were identified using data in Minimum Data Set (MDS) reports. Those who were included in the study population were over the age of 65, had two consecutive Cognitive Performance Scale scores of 6, were without evidence of significant subsequent improvement, and were not comatose.MEASUREMENTS: The MDS data on each resident were examined to determine subjects' age, ethnicity, gender, Medicaid eligibility, disease diagnoses, physical functioning, and oral/nutritional status, including feeding tube status. The MDS was also used to determine urban versus rural location of the nursing home. The association between the use of feeding tubes and selected demographic and clinical characteristics was then examined using bivariate and logistic regression tests.RESULTS: Of the 4997 residents in the study population, 577 (11.6%) had feeding tubes. In multivariate analysis, feeding tube use was found to be associated with swallowing problems (odds ratio (OR) 5.4, 95% confidence interval (CI) 4.3–6.8); urban location of nursing home (OR 2.9, 95% CI 2.3–3.5); non‐white race (OR 2.7, 95% CI 1.9–3.6); stroke (OR 2.5, 95% CI 2.0–3.1); and absence of dementia (OR 2.5, 95% CI 2.0–3.1). Feeding tubes were also more weakly associated with age <86 years, male gender, dependency for all activities of daily living, and absence of a living will. Feeding tube use was not found to be associated with chewing problems, Medicaid status, or resuscitation status.CONCLUSIONS: Clinical variables including swallowing problems, stroke, and absence of dementia were strongly associated with the use of feeding tubes in this cross‐sectional, population‐based study. In addition, urban location of nursing home and non‐white race were significantly associated with feeding tubes. These findings suggest that feeding tube decisions are strongly influenced by nonclinical factors and invite further investigation.
The Validity of the Minimum Data Set in Measuring the Cognitive Impairment of Persons Admitted to Nursing Homes
Authors: Gruber‐Baldini Ann L. , Zimmerman Sheryl Itkin , Mortimore Edward , Magaziner Jay 
Published: April 2015

OBJECTIVES: This study examined the construct validity of two cognitive scales from the federally mandated Minimum Data Set (MDS) of the nursing home Resident Assessment Instrument.DESIGN: A cross‐sectional comparisons of the MDS measures, with scales provided by the resident, a proxy person, and nursing staff.SETTING: Subjects residing in 59 nursing homes (NHs) in Maryland from 1992 to 1995.PARTICIPANTS: Subjects were 1939 new admissions to NHs, aged 65 and older, with complete MDS information at admission.MEASUREMENTS: Two MDS scales, the Cognitive Performance Scale (CPS) and the MDS Cognition Scale (MDS‐COGS), were compared with the Mini‐Mental State Examination (MMSE) and the staff rating on the Psychogeriatric Dependency Rating Scale (PGDRS) Orientation scale, as well as measures of functioning and functional decline.RESULTS: The CPS and the MDS‐COGS were highly correlated (r = 0.92). Both correlated moderately well with the MMSE (r = −0.65 and −0.68) and with staff's rating on the PGDRS Orientation scale (r = 0.63 and r = 0.66). Correlations with the MMSE (r < 0.70) are lower than previously reported (r ≥ 0.80). The proportion of cognitively impaired residents in this NH admission cohort was higher using the MDS‐COGS than the CPS (65% vs 57%), but both MDS scales produced lower proportions than the MMSE (70%) and higher proportions than the PGDRS (47%). The internal consistency of the CPS was better without the comatose item (alpha = 0.80 vs 0.70). The MDS‐COGS had higher internal consistency (alpha = 0.85) and was simpler to compute.CONCLUSIONS: This is the first study to examine the validity of the MDS in a large sample of residents and NHs in situations where the MDS was not completed by research‐trained staff. Compared with other instruments, the MDS‐COGS and the CPS had moderate and similar validity for assessing cognitive impairment. Differences in the scales could provide different estimates of impairment among persons admitted to nursing homes.
Body Positions Used by Healthy and Frail Older Adults to Rise from the Floor
Authors: Ulbrich Jessica , Raheja Aarti , Alexander Neil B. 
Published: April 2015

OBJECTIVE: The purpose of this study was to describe how older adults, particularly more physically impaired older adults, might differ from healthy controls in the body positions used to rise from the floor.DESIGN: Cross‐sectional analysis of young, healthy older, and congregate housing older women.SETTING: University‐based laboratory and congregate housing facility.PARTICIPANTS: Healthy young university student controls (n = 22, mean age 23 years); healthy old adults living independently in the community (n = 24, mean age 73 years); and congregate housing older adults (n = 29, mean age 81 years).INTERVENTION: Videotaping and timing of rising from a supine position on the floor to standing.MAIN OUTCOME MEASURES: In addition to the time taken to rise from the floor, 10 specific trunk and extremity positions used during the rise, termed Intermediate Positions (IP), were identified.RESULTS: The Young controls had the fastest rise time and used the fewest number of IP, whereas the Congregate residents had the slowest rise time and used the most IP, with the Healthy old adults intermediate in both time and IP use. Prevalence of certain IP, together with correlational and factor analyses, suggest that use of Sit and Crouch was the most preferred rise strategy for the Young controls, whereas use of Tuck, Crouch‐Kneel, All Fours, and Bearwalk was the most preferred rise strategy among the Congregate residents. The Healthy old used IP common to both Young and Congregate residents, reflecting a rise strategy intermediate to the latter groups. A substantial subset of the Congregate residents (38%) were unable to rise without assistance and appeared to use certain preparatory positions (Sit, Kneel, Tuck) but were unable to get into presumably more challenging positions (Crouch‐Kneel, All Fours, Bearwalk).CONCLUSIONS: With increasing age and physical impairment, body positions used during rising from the floor suggest a preference for maintaining upper and lower extremity contact with the floor, presumably minimizing the lower extremity strength requirements to rise and maximizing stability and postural control. These intermediate body positions may be useful as the basis for training older adults to rise from the floor.
Higher Basal Cortisol Predicts Verbal Memory Loss in Postmenopausal Women: Rancho Bernardo Study
Authors: Greendale Gail A. , Kritz‐Silverstein Donna , Seeman Teresa , Barrett‐Connor Elizabeth 
Published: April 2015

BACKGROUND: In animals, higher endogenous or exogenous corticosteroids cause neuronal dysfunction, damage, and loss, especially in the hippocampus. In humans, high cortisol levels have been linked to memory impairment.OBJECTIVE: To prospectively examine the relation between morning basal cortisol level and change in cognitive performance during an average follow‐up of 2 years.DESIGN: Longitudinal cohort.SETTING: Geographic community in southern California.MEASUREMENTS: Between 1984 and 1987, blood for basal morning cortisol was obtained along with pertinent medical, behavioral, and physical covariates from 749 postmenopausal women, mean age 72 years, who were not taking corticosteroids or postmenopausal hormones. Cognitive function was assessed in 502 women in the period from 1988 to 1991 and repeated in 136 women in the period from 1991 to 1993.RESULTS: In both age‐ and multiply adjusted linear regression models, higher baseline cortisol was a significant predictor of worsened category fluency. No other cognitive domain tested was related to cortisol.CONCLUSIONS: These results support the hypothesis that subtle dysregulation of cortisol axis is related to memory loss. Interventions that block this pathway may provide new therapeutic options to prevent cognitive decline.
Physicians Are Less Willing to Treat Suicidal Ideation in Older Patients
Authors: Uncapher Heather , Areán Patricia A. 
Published: April 2015

OBJECTIVE: Older adults have the highest rate of suicide of any age group, and reducing the number of late‐life suicides has become a national priority. The objective of this study was to determine if an age bias exists among primary care physicians when they contemplate treating suicidal patients.DESIGN: Primary care providers were mailed one of two case vignettes of a suicidal, depressed patient. The only difference between the two vignettes was the age of the patient (38 or 78 years old) and employment status (employed vs retired as a factory worker). A questionnaire was included to determine provider recognition of suicidal ideation, and a scale was designed to detect willingness to treat the vignette patient.SETTING/PARTICIPANTS: Physicians were selected randomly from the University of California, San Francisco physician roster and invited to participate in the study. A total of 342 physicians (63% response rate), including specialists, responded to the mailings. For this study, the responses of 215 primary care physicians were analyzed.INTERVENTION: The randomly assigned experimental group received a vignette of a geriatric, retired patient who was depressed and suicidal (n = 100 participants). The control group received an identical but younger, employed patient (n = 115 participants).MEASUREMENTS: A 21‐item Suicidal Patient Treatment Scale measured willingness to treat the suicidal patient.RESULTS: The physicians in this study recognized depression and suicidal risk in both the adult and the geriatric vignette, but they reported less willingness to treat the older suicidal patient compared with the younger patient. The physicians were more likely to feel that suicidal ideation on the part of the older patient was rational and normal. They were less willing to use therapeutic strategies to help the older patient, and they were not optimistic that psychiatrists or psychologists could help the suicidal patient.CONCLUSIONS: This study suggests that primary care physicians are capable of recognizing suicidal ideation but are less willing to treat it if the patient is older and retired. Future research needs to determine etiologic factors for this age bias. J Am Geriatr Soc 48: 188–192, 2000.
Fatigue in an Older Population
Authors: Liao Solomon , Ferrell Bruce A. 
Published: April 2015

OBJECTIVES: Fatigue is a common symptom that has not been studied well in the older populations. The purpose of this pilot study was to examine the epidemiology of fatigue symptoms in relation to demographic and medical characteristics of older patients in a long‐term care setting.DESIGN: A cross‐sectional interviewer‐assisted survey.PARTICIPANTS/SETTING: A total of 199 ambulatory older residents of a single residential care facility.MEASUREMENTS: Along with medical and demographic characteristics, the survey included mental status (Folstein), activities of daily living (Katz and Lawton), depression (Yesavage GDS), a 3‐minute walk, a 7‐item pain scale, and the modified Piper Fatigue Scale.RESULTS: One‐hundred ninety‐nine (65%) of 308 potential subjects completed the study (mean age 88 years, 82% female). Of these 199 subjects, 195 (98%) reported some fatigue symptoms (median duration 44 weeks). Significant (P < .0005) relationships were found between fatigue and GDS (r = 0.57), 3‐minute walk (r = −0.29), Lawton IADLs (r = 0.31), pain (r = 0.36), and number of medications (r = 0.26). No significant relationships were found between fatigue and age, sex, Folstein score, or number of medical diagnoses. Multivariate regression analysis identified GDS, pain, number of medications and 3‐minute walk as significant predictors of fatigue intensity (multiple R = 0.68, r2 = 0.46, P < .02).CONCLUSIONS: Fatigue is a symptom often found among older residents of a residential facility and has important implications for quality of life. Fatigue is poorly recognized and probably undertreated in older people. J Am Geriatr Soc 48: 426–430, 2000.
Effects of an Abilities‐Focused Program of Morning Care on Residents Who Have Dementia and On Caregivers
Authors: Mezey Mathy , Fulmer Terry , Wells Donna L. , Dawson Pamela , Sidani Souraya , Craig Dorothy , Pringle Dorothy 
Published: April 2015

OBJECTIVE: To conduct a controlled investigation to examine the effects of an abilities‐focused program of morning care on the interaction behaviors and functioning of residents with dementia and on caregivers' interaction behaviors and perceptions of caregiving.DESIGN: A quasi‐experimental, repeated measures design.SETTING: The study was conducted on four, nursing‐home‐level cognitive supports units in a geriatric care center. One of the units was randomly selected as the experimental unit; the other three served as controls.PARTICIPANTS: The final sample consisted of 40 residents (20 each in the experimental and three control groups) and 44 caregivers (16 on the experimental unit and 28 on the three control units).INTERVENTION: An educational program on delivering abilities‐focused morning care, designed by the authors, was provided to caregivers on the experimental unit.MEASUREMENTS: Measures were taken at baseline and at 3 and 6 months postintervention with regard to residents' interaction behaviors, level of agitation, and level of function and to caregivers' interaction behaviors, perceived ease of caregiving, and level of stress.RESULTS: Repeated measures analysis of variance (RM‐ANOVA) was used to compare the experimental and control groups in regard to changes in the outcomes over time. Results indicated that the abilities‐focused program had statistically significant effects on (a) residents' personal attending and calm/functional behaviors, level of agitation, and levels of overall and social function, and (b) caregivers' verbal relevance and personal attending, relaxed, and social/flexible behaviors.CONCLUSIONS: The evidence suggests that both residents and caregivers benefit from morning care that is oriented toward the abilities of people with dementia. J Am Geriatr Soc 48: 442–449, 2000.
Depressed Mood and Body Mass Index as Predictors of Muscle Strength Decline in Old Men
Authors: Rantanen Taina , Penninx Brenda W.J.H. , Masaki Kamal , Lintunen Taru , Foley Dan , Guralnik Jack M. 
Published: April 2015

OBJECTIVE: To study depressed mood as a predictor of strength decline within body weight categories over a 3‐year follow‐up period.DESIGN: A prospective cohort study over 3 years.SETTING: Honolulu, Hawaii.PARTICIPANTS: The subjects were 2275 men participating in the Honolulu Heart Program with an average age of 77.1 years (range 71–92 years), who were not cognitively impaired at baseline (Exam 4), and who participated in maximal hand grip strength measurements at baseline and 3 years later (Exam 5).MEASUREMENTS: Hand grip strength was measured using a dynamometer. Depressive symptoms were studied using an 11‐item version of Center for Epidemiologic Studies Depression Scale with 9 as a cutoff. Body weight categories were formed on the basis of body mass index (BMI) (BMI = weight/height2; underweight: BMI < 20; normal weight: BMI 20–24.99, overweight: BMI ≥ 25).MAIN RESULTS: At baseline, 9.4% of the participants were rated as having depressed mood. The mean individual strength change over 3 years was −6.9% (standard deviation 14.0). Steep strength decline was determined as losing ≥14% (lowest quartile). The proportions of those with steep strength decline in the groups based on combined distributions of BMI and depressed mood were: underweight/depressed (n = 22) 41%, underweight/not depressed (n = 200) 28%, normal weight/depressed (n = 127) 30%, normal weight/not depressed (n = 1181) 25%, overweight/depressed (n = 55) 31%, overweight/not depressed (n = 675, referent) 21%. After adjusting for baseline strength, age, height, sociodemographic variables and diseases, the odds ratio for steep strength decline was more than four times greater among those who were depressed and underweight, and twice as great among people who were depressed and normal weight compared with those who were nondepressed and overweight. The risks of nondepressed under‐ and normal weight people and depressed overweight people did not differ from the reference group.CONCLUSIONS: Depressed mood was associated with increased risk of steep strength decline, in particular in older men with low body weight. Low body weight in combination with depressed mood may be an indicator of frailty or severe disease status that leads to accelerated strength loss and disability. J Am Geriatr Soc 48:613–617, 2000.
Delirium Is Independently Associated with Poor Functional Recovery After Hip Fracture
Authors: Marcantonio Edward R. , Flacker Jonathan M. , Michaels Mary , Resnick Neil M. 
Published: April 2015

OBJECTIVE: To evaluate the role of delirium in the natural history of functional recovery after hip fracture surgery, independent of prefracture status.DESIGN: Prospective cohort study.SETTING: Orthopedic surgery service at a large academic tertiary hospital, with follow‐up extending into rehabilitation hospitals, nursing homes, and the community.PARTICIPANTS: One hundred twenty‐six consenting subjects older than 65 years (mean age 79 ± 8 years, 79% women) admitted emergently for surgical repair of hip fracture.MEASUREMENTS: Detailed assessment at enrollment to ascertain prefracture status through interviews with the patient and designated proxy and review of the medical record. Interviews included administration of standardized instruments (Activities of Daily Living (ADL) Scale, Blessed Dementia Rating Scale, Delirium Symptom Interview) and assessment of ambulation, and prefracture living situation. Medical comorbidity, the nature of the hip fracture, and the surgical repair were obtained from the medical record. All subjects underwent daily interviews for the duration of the hospitalization, including the Mini‐Mental State Examination and Delirium Symptom Interview, and delirium was diagnosed using the Confusion Assessment Methods algorithm. Patients and proxies were recontacted 1 and 6 months after fracture, and underwent interviews similar to those at enrollment to determine death, persistent delirium, decline in ADL function, decline in ambulation, or new nursing home placement.RESULTS: Delirium occurred in 52/126 (41%) of patients, and persisted in 20/52 (39%) at hospital discharge, 15/52 (32%) at 1 month, and 3/52 (6%) at 6 months. Patients aged 80 years or older, and those with prefracture cognitive impairment, ADL functional impairment, and high medical comorbidity were more likely to develop delirium. However, after adjusting for these factors, delirium was still significantly associated with outcomes indicative of poor functional recovery 1 month after hip fracture: ADL decline (odds ratio (OR) = 2.6; 95% confidence interval (95% CI), 1.1‐ 6.1), decline in ambulation (OR = 2.6; 95% CI, 1.03–6.5), and death or new nursing home placement (OR = 3.0; 95% CI, 1.1–8.4). Patients whose delirium persisted at 1 month had worse outcomes than those whose delirium had resolved.CONCLUSIONS: Delirium is common, persistent, and independently associated with poor functional recovery 1 month after hip fracture even after adjusting for prefracture frailty. Further research is necessary to identify the mechanisms by which delirium contributes to poor functional recovery, and to determine whether interventions designed to prevent or reduce delirium can improve recovery after hip fracture. J Am Geriatr Soc 48:618–624, 2000.
Predicting 10‐Year Care Requirements for Older People with Suspected Alzheimer's Disease
Authors: Kinosian Bruce P. , Stallard Eric , Lee Jason H. , Woodbury Max A. , Zbrozek Arthur S. , Glick Henry A. 
Published: April 2015

OBJECTIVE: To describe the types and costs of care received for 10 years after the identification of an older person with suspected Alzheimer's disease (AD) by using data from 3254 patients with suspected AD who participated in the National Long Term Care Survey (NLTCS).METHODS: By using a Markov model derived using grade of membership techniques, the following were determined: survival probabilities at 10 years; years of survival during the 10 years; years in institutions; years with two or more impairments in basic activities of daily living; hours of paid and informal care while the older person lived in the community; and costs of paid community, institutional, and medical care.RESULTS: Greater degrees of cognitive impairment present when AD was identified were associated with reduced predicted probability of surviving 10 years, increased predicted number of years spent in institutions, increased hours of care required while affected individuals remained in the community, and increased costs of paid community, institutional, and medical care. Substantial differences between men and women were seen: severity‐adjusted 10‐year costs were almost two times higher for women with AD than for men ($75,000 compared with $44,000); according to sensitivity analysis, average 10‐year costs might be as high as $109,000 for women and $67,000 for men.CONCLUSIONS: AD imposes a substantial burden on older persons. Interventions that slow the progression of the disease may therefore affect community survival as well as healthcare costs. J Am Geriatr Soc 48:631–638, 2000.