bluuebunny/crossref_metadata_2025_split huggingface dataset:
Social Service Interventions for Caregivers of Patients with Dementia: Impact on Health Care Utilization and Expenditures
Authors: Weinberger Morris , Gold Deborah T. , Divine George W. , Cowper Patricia A. , Hodgson Lynne G. , Schreiner Pamela J. , George Linda K. 
Published: April 2015

ObjectivesAn intervention, which had as its primary goal the enhancement of compliance to social work recommendations, was shown to produce extremely high rates of compliance. This report addresses the secondary objective of the study: to evaluate the impact of the intervention on short‐term (ie, 6‐month) health services utilization and expenditures.DesignRandomized controlled trial.SettingUniversity‐based memory disorders clinic.ParticipantsCaregivers of patients with progressive memory disorders.Main Outcome MeasuresService utilization and expenditures.ResultsThe intervention did not have a statistically significant impact on utilization of either health care or community resources. The intervention group had $903 less expenditures during the study period, a difference that did not achieve statistical significance. The results were consistent when controlling for caregiver characteristics that differed at baseline.ConclusionsAlthough the intervention was successful in enhancing compliance with recommendations, more intensive interventions may be required to increase subsequent service utilization. Future investigations may wish to target the appropriateness of services used over a period longer than 6 months.
Influenza A Virus‐Specific Cytotoxic T Lymphocyte Activity Declines with Advancing Age
Authors: Powers Douglas C. 
Published: April 2015

Objective: To investigate whether influenza A‐specific cytotoxic T lymphocyte (CTL) activity is reduced in elderly compared with younger adults.Design: Case series comparing outcomes in young and elderly cohorts.Setting: Saint Louis University Division of Geriatric Medicine.Participants: Healthy adult outpatients and staff members aged <50 (young) or >65 (elderly) years.Methods: Peripheral blood mononuclear cells were assayed for CTL activity by a 51chromium release assay following 1 week of in vitro stimulation with influenza A/PR/8/34 (H1N1) virus.Measurements: Percent specific lysis of autologous and allogeneic influenza virus‐infected target cells.Main Results: Specific lysis of autologous A/PR‐infected targets was significantly lower in elderly compared to young subjects (P < 0.01), and exceeded 10% in a significantly lower proportion of elderly compared with younger subjects (P < 0.05), but was not influenced by a history of vaccination within the preceding 12 months. Cytotoxic effectors were class I human leukocyte antigen (HLA)‐restricted and displayed heterosubtypic cross‐reactivity but were unable to lyse influenza B‐infected targets.Conclusions: These results demonstrate an age‐related decline of influenza A virus‐specific CTL activity and suggest that CTL responses to inactivated virus vaccine are of short duration.
Rate of Progression and Prognostic Factors in Alzheimer's Disease: A Prospective Study
Authors: Lucca Ugo , Comelli Mario , Tettamanti Mauro , Tiraboschi Pietro , Spagnoli Alberto 
Published: April 2015

Objective: To study rate of progression and correlates of cognitive and functional/behavioral deterioration in Alzheimer patients.Design: A 1‐year multicenter prospective study.Setting: Outpatients and inpatients at geriatric institutions.Patients: Fifty‐six patients with a clinical diagnosis of Alzheimer's disease according to DSM‐III criteria of Primary Degenerative Dementia.Main Outcome Measures: Blessed Dementia Scale (BDS) and Blessed Information‐Memory‐Concentration test (BIMC) measured at baseline, third, sixth, and twelfth month.Results: The mean annual (±SD) rate of progression of our sample was 3.5 (±3.7) points on the BDS and 2.6 (±4.9) on the BIMC, with a wide range of variability. The level of cognitive impairment (BIMC score) at baseline predicted functional and behavioral deterioration: the better the initial BIMC score, the less the rate of negative change of BDS (r = 0.37, P = 0.006). Furthermore, the younger the patients at the disease onset, the faster the progression of cognitive impairment (r = 0.48, P = 0.0003), with men having a slower rate of progression (P = 0.004) than women.Conclusions: The present study confirms previous findings showing a wide individual variability in rate of progression of cognitive and functional/behavioral impairment as assessed by BIMC and BDS. The cognitive profile may predict the clinical evolution better than the functional and behavioral status, with patients with an earlier onset and women having a faster deterioration.
Characteristics and Quality of Prescribing by Doctors Practicing in Nursing Homes
Authors: Beers Mark H. , Fingold Susan F. , Ouslander Joseph G. , Reuben David B. , Morgenstern Hal , Beck John C. 
Published: April 2015

Objectives: To describe the professional characteristics of doctors practicing in nursing homes and to determine whether those characteristics correlate with quality of prescribing.Design: A prospective, cohort study.Participants: 306 physicians practicing in 12 nursing homes in greater Los Angeles.Measurements: We surveyed doctors about their age, sex, education, credentials, and NH practice. We also determined medication orders for a 1‐month period and evaluated them using explicit criteria for appropriateness developed by an expert panel.Results: We obtained data from 72% of MDs. Respondents had a mean age of 53 years (29–78) and were 94% male. Fifty‐seven percent trained in internal medicine, 20% graduated outside the US or Canada, 67% were board certified in their declared specialty, and 5% had a certificate of added qualification in geriatrics (CAQ). Sixteen percent spent >10% of their professional time in NHs, and 46% had NH practices that were >20% Medicaid; most did not consult psychiatrists when prescribing psychoactive drugs. Forty percent of residents had at least one inappropriate prescription. The characteristics of doctors associated with the best prescribing quartile were female sex, CAQ, no board certification, and frequent consultation with psychiatrists. The characteristics of doctors in the most inappropriate quartile were older age, graduation from medical school before 1965, graduation from US medical school, small NH practice, and infrequent consultation with psychiatrists.Conclusions: Although the quality of prescribing in nursing homes is related to some physician characteristics, the relationships are not those most commonly stated.
Disposition of Intramuscular Cefonicid in Elderly Patients
Authors: Karki Shyam D. , Bentley David W. , Luzier Aileen , Taylor Charlene , Morse Gene D. 
Published: April 2015

Objective: To examine the disposition of intramuscular (IM) cefonicid in elderly patients with bacterial pneumonia.Design: Pharmacokinetic study.Setting: A 620‐bed university‐affiliated long‐term care institution with its own 39‐bed acute care unit.Patients: Nine consecutive elderly patients with bacterial pneumonia treated with IM cefonicid.Measurements: Blood samples were collected on the seventh day of therapy over a 24‐hour period and analyzed by high performance liquid chromatography. Pharmacokinetic parameters (volume of distribution, half‐life, and clearance) and protein binding were calculated. Clinical outcome of IM cefonicid therapy was also noted.Results: The estimated creatinine clearance (Clcr) ranged from 32 to 145 mL/min. Peak cefonicid serum concentrations occurred at 0.5–1.5 hours, with a mean value of 118 ± 41 μ/mL. Cefonicid concentrations declined monoexponentially to 57 ± 16 μg/mL at 12 hours and 28 ± 14 μg/mL at 24 hours. The mean apparent distribution volume was 0.2 ± 0.07 L/kg, and the mean apparent total clearance was 15 ± 12 mL/min. The half‐life ranged from 3.1 to 38 hours. A linear correlation was noted between Clcr and cefonicid clearance (r = 0.99).Conclusions: Cefonicid absorption was variable among these patients, and the serum half‐life was longer than previous values noted in younger patients with similar degree of renal dysfunction. Pharmacokinetic and clinical outcome data from our study group indicate the potential role of IM cefonicid in treating elderly patients with bacterial pneumonia.
The Effects of Thiazide Diuretics on Calcium Metabolism in the Aged
Authors: Perry Horace M. , Jensen Judy , Kaiser Fran E. , Horowitz Michael , Perry H. Mitchell , Morley John E. 
Published: April 2015

Objective: To determine the effects of long‐term use of the thiazide diuretic chlorthalidone on serum bone‐related biochemical variables in older persons.Design: Cross‐sectional comparison.Setting: Community‐dwelling subjects who had participated in the Systolic Hypertension in the Elderly (SHEP) program.Participants: Sixty‐six Caucasians (36 male and 30 female), age range 70 to 89 years, of whom 23 were taking a thiazide diuretic.Measurements: 25‐hydroxyvitamin D (25OHD), parathyroid hormone, osteocalcin, calcitonin, and serum bioavailable testosterone.Results: In both groups, there was a high prevalence of low 25 (OHD) levels (30%). Log 25OHD showed a significant inverse relationship to parathyroid hormone (r = .33, P < 0.05). Thiazide users had lower levels of osteocalcin (P < 0.05) and parathyroid hormone levels (P < 0.05) compared with non‐thiazide users. Male thiazide users had decreased bioavailable testosterone levels compared with non‐thiazide users (P < 0.05). Serum osteocalcin was significantly related to bioavailable testosterone in men not on thiazide (r = .43, P < 0.05).Conclusions: Hypovitaminosis D is a common finding in older individuals with associated elevations in parathyroid hormone. Parathyroid hormone and testosterone concentration (in men) are correlated with serum osteocalcin, a measure of osteoblastic activity. Long‐term thiazide use alters these relationships and produces a biochemical profile suggestive of decreased bone formation. Reduced bioavailable testosterone may also play a role in these biochemical changes.
Serum Thyrotropin and Thyroid Hormone Levels in Elderly and Middle‐Aged Euthyroid Persons
Authors: Hershman Jerome M. , Pekary A. Eugene , Berg Loretta , Solomon David H. , Sawin Clark T. 
Published: April 2015

Objective: To determine whether serum thyrotropin (TSH) levels are altered in euthyroid older persons compared with middle‐aged adults.Design: Serum TSH and thyroid hormone levels were measured in a large group of older persons (>70 years old, n = 216) and their middle‐aged offspring (40–60 years old, n = 211) after excluding those with clinical or historical evidence of thyroid disease or abnormal thyroid function.Measurements: Serum TSH, thyroxine (T4), free T4 index, estimated free T4, triiodothyronine (T3), estimated free T3, and ferritin levels were measured on the Abbott IMx instrument. Peroxidase and thyroglobulin antibodies were measured by radioimmunoassay using Kronus kits.Main Results: Overall, serum TSH showed a log‐normal distribution. The geometric mean TSH (mU/L) and 95% confidence limits in the older persons, 1.24 (0.29–5.4), did not differ significantly from that in the middle‐aged, 1.45 (0.54–3.9). The mean TSH in the 264 women, 1.37 (0.34–5.5), was similar to that of the 163 men, 1.30 (0.48–3.5). The mean TSH in older women, 1.21 (0.22–6.6), was slightly but significantly lower than that in middle‐aged women, 1.52 (0.55–4.2). However, when euthyroid women with positive antibodies were excluded, this difference was not significant. Four of the 123 older women had TSH <0.1 mU/L, but none of the men or middle‐aged women had a suppressed serum TSH. The mean TSH in older men, 1.28 (0.43–3.8), was similar to that in middle‐aged men, 1.32 (0.55–3.2). Free T4 was slightly higher in older women than middle‐aged women. There were no significant correlations between TSH and any thyroid hormone level. Serum ferritin, measured as a potential marker for the action of thyroid hormone, did not correlate with any measure of thyroid function. At least one antibody level was >10 U/mL in 14.6% of older women, 15.6% of middle‐aged women, 4.3% of older men, and no middle‐aged men. When those with milder elevations of antibody levels were included (at least one level >1 U/mL), the prevalence was 32% of older women, 43.3% of middle‐aged women, 15% of older men, and 11.4% of middle‐aged men.Conclusions: Euthyroid older persons have about the same levels of serum TSH as younger ones, although older euthyroid women have a slightly lower serum TSH than middle‐aged women. We recommend that the normal range of serum TSH in the elderly be considered to be the same as that in healthy middle‐aged subjects.
Poisoning in the Elderly: Characterization of Exposures Reported to a Poison Control Center
Authors: Kroner Beverly A. , Scott Robert B. , Waring Evelyn R. , Zanga Joseph R. 
Published: April 2015

Objective: To determine the incidence of poison center calls involving the elderly, characterize these poisonings, and compare them with poisonings that occur in people younger than 60 years of age.Design: Concurrent, observational survey.Setting: The Virginia Poison Center in Richmond, Virginia.Participants: All persons 60 years of age and older who were involved in a poison exposure reported to the Virginia Poison Center from October 1, 1991 through March 31, 1992.Measurements: Incidence, type, route, location, management site, medical outcome of exposures and reasons for these exposures.Results: Exposures in persons 60 years of age and older accounted for 2.3% of all poison center calls during the 6‐month study period. These calls were most likely to involve women who unintentionally ingested extra doses of medications. The majority of these exposures occurred in the home and resulted in either no effect or minor effects. For those exposures that necessitated an emergency room visit, elderly persons were more likely to be admitted to the hospital than younger persons (P < 0.05).Conclusions: The majority of poisonings that occur in persons 60 years of age and older are unintentional and may be amenable to poison prevention education.
A Randomized, Controlled Trial of Outpatient Geriatric Evaluation and Management in a Large Public Hospital
Authors: Rubin Craig D. , Sizemore Mark T. , Loftis Paula A. , de Mola Nancy Loret 
Published: April 2015

Objective: To study the effect of outpatient geriatric evaluation and management on physical function, mental status, and subjective well‐being.Design: Prospective randomized controlled trial with a 1‐year study period.Setting: Large medical school‐affiliated public hospital in an urban community.Subjects: Patients at least 70 years old admitted to the medicine service were screened, randomized, and completed a 1‐year follow‐up interview.Interventions: Comprehensive geriatric evaluation and an outpatient care management program.Main Outcome Measures: Mental status (SPMSQ), ADL (Katz Index), IADL (Five‐Item OARS Scale), Life satisfaction (LSI‐Z), and self‐perception of health status (physical health section of OARS).Results: No significant differences were found for cognitive status, ADL functioning, life satisfaction, nursing home placement, or mortality. The experimental patients reported significantly higher function in IADL and more favorable self‐perception of health status compared with controls.Conclusion: Outpatient comprehensive geriatric evaluation and management appears to be a useful model for providing care to medically frail elderly patients.
Oral Disease and Physical Disability in Community‐Dwelling Older Persons
Authors: Jette Alan M. , Feldman Henry A. , Douglass Chester 
Published: April 2015

Objective: The aim of this epidemiologic investigation was to determine whether poor oral health in older persons was associated with physical disability.Design: The study was a cross‐sectional survey involving in‐home interviews and dental examinations of older persons.Setting: A random sample of 68 cities and towns was selected from the six New England states, with stratification according to population size.Participants: The study sample consisted of 1,156 community‐dwelling (non‐institutionalized) individuals aged 70 and over, randomly selected from the Medicare beneficiary lists for each city and town.Measurements: Oral health was assessed by three dichotomous indices: edentulism (no teeth); current caries, including either coronal or root decay; and periodontal disease, as measured by gingival pocket depth. Physical disability was indicated by the subject's self‐report of difficulty in the areas of personal care (eating, bathing, dressing, and using the toilet) and mobility (walking, bed transfer, getting outside), Additional independent variables included age, sex, number of teeth, education, living alone, oral hygiene practices, and time since last dental visit.Results: We found a direct association between specific areas of physical disability and current caries and edentulism. The risk of poor oral health did not increase with advancing age once the related risk factors were controlled for. Those subjects with mobility disabilities were at increased risk of tooth loss; those with personal care limitations were at increased risk of current caries.Conclusions: Physical disability should be added to the list of known risk factors for oral disease among the older population. Our findings call attention to the need for health care providers to screen for oral health problems among disabled older persons. Further gerontologic research is needed to identify the mechanisms linking physical disability with oral disease in older persons.
Metabolic and Behavioral Covariates of High‐Density Lipoprotein Cholesterol and Triglyceride Concentrations in Postmenopausal Women
Authors: Laws Ami , King Abby C. , Haskell Williain L. , MD Gerald M. Reaven 
Published: April 2015

Objective: To determine predictors of high‐density lipoprotein cholesterol (HDL) and triglyceride (TG) concentrations in postmenopausal women.Design: Cross‐sectional study.Setting: Clinical research facility.Participants: One hundred twenty‐seven healthy, relatively sedentary, postmenopausal women not on estrogen replacement, mean age 57 years.Measurements: Alcohol intake, cigarette smoking, aerobic fitness (VO2max), body mass index (BMI), percent body fat, waist‐hip ratio, lipids and lipoproteins, fasting plasma glucose (FPG), and insulin (FPI) concentrations.Results: In univariate analyses, HDL was significantly (P < 0.05) inversely related to BMI, waist‐hip ratio, smoking, FPG, and FPI, and directly related to VO2max and alcohpl intake. Triglycerides were related directly to BMI, waist‐hip ratio, percent body fat, FPG, and FPI, and inversely to VO2max. In stepwise multiple regressions, BMI, waist‐hip ratio, alcohol, smoking, and FPG were significantly associated with HDL (R2 for the model = 0.43). Addition of TG to these models reduced relations of BMI and waist‐hip ratio, but not the other variables, to insignificance. For triglycerides, waist‐hip ratio, alcohol, smoking, FPG, and FPI were significant predictors (R2 = 0.33). VO2max and percent body fat did not contribute to any model.Conclusions: Obesity, abdominal obesity, smoking, alcohol intake, and measures of carbohydrate metabolism predict HDL and triglyceride concentrations in postmenopausal women.
Physical Activity and Serum Lipids and Lipoproteins in Elderly Women
Authors: Nieman David C. , Warren Beverly J. , O'Donnell Kelley A. , Dotson Ruth G. , Butterworth Diane E. , Henson Dru A. 
Published: April 2015

Objective: The relationship between cardiorespiratory exercise and serum lipid and lipoprotein levels was studied in elderly women.Design: Randomized controlled experimental design with a follow up of 12 weeks; cross‐sectional comparison at baseline.Setting: Community‐living elders in university exercise facilities.Participants: Thirty‐two apparently healthy, sedentary elderly Caucasian women, 67 to 85 years of age. Ten highly conditioned elderly women, 65 to 84 years of age, who were active in endurance competitions and had been training for 11.2 ±: 1.2 years, were recruited at baseline for cross‐sectional comparisons.Interventions: Sedentary subjects were randomized to either a walking or calisthenic group. Intervention groups exercised 30 to 40 minutes, 5 days a week for 12 weeks, with the walking group training at 60% heart rate reserve and the calisthenic group engaging in mild range‐of‐motion and flexibility movements that kept their heart rates close to resting levels.Measurements: Serum lipids and lipoproteins, maximal aerobic capacity (V̇O2 max), four skinfolds, and dietary intake at baseline and after 5 and 12 weeks.Results: When the highly conditioned group and combined group of sedentary subjects were compared at baseline, serum high‐density lipoprotein cholesterol (HDL‐C; 1.61 ± 0.14 vs 1.27 ± 0.05 mmol/L, respectively; P = 0.048) and triglycerides (1.29 ± 0.15 vs 2.00 ± 0.15, respectively; P = 0.002), but not total serum cholesterol (5.72 ± 0.36 vs 5.72 ± 0.19 mmol/L, respectively) and low‐density lipoprotein cholesterol (LDL‐C; 3.62 ± 0.36 vs 3.72 ± 0.18 mmol/L, respectively), were significantly different. Twelve weeks of moderate cardiorespiratory exercise improved the VO2max of the sedentary subjects 12.6% but did not result in any change in body weight, energy intake, dietary quality, or any of the serum lipids or lipoproteins.Conclusion: Highly conditioned and lean elderly women, when compared with their sedentary counterparts, had higher HDL‐C and lower triglycerides, but similar total serum cholesterol and LDL‐C values. However, twelve weeks of moderate cardiorespiratory exercise were not associated with an improvement in serum lipid or lipoprotein profiles in previously sedentary elderly women.
Left Ventricular Diastolic Filling in Elderly Hypertensive Patients
Authors: MD Antonio Nicolino , MD Nicola Ferrara , MD Giancarlo Longobardi , MD Domenico Acanfora , MD Carlo Rengo , MD Franco Rengo 
Published: April 2015

Objective: To evaluate the effects of mild to moderate hypertension and of LVH on diastolic filling and other Doppler indices in the elderly.Design: Survey with a control group.Subjects: Seventy‐one hypertensives (34 men, 37 women) referred for echocardiograms and 32 age‐ and sex‐matched normotensive volunteers. Thirty‐six of the hypertensives had LVH; 34 did not.Setting: Echocardiography laboratory.Measurements: M‐mode, two‐dimensional, and pulsed Doppler echocardiograms. A wide variety of Doppler‐derived indices of diastolic function were assessed.Results: All Doppler derived indices of left ventricular diastolic filling (peak E, peak A, their ratio, EF slope, time‐velocity integrals, atrial filling fraction, and isovolumic relaxation time) were similar among the three groups.Conclusion: Elderly mild to moderate hypertensives with or without LVH have LV diastolic filling that is normal for age. The identification of pathological diastolic dysfunction requires comparison to age‐matched controls, since aging, a major factor influencing diastolic filling, can mask the effect of hypertension.